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Siviero-Miachon AA, Lopes de Sousa AV, Simião BM, Araújo EO, Alvarenga R, Spinola-Castro AM, Longui CA. Glucocorticoid Sensitivity Among Young Survivors of Childhood Acute Lymphoblastic Leukemia: What Does It Matter? Horm Metab Res 2024; 56:718-726. [PMID: 39102841 DOI: 10.1055/a-2363-4823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
The aim of the study was to assess glucocorticoid sensitivity in survivors of childhood acute lymphoblastic leukemia using in vivo and in vitro tests. Thirty leukemia survivors of both sexes aged ≥18 years participated in the study and at least two years after therapy withdrawal. In vivo tests comprised: a) a very low dose intravenous dexamethasone suppression test for measurement of serum cortisol before, after, and % suppression, compared with 32 age-matched controls; and b) 0.25 mg overnight oral dexamethasone suppression test for assessment of salivary cortisol before, after, and % suppression. In vitro methods comprised: c) glucocorticoid receptor polymorphisms: BcI1-NR3C1 and A3669G; and d) splicing variant of glucocorticoid receptor GR-α mRNA by real-time quantitative polymerase chain reaction, compared with 32 controls. There was a reduction in salivary cortisol, and 73.3% of leukemia survivors showed high sensitivity according to % suppression after oral dexamethasone (p<0.05). Serum cortisol at baseline, after the test, % suppression after intravenous dexamethasone, and the percentage of high sensitivity were reduced in the leukemia group (%F=36.7; p<0.05). The BcI1-NR3C1 and A3669G polymorphisms were present in 11/30 (36.7%) and 5/30 (16.7%) patients, respectively. GR-α mRNA levels were lower in the leukemia group than in the controls (p<0.05). Survivors of acute lymphoblastic leukemia presented with reduced glucocorticoid sensitivity. Glucocorticoid sensitivity allows individualized treatment to avoid adverse effects and may be involved in cardiovascular disease risk among this particular group of cancer survivors.
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Affiliation(s)
- Adriana Aparecida Siviero-Miachon
- Pediatric Endocrinology, Federal University of Sao Paulo - UNIFESP/EPM, Sao Paulo, Brazil
- Pediatric Endocrinology, Hospital of the Support Group for Adolescent and Children with Cancer - GRAACC, Sao Paulo, Brazil
| | - Ana Virgínia Lopes de Sousa
- Pediatric Oncology, Hospital of the Support Group for Adolescent and Children with Cancer - GRAACC, Sao Paulo, Brazil
| | - Bruno Moreira Simião
- Pediatric Endocrinology, Federal University of Sao Paulo - UNIFESP/EPM, Sao Paulo, Brazil
| | - Elisangela Oliveira Araújo
- Physiological Sciences, Faculty of Medical Sciences of Santa Casa de Sao Paulo - FCM SCSP, Sao Paulo, Brazil
| | - Renato Alvarenga
- Physiological Sciences, Faculty of Medical Sciences of Santa Casa de Sao Paulo - FCM SCSP, Sao Paulo, Brazil
| | - Angela Maria Spinola-Castro
- Pediatric Endocrinology, Federal University of Sao Paulo - UNIFESP/EPM, Sao Paulo, Brazil
- Pediatric Endocrinology, Hospital of the Support Group for Adolescent and Children with Cancer - GRAACC, Sao Paulo, Brazil
| | - Carlos Alberto Longui
- Physiological Sciences, Faculty of Medical Sciences of Santa Casa de Sao Paulo - FCM SCSP, Sao Paulo, Brazil
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Rossi E, Cassioli E, Dani C, Marchesoni G, Monteleone AM, Wonderlich SA, Ricca V, Castellini G. The maltreated eco-phenotype of eating disorders: A new diagnostic specifier? A systematic review of the evidence and comprehensive description. Neurosci Biobehav Rev 2024; 160:105619. [PMID: 38462152 DOI: 10.1016/j.neubiorev.2024.105619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
This systematic review aimed to summarize the evidence on the existence of a distinct phenotypic expression of Eating Disorders (EDs) associated with childhood maltreatment (CM), the so-called maltreated eco-phenotype of EDs. PRISMA standards were followed. Articles providing data about the characteristics of individuals with an ED reporting CM were included. Relevant results were extracted and summarized. A quality assessment was performed. A total of 1207 records were identified and screened, and 97 articles published between 1994 and 2023 were included. Findings revealed distinct biological and clinical features in patients with EDs reporting CM, including neuroanatomical changes, altered stress responses, ghrelin levels, inflammation markers, and gut microbiota composition. Clinically, CM correlated with severer eating behaviors, higher psychiatric comorbidity, impulsivity, emotional dysregulation, and risky behaviors. Additionally, CM was associated with poorer treatment outcomes, especially in general psychopathology and psychiatric comorbidities. This review highlighted the need to move towards an etiologically informed nosography, recognizing CM not merely as a risk factor, but also as an etiologic agent shaping different eco-phenotypic variants of EDs.
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Affiliation(s)
- Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristiano Dani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.
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3
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Cascino G, Monteleone AM. Early traumatic experiences and the hypothalamus-pituitary-adrenal axis in people with eating disorders: A narrative review. Psychoneuroendocrinology 2024; 159:106665. [PMID: 37944210 DOI: 10.1016/j.psyneuen.2023.106665] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
Exposure to trauma during childhood is a non-specific risk factor for psychiatric disorders, including eating disorders (EDs), over the life course. Moreover, an association between stressful life events and the onset/maintenance of EDs has been documented. Therefore, the hypothalamus-pituitary-adrenal (HPA) axis, namely the main component of the endogenous stress response system, has been proposed to be implicated in the pathophysiology of EDs. In this narrative review the current knowledge concerning the effects of early trauma exposure on the HPA axis activity and their putative role in the pathophysiology of EDs will be illustrated. Research findings corroborate the idea that childhood trauma exposure has long-lasting dysregulating effects on the activity of the HPA axis, which may contribute to the biological background of the early trauma-related risk for the development of EDs across the life span. Moreover, literature data support the existence of a "maltreated ecophenotype" in EDs characterized by specific clinic and neuroendocrine features, which may have important implications in treatment programming for such a type of patients.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.
