Features of schizophrenia following premorbid eating disorders

Body image as a mediator in the relationship between psychotic experiences and later disordered eating: A 12-month longitudinal study in high school adolescents

BACKGROUND

The relationship between psychosis and disordered eating remains a challenging area of research to which little interest was paid. Using longitudinal data, we aimed to explore the hypothesis that the pathways from psychotic experiences (PEs) to disordered eating (DE) and body-mass index (BMI) are mediated by body-image disturbances.

METHODS

A prospective longitudinal study was performed. High-school students (N = 510, 61.2% females, mean age of 16.05 ± 1.01 years) were asked to complete three scheduled assessments (Baseline, 6 months, and 12 months).

RESULTS

Two body image components, that is, Overweight Preoccupation and Body Area Satisfaction, mediated the prospective association between baseline PEs and DE 12 months later. Direct effects were significant. After accounting for indirect effects through more severe body image concerns at 6 months, higher baseline PEs were significantly associated with greater DE at 12 months. Baseline PEs and 6-month body image explained a significant proportion of variance in 12-month DE. However, we did not find evidence of a direct prospective association between PEs and BMI.

CONCLUSION

This study is the first to assess the mediating role of body image between PEs and DE. Findings offer promising new avenues for early intervention to help mitigate the effects of PEs on DE in adolescents.

A sister's search for the seeds of psychosis

Dr. Dolores Malaspina sought a better way to understand the origins of psychosis than a schizophrenogenic mother, as her family had been informed upon her sisters illness. She moved her attention from environmental biology and zoology, to medical science and assembled knowledge on the multilevel components purported to underpin severe mental illness. Her studies cross levels to consider connections among exposures and genetic etiologies, intrinsic homeostatic mechanisms, stimuli perception and clinical illness features. Original contributions include associating later paternal age with increasing risk for schizophrenia in offspring and proposing that de novo mutations with shorter cell cycles explained the association, showing increased resting hippocampal blood flow in psychosis and that it was associated with inflammation, and that autonomic nervous system dysfunction was related to hippocampal inflammation, plausibly reflecting vascular abnormalities. She has been a professor of psychiatry in medical schools at Columbia University, New York University and at Mount Sinai in New York, USA.

Prenatal ambient temperature and risk for schizophrenia

OBJECTIVE

We conducted a systematic review of the published literature to test the hypothesis that maternal exposure to extremes of ambient temperatures during pregnancy is associated with the risk for psychiatric disorders or congenital malformations in offspring, both of which are indicative of perturbations of fetal neurodevelopment.

METHOD

This study was conducted in accordance with the recommendations outlined in the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting proposal. Electronic databases (Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Ovid Global Health, Web of Science, and Cochrane Library) were searched. Four independent reviewers selected studies with the following criteria: (1) prenatal maternal ambient temperature exposure; (2) outcome of offspring psychiatric disorder or congenital defects; (3) empirical study; (4) full-length article, no conference presentations or abstracts.

RESULTS

Twenty-two studies met criteria and one was added from a reference list (n = 23). Of these, schizophrenia (n = 5), anorexia nervosa (n = 3) and congenital cardiovascular malformations (n = 6) studies were the most common. Each of these categories showed some evidence of association with an early pregnancy maternal ambient heat exposure effect, with other evidence for a late pregnancy cold effect.

CONCLUSION

Some evidence supports a role for early pregnancy maternal exposure to extreme ambient heat in the development of psychiatric disorders, but large-scale, prospective cohort data on individual births is essential. Optimal studies will be conducted in seasonally variable climates, accounting for actual maternal residence over the pregnancy and at parturition, local environmental temperature records, and appropriate covariates, similar to studies identified by this systematic review for congenital malformations.

