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Vickers ML, Chan HY, Elliott S, Ketheesan S, Ramineni V, Eriksson L, McMahon K, Oddy B, Scott JG. Stimulant medications in the management of bulimia nervosa and anorexia nervosa in patients with and without comorbid attention deficit hyperactivity disorder: A systematic review. Eat Behav 2024; 54:101908. [PMID: 39137484 DOI: 10.1016/j.eatbeh.2024.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/03/2024] [Accepted: 08/08/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE People with attentional problems are at increased risk of eating disorders. This paper aimed to systematically review and synthesize the existing evidence on stimulant medication in the management of patients with bulimia nervosa (BN) or anorexia nervosa (AN) with or without comorbid attention deficit hyperactivity disorder (ADHD). METHOD A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A protocol for the review was registered with Open Science Framework (OSF) Registry and critical appraisal of the literature was conducted using Joanna Briggs Institute (JBI) Critical Appraisal Tools. RESULTS Thirteen articles met inclusion criteria including two quasi-experimental studies, one randomized controlled trial, four case series, and six case reports. 26 cases were included from studies and 32 from case series/reports. Only two cases from a single case report had a diagnosis of AN, while the remainder had BN. Stimulants included methylamphetamine, lisdexamfetamine, methylphenidate, dextroamphetamine sulphate and mixed amphetamine salt. In nearly all cases of BN there were reported reductions in eating disorder symptoms. The rates of adverse effects were high and included weight loss, decreased appetite, tachycardia, dry mouth, fatigue, insomnia, restlessness, nausea, bruxism, headache, palpitations, blood pressure changes, irritability, anxiety, depressed mood, and diaphoresis. CONCLUSION There is currently insufficient evidence to support the use of stimulant medications to treat symptoms of BN or AN. The authors recommend considering screening patients with BN for ADHD.
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Affiliation(s)
- Mark L Vickers
- Metro North Mental Health Service, Herston, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia.
| | - Hong Yin Chan
- Metro North Mental Health Service, Herston, Brisbane, Australia.
| | - Stephen Elliott
- Metro North Mental Health Service, Herston, Brisbane, Australia
| | - Sarangan Ketheesan
- Metro North Mental Health Service, Herston, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Vinay Ramineni
- Metro North Mental Health Service, Herston, Brisbane, Australia
| | - Lars Eriksson
- Herston Health Sciences Library, University of Queensland, Brisbane, Australia
| | - Kirsten McMahon
- Metro North Mental Health Service, Herston, Brisbane, Australia
| | - Belinda Oddy
- Metro North Mental Health Service, Herston, Brisbane, Australia
| | - James G Scott
- Child Health Research Centre, The University of Queensland Brisbane, Australia; Child and Youth Mental Health Service, Children's Health Queensland, Brisbane, Australia
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Keshen A, Bartel S, Frank GKW, Svedlund NE, Nunes A, Dixon L, Ali SI, Kaplan AS, Hay P, Touyz S, Romo-Nava F, McElroy SL. The potential role of stimulants in treating eating disorders. Int J Eat Disord 2022; 55:318-331. [PMID: 34846763 DOI: 10.1002/eat.23650] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Many individuals with eating disorders remain symptomatic after a course of psychotherapy and pharmacotherapy; therefore, the development of innovative treatments is essential. METHOD To learn more about the current evidence for treating eating disorders with stimulants, we searched for original articles and reviews published up to April 29, 2021 in PubMed and MEDLINE using the following search terms: eating disorders, anorexia, bulimia, binge eating, stimulants, amphetamine, lisdexamfetamine, methylphenidate, and phentermine. RESULTS We propose that stimulant medications represent a novel avenue for future research based on the following: (a) the relationship between eating disorders and attention deficit/hyperactivity disorder (ADHD); (b) a neurobiological rationale; and (c) the current (but limited) evidence for stimulants as treatments for some eating disorders. Despite the possible benefits of such medications, there are also risks to consider such as medication misuse, adverse cardiovascular events, and reduction of appetite and pathological weight loss. With those risks in mind, we propose several directions for future research including: (a) randomized controlled trials to study stimulant treatment in those with bulimia nervosa (with guidance on strategies to mitigate risk); (b) examining stimulant treatment in conjunction with psychotherapy; (c) investigating the impact of stimulants on "loss of control" eating in youth with ADHD; and (d) exploring relevant neurobiological mechanisms. We also propose specific directions for exploring mediators and moderators in future clinical trials. DISCUSSION Although this line of investigation may be viewed as controversial by some in the field, we believe that the topic warrants careful consideration for future research.
