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Boraska V, Franklin CS, Floyd JAB, Thornton LM, Huckins LM, Southam L, Rayner NW, Tachmazidou I, Klump KL, Treasure J, Lewis CM, Schmidt U, Tozzi F, Kiezebrink K, Hebebrand J, Gorwood P, Adan RAH, Kas MJH, Favaro A, Santonastaso P, Fernández-Aranda F, Gratacos M, Rybakowski F, Dmitrzak-Weglarz M, Kaprio J, Keski-Rahkonen A, Raevuori A, Van Furth EF, Slof-Op 't Landt MCT, Hudson JI, Reichborn-Kjennerud T, Knudsen GPS, Monteleone P, Kaplan AS, Karwautz A, Hakonarson H, Berrettini WH, Guo Y, Li D, Schork NJ, Komaki G, Ando T, Inoko H, Esko T, Fischer K, Männik K, Metspalu A, Baker JH, Cone RD, Dackor J, DeSocio JE, Hilliard CE, O'Toole JK, Pantel J, Szatkiewicz JP, Taico C, Zerwas S, Trace SE, Davis OSP, Helder S, Bühren K, Burghardt R, de Zwaan M, Egberts K, Ehrlich S, Herpertz-Dahlmann B, Herzog W, Imgart H, Scherag A, Scherag S, Zipfel S, Boni C, Ramoz N, Versini A, Brandys MK, Danner UN, de Kovel C, Hendriks J, Koeleman BPC, Ophoff RA, Strengman E, van Elburg AA, Bruson A, Clementi M, Degortes D, Forzan M, Tenconi E, Docampo E, Escaramís G, Jiménez-Murcia S, Lissowska J, Rajewski A, Szeszenia-Dabrowska N, Slopien A, Hauser J, Karhunen L, Meulenbelt I, Slagboom PE, Tortorella A, Maj M, Dedoussis G, Dikeos D, Gonidakis F, Tziouvas K, Tsitsika A, Papezova H, Slachtova L, Martaskova D, Kennedy JL, Levitan RD, Yilmaz Z, Huemer J, Koubek D, Merl E, Wagner G, Lichtenstein P, Breen G, Cohen-Woods S, Farmer A, McGuffin P, Cichon S, Giegling I, Herms S, Rujescu D, Schreiber S, Wichmann HE, Dina C, Sladek R, Gambaro G, Soranzo N, Julia A, Marsal S, Rabionet R, Gaborieau V, Dick DM, Palotie A, Ripatti S, Widén E, Andreassen OA, Espeseth T, Lundervold A, Reinvang I, Steen VM, Le Hellard S, Mattingsdal M, Ntalla I, Bencko V, Foretova L, Janout V, Navratilova M, Gallinger S, Pinto D, Scherer SW, Aschauer H, Carlberg L, Schosser A, Alfredsson L, Ding B, Klareskog L, Padyukov L, Courtet P, Guillaume S, Jaussent I, Finan C, Kalsi G, Roberts M, Logan DW, Peltonen L, Ritchie GRS, Barrett JC, Estivill X, Hinney A, Sullivan PF, Collier DA, Zeggini E, Bulik CM. A genome-wide association study of anorexia nervosa. Mol Psychiatry 2014; 19:1085-94. [PMID: 24514567 PMCID: PMC4325090 DOI: 10.1038/mp.2013.187] [Citation(s) in RCA: 241] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 11/21/2013] [Accepted: 11/25/2013] [Indexed: 02/06/2023]
Abstract
Anorexia nervosa (AN) is a complex and heritable eating disorder characterized by dangerously low body weight. Neither candidate gene studies nor an initial genome-wide association study (GWAS) have yielded significant and replicated results. We performed a GWAS in 2907 cases with AN from 14 countries (15 sites) and 14 860 ancestrally matched controls as part of the Genetic Consortium for AN (GCAN) and the Wellcome Trust Case Control Consortium 3 (WTCCC3). Individual association analyses were conducted in each stratum and meta-analyzed across all 15 discovery data sets. Seventy-six (72 independent) single nucleotide polymorphisms were taken forward for in silico (two data sets) or de novo (13 data sets) replication genotyping in 2677 independent AN cases and 8629 European ancestry controls along with 458 AN cases and 421 controls from Japan. The final global meta-analysis across discovery and replication data sets comprised 5551 AN cases and 21 080 controls. AN subtype analyses (1606 AN restricting; 1445 AN binge-purge) were performed. No findings reached genome-wide significance. Two intronic variants were suggestively associated: rs9839776 (P=3.01 × 10(-7)) in SOX2OT and rs17030795 (P=5.84 × 10(-6)) in PPP3CA. Two additional signals were specific to Europeans: rs1523921 (P=5.76 × 10(-)(6)) between CUL3 and FAM124B and rs1886797 (P=8.05 × 10(-)(6)) near SPATA13. Comparing discovery with replication results, 76% of the effects were in the same direction, an observation highly unlikely to be due to chance (P=4 × 10(-6)), strongly suggesting that true findings exist but our sample, the largest yet reported, was underpowered for their detection. The accrual of large genotyped AN case-control samples should be an immediate priority for the field.
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Affiliation(s)
- V Boraska
- 1] Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK [2] University of Split School of Medicine, Split, Croatia
| | - C S Franklin
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - J A B Floyd
- 1] Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK [2] William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, UK
| | - L M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L M Huckins
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - L Southam
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - N W Rayner
- 1] Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK [2] Wellcome Trust Centre for Human Genetics (WTCHG), University of Oxford, Oxford, UK [3] Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Oxford, UK
| | - I Tachmazidou
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - K L Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - J Treasure
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, UK
| | - C M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
| | - U Schmidt
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, UK
| | - F Tozzi
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K Kiezebrink
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - J Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Universitätsklinikum Essen, University of Duisburg-Essen, Essen, Germany
| | - P Gorwood
- 1] INSERM U894, Centre of Psychiatry and Neuroscience, Paris, France [2] Sainte-Anne Hospital (CMME), University of Paris-Descartes, Paris, France
| | - R A H Adan
- 1] Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands [2] Altrecht Eating Disorders Rintveld, Zeist, The Netherlands
| | - M J H Kas
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Favaro
- Department of Neurosciences, University of Padova, Padova, Italy
| | - P Santonastaso
- Department of Neurosciences, University of Padova, Padova, Italy
| | - F Fernández-Aranda
- 1] Department of Psychiatry and CIBERON, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain [2] Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - M Gratacos
- 1] Genomics and Disease Group, Centre for Genomic Regulation (CRG), Barcelona, Spain [2] Universitat Pompeu Fabra (UPF), Barcelona, Spain [3] Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain [4] Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - F Rybakowski
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - M Dmitrzak-Weglarz
- Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - J Kaprio
- 1] Hjelt Institute, University of Helsinki, Helsinki, Finland [2] Institute of Molecular Medicine, University of Helsinki, Helsinki, Finland [3] Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | | | - A Raevuori
- 1] Hjelt Institute, University of Helsinki, Helsinki, Finland [2] Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - E F Van Furth
- 1] Center for Eating Disorders Ursula, Leidschendam, The Netherlands [2] Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - M C T Slof-Op 't Landt
- 1] Center for Eating Disorders Ursula, Leidschendam, The Netherlands [2] Molecular Epidemiology Section, Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - J I Hudson
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - T Reichborn-Kjennerud
- 1] Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health, Oslo, Norway [2] Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - G P S Knudsen
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - P Monteleone
- 1] Department of Psychiatry, University of Naples SUN, Naples, Italy [2] Chair of Psychiatry, University of Salerno, Salerno, Italy
| | - A S Kaplan
- 1] Centre for Addiction and Mental Health, Toronto, ON, Canada [2] Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - A Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - H Hakonarson
- 1] The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA [2] The Division of Human Genetics, Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - W H Berrettini
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Y Guo
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - D Li
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N J Schork
- Department of Molecular and Experimental Medicine and The Scripps Translational Science Institute, The Scripps Research Institute, La Jolla, CA, USA
| | - G Komaki
- 1] Department of Psychosomatic Research, National Institute of Mental Health, NCNP, Tokyo, Japan [2] School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - T Ando
- Department of Psychosomatic Research, National Institute of Mental Health, NCNP, Tokyo, Japan
| | - H Inoko
- Department of Molecular Life Sciences, Tokai University School of Medicine, Kanagawa, Japan
| | - T Esko
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - K Fischer
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - K Männik
- 1] Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia [2] Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - A Metspalu
- 1] Estonian Genome Center, University of Tartu, Tartu, Estonia [2] Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - J H Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R D Cone
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - J Dackor
- Department of Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J E DeSocio
- Seattle University College of Nursing, Seattle, WA, USA
| | - C E Hilliard
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - J Pantel
- Centre de Psychiatrie et Neurosciences - Inserm U894, Paris, France
| | - J P Szatkiewicz
- Department of Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C Taico
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S E Trace
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - O S P Davis
- 1] Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK [2] Department of Genetics, Evolution and Environment, University College London, UCL Genetics Institute, London, UK
| | - S Helder
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
| | - K Bühren
