La fréquence des troubles anxio-dépressifs diffère-t-elle entre les types diagnostiques d’anorexie mentale et de boulimie ?

[Bipolar disorders and anorexia nervosa: A clinical study]

PURPOSE

Anorexia nervosa is often accompanied by comorbid mood disorders, in particular depression, but individual or family history of bipolar disorders has not frequently been explored in anorexia nervosa. The objectives of the present study were: (1) to assess the frequency of bipolar disorders in patients with anorexia nervosa hospitalized in adolescence and in their parents, (2) to determine whether the patients with a personal or family history of bipolar disorders present particular characteristics in the way in which anorexia nervosa manifests itself, in their medical history, in the secondary diagnoses established, and in the treatments prescribed.

METHOD

Overall, 97 female patients aged 13 to 20 hospitalized for anorexia nervosa and their parents were assessed. The diagnoses of anorexia nervosa and bipolar disorders were established on the basis of DSM-IV-TR criteria.

RESULTS

A high frequency of type II and type V bipolar disorders was observed. The patients with anorexia nervosa and presenting personal or family histories of bipolar disorder had an earlier onset of anorexia nervosa, more numerous hospitalizations, a longer time-lapse between anorexia nervosa onset and hospitalization, more suicide attempts and more psychiatric comorbidities.

CONCLUSION

The occurrence of anorexia nervosa-bipolar disorders comorbidity appears to be considerable and linked to the severity of anorexia nervosa, raising the issue of the relationship between anorexia nervosa and bipolar disorders.

Mood disorders in eating disorder patients: Prevalence and chronology of ONSET

OBJECTIVES

In a clinical population, we estimated the frequency of mood disorders among 271 patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in comparison to a control group matched for age and gender.

METHOD

The frequency of mood disorders was measured using the Mini International Neuropsychiatric Interview (MINI), DSM-IV version.

RESULTS

Mood disorders were more frequent among eating disorder (ED) patients than among controls, with a global prevalence of the order of 80% for each ED group. The majority of the mood disorders comorbid with ED were depressive disorders (MDD and dysthymia). The relative chronology of onset of these disorders was equivocal, because mood disorders in some cases preceded and in others followed the onset of the eating disorders.

LIMITATIONS

Our sample was characterized by patients with severe ED and high comorbidities, and thus do not represent the entire population of AN or BN. This also may have resulted in an overestimation of prevalence.

CONCLUSION

Mood disorders appear significantly more frequently in patients seeking care for ED than in controls. These results have implications for the assessment and treatment of ED patients, and for the aetio-pathogenesis of these disorders.

A 3-month at-home tube feeding in 118 bulimia nervosa patients: a one-year prospective survey in adult patients

BACKGROUND & AIMS

To study the 1-yr follow-up of 118 bulimia nervosa (BN) patients after a 3-month at-home tube feeding (TF) in a prospective study.

METHODS

At-home TF lasted 3 months, including one month of exclusive TF (no food). All patients fulfilled 4 questionnaires (score of binge/purging episodes (BP), eating disorder inventory, anxiety, depression), before, at the 3-month TF point, and 6 and 12 months latter.

RESULTS

The score of BP episodes dramatically decreased from 28.8 ± 15 (before TF) to 7.3 ± 5.4 at 3 months, as well as at 1 yr (15.1 ± 6.2). We also obtained a 50% decrease in Beck score (depression) and Hamilton score (anxiety). Curiously, there was no difference between the BP scores of the patients following psychotherapy and those who did not, despite lower scores for anxiety and depression.

CONCLUSION

In conclusion, in bulimia nervosa patients having normal BMI and purging behavior, home-TF allow to obtain total withdrawal from bingeing/purging in at least 75% of the cases at short term (3 months) and in 25% of the patients at one year, whatever the patients have or have not psychotherapy.

The clinician administered staging instrument for anorexia nervosa: development and psychometric properties

OBJECTIVE

To develop and evaluate an instrument to assess severity in anorexia nervosa (AN), the Clinician Administered Staging Instrument for Anorexia Nervosa (CASIAN).

METHOD

Candidate items for the CASIAN were developed in three phases (domain, content, and item generation) followed by a pilot study. The psychometric properties of the resultant 34-item questionnaire were investigated in cross-sectional and longitudinal samples (N = 171) with DSM-IV AN and subthreshold AN.

RESULTS

Item and factor analysis procedures resulted in a refined 23-item CASIAN comprising of six factors ("Motivation," "Weight," "Illness Duration," "Obsessionality," "Bulimic Behaviors," and "Acute Issues"). The CASIAN had high internal consistency (.811), test-retest (.957), and interrater reliability (.973). Preliminary support for the convergent, discriminant, concurrent, and predictive validity of the CASIAN was found.

DISCUSSION

The CASIAN is a psychometrically sound instrument. Further studies are needed to confirm the factor structure and assess its clinical and research utility.

Efficacy of tube feeding in binge-eating/vomiting patients: a 2-month randomized trial with 1-year follow-up

BACKGROUND

In many binge-eating/vomiting patients, abstinence could not be obtained from classical treatments. Since the authors showed that tube feeding (TF) reduced such episodes in anorexia nervosa (AN)-hospitalized patients, they carried out a randomized trial on the efficacy of TF plus cognitive behavioral therapy (CBT) vs CBT alone in AN and bulimia nervosa adult outpatients.

METHODS

The authors randomly assigned 103 ambulatory patients to receive 16 sessions of CBT alone (n = 51) or CBT plus 2 months of TF (n = 52). The main goal was abstinence of binge-eating/vomiting episodes. Other criteria were gains in fat-free mass and muscle mass improvements in nutrition markers, and quality of life (SF-36 Health Survey), depression (Beck Depression Inventory), and anxiety (Hamilton Anxiety Rating Scale) scores. Evaluations were performed at 1, 2 (end of treatment), 5, 8, and 14 months (analysis of variance).

RESULTS

TF patients were rapidly and more frequently abstinent at the end of treatment (2 months) than the CBT patients: 81% vs 29% (P < .001). Fat-free mass, biological markers, depressive state (-58% vs -26%), anxiety (-48% vs -15%), and quality of life (+42% vs +13%) were more improved in the TF group than in the CBT group (P < .05). One year later, more TF patients remained abstinent (68% vs 27%, P = .02); they were less anxious, were less depressed, and had better quality of life than the CBT patients (P < .05).

CONCLUSION

TF combined with CBT offered better results than CBT alone.

Explicit vs. implicit body image evaluation in restrictive anorexia nervosa

In the present study we investigated the evaluation of body shapes in patients with restrictive anorexia nervosa (AN) on both automatic and controlled levels. The first aim of the study was to examine whether an ultra-thin ideal or negative attitudes toward overweight might be the motivation behind pathological restriction. The second aim was to investigate the relationship between body figure evaluations, eating disorder symptoms and mood. A Modified Affective Priming Test was used to measure implicit evaluations of body silhouettes, while a Likert scale was used to assess explicit evaluations. The study involved 35 women with restrictive anorexia nervosa and 35 age- and education-level-matched controls with normal body weight. In contrast to the control group, the patients did not show a positive attitude toward the ultra-thin body shape on the automatic level. The AN group both on the automatic and the self-reported levels evaluated the overweight body as negative. Depression and anxiety did not influence body evaluation. Strong negative evaluation of overweight appears to be a key issue in AN rather than positive evaluation of ultra-thin role models.