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Affiliation(s)
- Aaron Keshen
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Bartel
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guido K W Frank
- Department of Psychiatry, University of California at San Diego, San Diego, California, USA.,Rady Children's Hospital San Diego, San Diego, California, USA
| | - Nils Erik Svedlund
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet-Stockholm Health Care Services, Stockholm, Sweden
| | - Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laura Dixon
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Sarrah I Ali
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Allan S Kaplan
- Centre for Addiction and Mental Health, Department of Psychiatry, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Stephan Touyz
- School of Psychology and Inside Out Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Francisco Romo-Nava
- Lindner Center of HOPE, Mason, Ohio, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, Ohio, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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El Archi S, Cortese S, Ballon N, Réveillère C, De Luca A, Barrault S, Brunault P. Negative Affectivity and Emotion Dysregulation as Mediators between ADHD and Disordered Eating: A Systematic Review. Nutrients 2020; 12:nu12113292. [PMID: 33121125 PMCID: PMC7693832 DOI: 10.3390/nu12113292] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022] Open
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with disordered eating, especially addictive-like eating behavior (i.e., binge eating, food addiction, loss of control overeating). The exact mechanisms underlying this association are unclear. ADHD and addictive-like eating behavior are both associated with negative affectivity and emotion dysregulation, which we hypothesized are mediators of this relationship. The purpose of this systematic review was to review the evidence related to this hypothesis from studies assessing the relationship between childhood or adulthood ADHD symptomatology, negative affectivity, emotion dysregulation and addictive-like eating behavior. The systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. The literature search was conducted in PubMed and PsycINFO (publication date: January 2015 to August 2020; date of search: 2 September 2020). Out of 403 potentially relevant articles, 41 were retained; 38 publications reported that ADHD and disordered eating or addictive-like eating behavior were significantly associated, including 8 articles that suggested a mediator role of negative affectivity or emotion dysregulation. Sixteen publications reported that the association between ADHD symptomatology and disordered eating or addictive-like eating behavior differed according to gender, eating behavior and ADHD symptoms (hyperactivity, impulsivity and inattention). We discuss the practical implications of these findings and directions future research.
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Affiliation(s)
- Sarah El Archi
- Qualipsy, EE 1901, Université de Tours, 37041 Tours, France; (S.E.A.); (C.R.); (S.B.)
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology, Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
- Solent NHS Trust, Southampton SO19 8BR, UK
- New York University Child Study Center, New York, NY 10016, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG72UH, UK
| | - Nicolas Ballon
- CHRU de Tours, Service d’Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, 37044 Tours, France;
- UMR 1253, iBrain, Université de Tours, INSERM, 37032 Tours, France
| | - Christian Réveillère
- Qualipsy, EE 1901, Université de Tours, 37041 Tours, France; (S.E.A.); (C.R.); (S.B.)
| | - Arnaud De Luca
- CHRU de Tours, Centre Spécialisé de l’Obésité, 37044 Tours, France;
- UMR 1069, Nutrition, Croissance et Cancer, Université de Tours, INSERM, 37032 Tours, France
| | - Servane Barrault
- Qualipsy, EE 1901, Université de Tours, 37041 Tours, France; (S.E.A.); (C.R.); (S.B.)
- CHRU de Tours, Service d’Addictologie Universitaire, Centre de Soins d’Accompagnement et de Prévention en Addictologie d’Indre-et-Loire (CSAPA-37), 37000 Tours, France
| | - Paul Brunault
- Qualipsy, EE 1901, Université de Tours, 37041 Tours, France; (S.E.A.); (C.R.); (S.B.)