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - R Burghardt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - M de Zwaan
- 1] Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany [2] Department of Psychosomatic Medicine and Psychotherapy, University of Erlangen-Nuremberg, Erlangen, Germany
| | - K Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Würzburg, Würzburg, Germany
| | - S Ehrlich
- 1] Department of Child and Adolescent Psychiatry, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany [2] Athinoula A. Martinos Center for Biomedical Imaging, Psychiatric Neuroimaging Research Program, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - B Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - W Herzog
- Departments of Psychosocial and Internal Medicine, Heidelberg University, Heidelberg, Germany
| | - H Imgart
- Parklandklinik, Bad Wildungen, Germany
| | - A Scherag
- Institute for Medical Informatics, Biometry and Epidemiology, Universitätsklinikum Essen, University of Duisburg-Essen, Essen, Germany
| | - S Scherag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Universitätsklinikum Essen, University of Duisburg-Essen, Essen, Germany
| | - S Zipfel
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
| | - C Boni
- INSERM U894, Centre of Psychiatry and Neuroscience, Paris, France
| | - N Ramoz
- INSERM U894, Centre of Psychiatry and Neuroscience, Paris, France
| | - A Versini
- INSERM U894, Centre of Psychiatry and Neuroscience, Paris, France
| | - M K Brandys
- 1] Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands [2] Altrecht Eating Disorders Rintveld, Zeist, The Netherlands
| | - U N Danner
- Altrecht Eating Disorders Rintveld, Zeist, The Netherlands
| | - C de Kovel
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Hendriks
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B P C Koeleman
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R A Ophoff
- 1] Center for Neurobehavioral Genetics, University of California, Los Angeles, Los Angeles, CA, USA [2] Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Strengman
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A A van Elburg
- 1] Altrecht Eating Disorders Rintveld, Zeist, The Netherlands [2] Department of Child and Adolescent Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Bruson
- Clinical Genetics Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - M Clementi
- Clinical Genetics Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - D Degortes
- Department of Neurosciences, University of Padova, Padova, Italy
| | - M Forzan
- Clinical Genetics Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - E Tenconi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - E Docampo
- 1] Genomics and Disease Group, Centre for Genomic Regulation (CRG), Barcelona, Spain [2] Universitat Pompeu Fabra (UPF), Barcelona, Spain [3] Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain [4] Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - G Escaramís
- 1] Genomics and Disease Group, Centre for Genomic Regulation (CRG), Barcelona, Spain [2] Universitat Pompeu Fabra (UPF), Barcelona, Spain [3] Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain [4] Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - S Jiménez-Murcia
- 1] Department of Psychiatry and CIBERON, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain [2] Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Lissowska
- M. Sklodowska-Curie Cancer Center and Institute of Oncology, Warsaw, Poland
| | - A Rajewski
- Department of Epidemiology, Institute of Occupational Medicine, Department of Epidemiology, Lodz, Poland
| | - N Szeszenia-Dabrowska
- Department of Epidemiology, Institute of Occupational Medicine, Department of Epidemiology, Lodz, Poland
| | - A Slopien
- Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - J Hauser
- Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - L Karhunen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - I Meulenbelt
- Molecular Epidemiology Section, Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - P E Slagboom
- 1] Molecular Epidemiology Section, Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands [2] Netherlands Consortium for Healthy Ageing, Leiden University Medical Center, Leiden, The Netherlands
| | - A Tortorella
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - M Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - G Dedoussis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - D Dikeos
- 1st Department of Psychiatry, Athens University Medical School, Athens, Greece
| | - F Gonidakis
- Eating Disorders Unit, 1st Department of Psychiatry, Athens University Medical School, Athens, Greece
| | - K Tziouvas
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - A Tsitsika
- Adolescent Health Unit (A.H.U.), 2nd Department of Pediatrics - Medical School, University of Athens 'P. & A. Kyriakou' Children's Hospital, Athens, Greece
| | - H Papezova
- Department of Psychiatry, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - L Slachtova
- Department of Pediatrics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - D Martaskova
- Department of Psychiatry, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - J L Kennedy
- 1] Centre for Addiction and Mental Health, Toronto, ON, Canada [2] Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - R D Levitan
- 1] Centre for Addiction and Mental Health, Toronto, ON, Canada [2] Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Z Yilmaz
- 1] Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA [2] Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - J Huemer
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - D Koubek
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - E Merl
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - G Wagner
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - P Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - G Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
| | - S Cohen-Woods
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
| | - A Farmer
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
| | - P McGuffin
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
| | - S Cichon
- 1] Department of Genomics, Life & Brain Center, Institute of Human Genetics, University of Bonn, Bonn, Germany [2] Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany [3] Division of Medical Genetics, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - I Giegling
- Klinikum der Medizinischen Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | - S Herms
- 1] Department of Genomics, Life & Brain Center, Institute of Human Genetics, University of Bonn, Bonn, Germany [2] Division of Medical Genetics, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - D Rujescu
- Klinikum der Medizinischen Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | - S Schreiber
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - H-E Wichmann
- 1] Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany [2] Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - C Dina
- CNRS 8090-Institute of Biology, Pasteur Institute, Lille, France
| | - R Sladek
- McGill University and Genome Quebec Innovation Centre, Montreal, QC, Canada
| | - G Gambaro
- Division of Nephrology, Department of Internal Medicine and Medical Specialties, Columbus-Gemelly Hospitals, Catholic University, Rome, Italy
| | - N Soranzo
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - A Julia
- Unitat de Recerca de Reumatologia (URR), Institut de Recerca Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - S Marsal
- Unitat de Recerca de Reumatologia (URR), Institut de Recerca Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - R Rabionet
- 1] Genomics and Disease Group, Centre for Genomic Regulation (CRG), Barcelona, Spain [2] Universitat Pompeu Fabra (UPF), Barcelona, Spain [3] Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain [4] Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - V Gaborieau
- Genetic Epidemiology Group, International Agency for Research on Cancer (IARC), Lyon, France
| | - D M Dick
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - A Palotie
- 1] Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK [2] The Finnish Institute of Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland [3] The Program for Human and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - S Ripatti
- 1] The Finnish Institute of Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland [2] Finnish Institute of Occupational Health, Helsinki, Finland
| | - E Widén
- 1] The Finnish Institute of Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland [2] Finnish Institute of Occupational Health, Helsinki, Finland
| | - O A Andreassen
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T Espeseth
- 1] NORMENT, K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway [2] Department of Psychology, University of Oslo, Oslo, Norway
| | - A Lundervold
- 1] Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway [2] Kavli Research Centre for Aging and Dementia, Haraldsplass Deaconess Hospital, Bergen, Norway [3] K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
| | - I Reinvang
- Department of Psychology, University of Oslo, Oslo, Norway
| | - V M Steen
- 1] Department of Clinical Science, K.G. Jebsen Centre for Psychosis Research, Norwegian Centre For Mental Disorders Research (NORMENT), University of Bergen, Bergen, Norway [2] Dr Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - S Le Hellard
- 1] Department of Clinical Science, K.G. Jebsen Centre for Psychosis Research, Norwegian Centre For Mental Disorders Research (NORMENT), University of Bergen, Bergen, Norway [2] Dr Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - M Mattingsdal
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - I Ntalla
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - V Bencko
- Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - L Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - V Janout
- Palacky University, Olomouc, Czech Republic
| | - M Navratilova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - S Gallinger
- 1] University Health Network, Toronto General Hospital, Toronto, ON, Canada [2] Mount Sinai Hospital, Samuel Lunenfeld Research Institute, Toronto, ON, Canada
| | - D Pinto