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4
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da Luz Neto LM, Pinto TCC, Sougey EB, Dionisio WÁDS, Dos Santos AV, Ximenes RCC. Risk of eating disorders, changes in salivary cortisol concentrations and nutritional status of adolescents. Eat Weight Disord 2022; 27:2415-2423. [PMID: 35226345 DOI: 10.1007/s40519-022-01382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/15/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The imposition of the thin body as an ideal of beauty and the changes that occur in adolescence lead to a constant concern with adolescents' body weight, putting them at risk for eating disorders. Thus, the study sought to investigate associations between eating disorders and salivary cortisol concentrations, nutritional status and depressive symptoms in female adolescents with bulimia. METHODS A cross-sectional study was carried out with 1435 adolescents aged 10-19 years. The Bulimic Investigatory Test of Edinburgh (BITE) and Body Shape Questionnaire (BSQ) questionnaires were used. A follow-up study was conducted from a random selection of female adolescents diagnosed with Bulimia Development and Well-Being Assessment-(DAWBA) to assess associations with salivary cortisol concentrations and nutritional status. RESULTS The prevalence of body dissatisfaction among adolescents with symptoms of bulimia was 37%. There was a significant difference between salivary cortisol and bulimia (Risk Group = 0.33 ± 0.20 μg/100 ml, Diagnostic Group = 0.44 ± 0.21 μg/100 ml p = 0.040), and correlation positive between the risk of bulimia with symptoms of depression (0.355 p = 0.002) and with Body Mass Index (0.259 p = 0.028). High concentrations of salivary cortisol in bulimic adolescents may be associated with hyperactivity of the hypothalamic-pituitary-adrenal axis and depressive symptoms. CONCLUSIONS Nutritional status indicators cannot be used alone for the diagnosis of bulimia, since cortisol levels seem to be a reliable parameter in the identification of bulimia, provided they are used with other diagnostic criteria. LEVEL III Evidence obtained from cross-sectional study.
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Affiliation(s)
- Laércio Marques da Luz Neto
- Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco (UFPE), Av. da Engenharia, 186-298 - Cidade Universitária, Recife, Pernambuco, 50740-600, Brazil
| | - Tiago Coimbra Costa Pinto
- Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco (UFPE), Av. da Engenharia, 186-298 - Cidade Universitária, Recife, Pernambuco, 50740-600, Brazil
| | - Everton Botelho Sougey
- Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco (UFPE), Av. da Engenharia, 186-298 - Cidade Universitária, Recife, Pernambuco, 50740-600, Brazil
| | - Weslley Álex da Silva Dionisio
- Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco (UFPE), Av. da Engenharia, 186-298 - Cidade Universitária, Recife, Pernambuco, 50740-600, Brazil.
| | - Alisson Vinicius Dos Santos
- Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco (UFPE), Av. da Engenharia, 186-298 - Cidade Universitária, Recife, Pernambuco, 50740-600, Brazil
| | - Rosana Christine Cavalcanti Ximenes
- Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco (UFPE), Av. da Engenharia, 186-298 - Cidade Universitária, Recife, Pernambuco, 50740-600, Brazil
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Molina-Ruiz RM, Looi JCL, Walterfang M, García-Saiz T, Wilkes FA, Liu LL, Velakoulis D, Perera JLC, Diaz-Marsa M. Striatal volumes as potential biomarkers in Eating Disorders: A pilot study. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:65-73. [PMID: 35840286 DOI: 10.1016/j.rpsmen.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 01/20/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Differences in bulimic and impulsive behaviours in Eating Disorders (ED) have been associated with cortico-striatal circuit dysfunction at a neurobiological level. We sought to investigate neo-striatal volume as a biomarker in ED subgroups as well as the possible relationship with trauma history. MATERIAL AND METHODS We studied 24 female patients: Anorexia Nervosa AN (n=8), Bulimia Nervosa BN (n=9), comorbid ED with borderline personality disorder (EDc; n=7), and a group of Healthy Controls (n=19). Binge eating behaviours and impulsivity scales were used to characterize our sample as well as Trauma Questionnaires and Magnetic resonance imaging (MRI) volumetric manual measurements of caudate and putamen nuclei (striatum). RESULTS Our preliminary results showed a significantly larger left putaminal volume in AN compared to the other three groups [C (p=0.008), BN (p<.001) and EDc (p=.001)] and a smaller right putaminal volume in EDc compared to controls (p=.045) and AN (p=.039). Some negative correlations were found between bilateral putaminal volumes and self-reported general and early traumatization scores. CONCLUSION This pilot study suggested that striatal volumes might differentiate AN from BN and EDc at a neurobiological level with implications for treatment strategies. Larger scale studies should be carried out that allow replication of these data.