- CHRU de Tours, Service d’Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, 37044 Tours, France;
- UMR 1253, iBrain, Université de Tours, INSERM, 37032 Tours, France
- Correspondence: ; Tel.: +33-2-18-37-05-81
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Halevy-Yosef R, Bachar E, Shalev L, Pollak Y, Enoch-Levy A, Gur E, Weizman A, Stein D. The complexity of the interaction between binge-eating and attention. PLoS One 2019; 14:e0215506. [PMID: 31017971 PMCID: PMC6481844 DOI: 10.1371/journal.pone.0215506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/04/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate whether binge-eating in patients with eating disorders (EDs) is associated with attentional deficits. METHODS We studied ED patients with binge-eating (n = 51), no binge-eating (n = 59) and controls (n = 58). ED patients were assessed following the stabilization of weight and ED pathology. Attention assessment included evaluation of attention deficit hyperactivity disorder (ADHD) diagnosis, the Adult ADHD Self-Report (ASRS) and ADHD Rating Scale-IV-Home Version (ADHD-RS) questionnaires, and attention functioning assessed with neuropsychological tools. The severity of eating-related pathology, depression, anxiety and obsessionality was also monitored. RESULTS Patients with binge-eating showed more ADHD symptomatology on the ADHD-RS compared with non-binge-eating patients. No differences were found between binge-eating and non-binge-eating patients in ADHD diagnosis and neuropsychological functioning. Among the specific ED subtypes, patients with anorexia nervosa binge/purge type (AN-B/P) showed the highest rates of ADHD symptomatology on the ADHD-RS, and were characterized with sustained attention deficits. CONCLUSION Binge-eating is not associated with attention deficits as measured by objective neuropsychological tools. Nonetheless, it is associated with attentional difficulties as measured with the self-reported ADHD-RS. AN-B/P patients are the only ED category showing objective sustained attention deficits.
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Affiliation(s)
- Roni Halevy-Yosef
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
- Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Eytan Bachar
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
| | - Lilach Shalev
- School of Education and School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | - Yehuda Pollak
- The Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Enoch-Levy
- Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Eitan Gur
- Sheba Medical Center, Tel Hashomer, Israel
| | - Abraham Weizman
- Geha Mental Health Center and Felsenstein Medical Research Center, Rabin Medical Center, Petah Tiqva, Israel
| | - Daniel Stein
- Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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McElroy SL, Guerdjikova AI, Mori N, Romo-Nava F. Progress in Developing Pharmacologic Agents to Treat Bulimia Nervosa. CNS Drugs 2019; 33:31-46. [PMID: 30523523 DOI: 10.1007/s40263-018-0594-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper reviews past and current progress in developing pharmacologic agents for the treatment of individuals with bulimia nervosa (BN). We searched the literature and clinical trial registries for compounds studied in BN, the related condition, binge eating disorder (BED), and preclinical models of binge-eating behavior. Drug classes evaluated included antidepressants, antiepileptic drugs, stimulants and other medications for attention-deficit/hyperactivity disorder, opioid antagonists, and weight loss agents, among others. The only available drugs with established efficacy in BN at this time include antidepressants (especially selective serotonin reuptake inhibitors [SSRIs]) and the antiepileptic topiramate, though the efficacy of these compounds is modest at best. The only medications we found currently receiving empirical study in people with BN were fluoxetine, other serotonergic antidepressants, intranasal naloxone, lisdexamfetamine dimesylate, phentermine-topiramate combination, the antiandrogenic oral contraceptive ethinyl estradiol plus drospirenone, and prazosin. Preclinical models suggest that nociceptin receptor antagonists, the selective serotonin 5-HT2C receptor agonist lorcaserin, monoamine stabilizers, and selective orexin-1 receptor antagonists might be helpful. We found no evidence of a drug developed specifically for the treatment of individuals with BN. Future areas for research in the pharmacotherapy of BN are suggested. Importantly, until drugs are developed specifically for eating disorders, drugs developed for other conditions that are centrally acting and associated with beneficial psychotropic effects and/or reduced appetite or weight loss might be considered for repurposing in BN.