- Departments of Psychiatry, and Genetics and Genomic Sciences, Seaver Autism Center, and the Mindich Child Health and Development Institute, Mount Sinai School of Medicine, New York, NY, USA
| | - S W Scherer
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - H Aschauer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - L Carlberg
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - A Schosser
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - L Alfredsson
- The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - B Ding
- The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - L Klareskog
- Rheumatology Unit, Department of Medicine at the Karolinska University Hospital, Solna, Sweden
| | - L Padyukov
- Rheumatology Unit, Department of Medicine at the Karolinska University Hospital, Solna, Sweden
| | - P Courtet
- 1] Inserm, U1061, Université Montpellier 1, Montpellier, France [2] Department of Emergency Psychiatry, CHU Montpellier, Montpellier, France
| | - S Guillaume
- 1] Inserm, U1061, Université Montpellier 1, Montpellier, France [2] Department of Emergency Psychiatry, CHU Montpellier, Montpellier, France
| | - I Jaussent
- 1] Inserm, U1061, Université Montpellier 1, Montpellier, France [2] Department of Emergency Psychiatry, CHU Montpellier, Montpellier, France
| | - C Finan
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - G Kalsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
| | - M Roberts
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
| | - D W Logan
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - L Peltonen
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - G R S Ritchie
- 1] Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK [2] European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge
| | - J C Barrett
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - X Estivill
- 1] Genomics and Disease Group, Centre for Genomic Regulation (CRG), Barcelona, Spain [2] Universitat Pompeu Fabra (UPF), Barcelona, Spain [3] Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain [4] Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - A Hinney
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Universitätsklinikum Essen, University of Duisburg-Essen, Essen, Germany
| | - P F Sullivan
- 1] Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA [2] Department of Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D A Collier
- 1] Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK [2] Eli Lilly and Company, Erl Wood Manor, Windlesham, UK
| | - E Zeggini
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - C M Bulik
- 1] Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA [2] Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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2
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Scott-Van Zeeland AA, Bloss CS, Tewhey R, Bansal V, Torkamani A, Libiger O, Duvvuri V, Wineinger N, Galvez L, Darst BF, Smith EN, Carson A, Pham P, Phillips T, Villarasa N, Tisch R, Zhang G, Levy S, Murray S, Chen W, Srinivasan S, Berenson G, Brandt H, Crawford S, Crow S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, La Via M, Mitchell JE, Strober M, Rotondo A, Treasure J, Woodside DB, Bulik CM, Keel P, Klump KL, Lilenfeld L, Plotnicov K, Topol EJ, Shih PB, Magistretti P, Bergen AW, Berrettini W, Kaye W, Schork NJ. Evidence for the role of EPHX2 gene variants in anorexia nervosa. Mol Psychiatry 2014; 19:724-32. [PMID: 23999524 PMCID: PMC3852189 DOI: 10.1038/mp.2013.91] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 06/19/2013] [Accepted: 06/24/2013] [Indexed: 01/08/2023]
Abstract
Anorexia nervosa (AN) and related eating disorders are complex, multifactorial neuropsychiatric conditions with likely rare and common genetic and environmental determinants. To identify genetic variants associated with AN, we pursued a series of sequencing and genotyping studies focusing on the coding regions and upstream sequence of 152 candidate genes in a total of 1205 AN cases and 1948 controls. We identified individual variant associations in the Estrogen Receptor-ß (ESR2) gene, as well as a set of rare and common variants in the Epoxide Hydrolase 2 (EPHX2) gene, in an initial sequencing study of 261 early-onset severe AN cases and 73 controls (P=0.0004). The association of EPHX2 variants was further delineated in: (1) a pooling-based replication study involving an additional 500 AN patients and 500 controls (replication set P=0.00000016); (2) single-locus studies in a cohort of 386 previously genotyped broadly defined AN cases and 295 female population controls from the Bogalusa Heart Study (BHS) and a cohort of 58 individuals with self-reported eating disturbances and 851 controls (combined smallest single locus P<0.01). As EPHX2 is known to influence cholesterol metabolism, and AN is often associated with elevated cholesterol levels, we also investigated the association of EPHX2 variants and longitudinal body mass index (BMI) and cholesterol in BHS female and male subjects (N=229) and found evidence for a modifying effect of a subset of variants on the relationship between cholesterol and BMI (P<0.01). These findings suggest a novel association of gene variants within EPHX2 to susceptibility to AN and provide a foundation for future study of this important yet poorly understood condition.
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Affiliation(s)
- A A Scott-Van Zeeland
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - C S Bloss
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - R Tewhey
- Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - V Bansal
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - A Torkamani
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - O Libiger
- The Scripps Translational Science Institute, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - V Duvvuri
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - N Wineinger
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - L Galvez
- The Scripps Translational Science Institute, La Jolla, CA, USA
| | - B F Darst
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - E N Smith
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - A Carson
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - P Pham
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - T Phillips
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - N Villarasa
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - R Tisch
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - G Zhang
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - S Levy
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - S Murray
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - W Chen
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - S Srinivasan
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - G Berenson
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - H Brandt
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Crawford
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - M M Fichter
- Roseneck Hospital for Behavioral Medicine, Prien, Germany
| | - K A Halmi
- Eating Disorder Research Program Weill Cornell Medical College, White Plains, NY, USA
| | - C Johnson
- Eating Recovery Center, Denver, CO, USA
| | - A S Kaplan
- Center for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - M La Via
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J E Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - M Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - A Rotondo
- Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, University of Pisa, Pisa, Italy
| | - J Treasure
- Department of Academic Psychiatry, Bermondsey Wing Guys Hospital, University of London, London, UK
| | - D B Woodside
- Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - C M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - P Keel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - K L Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - L Lilenfeld
- Clinical Psychology Program, American School of Professional Psychology at Argosy University, Washington, DC, USA
| | - K Plotnicov
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - E J Topol
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - P B Shih
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - P Magistretti
- Laboratory of Neuroenergetics and Cellular Dynamics, The University of Lausanne, Lausanne, Switzerland
| | - A W Bergen
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - W Berrettini
- Department of Psychiatry, The University of Pennsylvania, Philadelphia, PA, USA
| | - W Kaye
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - N J Schork
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, 3344 N Torrey Pines Court, Room 306, La Jolla, CA 92037, USA. E-mail:
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Abstract
BACKGROUND Anorexia nervosa (AN) is a serious psychiatric illness associated with significant morbidity and mortality. There is little empirical support for specific treatments and new approaches are sorely needed. This two-site study aimed to determine whether olanzapine is superior to placebo in increasing body mass index (BMI) and improving psychological symptoms in out-patients with AN. METHOD A total of 23 individuals with AN were randomly assigned in double-blind fashion to receive olanzapine or placebo for 8 weeks together with medication management sessions that emphasized compliance. Weight, other physical assessments and measures of psychopathology were collected. RESULTS End-of-treatment BMI, with initial BMI as a covariate, was significantly greater in the group receiving olanzapine [F(1, 20)=6.64, p=0.018]. Psychological symptoms improved in both groups, but there were no statistically significant group differences. Of the 23 participants, 17 (74%) completed the 8-week trial. Participants tolerated the medication well with sedation being the only frequent side effect and no adverse metabolic effects were noted. CONCLUSIONS This small study suggests that olanzapine is generally well tolerated by, and may provide more benefit than placebo for out-patients with AN. Further study is indicated to determine whether olanzapine may affect psychological symptoms in addition to BMI.