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Affiliation(s)
- Rosa M Molina-Ruiz
- Complutense University Medical School, Hospital Clínico San Carlos, Madrid, Spain.
| | - Jeffrey C L Looi
- Research Centre for Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra. Hospital, Canberra, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital; Melbourne Neuropsychiatry Centre, University of Melbourne and Northwestern Mental Health, Melbourne, Australia
| | | | - Fiona A Wilkes
- Research Centre for Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra. Hospital, Canberra, Australia
| | - Lena L Liu
- Research Centre for Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra. Hospital, Canberra, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital; Melbourne Neuropsychiatry Centre, University of Melbourne and Northwestern Mental Health, Melbourne, Australia
| | | | - Marina Diaz-Marsa
- Complutense University Medical School, Hospital Clínico San Carlos, Madrid, Spain
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6
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Molina-Ruiz RM, Looi JCL, Walterfang M, García-Saiz T, Wilkes FA, Liu LL, Velakoulis D, Perera JLC, Diaz-Marsa M. Striatal volumes as potential biomarkers in Eating Disorders: A pilot study. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 15:S1888-9891(20)30022-7. [PMID: 32513624 DOI: 10.1016/j.rpsm.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 10/02/2019] [Accepted: 01/20/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Differences in bulimic and impulsive behaviours in Eating Disorders (ED) have been associated with cortico-striatal circuit dysfunction at a neurobiological level. We sought to investigate neo-striatal volume as a biomarker in ED subgroups as well as the possible relationship with trauma history. MATERIAL AND METHODS We studied 24 female patients: Anorexia Nervosa AN (n=8), Bulimia Nervosa BN (n=9), comorbid ED with borderline personality disorder (EDc; n=7), and a group of Healthy Controls (n=19). Binge eating behaviours and impulsivity scales were used to characterize our sample as well as Trauma Questionnaires and Magnetic resonance imaging (MRI) volumetric manual measurements of caudate and putamen nuclei (striatum). RESULTS Our preliminary results showed a significantly larger left putaminal volume in AN compared to the other three groups [C (p=0.008), BN (p<.001) and EDc (p=.001)] and a smaller right putaminal volume in EDc compared to controls (p=.045) and AN (p=.039). Some negative correlations were found between bilateral putaminal volumes and self-reported general and early traumatization scores. CONCLUSION This pilot study suggested that striatal volumes might differentiate AN from BN and EDc at a neurobiological level with implications for treatment strategies. Larger scale studies should be carried out that allow replication of these data.
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Affiliation(s)
- Rosa M Molina-Ruiz
- Complutense University Medical School, Hospital Clínico San Carlos, Madrid, Spain.
| | - Jeffrey C L Looi
- Research Centre for Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra. Hospital, Canberra, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital; Melbourne Neuropsychiatry Centre, University of Melbourne and Northwestern Mental Health, Melbourne, Australia
| | | | - Fiona A Wilkes
- Research Centre for Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra. Hospital, Canberra, Australia
| | - Lena L Liu
- Research Centre for Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra. Hospital, Canberra, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital; Melbourne Neuropsychiatry Centre, University of Melbourne and Northwestern Mental Health, Melbourne, Australia
| | | | - Marina Diaz-Marsa
- Complutense University Medical School, Hospital Clínico San Carlos, Madrid, Spain
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7
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González-Vives S, Díaz-Marsá M, De la Vega I, Palomares N, Vázquez S, López-Villatoro JM, Palomo T, Carrasco JL. Hypothalamic-pituitary axis response to a 0.25-MG dexamethasone test in women with fibromyalgia. Stress 2020; 23:284-289. [PMID: 31591938 DOI: 10.1080/10253890.2019.1678024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Fibromyalgia has been reported as having some clinical overlap with both depression and emotionally-unstable disorders, although both types of disorders present different cortisol suppression response to dexamethasone. In this study we investigated the hypothalamic-pituitary-adrenal system (HPA) in the fibromyalgic syndrome (FMS) using a dexamethasone suppression test (DST) of 0.25 mg designed to specifically detect cortisol hypersuppression. We studied 59 women (20 patients and 39 healthy controls) to whom the DST was administered together with a battery of psychometric tests. In our results, patients with FMS had significant lower levels of basal cortisol pre- and post-DST compared with control subjects. However, cortisol suppression rate in patients after DST was not significantly different than in controls. As other syndromes like post-traumatic stress disorder or emotionally unstable personality disorders, also related with high incidence of severe trauma, FMS patients presented significant low basal cortisol. However, they did not have cortisol hypersuppression as is commonly found in the mentioned disorders. The relation of FMS with lifetime traumas and with emotional instability should be further investigated in order to improve psychological treatment approaches for these patients.LAY SUMMARYPatients with fibromyalgic syndrome have basal hypocortisoism but no cortisol hypersuppression after dexamethasone infusion compared to control subjects, as other trauma-related syndromes.
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Affiliation(s)
- Sara González-Vives
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Marina Díaz-Marsá
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
| | - Irene De la Vega
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Nerea Palomares
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
- Department of Personality, Evaluation and Clinical Psychology, Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Susana Vázquez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Tomás Palomo
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
| | - José Luis Carrasco
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
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8
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Chami R, Monteleone AM, Treasure J, Monteleone P. Stress hormones and eating disorders. Mol Cell Endocrinol 2019; 497:110349. [PMID: 30557597 DOI: 10.1016/j.mce.2018.12.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 12/30/2022]
Abstract
AIMS The aim of this paper is to emphasize the role of stress processes in the aetiology of eating disorders. METHODS We have examined the literature for evidence that people with eating disorders might exhibit markers of stress and show signs of the "maltreated ecophenotype". RESULTS Early adversity is more common among people with binge eating behaviours. The secondary effects of malnutrition, which are mostly marked in anorexia nervosa, may be an added stressor that could also contribute to the stress related phenotype. People with eating disorders have anomalies in brain structure, reward and punishment sensitivity, and the balance between HPA and SMA function. These may be potential targets for treatment.