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Affiliation(s)
- Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA. .,University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Anna I Guerdjikova
- Lindner Center of HOPE, Mason, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Francisco Romo-Nava
- Lindner Center of HOPE, Mason, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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6
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Svedlund NE, Norring C, Ginsberg Y, von Hausswolff-Juhlin Y. Are treatment results for eating disorders affected by ADHD symptoms? A one-year follow-up of adult females. EUROPEAN EATING DISORDERS REVIEW 2018; 26:337-345. [PMID: 29717794 DOI: 10.1002/erv.2598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore the influence of self-reported Attention Deficit Hyperactivity Disorder (ADHD) symptoms on recovery rate at 1-year follow-up in an unselected group of patients in a specialized eating disorder (ED) clinic. METHODS Four hundred forty-three adult females with an ED were assessed with the ADHD Self-Report Scale for Adults (ASRS-screener), and for demographic variables and ED symptoms. Recovery was registered at 1-year follow-up. RESULTS A high degree of ADHD symptoms at baseline was predictive for nonrecovery of ED at 1-year follow-up in patients with loss of control over eating, bingeing, or purging. The presence of inattentive ADHD symptoms was stronger associated with nonrecovery than hyperactive/impulsive symptoms. CONCLUSIONS A high degree of ADHD symptoms may have a negative impact on recovery in ED. Screening/diagnostic evaluation of ADHD in all loss of control over eating/bingeing/purging ED patients and studies of the effect of implementing ADHD-treatment strategies in this patient group are recommended.
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Affiliation(s)
- Nils Erik Svedlund
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Centre for Eating Disorders, Stockholm, Sweden
| | - Claes Norring
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Centre for Eating Disorders, Stockholm, Sweden
| | - Ylva Ginsberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne von Hausswolff-Juhlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Centre for Eating Disorders, Stockholm, Sweden
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Carlucci S, Ivanova I, Bissada H, Tasca GA. Validity and reliability of the attention deficit hyperactivity disorder self-report scale (ASRS-v1.1) in a clinical sample with eating disorders. Eat Behav 2017; 26:148-154. [PMID: 28390269 DOI: 10.1016/j.eatbeh.2017.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/23/2017] [Accepted: 03/29/2017] [Indexed: 11/15/2022]
Abstract
Individuals with eating disorders (EDs) commonly experience comorbid attention deficit hyperactivity disorder (ADHD). The shared features of EDs and ADHD, such as inattention, impulsivity and hyperactivity, may exacerbate ED symptomatology and pose challenges to treatment. It is important to screen patients with EDs for symptoms of ADHD to optimize their treatment outcomes. However, the psychometrics of common measures of ADHD have not yet been examined within an ED population. An example of such a measure is the ADHD self-report scale (ASRS-v1.1) symptom checklist, which identifies the presence of ADHD symptoms. This study reports a psychometric study of the ASRS-v1.1 in a clinical sample of 500 adults with an ED. A confirmatory factor analysis indicated the ASRS-v1.1 maintained its two-factor structure of inattention and impulsivity/hyperactivity. The item loadings demonstrated path invariance across ED diagnostic groups indicating construct validity. Further, the subscales exhibited good internal consistency and they were significantly correlated with other measures of impulsivity indicating convergent validity. The ED sample had significantly higher mean scores than published nonclinical norms indicating predictive validity, but the ASRS-v1.1 scores were not significantly different among ED diagnostic groups. Results suggest the ASRS-v1.1 is a valid and reliable screening tool for identifying symptoms of ADHD among adults seeking treatment for ED.
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Affiliation(s)
| | - Iryna Ivanova
- Ottawa Hospital Research Institute, Ottawa, ON K1G 0H9, Canada; The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1G 0H9, Canada
| | - Hany Bissada
- Ottawa Hospital Research Institute, Ottawa, ON K1G 0H9, Canada; The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1G 0H9, Canada
| | - Giorgio A Tasca
- University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada; Ottawa Hospital Research Institute, Ottawa, ON K1G 0H9, Canada; The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1G 0H9, Canada.