Associations between psychosis symptoms and eating disorders among a national sample of U.S. college students

This study aimed to determine the associations between psychosis symptoms and eating disorders among a national sample of college and university students ages 18 to 26 years. Data from the 2020-2021 Healthy Minds Study (United States) were analyzed (N = 96,791). Multiple modified Poisson regression analyses were conducted to estimate the association between four self-reported lifetime psychosis symptoms and a positive eating disorder screen (measured using the SCOFF) and any self-reported lifetime eating disorder diagnosis, while adjusting for demographic and confounding variables. Participants who reported all four lifetime psychosis symptoms were more likely to screen positive for an eating disorder, while participants who reported three lifetime psychosis symptoms were more likely to report any lifetime eating disorder diagnosis. Those who reported a higher cumulative number of lifetime psychosis symptoms and reported any psychosis symptoms in the past 12 months were more likely to screen positive for an eating disorder and report any lifetime eating disorder diagnosis. Psychosis symptoms were associated with eating disorders among a national sample of college students. Health care professionals should be aware of the relationship between psychosis symptoms and eating disorders to ensure effective screening and early-intervention.

Does Schizophrenia Itself Cause Obesity?

BACKGROUND

Schizophrenia (SC) is considered the most serious of all mental disorders. Some antipsychotics are associated with weight gain and metabolic abnormalities. Whether SC itself causes obesity remains uncertain.

METHODS

We collected 185 first-episode drug-naive SC and 59 healthy controls (HCs) from the Third People's Hospital of Foshan, Guangdong, China, and distinguished their course of disease in order to understand the body mass index (BMI) and body fat metabolism of SC.

RESULTS

We found that excluding the drug factors, the longer the course of SC, the more obvious the increase of BMI and the higher the proportion of obesity. BMI was positively correlated with age, course of disease, fasting blood glucose (FBG), low-density lipoprotein (LDL), triglyceride (TG), and total cholesterol (TC), and negatively correlated with high-density lipoprotein (HDL). The results of regression analysis were further proof that age (B = 0.094, p < 0.001), duration (B = 0.081, p = 0.002), FBG (B = 0.987, p = 0.004), and TG (B = 0.918, p = 0.002) were the risk factors for the increase of BMI. HDL (B = -2.875, p < 0.001) was the protective factor.

CONCLUSION

SC itself can increase BMI and easily lead to obesity. We should pay more attention to the monitoring of blood metabolism indicators, so as to reduce the risk of obesity and improve the quality of life of patients.

Primary Psychosis: Risk and Protective Factors and Early Detection of the Onset

Primary psychosis, which includes schizophrenia and other psychoses not caused by other psychic or physical conditions, has a strong impact worldwide in terms of disability, suffering and costs. Consequently, improvement of strategies to reduce the incidence and to improve the prognosis of this disorder is a current need. The purpose of this work is to review the current scientific literature on the main risk and protective factors of primary psychosis and to examine the main models of prevention, especially those related to the early detection of the onset. The conditions more strongly associated with primary psychosis are socio-demographic and economic factors such as male gender, birth in winter, ethnic minority, immigrant status, and difficult socio-economic conditions while the best-established preventive factors are elevated socio-economic status and an economic well-being. Risk and protective factors may be the targets for primordial, primary, and secondary preventive strategies. Acting on modifiable factors may reduce the incidence of the disorder or postpone its onset, while an early detection of the new cases enables a prompt treatment and a consequential better prognosis. According to this evidence, the study of the determinants of primary psychosis has a pivotal role in designing and promoting preventive policies aimed at reducing the burden of disability and suffering of the disorder.

Disordered Eating among People with Schizophrenia Spectrum Disorders: A Systematic Review

Disordered eating, or abnormal eating behaviours that do not meet the criteria for an independent eating disorder, have been reported among people with schizophrenia. We aimed to systemati-cally review literature on disordered eating among people with schizophrenia spectrum disorder (SSD). Seven databases were systematically searched for studies that described the prevalence and correlates of disordered eating among patients with SSD from January 1984 to 15 February 2021. Qualitative analysis was performed using the National Institutes of Health scales. Of 5504 records identified, 31 studies involving 471,159 subjects were included in the systematic review. The ma-jority of studies (17) rated fair on qualitative analysis and included more men, and participants in their 30s and 40s, on antipsychotics. The commonest limitations include lack of sample size or power calculations, poor sample description, not using valid tools, or not adjusting for con-founders. The reported rates were 4.4% to 45% for binge eating, 16.1% to 64%, for food craving, 27% to 60.6% for food addiction, and 4% to 30% for night eating. Positive associations were re-ported for binge eating with antipsychotic use and female gender, between food craving and weight gain, between food addiction and increased dietary intake, and between disordered eating and female gender, mood and psychotic symptoms. Reported rates for disordered eating among people with SSD are higher than those in the general population. We will discuss the clinical, treatment and research implications of our findings.