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Affiliation(s)
- Rayane Chami
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, 103 Denmark Hill, London, SE5 8AF, United Kingdom.
| | | | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, 103 Denmark Hill, London, SE5 8AF, United Kingdom
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9
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Monteleone AM, Monteleone P, Volpe U, De Riso F, Fico G, Giugliano R, Nigro M, Maj M. Impaired cortisol awakening response in eating disorder women with childhood trauma exposure: evidence for a dose-dependent effect of the traumatic load. Psychol Med 2018; 48:952-960. [PMID: 28847330 DOI: 10.1017/s0033291717002409] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Childhood trauma is a non specific risk factor for adult eating disorders (ED), and the hypothalamic-pituitary-adrenal (HPA) axis seems to mediate such a risk. Here we explored the impact of different types of childhood trauma and of traumatic load on the cortisol awakening response (CAR) of women with anorexia nervosa (AN) or bulimia nervosa (BN). METHODS Saliva samples were collected at awakening and after 15, 30, 60 min to measure cortisol levels by 121 women (44 AN patients, 36 BN patients and 41 healthy women). Participants filled in the Childhood Trauma Questionnaire. RESULTS AN and BN patients with childhood maltreatment exhibited an attenuated CAR compared with non-maltreated ones. In the whole ED patient group, the CAR showed a progressive impairment with the increasing number of reported trauma types. Although significant negative correlations emerged between the type or the number of traumas and the CAR, only the number of traumas remained significantly associated with the CAR in a stepwise multiple regression analysis. CONCLUSIONS Present findings confirm that childhood trauma is associated with an impaired CAR in adult AN and BN patients and demonstrate for the first time a negative dose-dependent effect of the traumatic load on HPA axis activity.
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Affiliation(s)
- A M Monteleone
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - P Monteleone
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - U Volpe
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - F De Riso
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - G Fico
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - R Giugliano
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - M Nigro
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - M Maj
- Department of Psychiatry,University of Naples SUN,Naples,Italy
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10
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Easter A, Taborelli E, Bye A, Zunszain PA, Pariante CM, Treasure J, Schmidt U, Micali N. Perinatal hypothalamic-pituitary-adrenal axis regulation among women with eating disorders and their infants. Psychoneuroendocrinology 2017; 76:127-134. [PMID: 27914245 DOI: 10.1016/j.psyneuen.2016.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/31/2016] [Accepted: 11/04/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychiatric illness is associated with heightened hypothalamic-pituitary-adrenal (HPA) axis activity during pregnancy which may have long term effects on infant stress regulation. HPA axis regulation has not previously been investigated in women with eating disorders (ED) or their infants during the perinatal period. METHODS Women were recruited to a prospective longitudinal study in three groups: 1) current or active ED (C-ED=31), 2) past ED (P-ED=29) and healthy control (HC=57). Maternal psychopathology, diurnal cortisol levels, corticotropin-releasing hormone (CRH) and CRH binding protein (CRH-BP) were measured during the third trimester of pregnancy. At eight weeks postpartum infant cortisol was obtained before and after routine immunisations to determine infant hormonal response to a stressful situation. RESULTS Women with current ED had a significantly lower cortisol decline throughout the day compared to HC, in both adjusted and unadjusted analyses. Lower cortisol decline among women with a current ED were associated with higher levels of psychopathology during pregnancy. Women's cortisol awakening response, CRH and CRH-BP levels did not differ across the three groups. Infants' stress response was also significantly higher among those in the C-ED group, although this effect was attenuated after controlling for confounders. CONCLUSIONS During pregnancy women with ED have lower cortisol declines, suggestive of blunted diurnal cortisol rhythms. Postnatally, their infants also have a heightened response to stress. This is the first study to identify HPA axis dysfunction in pregnancy in women with ED, and to show an intergenerational effect. Since dysfunctions in HPA activity during childhood may represent a risk factor for psychological and physical health problems later in life, further investigation of the potential long-term implications of these findings is crucial.
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Affiliation(s)
- A Easter
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK; Department of Psychological Medicine and Psychiatry, Section of Eating Disorders, Institute of Psychiatry, Kings College London, London, UK; Health Services Research Department, Institute of Psychiatry, Kings College London, London, UK.
| | - E Taborelli
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK; Department of Psychological Medicine and Psychiatry, Section of Eating Disorders, Institute of Psychiatry, Kings College London, London, UK
| | - A Bye
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK; Department of Psychological Medicine and Psychiatry, Section of Eating Disorders, Institute of Psychiatry, Kings College London, London, UK; Health Services Research Department, Institute of Psychiatry, Kings College London, London, UK
| | - P A Zunszain
- Department of Psychological Medicine, Institute of Psychiatry, Section of Perinatal Psychiatry and Stress, Psychiatry and Immunology (SPI-lab), King's College London, London, UK
| | - C M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Section of Perinatal Psychiatry and Stress, Psychiatry and Immunology (SPI-lab), King's College London, London, UK
| | - J Treasure
- Department of Psychological Medicine and Psychiatry, Section of Eating Disorders, Institute of Psychiatry, Kings College London, London, UK
| | - U Schmidt
- Department of Psychological Medicine and Psychiatry, Section of Eating Disorders, Institute of Psychiatry, Kings College London, London, UK
| | - N Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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11
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Monteleone AM, Monteleone P, Marciello F, Pellegrino F, Castellini G, Maj M. Differences in Cortisol Awakening Response between Binge-Purging and Restrictive Patients with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2016; 25:13-18. [DOI: 10.1002/erv.2485] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/19/2016] [Accepted: 10/04/2016] [Indexed: 11/08/2022]
Affiliation(s)
| | - Palmiero Monteleone
- Department of Psychiatry; University of Naples SUN; Naples Italy
- Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, Section of Neurosciences; University of Salerno; Salerno Italy
| | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, Section of Neurosciences; University of Salerno; Salerno Italy
| | | | - Giovanni Castellini
- Department of Neurosciences, Unit of Psychiatry; University of Florence; Florence Italy
| | - Mario Maj
- Department of Psychiatry; University of Naples SUN; Naples Italy
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The Very Low-Dose Dexamethasone Suppression Test in the General Population: A Cross-Sectional Study. PLoS One 2016; 11:e0164348. [PMID: 27736954 PMCID: PMC5063373 DOI: 10.1371/journal.pone.0164348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 09/24/2016] [Indexed: 11/19/2022] Open
Abstract
Determinants of the hypothalamic-pituitary-adrenal (HPA) axis functioning are increasingly explored in population-based studies. However, functional tests measuring the negative feedback of the HPA axis cannot easily be implemented into large observational studies. Furthermore, high doses of dexamethasone often completely suppress the HPA axis in healthy persons. This study aimed to detect the effects of the health, lifestyle and sociodemographic factors, psychiatric problems and cognitive functions on the negative feedback of the HPA axis using a very low-dose (0.25 mg) dexamethasone suppression test (DST).We evaluated the associations of several determinants with the saliva cortisol concentrations after dexamethasone intake in a confounder-adjusted model also corrected for baseline saliva cortisol concentrations in the Rotterdam Study, a large population-based study (N = 1822). We found that female sex, low income, lack of exercise, instrumental disability and smoking were all independently associated with stronger suppression of the HPA axis. Even though there were no linear associations between psychiatric measures and cortisol suppression, we found that depressive symptoms and anxiety disorders were more common in persons with non-suppression of cortisol. Conversely, psychotropic medication use was related to enhanced suppression of cortisol after DST. In this large study, we found that female gender, low socioeconomic status and poor health were all related to suppression of the HPA axis. Non-linear associations were detected between the suppression of the HPA axis and common psychiatric disorders in community-dwelling persons.