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8
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Keshen A, Helson T. Preliminary Evidence for the Off-Label Treatment of Bulimia Nervosa With Psychostimulants: Six Case Reports. J Clin Pharmacol 2017; 57:818-822. [DOI: 10.1002/jcph.868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/08/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Aaron Keshen
- Eating Disorder Program, Nova Scotia Health Authority; Halifax Nova Scotia Canada
- Department of Psychiatry; Dalhousie University; Halifax Nova Scotia Canada
| | - Thomas Helson
- Eating Disorder Program, Nova Scotia Health Authority; Halifax Nova Scotia Canada
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9
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Svedlund NE, Norring C, Ginsberg Y, von Hausswolff-Juhlin Y. Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among adult eating disorder patients. BMC Psychiatry 2017; 17:19. [PMID: 28095885 PMCID: PMC5240294 DOI: 10.1186/s12888-016-1093-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very little is known about the prevalence of ADHD symptoms in Bulimia Nervosa and Binge Eating Disorder and even less in other eating disorders. This knowledge gap is of clinical importance since stimulant treatment is proven effective in Binge Eating Disorder and discussed as a treatment possibility for Bulimia Nervosa. The objective of this study was to explore the prevalence and types of self-reported ADHD symptoms in an unselected group of eating disorder patients assessed in a specialized eating disorder clinic. METHODS In total 1165 adults with an eating disorder were assessed with a battery of standardized instruments, for measuring inter alia ADHD screening, demographic variables, eating disorder symptoms and psychiatric comorbidity. Chi-square tests were used for categorical variables and Kruskal-Wallis tests for continuous variables. RESULTS Almost one third (31.3 %) of the patients scored above the screening cut off indicating a possible ADHD. The highest prevalence rates (35-37 %) were found in Bulimia Nervosa and Anorexia Nervosa bingeing/purging subtype, while Eating Disorder Not Otherwise Specified type 1-4 and Binge Eating Disorder patients reported slightly below average (26-31 %), and Anorexia Nervosa restricting subtype patients even lower (18 %). Presence of binge eating, purging, loss of control over eating and non-anorectic BMI were related to results indicating a possible ADHD. Psychiatric comorbidity correlated to ADHD symptoms without explaining the differences between eating disorder diagnoses. CONCLUSIONS There is a high frequency of ADHD symptoms in patients with binge eating/purging eating disorders that motivates further studies, particularly concerning the effects of ADHD medication. The finding that the frequency of ADHD symptoms in anorexia nervosa with binge eating/purging is as high as in bulimia nervosa highlights the need also for this group.
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Affiliation(s)
- Nils Erik Svedlund
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. .,Stockholm Centre for Eating Disorders, att: Nils Erik Svedlund, Wollmar Yxkullsgatan 27 B, 11850, Stockholm, Sweden.
| | - Claes Norring
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden ,Stockholm Centre for Eating Disorders, att: Nils Erik Svedlund, Wollmar Yxkullsgatan 27 B, 11850 Stockholm, Sweden
| | - Ylva Ginsberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden ,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Yvonne von Hausswolff-Juhlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden ,Stockholm Centre for Eating Disorders, att: Nils Erik Svedlund, Wollmar Yxkullsgatan 27 B, 11850 Stockholm, Sweden
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10
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Nazar BP, Bernardes C, Peachey G, Sergeant J, Mattos P, Treasure J. The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Int J Eat Disord 2016; 49:1045-1057. [PMID: 27859581 DOI: 10.1002/eat.22643] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/07/2016] [Accepted: 10/09/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE There has been interest in whether people with Attention-Deficit/Hyperactivity Disorder (ADHD) are at higher risk of developing an Eating Disorder (ED). The aim of this study was estimate the size of this association with a meta-analysis of studies. METHODS We retrieved studies following PRISMA guidelines from a broad range of databases. RESULTS Twelve studies fitted our primary aim in investigating ED in ADHD populations (ADHD = 4,013/Controls = 29,404), and five exploring ADHD in ED populations (ED = 1,044/Controls = 11,292). The pooled odds ratio of diagnosing any ED in ADHD was increased significantly, 3.82 (95% CI:2.34-6.24). A similar level of risk was found across all ED syndromes [Anorexia Nervosa = 4.28 (95% CI:2.24-8.16); Bulimia