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Affiliation(s)
- E Attia
- Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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Davis C, Zai C, Levitan RD, Kaplan AS, Carter JC, Reid-Westoby C, Curtis C, Wight K, Kennedy JL. Opiates, overeating and obesity: a psychogenetic analysis. Int J Obes (Lond) 2011; 35:1347-54. [PMID: 21266954 DOI: 10.1038/ijo.2010.276] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study provides an original perspective on the associations among endogenous opiates, overeating and obesity. The aim was to assess whether variability in the OPRM1 gene, as assessed by seven single-nucleotide polymorphisms, relates to individual differences in the preference for sweet and fatty foods. We also anticipated that these food preferences would be positively associated with binge eating, hedonic eating and emotionally driven eating-patterns of overeating that would, in turn, predict higher body mass index (BMI). DESIGN Analysis of variance procedures examined genotype differences in food preferences; bivariate correlation coefficients examined the relationships among food preferences and the overeating variables; and a regression analysis tested the combined influences of the overeating variables on BMI. DNA was extracted from whole blood for the genotyping, and measures of food preferences and eating behaviours were obtained from well-validated self-report questionnaires. SUBJECTS Participants were 300 healthy adult men and women recruited from the community. RESULTS All the predicted associations were supported by statistically significant results. In particular, the G/G genotype group of the functional A118G marker of the OPRM1 gene reported higher preferences for sweet and fatty foods compared with the other two groups. Food preferences were also related to all overeating measures, which in turn accounted for a substantial proportion of the variance in BMI. CONCLUSIONS Our findings suggest that some of the diversity in the preference for highly palatable foods can be explained by genotypic differences in the regulation of mu opioid receptors. The associations reported in this paper are important from a public-health perspective because of the abuse potential of sweet-fat foods and their strong relationship with obesity.
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Affiliation(s)
- C Davis
- Kinesiology & Health Sciences, Faculty of Health Sciences, York University, 4700 Keele Street, Toronto, Ontario, Canada.
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Kaplan AS, Walsh BT, Olmsted M, Attia E, Carter JC, Devlin MJ, Pike KM, Woodside B, Rockert W, Roberto CA, Parides M. The slippery slope: prediction of successful weight maintenance in anorexia nervosa. Psychol Med 2009; 39:1037-45. [PMID: 18845008 PMCID: PMC4449142 DOI: 10.1017/s003329170800442x] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous research has found that many patients with anorexia nervosa (AN) are unable to maintain normal weight after weight restoration. The objective of this study was to identify variables that predicted successful weight maintenance among weight-restored AN patients. METHOD Ninety-three patients with AN treated at two sites (Toronto and New York) through in-patient or partial hospitalization achieved a minimally normal weight and were then randomly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy (CBT) for 1 year. Clinical, demographic and psychometric variables were assessed after weight restoration prior to randomization and putative predictors of successful weight maintenance at 6 and 12 months were examined. RESULTS The most powerful predictors of weight maintenance at 6 and 12 months following weight restoration were pre-randomization body mass index (BMI) and the rate of weight loss in the first 28 days following randomization. Higher BMI and lower rate of weight loss were associated with greater likelihood of maintaining a normal BMI at 6 and 12 months. An additional predictor of weight maintenance was site; patients in Toronto fared better than those in New York. CONCLUSIONS This study found that the best predictors of weight maintenance in weight-restored AN patients over 6 and 12 months were the level of weight restoration at the conclusion of acute treatment and the avoidance of weight loss immediately following intensive treatment. These results suggest that outcome might be improved by achieving a higher BMI during structured treatment programs and on preventing weight loss immediately following discharge from such programs.
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Affiliation(s)
- A S Kaplan
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto General Hospital, Ontario, Canada.
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Jacobs MJ, Roesch S, Wonderlich SA, Crosby R, Thornton L, Wilfley DE, Berrettini WH, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, Lavia M, Mitchell JE, Rotondo A, Strober M, Woodside DB, Kaye WH, Bulik CM. Anorexia nervosa trios: behavioral profiles of individuals with anorexia nervosa and their parents. Psychol Med 2009; 39:451-461. [PMID: 18578898 PMCID: PMC3714180 DOI: 10.1017/s0033291708003826] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with behavioral traits that predate the onset of AN and persist after recovery. We identified patterns of behavioral traits in AN trios (proband plus two biological parents). METHOD A total of 433 complete trios were collected in the Price Foundation Genetic Study of AN using standardized instruments for eating disorder (ED) symptoms, anxiety, perfectionism, and temperament. We used latent profile analysis and ANOVA to identify and validate patterns of behavioral traits. RESULTS We distinguished three classes with medium to large effect sizes by mothers' and probands' drive for thinness, body dissatisfaction, perfectionism, neuroticism, trait anxiety, and harm avoidance. Fathers did not differ significantly across classes. Classes were distinguished by degree of symptomatology rather than qualitative differences. Class 1 (approximately 33%) comprised low symptom probands and mothers with scores in the healthy range. Class 2 ( approximately 43%) included probands with marked elevations in drive for thinness, body dissatisfaction, neuroticism, trait anxiety, and harm avoidance and mothers with mild anxious/perfectionistic traits. Class 3 (approximately 24%) included probands and mothers with elevations on ED and anxious/perfectionistic traits. Mother-daughter symptom severity was related in classes 1 and 3 only. Trio profiles did not differ significantly by proband clinical status or subtype. CONCLUSIONS A key finding is the importance of mother and daughter traits in the identification of temperament and personality patterns in families affected by AN. Mother-daughter pairs with severe ED and anxious/perfectionistic traits may represent a more homogeneous and familial variant of AN that could be of value in genetic studies.
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Affiliation(s)
- M J Jacobs
- University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA.
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Levitan RD, Kaplan AS, Masellis M, Basile VS, Richter MA, Kennedy JL. The serotonin-1Dbeta receptor gene and severity of obsessive-compulsive disorder in women with bulimia nervosa. Eur Neuropsychopharmacol 2006; 16:1-6. [PMID: 15944142 DOI: 10.1016/j.euroneuro.2005.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Revised: 04/12/2005] [Accepted: 04/12/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is significant evidence that eating disorders have an important biological overlap with obsessive-compulsive disorder (OCD), though the specific mediators of this relationship remain unclear. Recent evidence suggests that the G861C polymorphism of the 5HT-1Dbeta receptor gene and the G allele in particular may play a role in OCD. We thus hypothesized that, among a heterogenous group of probands with bulimia nervosa (BN), this same G allele might predict the presence and/or severity of OCD pathology. METHODS 165 consecutive female probands with BN were genotyped for the G861C polymorphism of the 5HT-1Dbeta receptor gene. Rates of full syndrome OCD, partial syndrome OCD and no OCD were compared across the three genotypic groups defined by this polymorphism. RESULTS 45 out of 165 BN probands (27.3%) had either full or partial syndrome OCD. In the full sample, there was a significant difference in the distribution of the three diagnostic groups by genotype (chi2=10.07, df=4, p=.039). The G861C polymorphism did not strongly predict which probands had any vs. no OCD pathology. However, among the 45 probands with OCD symptoms, the G861C polymorphism did strongly differentiate full syndrome vs. partial syndrome OCD (chi2=9.26, df=2, p=.01; odds ratio for full syndrome OCD with GG genotype=7.69, 95% CI=1.45-40.9). DISCUSSION In women with BN, the G861C polymorphism of the 5HT-1Dbeta gene does not appear to be associated with the generation of OCD symptoms; however, it might directly or indirectly be associated with a modulatory effect on syndrome severity in probands otherwise predisposed to OCD. While preliminary and in need of replication in other samples, this is the first association study to suggest how a particular gene might influence OCD pathology in an eating disorder population.
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Affiliation(s)
- R D Levitan
- Mood and Anxiety Division, Centre for Addiction and Mental Health, University of Toronto, Department of Psychiatry, Canada.