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Willemsen RH, van Leeuwen L, Voorend-van Bergen TAS, de Rijke YB, Pijnenburg MW, van den Akker ELT. Reproducibility and utility of an overnight 0.25 mg dexamethasone suppression test as a marker for glucocorticoid sensitivity in children with asthma. J Endocrinol Invest 2016; 39:93-6. [PMID: 26059835 PMCID: PMC4703608 DOI: 10.1007/s40618-015-0323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/22/2015] [Indexed: 11/08/2022]
Abstract
PURPOSE Inhaled corticosteroids (ICS) are the cornerstone of asthma treatment in children. However, there is considerable inter-individual variation in glucocorticoid sensitivity, leading to over- as well as undertreatment. A simple and fast test to predict glucocorticoid sensitivity would enable more tailored therapy in children with asthma. AIM To study reproducibility and utility of an overnight 0.25 mg dexamethasone suppression test (DST) with salivary cortisol levels as marker for glucocorticoid sensitivity in asthmatic children. METHODS 23 children with atopic asthma were recruited for two overnight 0.25 mg DST's, 1 month apart. RESULTS Baseline cortisol levels correlated well between both tests. However, cortisol levels, change in cortisol levels or fractional suppression of cortisol levels after dexamethasone did not correlate between the two tests. Bland-Altman plots showed that the difference in salivary cortisol levels between test 1 and 2 of an individual patient could go up to 12 nmol/l, which is a clinically relevant difference. ICS dose did not correlate with baseline cortisol levels, height and BMI SDS. CONCLUSION The low-dose salivary DST test in its current form is not suitable for use in clinical practice in children with asthma, due to low reproducibility. Therefore, studies using the 0.25 mg salivary DST should be interpreted cautiously.
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Affiliation(s)
- R H Willemsen
- Department of Paediatric Endocrinology, Erasmus MC Sophia, 3015 GJ, Rotterdam, The Netherlands.
- Department of Paediatrics, Box 116 Level 8 Addenbrooke's Hospital, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - L van Leeuwen
- Department of Paediatric Endocrinology, Erasmus MC Sophia, 3015 GJ, Rotterdam, The Netherlands
| | | | - Y B de Rijke
- Diagnostic Laboratory Endocrinology, Departments of Clinical Chemistry and Internal Medicine, Erasmus MC, 3015 GJ, Rotterdam, The Netherlands
| | - M W Pijnenburg
- Department of Paediatric Pulmonology, Erasmus MC Sophia, 3015 GJ, Rotterdam, The Netherlands
| | - E L T van den Akker
- Department of Paediatric Endocrinology, Erasmus MC Sophia, 3015 GJ, Rotterdam, The Netherlands
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Vannucci A, Nelson EE, Bongiorno DM, Pine DS, Yanovski JA, Tanofsky-Kraff M. Behavioral and neurodevelopmental precursors to binge-type eating disorders: support for the role of negative valence systems. Psychol Med 2015; 45:2921-2936. [PMID: 26040923 PMCID: PMC4589435 DOI: 10.1017/s003329171500104x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pediatric loss-of-control (LOC) eating is a robust behavioral precursor to binge-type eating disorders. Elucidating precursors to LOC eating and binge-type eating disorders may refine developmental risk models of eating disorders and inform interventions. METHOD We review evidence within constructs of the Negative Valence Systems (NVS) domain, as specified by the Research Domain Criteria framework. Based on published studies, we propose an integrated NVS model of binge-type eating-disorder risk. RESULTS Data implicate altered corticolimbic functioning, neuroendocrine dysregulation, and self-reported negative affect as possible risk factors. However, neuroimaging and physiological data in children and adolescents are sparse, and most prospective studies are limited to self-report measures. CONCLUSIONS We discuss a broad NVS framework for conceptualizing early risk for binge-type eating disorders. Future neural and behavioral research on the developmental trajectory of LOC and binge-type eating disorders is required.