Binge Eating Disorders in Antipsychotic-Treated Patients With Schizophrenia: Prevalence, Antipsychotic Specificities, and Changes Over Time

BACKGROUND

Excessive energy intake likely favors metabolic dysfunction in patients with schizophrenia and may be, in part, the consequence of antipsychotic treatments. However, previous studies on the prevalence of bulimia and binge eating symptoms in antipsychotic-treated patients are contradictory and not sufficiently informative.

METHODS

The prevalence of bulimia nervosa, binge eating disorder, and subsyndromal binge eating disorder was studied using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria in 156 patients with schizophrenia or schizoaffective disorder treated with antipsychotic monotherapy. The effects of different antipsychotics were compared.

RESULTS

The prevalence of full syndromal binge eating disorder was 4.4% and that of subsyndromal binge eating disorder was 18.7% in patients (23.1% for binge eating spectrum disorder), and there were no cases of bulimia nervosa. Compared with the whole sample, binge eating spectrum disorders were significantly more prevalent in clozapine- and olanzapine-treated patients. Comparisons of patients having undergone treatment for 2 years or less with patients treated for more than 2 years showed that binge eating spectrum disorders decrease significantly over time, the difference being significant in clozapine- and olanzapine-treated patients. Night eating, simply assessed by a single question, showed a prevalence of 30% and was more prevalent in women treated with clozapine and olanzapine, with no significant change over time.

CONCLUSIONS

Binge eating disorders should be considered as important factors involved in the development of weight gain and metabolic syndrome in antipsychotic-treated patients with schizophrenia. The difficulty to reliably assess binge eating spectrum disorders in patients with psychosis is highlighted.

The clinical characterization of the patient with primary psychosis aimed at personalization of management

The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recovery-oriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.

Descriptions of Disordered Eating in German Psychiatric Textbooks, 1803-2017

The most common eating disorders (EDs) according to DSM-5 are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). These disorders have received increasing attention in psychiatry due to rising prevalence and high morbidity and mortality. The diagnostic category "anorexia nervosa," introduced by Ernest-Charles Lasègue and William Gull in 1873, first appears a century later in a German textbook of psychiatry, authored by Gerd Huber in 1974. However, disordered eating behavior has been described and discussed in German psychiatric textbooks throughout the past 200 years. We reviewed content regarding eating disorder diagnoses but also descriptions of disordered eating behavior in general. As material, we carefully selected eighteen German-language textbooks of psychiatry across the period 1803-2017. Previously, in German psychiatry, disordered eating behaviors were seen as symptoms of depressive disorders, bipolar disorder or schizophrenia, or as manifestations of historical diagnoses no longer used by the majority of psychiatrists such as neurasthenia, hypochondria and hysteria. Interestingly, 19th and early 20th century psychiatrists like Kraepelin, Bumke, Hoff, Bleuler, and Jaspers reported symptom clusters such as food refusal and vomiting under these outdated diagnostic categories, whereas nowadays they are listed as core criteria for specific eating disorder subtypes. A wide range of medical conditions such as endocrinopathies, intestinal or brain lesions were also cited as causes of abnormal food intake and body weight. An additional consideration in the delayed adoption of eating disorder diagnoses in German psychiatry is that people with EDs are commonly treated in the specialty discipline of psychosomatic medicine, introduced in Germany after World War II, rather than in psychiatry. Viewed from today's perspective, the classification of disorders associated with disordered eating is continuously evolving. Major depressive disorder, schizophrenia and physical diseases have been enduringly associated with abnormal eating behavior and are listed as important differential diagnoses of EDs in DSM-5. Moreover, there are overlaps regarding the neurobiological basis and psychological and psychopharmacological therapies applied to all of these disorders.