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8
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Levitan RD, Masellis M, Lam RW, Muglia P, Basile VS, Jain U, Kaplan AS, Tharmalingam S, Kennedy SH, Kennedy JL. Childhood inattention and dysphoria and adult obesity associated with the dopamine D4 receptor gene in overeating women with seasonal affective disorder. Neuropsychopharmacology 2004; 29:179-86. [PMID: 14560322 DOI: 10.1038/sj.npp.1300314] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There is significant evidence that altered dopamine activity plays a role in seasonal affective disorder (SAD). The current study examined three separate genetic hypotheses for SAD related to the 7-repeat allele (7R) of the dopamine-4 receptor gene (DRD4), a variant associated with decreased affinity for dopamine. We examined the possible contribution of 7R to the overall expression of SAD, attention deficit disorder (ADD) comorbidity, and body weight regulation. As part of an ongoing genetic study of increased eating behavior and mood in female subjects, 108 women with winter SAD and carbohydrate craving/weight gain were administered the Wender-Utah Rating Scale to measure childhood ADD symptomatology, and a questionnaire to assess maximal lifetime body mass index (BMI). To test for an association between 7R and the categorical diagnosis of SAD, the transmission disequilibrium test (TDT) was used in a subsample of probands providing familial DNA. Standard parametric tests were used to compare childhood ADD symptoms and maximal lifetime BMI across the two genotypic groups defined by the presence or absence of 7R. The TDT found no initial evidence for an association between 7R and the categorical diagnosis of SAD. However, 7R carriers reported significantly greater inattention and dysphoria in childhood (p=0.01 and 0.001, respectively) and a higher maximal lifetime BMI (p=0.007) than did probands without this allele. Furthermore, excluding probands with extreme obesity (maximal BMI >40), a strong correlation was found linking childhood inattentive symptoms and maximal lifetime BMI (r=0.35, p=0.001). In overeating women with SAD, the 7R allele of DRD4 may be associated with a unique developmental trajectory characterized by attentional deficits and dysphoria in childhood and mild to moderate obesity in adulthood. This developmental course may reflect different manifestations of the same underlying vulnerability related to central dopamine dysfunction. Given the possibility of population stratification when studying genotype/phenotype relationships, future use of genomic controls and replication of our findings in other overeating and/or ADD populations are needed to confirm these initial results.
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Affiliation(s)
- R D Levitan
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Canada.
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Levitan RD, Masellis M, Basile VS, Lam RW, Jain U, Kaplan AS, Kennedy SH, Siegel G, Walker ML, Vaccarino FJ, Kennedy JL. Polymorphism of the serotonin-2A receptor gene (HTR2A) associated with childhood attention deficit hyperactivity disorder (ADHD) in adult women with seasonal affective disorder. J Affect Disord 2002; 71:229-33. [PMID: 12167522 DOI: 10.1016/s0165-0327(01)00372-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Several lines of research point to a possible overlap between seasonal affective disorder (SAD) and attention deficit hyperactivity disorder (ADHD), particularly in females. There is also emerging evidence that variation of the 5-HT2A receptor gene (HTR2A) contributes to both SAD and ADHD. The current study investigated whether variation in HTR2A was associated with symptoms of childhood ADHD in adult women with SAD. METHOD Sixty-six women with SAD were administered the Wender-Utah Rating Scale (WURS), which retrospectively assesses childhood ADHD, as part of an ongoing genetic study of SAD. WURS scores were compared across the three genotypic groups defined by the T102C polymorphism of HT2RA. RESULTS Analysis of variance indicated a significant difference in mean 25-item WURS scores across the three genotypic groups (p = 0.035). Post-hoc tests revealed that the C/C genotypic group had a significantly higher mean score than both the T/T group and T/C group. Based on previously established WURS criteria, 38% of subjects with the C/C genotype, and none with the T/T genotype, had scores consistent with childhood ADHD. LIMITATIONS The current sample size is small, and childhood ADHD diagnoses were based on retrospective recall. CONCLUSION These preliminary results suggest a possible association between variation in HTR2A, childhood ADHD, and the later development of SAD in women.
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Affiliation(s)
- R D Levitan
- Centre for Addiction and Mental Health, University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada.
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Grice DE, Halmi KA, Fichter MM, Strober M, Woodside DB, Treasure JT, Kaplan AS, Magistretti PJ, Goldman D, Bulik CM, Kaye WH, Berrettini WH. Evidence for a susceptibility gene for anorexia nervosa on chromosome 1. Am J Hum Genet 2002; 70:787-92. [PMID: 11799475 PMCID: PMC384957 DOI: 10.1086/339250] [Citation(s) in RCA: 159] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2001] [Accepted: 12/10/2001] [Indexed: 11/04/2022] Open
Abstract
Eating disorders, such as anorexia nervosa (AN), have a significant genetic component. In the current study, a genomewide linkage analysis of 192 families with at least one affected relative pair with AN and related eating disorders, including bulimia nervosa, was performed, resulting in only modest evidence for linkage, with the highest nonparametric linkage (NPL) score, 1.80, at marker D4S2367 on chromosome 4. Since the reduction of sample heterogeneity would increase power to detect linkage, we performed linkage analysis in a subset (n=37) of families in which at least two affected relatives had diagnoses of restricting AN, a clinically defined subtype of AN characterized by severe limitation of food intake without the presence of binge-eating or purging behavior. When we limited the linkage analysis to this clinically more homogeneous subgroup, the highest multipoint NPL score observed was 3.03, at marker D1S3721 on chromosome 1p. The genotyping of additional markers in this region led to a peak multipoint NPL score of 3.45, thereby providing suggestive evidence for the presence of an AN-susceptibility locus on chromosome 1p.
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Affiliation(s)
- D. E. Grice
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
| | - K. A. Halmi
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
| | - M. M. Fichter
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
| | - M. Strober
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
| | - D. B. Woodside
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
| | - J. T. Treasure
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
| | - A. S. Kaplan
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
| | - P. J. Magistretti
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
| | - D. Goldman
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
| | - C. M. Bulik
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
| | - W. H. Kaye
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
| | - W. H. Berrettini
- Department of Psychiatry, University of Pennsylvania, Philadelphia; Department of Psychiatry, Cornell University, White Plains, NY; Klinik Roseneck, Hospital for Behavioral Medicine, University of Munich, Prien, Germany; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles; The Toronto Hospital, Department of Psychiatry, University of Toronto, Toronto; Institute of Psychiatry, Kings College, London; Institute of Physiology, University of Lausanne, Lausanne, Switzerland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse Alcoholism, Bethesda, MD; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; and Department of Psychiatry, University of Pittsburgh, Pittsburgh
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11
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Levitan RD, Kaplan AS, Masellis M, Basile VS, Walker ML, Lipson N, Siegel GI, Woodside DB, Macciardi FM, Kennedy SH, Kennedy JL. Polymorphism of the serotonin 5-HT1B receptor gene (HTR1B) associated with minimum lifetime body mass index in women with bulimia nervosa. Biol Psychiatry 2001; 50:640-3. [PMID: 11690602 DOI: 10.1016/s0006-3223(01)01201-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Preclinical research has shown that the serotonin-1B receptor has important modulatory effects on feeding behavior and thus body weight. In the current study, we examined whether genetic variation of the serotonin-1B receptor was associated with minimum and maximum lifetime body mass indices (BMIs) in a sample of women with bulimia nervosa (BN). METHODS Ninety-eight women with BN were genotyped based on the G861C polymorphism of the serotonin-1B receptor gene (HTR1B). Minimum and maximum lifetime BMIs were compared across the three genotypic groups using analysis of variance. RESULTS There was a highly significant difference in minimum lifetime BMI across the three genotypic groups (p =.001). Both the G/C and C/C genotypes were associated with significantly lower minimum lifetime BMIs than was the G/G genotype. Maximum lifetime BMI was not significantly different across groups. These results were not attributable to different lifetime rates of anorexia nervosa across the three genotypic groups. CONCLUSIONS These preliminary findings suggest a possible association between HTR1B genetic polymorphism and minimum lifetime BMI in women with BN. These findings may shed light on why, in response to dieting, some BN patients achieve lower BMIs, whereas others have a natural limitation to their weight loss. Pending replication in a larger sample, these findings point to a possible genetic factor of fundamental importance to the BN population.