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Affiliation(s)
- Anna Vannucci
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), DHHS, Bethesda, MD
| | - Eric E. Nelson
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, National Institutes of Health (NIH), DHHS, Bethesda, MD
| | - Diana M. Bongiorno
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, National Institutes of Health (NIH), DHHS, Bethesda, MD
| | - Daniel S. Pine
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, National Institutes of Health (NIH), DHHS, Bethesda, MD
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), DHHS, Bethesda, MD
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), DHHS, Bethesda, MD
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Monteleone AM, Monteleone P, Serino I, Scognamiglio P, Di Genio M, Maj M. Childhood trauma and cortisol awakening response in symptomatic patients with anorexia nervosa and bulimia nervosa. Int J Eat Disord 2015; 48:615-21. [PMID: 25808182 DOI: 10.1002/eat.22375] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Exposure to trauma during childhood is a risk factor for eating disorders (EDs) in adulthood. The biological mechanisms underlying such increased risk seem to involve the endogenous stress response system (i.e., the hypothalamic-pituitary-adrenal [HPA] axis), which undergoes trauma-induced functional changes that may persist later in life. In the present study, we examined the effects of childhood trauma experiences on HPA-axis activity, comparing saliva cortisol awakening response (CAR) in adult patients with anorexia nervosa (AN) or bulimia nervosa (BN) with CAR in adult healthy controls. METHOD Twenty-three patients with symptomatic AN, 21 patients with symptomatic BN, and 29 healthy women collected saliva samples at awakening and again after 15, 30, and 60 min. Participants also completed the Childhood Trauma Questionnaire and eating-related psychopathological rating scales. RESULTS According to the Childhood Trauma Questionnaire, 13 individuals with AN and 12 individuals with BN, but none of the healthy women, reported childhood maltreatment. Compared with the control group, the non-maltreated AN patient group exhibited an enhanced CAR, whereas the group of non-maltreated BN patients showed a normal CAR. Moreover, both AN and BN patient groups with childhood maltreatment exhibited statistically significant blunting of CAR compared with non-maltreated groups. DISCUSSION The present findings add to the evidence supporting the concept that there is a dysregulation of HPA-axis activity in symptomatic patients with EDs and suggest that childhood trauma exposure may contribute to such dysregulation.
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Affiliation(s)
| | - Palmiero Monteleone
- Department of Psychiatry, University of Naples SUN, Naples, Italy.,Neurosciences Section, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Ismene Serino
- Department of Experimental Medicine, University of Naples SUN, Naples, Italy
| | | | - Monica Di Genio
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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Monteleone P, Scognamiglio P, Monteleone AM, Perillo D, Maj M. Cortisol awakening response in patients with anorexia nervosa or bulimia nervosa: relationships to sensitivity to reward and sensitivity to punishment. Psychol Med 2014; 44:2653-2660. [PMID: 25055178 DOI: 10.1017/s0033291714000270] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sensitivity to punishment (SP) and sensitivity to reward (SR) are personality characteristics that may have relevance for the pathophysiology of eating disorders (EDs). Moreover, personality characteristics are known to modulate the activity of the hypothalamus-pituitary-adrenal (HPA) axis, which is the main component of the endogenous stress response system. As stress has been implicated in the aetiology and the maintenance of EDs, we aimed to study the HPA axis activity in relation to SP and SR, as conceptualized by Gray's reinforcement sensitivity theory (RST), in patients with anorexia nervosa (AN) or bulimia nervosa (BN). METHOD Twenty-five women with AN, 23 women with BN and 19 healthy women volunteered for the study. HPA axis activity was assessed by measurement of the salivary cortisol awakening response (CAR). The subjects' SP and SR were measured by the behavioural inhibition system (BIS)/behavioural approach system (BAS) scales. RESULTS The CAR was significantly enhanced in AN patients, but not in BN patients, compared to healthy women. The CAR correlated significantly with BAS measures, negatively in healthy controls and positively in binge-purging AN patients and BN women. SP, measured by the BIS scale, was higher in patients than in controls. CONCLUSIONS These findings confirm the occurrence of an enhanced activity of the HPA axis in symptomatic AN, but not in symptomatic BN, and show for the first time that the CAR is associated with SR, as conceptualized by the RST, negatively in healthy subjects but positively in binge-purging ED patients.
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Affiliation(s)
- P Monteleone
- Department of Medicine and Surgery,University of Salerno,Italy
| | | | | | - D Perillo
- Department of Psychiatry,University of Naples SUN,Italy
| | - M Maj
- Department of Psychiatry,University of Naples SUN,Italy
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Tajima-Pozo K, Montes-Montero A, Güemes I, González-Vives S, Díaz-Marsá M, Carrasco JL. [Contributions of cortisol suppression tests to understanding of psychiatric disorders: a narrative review of literature]. ACTA ACUST UNITED AC 2013; 60:396-403. [PMID: 23623464 DOI: 10.1016/j.endonu.2012.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 08/03/2012] [Accepted: 09/04/2012] [Indexed: 12/01/2022]
Abstract
Activity of the hypothalamic-pituitary-adrenal axis had been studied for the past half century, when some researchers noted that some patients with Cushing's syndrome and severe mood disorders had high baseline cortisol levels, which resulted in an inhibited response in the 1mg dexamethasone suppression test. Altered dexamethasone suppression test results were subsequently found in many psychiatric diseases, including anorexia nervosa, obsessive-compulsive disorder, degenerative dementia, bipolar disorders, and schizophrenia. The relationship between high baseline cortisol levels and stress has also been studied. Some researches on the genesis of borderline personality disorder focused on traumatic childhood backgrounds. Other investigations aimed at elucidating the relationship between traumatic backgrounds and some psychiatric disorders noted that patients with post-traumatic stress disorder and borderline personality disorder showed an enhanced cortisol suppression with low cortisol doses (0.5 mg). Recent studies showed that use of an ultra-low dose of cortisol during the dexamethasone suppression test may be helpful for detecting disorders with hyperactivity of the hypothalamic-pituitary-adrenal axis. Recent advances in neuroimaging support the existence of hyperactivity of the hypothalamic-pituitary-adrenal axis in patients with borderline personality disorder, relating a decreased pituitary gland volume to major traumatic backgrounds and suicidal attempts. The purpose of this paper is to make a narrative review of research using dexamethasone suppression test in psychiatric disorders, in order to ascertain its value as a supplemental diagnostic test or as a prognostic marker.