Nervosa = 5.71 (95% CI: 3.56-9.16) and Binge Eating Disorder = 4.13 (95% CI:3-5.67)]. The risk was significantly higher if ADHD was diagnosed using a clinical interview [5.89 (95% CI:4.32-8.04)] rather than a self-report instrument [2.23 (95% CI:1.23-4.03)]. The pooled odds ratio of diagnosing ADHD in participants with ED was significantly increased, 2.57 (95% CI:1.30-5.11). Subgroup analysis of cohorts with binge eating only yielded a risk of 5.77 (95% CI:2.35-14.18). None of the variables examined in meta-regression procedures explained the variance in effect size between studies. DISCUSSION People with ADHD have a higher risk of comorbidity with an ED and people with an ED also have higher levels of comorbidity with ADHD. Future studies should address if patients with this comorbidity have a different prognosis, course and treatment response when compared to patients with either disorder alone. RESUMEN OBJETIVO Ha habido interés en saber si la gente con Trastorno por Déficit de Atención e Hiperactividad (TDAH) están en mayor riesgo de desarrollar un Trastorno de la Conducta Alimentaria (TCA). El objetivo de este estudio fue estimar el tamaño de esta asociación con un meta-análisis de los estudios. Métodos: Recuperamos estudios de una amplia gama base de datos, que siguen los lineamientos PRISMA. Resultados: Doce estudios encajaron con nuestro objetivo primario de investigar los TCA en poblaciones con TDAH (TDAH = 4,013/Controles = 29,404), y 5 exploraron TDAH en poblaciones con TCA (TCA = 1,044/Controles = 11,292). El odds ratio (OR) agrupado de diagnosticar cualquier TCA en el TDAH se incrementó significativamente, 3.82 (95% CI:2.34-6.24). Un nivel de riesgo similar fue encontrado en todos los síndromes de TCA [Anorexia Nervosa = 4.28 (95% CI:2.24-8.16); Bulimia Nervosa = 5.71 (95% CI:3.56-9.16) y Trastorno por Atracón = 4.13 (95% CI: 3-5.67)]. El riesgo fue significativamente mayor si el TDAH fue diagnosticado utilizando una entrevista clínica [5.89 (95% CI:4.32-8.04)] en lugar de un instrumento de auto-reporte [2.23 (95% CI:1.23-4.03)]. El odds ratio (OR) agrupado de diagnosticar TDAH en participantes con TCA fue significativamente incrementado, 2.57 (95% CI:1.30-5.11). El análisis de los subgrupos de cohort con atracones solamente produjo un riesgo de 5.77 (95% CI:2.35-14.18). Ninguna de las variables examinadas en los procedimientos de meta-regresión explicaron la varianza en el tamaño del efecto entre los estudios. Discusión: La gente con TDAH tiene un mayor riesgo de comorbilidad con un TCA y la gente con un TCA también tiene niveles altos de comorbilidad con TDAH. Los estudios futuros deberán abordar si los pacientes con esta comorbilidad tienen diferente pronóstico, curso y respuesta a tratamiento cuando son comparados con pacientes que solamente tienen uno de los trastornos. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016) © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1045-1057).
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Affiliation(s)
- Bruno Palazzo Nazar
- Institute of Psychiatry (IPUB-UFRJ), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College, London
| | - Camila Bernardes
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Gemma Peachey
- South London and the Maudsley National Health Trust (SLaM - NHS), London
| | | | - Paulo Mattos
- Institute of Psychiatry (IPUB-UFRJ), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College, London.,South London and the Maudsley National Health Trust (SLaM - NHS), London
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11
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Levin RL, Rawana JS. Attention-deficit/hyperactivity disorder and eating disorders across the lifespan: A systematic review of the literature. Clin Psychol Rev 2016; 50:22-36. [PMID: 27693587 DOI: 10.1016/j.cpr.2016.09.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 09/07/2016] [Accepted: 09/21/2016] [Indexed: 12/25/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and eating disorders are common and concerning mental health disorders. There is both empirical and theoretical support for an association between ADHD and eating disorders or disordered eating. This systematic review aims to summarize the extant literature on the comorbidity of ADHD and eating disorders across the lifespan, including the influences of sex, age, eating disorder diagnosis, and potential mediators. A total of 37 peer-reviewed studies on diagnosed ADHD and eating disturbances were identified through key research databases. Twenty-six studies supported a strong empirical association between ADHD and eating disorders or disordered eating. The systematic review findings suggest that children with ADHD are at risk for disordered eating, while adolescents, emerging adults, and adults are at risk for both eating disorders and disordered eating. Methodological considerations, future research, and clinical implications are discussed.