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Affiliation(s)
- R D Levitan
- Depression Clinic, Centre for Addiction and Mental Health, University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
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12
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Kaplan AS. Silver nitrate stick helps manage aphthous ulcers. Am Fam Physician 2001; 64:737. [PMID: 11563566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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13
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Abstract
This article reports on the relations between depression and stages of change for smoking cessation. A convenience sample of 205 psychiatric outpatients (68% female, mean age 41) completed measures of depression Primary Care Evaluation of Mental Disorders [PRIME-MD] and Beck Depression Inventory-II [BDI-II]), all transtheoretical model constructs related to smoking (stages and processes of change, pros and cons of smoking, and situational temptations), and thoughts about abstinence. As hypothesized, patients who had never smoked showed substantially lower rates of currently diagnosed major depressive disorder (MDD) than those who had ever smoked. Patients in early stages of change did not show more MDD or depressive symptoms but, as hypothesized, showed more negative thoughts about abstinence. Findings are consistent with the documented association between smoking and depression and suggest the appropriateness of building smoking cessation interventions based on the transtheoretical model of change for use with psychiatric populations.
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Affiliation(s)
- G S Acton
- Langley Porter Psychiatric Institute, University of California, San Francisco, 94143-0984, USA.
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14
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Sutton L, Swinehart JM, Cato A, Kaplan AS. A clinical study to determine the efficacy and safety of 1% methotrexate/Azone (MAZ) gel applied topically once daily in patients with psoriasis vulgaris. Int J Dermatol 2001; 40:464-7. [PMID: 11679005 DOI: 10.1046/j.1365-4362.2001.01244.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- L Sutton
- Cato Research Ltd., Durham, North Carolina 27713, USA.
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15
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Abstract
This article has reviewed what is currently known regarding the relationship between specific patient variables and treatment response in AN, BN, and BED. Matching patient variables to treatment intensity remains an important and fruitful area for future research. There is a need for established guidelines for clinicians regarding the choice of the appropriateness of treatment settings and type of interventions delivered in those settings. These guidelines should be evidence based, with clear clinical indicators for each of the recognized eating disorders and their subclinical variants.
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Affiliation(s)
- A S Kaplan
- Program for Eating Disorders, Toronto General Hospital, Toronto, Ontario, Canada.
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16
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Abstract
UNLABELLED Eating disorder patients are notoriously ambivalent about treatment and often lack motivation to change. These characteristics may decrease the number of patients entering treatment and increase the number of patients dropping out of treatment prematurely. OBJECTIVE The aim of this pilot study was to develop and evaluate a motivational enhancement therapy (MET) group program for eating disorder patients. The goal of the MET intervention was to increase participants' motivation to change, which might be expected to increase the success of future treatment of patients with eating disorders. METHOD Nineteen individuals who were referred for specialized treatment took part in the study. The intervention was based on existing literature in the field of addictions and modified for eating disorders. RESULTS The motivational measures suggested that the participants' motivation to change increased following the intervention. A decrease in depressive symptoms and an increase in self-esteem were also found. DISCUSSION The results of this study suggest that MET could be valuable for the treatment of eating disorder patients and provide a rationale to conduct further research in this area.
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Affiliation(s)
- R Feld
- Department of Psychiatry, Toronto General Hospital and University of Toronto, Toronto, Canada
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17
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Woodside DB, Garfinkel PE, Lin E, Goering P, Kaplan AS, Goldbloom DS, Kennedy SH. Comparisons of men with full or partial eating disorders, men without eating disorders, and women with eating disorders in the community. Am J Psychiatry 2001; 158:570-4. [PMID: 11282690 DOI: 10.1176/appi.ajp.158.4.570] [Citation(s) in RCA: 197] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors compared 62 men who met all or most of the DSM-III-R criteria for eating disorders with 212 women who had similar eating disorders and 3,769 men who had no eating disorders on a wide variety of clinical and historical variables. METHOD The groups of subjects were derived from a community epidemiologic survey performed in the province of Ontario that used the World Health Organization's Composite International Diagnostic Interview. RESULTS Men with eating disorders were very similar to women with eating disorders on most variables. Men with eating disorders showed higher rates of psychiatric comorbidity and more psychosocial morbidity than men without eating disorders. CONCLUSIONS These results confirm the clinical similarities between men with eating disorders and women with eating disorders. They also reveal that both groups suffer similar psychosocial morbidity. Men with eating disorders show a wide range of differences from men without eating disorders; the extent to which these differences are effects of the illness or possible risk factors for the occurrence of these illnesses in men is not clear.
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Affiliation(s)
- D B Woodside
- Department of Psychiatry, The Toronto Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4.
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18
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Abstract
BACKGROUND Atopic dermatitis is a chronic, relapsing condition affecting up to 14% of the population in Western countries. Topical corticosteroids are the mainstay of treatment. Triamcinolone acetonide, a corticoid of intermediate potency, has proven useful in the treatment of atopic dermatitis. AIM To evaluate the effectiveness of a triamcinolone acetonide-laurocapram combination in the treatment of atopic dermatitis. METHODS One hundred and fifty patients were enrolled in a three-arm, parallel group, controlled clinical trial evaluating the effectiveness of a triamcinolone acetonide (0.05%) and laurocapram combination, applied twice daily for 2 weeks, in the treatment of atopic dermatitis. Fifty patients received triamcinolone acetonide-laurocapram (TNX), 50 triamcinolone acetonide (TN), and 50 a vehicle control formulation (AN). Response to treatment was evaluated by change in disease severity at 6 h, at 3, 8, and 15 days after the start of treatment, and by the global change in disease status. RESULTS TNX effected a significantly higher degree of improvement in the signs and symptoms of atopic dermatitis (erythema, induration, and pruritus) and a greater overall improvement in disease status compared with treatment with TN or AN. Treatment-associated side-effects were local reactions, occurring in three, two, and six patients in the TNX, TN, and AN groups, respectively. CONCLUSIONS The results suggest that the incorporation of laurocapram in the formulation enhances the effectiveness of triamcinolone acetonide, without compromising its safety profile.
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Affiliation(s)
- A Cato
- Cato Research Ltd., Durham, North Carolina 27713, USA.
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19
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Abstract
In 6 experiments, the authors examined the use of prior knowledge in category learning. Previous studies of the effects of knowledge on category learning have used categories in which knowledge was related to all of the category's features. However, people's knowledge of real-world categories often consists of many "rote" features that are not related to their prior knowledge. Five experiments found that even minimal prior knowledge (1 knowledge-relevant feature and 5 rote features per exemplar) can facilitate category learning. Posttests revealed that although the knowledge aided learning, subjects also acquired the rote features that were not related to knowledge, contradicting predictions of an attentional explanation of the knowledge effect. The results of Experiment 6 suggested that subjects attempt to link even rote features to their knowledge.
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Affiliation(s)
- A S Kaplan
- Department of Psychology, University of Illinois at Urbana-Champaign, USA
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20
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Abstract
Three experiments examined the interactions of category structure and prior knowledge in category learning. Experiment 1 examined the distribution of atypical or "crossover" features in category learning. In real categories, crossover features may be unevenly distributed--found primarily in very unusual examples of a category (like whales or ostriches). In contrast, in many psychology experiments, each item has exactly one crossover feature. Even versus uneven distribution of crossover features did not affect category learning when the features were neutral. However, when the features were connected by prior knowledge, it was much harder for subjects to learn the structure with the uneven distribution of crossover features. Experiments 2 and 3 found similar results with a slightly less uneven condition. We conclude that learning is a function of the interaction of category structure and prior knowledge rather than either one alone. Furthermore, knowledge benefits learning even when the category contains contradictions of the knowledge, so long as the contradictions are not very salient.
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Affiliation(s)
- G L Murphy
- Department of Psychology, University of Illinois, 603 East Daniel St., Champaign, IL 61820, USA.