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Affiliation(s)
- Kazuhiro Tajima-Pozo
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, España.
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Phassouliotis C, Garner BA, Phillips LJ, Bendall S, Yun Y, Markulev C, Kerr M, McGorry PD. Enhanced cortisol suppression following administration of low-dose dexamethasone in first-episode psychosis patients. Aust N Z J Psychiatry 2013; 47:363-70. [PMID: 23172653 DOI: 10.1177/0004867412465125] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Impaired regulation of the hypothalamic-pituitary-adrenal (HPA) axis and hyper-activity of this system have been described in patients with psychosis. Conversely, some psychiatric disorders such as post-traumatic stress disorder (PTSD) are characterised by HPA hypo-activity, which could be related to prior exposure to trauma. This study examined the cortisol response to the administration of low-dose dexamethasone in first-episode psychosis (FEP) patients and its relationship to childhood trauma. METHOD The low-dose (0.25 mg) Dexamethasone Suppression Test (DST) was performed in 21 neuroleptic-naïve or minimally treated FEP patients and 20 healthy control participants. Childhood traumatic events were assessed in all participants using the Childhood Trauma Questionnaire (CTQ) and psychiatric symptoms were assessed in patients using standard rating scales. RESULTS FEP patients reported significantly higher rates of childhood trauma compared to controls (p = 0.001) and exhibited lower basal (a.m.) cortisol (p = 0.04) and an increased rate of cortisol hyper-suppression following dexamethasone administration compared to controls (33% (7/21) vs 5% (1/20), respectively; p = 0.04). There were no significant group differences in mean cortisol decline or percent cortisol suppression following the 0.25 mg DST. This study shows for the first time that a subset of patients experiencing their first episode of psychosis display enhanced cortisol suppression. CONCLUSIONS These findings suggest there may be distinct profiles of HPA axis dysfunction in psychosis which should be further explored.
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Steiger H, Labonté B, Groleau P, Turecki G, Israel M. Methylation of the glucocorticoid receptor gene promoter in bulimic women: associations with borderline personality disorder, suicidality, and exposure to childhood abuse. Int J Eat Disord 2013; 46:246-55. [PMID: 23417893 DOI: 10.1002/eat.22113] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare levels of methylation of the glucocorticoid receptor (GR) gene (NR3C1) promoter between women with bulimia nervosa (BN) and women with no eating disorder (ED), and also to explore, in women with BN, the extent to which methylation of the GR gene promoter corresponds to childhood abuse, suicidality, or borderline personality disorder (BPD). METHOD We measured methylation levels in selected NR3C1 promoter regions using DNA obtained from lymphocytes in 64 women with BN (32 selected as having a history of severe childhood abuse and 32 selected as having no such history) and 32 comparison women with no ED or history of childhood abuse. RESULTS Compared to noneating disordered women, women with BN and comorbid BPD (or BN with a history of suicidality) showed significantly more methylation of specific exon 1C sites. There was also a (nonsignificant) result indicative of greater methylation in some 1C sites among women with BN, when compared (as a group) to women with no ED. No parallel effects owing to childhood abuse were observed. DISCUSSION Our findings associate BN (when accompanied by BPD or suicidality) with hypermethylation of certain GR exon 1C promoter sites. We discuss theoretical and clinical implications of our findings.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas University Institute, Quebec, Canada.
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Bruce KR, Steiger H, Israël M, Groleau P, Ng Ying Kin NMK, Ouellette AS, Sycz L, Badawi G. Cortisol responses on the dexamethasone suppression test among women with Bulimia-spectrum eating disorders: associations with clinical symptoms. Prog Neuropsychopharmacol Biol Psychiatry 2012; 38:241-6. [PMID: 22575215 DOI: 10.1016/j.pnpbp.2012.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 04/05/2012] [Accepted: 04/06/2012] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Evidence associates Bulimia Nervosa (BN) with altered functioning of the hypothalamic-pituitary-adrenal (HPA) axis, but the clinical implications of such alterations need to be better understood. We contrasted cortisol responses to the dexamethasone suppression test (DST) in bulimic and non-eating disordered women and examined relationships among DST cortisol responses, eating symptoms and co-morbid disturbances. METHOD Sixty women with Bulimia Spectrum (BS) Disorders (either BN or normal weight Eating Disorder NOS with regular binge eating or purging) and 54 non-eating disordered women of similar age and body mass index participated in a 0.5 mg DST, and completed interviews and questionnaires assessing eating symptoms and co-morbid psychopathology. RESULTS Compared with the normal-eater group, the BS women demonstrated significantly less DST suppression. Among BS women, DST non-suppression was associated with more severe depression, anxiety and eating preoccupations. CONCLUSIONS Our findings show BS women to show less DST suppression compared to normal eater women, and results link extent of non-suppression, in BS individuals, to severity of depression, anxiety and eating preoccupations.
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Affiliation(s)
- Kenneth R Bruce
- Douglas Mental Health University Institute & McGill University, Montreal, Canada.