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Affiliation(s)
- Rivka L Levin
- York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Jennine S Rawana
- York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
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12
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Seitz J, Hueck M, Dahmen B, Schulte-Rüther M, Legenbauer T, Herpertz-Dahlmann B, Konrad K. Attention Network Dysfunction in Bulimia Nervosa - An fMRI Study. PLoS One 2016; 11:e0161329. [PMID: 27607439 PMCID: PMC5015972 DOI: 10.1371/journal.pone.0161329] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 08/03/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Recent evidence has suggested an increased rate of comorbid ADHD and subclinical attentional impairments in bulimia nervosa (BN) patients. However, little is known regarding the underlying neural mechanisms of attentional functions in BN. METHOD Twenty BN patients and twenty age- and weight-matched healthy controls (HC) were investigated using a modified version of the Attention Network Task (ANT) in an fMRI study. This design enabled an investigation of the neural mechanisms associated with the three attention networks involved in alerting, reorienting and executive attention. RESULTS The BN patients showed hyperactivation in parieto-occipital regions and reduced deactivation of default-mode-network (DMN) areas during alerting compared with HCs. Posterior cingulate activation during alerting correlated with the severity of eating-disorder symptoms within the patient group. Conversely, BN patients showed hypoactivation during reorienting and executive attention in anterior cingulate regions, the temporo-parietal junction (TPJ) and parahippocampus compared with HCs, which was negatively associated with global ADHD symptoms and impulsivity, respectively. DISCUSSION Our findings demonstrate altered brain mechanisms in BN associated with all three attentional networks. Failure to deactivate the DMN and increased parieto-occipital activation required for alerting might be associated with a constant preoccupation with food or body image-related thoughts. Hypoactivation of executive control networks and TPJ might increase the likelihood of inattentive and impulsive behaviors and poor emotion regulation. Thus, dysfunction in the attentional network in BN goes beyond an altered executive attentional domain and needs to be considered in the diagnosis and treatment of BN.
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Affiliation(s)
- Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany
- Department of Cognitive Neuroscience, Faculty of Psychology and Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Manuel Hueck
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany
| | - Martin Schulte-Rüther
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany
- JARA-BRAIN, 52074 Aachen, Germany
| | - Tanja Legenbauer
- LWL Child and Adolescent Psychiatry, University Hospital Hamm, Ruhr-University Bochum, Hamm, Germany
- Psychiatric Outpatient Clinic, University Mainz, Mainz, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany
| | - Kerstin Konrad
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany
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13
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Jain R, Stark JG. Safety and efficacy considerations due to misuse of extended-release formulations of stimulant medications. Postgrad Med 2016; 128:672-81. [DOI: 10.1080/00325481.2016.1218259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Rakesh Jain
- Department of Psychiatry, Texas Tech Health Sciences Center Medical School at Permian Basin, Midland, TX, USA
| | - Jeffrey G. Stark
- Division of Early Phase Services, Worldwide Clinical Trials, Austin, TX, USA
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14
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Ptacek R, Stefano GB, Weissenberger S, Akotia D, Raboch J, Papezova H, Domkarova L, Stepankova T, Goetz M. Attention deficit hyperactivity disorder and disordered eating behaviors: links, risks, and challenges faced. Neuropsychiatr Dis Treat 2016; 12:571-9. [PMID: 27042070 PMCID: PMC4780667 DOI: 10.2147/ndt.s68763] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists in adulthood. It is defined by inattention and/or hyperactivity-impulsivity. ADHD is associated with many comorbidities, including eating disorders (EDs). In the last decade, studies have reported that ADHD is linked with binge EDs, bulimia nervosa, and anorexia nervosa. Many postulates have been proposed to explain the association: 1) impulsive behavior in ADHD patients leads to disordered eating behavior; 2) other psychologic comorbidities present in ADHD patients account for eating behavior; 3) poor eating habits and resulting nutritional deficiencies contribute to ADHD symptoms; and 4) other risk factors common to both ADHD and EDs contribute to the coincidence of both diseases. Additionally, sex differences become a significant issue in the discussion of EDs and ADHD because of the higher incidence of bulimia nervosa and anorexia nervosa in females and the ability of females to mask the symptoms of ADHD. Interestingly, both EDs and ADHD rely on a common neural substrate, namely, dopaminergic signaling. Dopaminergic signaling is critical for motor activity and emotion, the latter enabling the former into a combined motivated movement like eating. This linkage aids in explaining the many comorbidities associated with ADHD. The interconnection of ADHD and EDs is discussed from both a historical perspective and the one based on the revealing nature of its comorbidities.