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21
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Kubany ES, Leisen MB, Kaplan AS, Kelly MP. Validation of a brief measure of posttraumatic stress disorder: the Distressing Event Questionnaire (DEQ). Psychol Assess 2000. [PMID: 10887766 DOI: 10.1037//1040-3590.12.2.197] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Distressing Event Questionnaire (DEQ) is a brief instrument for assessing posttraumatic stress disorder (PTSD) according to criteria provided in Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The DEQ possesses high internal consistency and exhibited satisfactory short-term temporal stability in studies with Vietnam War combat veterans and battered women. In a sample of Vietnam War veterans and 4 separate samples of abused women (with histories of incest, rape, intimate partner abuse, or prostitution and abuse), the DEQ exhibited very good discriminative validity when judged against structured interview assessment of PTSD. The DEQ exhibited strong convergent validity with other PTSD measures and other indexes of adjustment and also exhibited strong convergent validity as a measure of PTSD across ethnic groups in both the veteran sample and the combined women's sample.
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Affiliation(s)
- E S Kubany
- National Center for PTSD, Pacific Islands Division, Department of Veterans Affairs, VAM&ROC, Honolulu, Hawai'i 96813, USA.
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22
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Kubany ES, Haynes SN, Leisen MB, Owens JA, Kaplan AS, Watson SB, Burns K. Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: the Traumatic Life Events Questionnaire. Psychol Assess 2000. [PMID: 10887767 DOI: 10.1037//1040-3590.12.2.210] [Citation(s) in RCA: 324] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article describes the development and preliminary validation of a brief questionnaire that assesses exposure to a broad range of potentially traumatic events. Items were generated from multiple sources of information. Events were described in behaviorally descriptive terms, consistent with Diagnostic and Statistical Manual of Mental Disorders IV posttraumatic stress disorder stressor criterion A1. When events were endorsed, respondents were asked if they experienced intense fear, helplessness, or horror (stressor criterion A2). In separate studies with college students, Vietnam veterans, battered women, and residents of a substance abuse program, most items possessed adequate to excellent temporal stability. In a study comparing questionnaire and structured-interview inquiries of trauma history, the 2 formats yielded similar rates of disclosure. Preliminary data on positive predictive power are also presented.
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Affiliation(s)
- E S Kubany
- National Center for PTSD, Pacific Island Division, Department of Veterans Affairs, Honolulu, Hawai'i 96813, USA.
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23
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Abstract
In 6 experiments, the authors examined the use of prior knowledge in category learning. Previous studies of the effects of knowledge on category learning have used categories in which knowledge was related to all of the category's features. However, people's knowledge of real-world categories often consists of many "rote" features that are not related to their prior knowledge. Five experiments found that even minimal prior knowledge (1 knowledge-relevant feature and 5 rote features per exemplar) can facilitate category learning. Posttests revealed that although the knowledge aided learning, subjects also acquired the rote features that were not related to knowledge, contradicting predictions of an attentional explanation of the knowledge effect. The results of Experiment 6 suggested that subjects attempt to link even rote features to their knowledge.
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Affiliation(s)
- A S Kaplan
- Department of Psychology, University of Illinois at Urbana-Champaign, USA
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24
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Kaplan AS. History and examination of the orofacial pain patient. Tex Dent J 2000; 117:42-9. [PMID: 11858063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Taking a history and performing an examination on an orofacial pain patient differs significantly from that in the general dental patient. Orofacial pain dentists must be familiar with the disorders that cause chronic head and neck pain. In addition, they must know the pertinent aspects of history taking with regard to the chief complaint, history of the present illness, the relevance of the past medical and dental history and how the social history can act as an important etiologic and prognostic factor. The clinician must also be versed in the elements of the orofacial pain examination which include evaluation of the TMJ and cervical spine; head, neck and dental examination; and, often, neurological and otolaryngological screening. The clinician should also have a familiarity with blood testing, urinalysis and know the uses and limitations of diagnostic imaging.
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25
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Kubany ES, Leisen MB, Kaplan AS, Kelly MP. Validation of a brief measure of posttraumatic stress disorder: the Distressing Event Questionnaire (DEQ). Psychol Assess 2000; 12:197-209. [PMID: 10887766 DOI: 10.1037/1040-3590.12.2.197] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Distressing Event Questionnaire (DEQ) is a brief instrument for assessing posttraumatic stress disorder (PTSD) according to criteria provided in Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The DEQ possesses high internal consistency and exhibited satisfactory short-term temporal stability in studies with Vietnam War combat veterans and battered women. In a sample of Vietnam War veterans and 4 separate samples of abused women (with histories of incest, rape, intimate partner abuse, or prostitution and abuse), the DEQ exhibited very good discriminative validity when judged against structured interview assessment of PTSD. The DEQ exhibited strong convergent validity with other PTSD measures and other indexes of adjustment and also exhibited strong convergent validity as a measure of PTSD across ethnic groups in both the veteran sample and the combined women's sample.
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Affiliation(s)
- E S Kubany
- National Center for PTSD, Pacific Islands Division, Department of Veterans Affairs, VAM&ROC, Honolulu, Hawai'i 96813, USA.
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26
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Kubany ES, Haynes SN, Leisen MB, Owens JA, Kaplan AS, Watson SB, Burns K. Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: the Traumatic Life Events Questionnaire. Psychol Assess 2000; 12:210-24. [PMID: 10887767 DOI: 10.1037/1040-3590.12.2.210] [Citation(s) in RCA: 587] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article describes the development and preliminary validation of a brief questionnaire that assesses exposure to a broad range of potentially traumatic events. Items were generated from multiple sources of information. Events were described in behaviorally descriptive terms, consistent with Diagnostic and Statistical Manual of Mental Disorders IV posttraumatic stress disorder stressor criterion A1. When events were endorsed, respondents were asked if they experienced intense fear, helplessness, or horror (stressor criterion A2). In separate studies with college students, Vietnam veterans, battered women, and residents of a substance abuse program, most items possessed adequate to excellent temporal stability. In a study comparing questionnaire and structured-interview inquiries of trauma history, the 2 formats yielded similar rates of disclosure. Preliminary data on positive predictive power are also presented.
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Affiliation(s)
- E S Kubany
- National Center for PTSD, Pacific Island Division, Department of Veterans Affairs, Honolulu, Hawai'i 96813, USA.
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27
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Abstract
OBJECTIVE Patients with eating disorders (EDs) are often difficult to treat. Despite recent advances in treatment, a significant percentage of patients remain treatment refractory. This paper reviews variables that contribute to these difficulties and recent strategies that focus on increasing patient motivation for treatment. METHOD The authors relate their clinical experience and synthesize the literature examining aspects of patients with EDs that may contribute to their treatment resistance and therapist variables that may contribute to negative nontherapeutic reactions. RESULTS Patient variables include the nature of the symptoms that patients experience, issues of trust, the not uncommon failure of ambulatory treatments, and issues related to comorbidity. Aspects of clinicians include lack of understanding of the biopsychosocial pathophysiology of these conditions and lack of experience and appreciation for the countertransferential reactions that these patients evoke in caregivers. CONCLUSIONS Improving understanding of the reasons for treatment refractoriness in patients with EDs is critical to improving their care. New interventions aimed at enhancing motivation may facilitate this process.
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Affiliation(s)
- A S Kaplan
- Program for Eating Disorders, Toronto Hospital, ON.
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28
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Abstract
Four experiments examined the extent to which prior knowledge influences the acquisition of category structure in unsupervised learning conditions. Prior knowledge is general knowledge about a broad domain that explains why an object has the features it does. Category structure refers to the statistical regularities of features within and across categories. Subjects viewed items and then divided them up into the categories that seemed most natural. Each item had one feature that was related to prior knowledge and five features that were not. The results showed that even this small amount of prior knowledge helped subjects to discover the category structure. In addition, prior knowledge enhanced the learning of many of the category's features, and not just the features that were directly relevant to the knowledge. The results suggest that prior knowledge may help to integrate the features of a category, thereby improving the acquisition of category structure.