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The role of depression and childhood trauma on cortisol suppression in women with bulimia nervosa: a pilot study. Eat Weight Disord 2012; 17:e17-21. [PMID: 22751268 DOI: 10.1007/bf03325324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Although some studies have shown cortisol nonsuppression following dexamethasone suppression test (DST) in current bulimia nervosa (BN), no study has looked at HPA axis abnormalities in behaviorally recovered BN patients. The purpose of this pilot study is to explore the role of current vs behaviorally recovered BN, as well as depression and childhood trauma in cortisol suppression in BN. METHODS A 0.5 mg DST was performed on 21 patients with behaviorally recovered BN, 9 women with current BN and 14 controls. BN group also completed the Hamilton Depression Rating Scale and Childhood Trauma Questionnaire. RESULTS There were no differences between the three groups in cortisol suppression, and BMI was not associated with cortisol levels following DST. Within the BN group, depression was significantly associated with afternoon cortisol nonsuppression (p=0.005). DISCUSSION As researchers look for more accurate ways to identify biological phenotypes of BN, presence of comorbid depression may help explain differences in cortisol suppression.
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Contributions of the glucocorticoid receptor polymorphism (Bcl1) and childhood abuse to risk of bulimia nervosa. Psychiatry Res 2011; 187:193-7. [PMID: 21093928 DOI: 10.1016/j.psychres.2010.10.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 08/05/2010] [Accepted: 10/25/2010] [Indexed: 01/09/2023]
Abstract
This study evaluated the hypothesis that traumatic stress can increase risk of bulimia nervosa (BN) in individuals who are genetically disposed towards lower modulation of physiological stress reactions. We explored the extent to which childhood abuse (physical or sexual), variants of a main glucocorticoid receptor (GR) polymorphism (Bcl1), or their interaction, differentiated women with and without BN. Women seeking treatment for BN (N=129) and non-eating-disordered comparison women (N=98) provided blood samples for assays of the Bcl1 polymorphism, and completed structured interviews assessing eating symptoms, psychiatric symptoms and childhood abuse. Compared to normal-eaters, bulimic women were significantly more likely to carry the low-function Bcl1 C allele (CC or CG genotypes), to report a history of childhood abuse and, more importantly, to be positive for both factors. We interpret our findings as indicating that traumatic stress, when impacting individuals disposed to lower GR modulation, can be etiological for BN.
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Jahng JW. An animal model of eating disorders associated with stressful experience in early life. Horm Behav 2011; 59:213-20. [PMID: 21093444 DOI: 10.1016/j.yhbeh.2010.11.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 10/28/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
Experience of childhood abuse is prevalent among patients with eating disorders, and dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is implicated in its pathophysiology. Neonatal maternal separation is considered as an animal model of stressful experience early in life. Many of studies have demonstrated its impact both on the activity of HPA axis and the development of psycho-emotional disorders later in life. In this paper, a series of our researches on developing an animal model of eating disorders is reviewed. An animal model of neonatal maternal separation was used; Sprague-Dawley pups were separated from dam daily for 180 min during the first 2 weeks of life (MS) or undisturbed. Anxiety-/depression-like behaviors were observed in MS rats at the age of two months with decreased serotonergic activity in the hippocampus and the raphe. Post-weaning social isolation promoted food intake and weight gain of adolescent MS pups, with impacts on anxiety-like behaviors. Sustained hyperphagia was observed in the MS pups subjected to a fasting/refeeding cycle repeatedly during adolescence, with increased plasma corticosterone levels. Anhedonia, major symptom of depression, to palatable food was observed in adolescent MS pups with blunted response of the mesolimbic dopaminergic activity to stress. Results suggest that neonatal maternal separation lead to the development of eating disorders when it is challenged with social or metabolic stressors later in life, in which dysfunctions in the HPA axis and the brain monoaminergic systems may play important roles.
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Affiliation(s)
- Jeong Won Jahng
- Dental Research Institute, Seoul National University School of Dentistry, Seoul, 110-768, Republic of Korea.
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The other side of the curve: examining the relationship between pre-stressor physiological responses and stress reactivity. Psychoneuroendocrinology 2010; 35:1363-73. [PMID: 20456867 DOI: 10.1016/j.psyneuen.2010.03.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 02/03/2010] [Accepted: 03/24/2010] [Indexed: 11/23/2022]
Abstract
There is widespread consensus that stress induces dramatic physiological changes, but no agreement on the quantitative parameters that are appropriate to measure these responses. More importantly, the interpretation of various stress measurements, and how individual responses should be evaluated, has not been properly addressed. Even the definition of baseline, against which stress responses must be measured, is not clearly established. The current experiment sought to address these shortcomings by comparing the predictive value of different calculated parameters for psychosocial and physiological measures of stress across individuals. Subjects were 29 male and 59 female healthy undergraduate students with saliva samples collected over a 3-h interval that included a Trier Social Stress Test. Salivary cortisol and alpha-amylase response were analyzed using the absolute concentration, the percent change in concentration, the area under the curve (Pruessner et al., 2003), and the arrival index (change from arrival to 1h after arrival). The arrival index correlated with the subsequent stress response for both cortisol (r=0.76, p<0.01) and alpha-amylase (r=0.86, p<0.01). The arrival index for both cortisol and alpha-amylase was also related to subjective ratings of anxiety following the psychosocial stressor. A subset of individuals with high self-reported anxiety also displayed higher reactivity in response to the psychosocial stressor. Thus, the magnitude of the difference in cortisol and alpha-amylase between arrival and 1h after arrival was a predictor of subsequent stress reactivity. These findings suggest that different psychosocial profiles may be reflected in cortisol and alpha-amylase changes. For this reason: (1) a recovery period after arrival is essential to establish a baseline, (2) the difference between arrival and post-recovery period baseline should be included in experimental designs as a predictive variable, and (3) transformation of individual measures into proportional changes relative to the arrival sample is very likely to obscure important underlying individual differences.
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