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Affiliation(s)
- Radek Ptacek
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic; Department of Psychology, University of New York in Prague, Prague, Czech Republic
| | - George B Stefano
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic; MitoGenetics Research Institute, MitoGenetics, LLC, Farmingdale, NY, USA
| | - Simon Weissenberger
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Devang Akotia
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Jiri Raboch
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Hana Papezova
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Lucie Domkarova
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Tereza Stepankova
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Michal Goetz
- Department of Child Psychiatry, Charles University Second Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
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15
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Dietary-induced binge eating increases prefrontal cortex neural activation to restraint stress and increases binge food consumption following chronic guanfacine. Pharmacol Biochem Behav 2014; 125:21-28. [PMID: 25158105 DOI: 10.1016/j.pbb.2014.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/13/2014] [Accepted: 08/16/2014] [Indexed: 01/27/2023]
Abstract
Binge eating is a prominent feature of bulimia nervosa and binge eating disorder. Stress or perceived stress is an often-cited reason for binge eating. One notion is that the neural pathways that overlap with stress reactivity and feeding behavior are altered by recurrent binge eating. Using young adult female rats in a dietary-induced binge eating model (30 min access to binge food with or without 24-h calorie restriction, twice a week, for 6 weeks) we measured the neural activation by c-Fos immunoreactivity to the binge food (vegetable shortening mixed with 10% sucrose) in bingeing and non-bingeing animals under acute stress (immobilization; 1 h) or no stress conditions. There was an increase in the number of immunopositive cells in the dorsal medial prefrontal cortex (mPFC) in stressed animals previously exposed to the binge eating feeding schedules. Because attention deficit hyperactive disorder (ADHD) medications target the mPFC and have some efficacy at reducing binge eating in clinical populations, we examined whether chronic (2 weeks; via IP osmotic mini-pumps) treatment with a selective alpha-2A adrenergic agonist (0.5 mg/kg/day), guanfacine, would reduce binge-like eating. In the binge group with only scheduled access to binge food (30 min; twice a week; 8 weeks), guanfacine increased total calories consumed during the 30-min access period from the 2-week pre-treatment baseline and increased binge food consumption compared with saline-treated animals. These experiments suggest that mPFC is differentially activated in response to an immobilization stress in animals under different dietary conditions and chronic guanfacine, at the dose tested, was ineffective at reducing binge-like eating.
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16
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Ioannidis K, Serfontein J, Müller U. Bulimia nervosa patient diagnosed with previously unsuspected ADHD in adulthood: clinical case report, literature review, and diagnostic challenges. Int J Eat Disord 2014; 47:431-6. [PMID: 24311027 DOI: 10.1002/eat.22231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2013] [Indexed: 11/07/2022]
Abstract
There is increasing literature suggesting a link between attention-deficit hyperactivity disorder (ADHD) and eating disorders (EDs), especially bulimia nervosa. ADHD is under-diagnosed in girls and children of high intelligence are typically missed. We identified a case of a 23-year-old woman suffering from severe bulimia nervosa and previously unsuspected ADHD in adulthood; we diagnosed and treated her with extended-release methylphenidate. We performed a literature review on the ADHD and bulimia nervosa comorbidity. We discuss the reasons why her ADHD remained undiagnosed and the difficulties in diagnosing ADHD in patients with EDs. We suggest that identifying comorbid ADHD is crucial for these patients and argue for the use of a structured interview, collateral history and investigation of onset of symptoms to establish a diagnosis of ADHD in adults with bulimia nervosa. Comorbidities and overlap of symptomatology need to be taken into account.
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