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29
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Abstract
OBJECTIVE This article describes a treatment protocol for laxative withdrawal and presents some preliminary information about response to treatment at 3 to 20-month follow-up. METHOD Patients were contacted 3 to 20 months after admission and evaluated with a shortened form of the Eating Disorders Examination (EDE). RESULTS Fifty-seven percent of patients were abstinent from laxatives at follow-up and there were significant reductions in laxative-related symptom variables. Abstinence from laxatives was not accompanied by any other changes in eating behavior and was not associated with any pretreatment variables that were assessed. DISCUSSION It appears to be feasible to withdraw patients from laxatives as an isolated intervention with a reasonably high rate of success.
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Affiliation(s)
- P Colton
- Department of Psychiatry, Toronto Hospital, Canada
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30
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Abstract
The relationship between characteristics of irritable bowel syndrome (IBS) and eating disorders (ED) was investigated in a clinical sample of 43 female and 17 male IBS patients who completed the Eating Disorder Inventory (EDI). A diagnosis of IBS was generally unrelated to the Body Dissatisfaction, Perfectionism, and Ineffectiveness subscales of the EDI, but symptom severity was correlated with Perfectionism and Ineffectiveness. Severe bouts of vomiting were significantly associated with desires for lower body weight and reported binge-purge behaviors and cognitions measured by the Bulimia subscale of the EDI. Results suggest the need for a more comprehensive understanding of both types of illness as well as a possible framework for future empirical work.
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Affiliation(s)
- T N Tang
- Women's Mental Health Research Programme, Clarke Institute of Psychiatry, Toronto, Ontario, Canada
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31
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Abstract
OBJECTIVE Research has confirmed substantial links between OCD and AN. Not only are there psychopathological similarities between the two syndromes, but a marked neurochemical correspondence. Extensive exercising is a common feature of AN and also has relevance in its links with OCD. There is evidence from the exercise-induced weight-loss syndrome in animals that exercise and caloric restriction, in combination, tend to increase serotonergic activity in a synergistic manner. This syndrome has been proposed as a valid model of OCD as well as for AN. To date, little research has directly tested this theory in the human condition. METHOD Fifty-three AN patients were categorized as high-level exercisers (N = 22) or moderate/nonexercisers (N = 31) based on the frequency of their physical activity over the year before assessment. RESULTS Exercisers scored significantly higher on a measure of OC personality characteristics, OC symptomatology, and perfectionism--a personality factor associated with the development of Obsessive-Compulsive Personality Disorder. On the other hand, there were no group differences on other salient eating disorder characteristics such as body esteem, self-esteem, or weight preoccupation. There were also no differences in degree of emaciation as indicated by Body Mass Index. CONCLUSIONS Findings suggest that among AN patients obsessional personality characteristics are linked to high-level exercising, and that exercising is associated with a greater degree of OC symptomatology. Results are discussed in the context of current theories of AN, OCD, and some biological mechanisms.
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Affiliation(s)
- C Davis
- Department of Psychiatry, Toronto Hospital, Canada
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Levitan RD, Kaplan AS, Brown GM, Vaccarino FJ, Kennedy SH, Levitt AJ, Joffe RT. Hormonal and subjective responses to intravenous m-chlorophenylpiperazine in women with seasonal affective disorder. Arch Gen Psychiatry 1998; 55:244-9. [PMID: 9510218 DOI: 10.1001/archpsyc.55.3.244] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND There is emerging evidence of serotonergic dysfunction in patients with seasonal affective disorder (SAD). We examined central serotonergic function in female patients with SAD (fall-winter pattern) by means of neuroendocrine and subjective responses to the postsynaptic serotonin receptor agonist m-chlorophenylpiperazine. METHODS Using a double-blind, randomized, placebo-controlled design, we assessed neuroendocrine and subjective responses to m-chlorophenylpiperazine (0.1 mg/kg intravenously) and placebo in 14 unmedicated female patients with SAD in the depressed state and 15 female normal controls. All testing was done in the fall-winter months and during the follicular phase of the menstrual cycle. Plasma prolactin and cortisol levels were used as neuroendocrine measures, while subjective responses were assessed by means of visual analog scales of 10 mood states. RESULTS On the basis of net responses to m-chlorophenylpiperazine (placebo effects subtracted from drug effects), patients with SAD exhibited blunted prolactin responses and less sadness than normal controls in response to the drug. When order of presentation of drug and placebo was taken into consideration, altered "calm" and "high" responses were also found in the patient group. CONCLUSION Evidence of dysfunction at or downstream to central serotonergic receptors in female patients with SAD confirms and extends findings from previous research.
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Affiliation(s)
- R D Levitan
- Clarke Institute of Psychiatry, Department of Psychiatry, University of Toronto, Ontario, Canada
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Abstract
OBJECTIVE To evaluate the body composition, resting energy expenditure (REE), and energy intake of adolescents and adults with Williams syndrome (WS) compared with matched healthy control subjects. METHODS Body composition was determined by total body electrical conductivity and anthropometric measurements in six subjects with WS from the WS Clinic at Children's Hospital of Philadelphia and six healthy control subjects matched for age, height, and pubertal stage. REE was measured by open-circuit indirect calorimetry. Dietary intake was assessed by 3-day dietary records. RESULTS Subjects with WS had similar anthropometric measurements to the control group except for a significantly lower percent body fat (17.1%+/-5.2% vs. 25.0%+/-6.7%). Dietary intake (measured in kilocalories per day) was similar between the two groups. REE was statistically higher by 155 kcal/day in the WS group after controlling for age, gender, and body composition. In addition, the WS group had a significantly higher percent predicted REE according to the World Health Organization equation, which adjusts for age, gender, and body weight. CONCLUSION Adolescents and adults with WS have a similar dietary intake but a lower body fat than healthy control subjects. A higher REE may contribute to the thin body habitus and reduced total body fat stores of people with WS.
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Affiliation(s)
- A S Kaplan
- Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, USA
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Davis C, Katzman DK, Kaptein S, Kirsh C, Brewer H, Kalmbach K, Olmsted MP, Woodside DB, Kaplan AS. The prevalence of high-level exercise in the eating disorders: etiological implications. Compr Psychiatry 1997; 38:321-6. [PMID: 9406737 DOI: 10.1016/s0010-440x(97)90927-5] [Citation(s) in RCA: 222] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
There is increasing evidence both from animal experimentation and from clinical field studies that physical activity can play a central role in the pathogenesis of some eating disorders. However, few studies have addressed the issue of prevalence or whether there are different rates of occurrence across diagnostic categories, and the estimates that do exist are not entirely satisfactory. The present study was designed to conduct a detailed examination of the physical activity history in patients with anorexia nervosa (AN) and bulimia nervosa (BN) both during and prior to the onset of their disorder. A sample of adult patients and a second sample of adolescent AN patients took part in the study. A series of chi-square analyses compared diagnostic groups on a number of variables related to sport/exercise behaviors both premorbidly and comorbidly. Data were obtained by means of a detailed structured interview with each patient. We found that a large proportion of eating disorder patients were exercising excessively during an acute phase of the disorder, overexercising is significantly more frequent among those with AN versus BN, and premorbid activity levels significantly predict excessive exercise comorbidity. These findings underscore the centrality of physical activity in the development and maintenance of some eating disorders. They also have important clinical implications in light of the large proportion of individuals who combine dieting and exercise in an attempt to lose weight, and the increasing recognition of the adverse effects of strenuous physical activity in malnourished individuals.
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Affiliation(s)
- C Davis
- Department of Psychiatry, The Toronto Hospital, the Faculty of Medicine, University of Toronto, Ontario, Canada
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35
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Abstract
Medin, Goldstone, and Markman (1995) recently described a series of parallel effects in similarity and choice. They suggested that similarity and choice are related in a nontrivial way such that choice may entail a similarity judgment to an explicit or constructed ideal. In this paper, the correspondences between similarity and choice were investigated with respect to a phenomenon in similarity known as the coincidence effect. In coincidence (pronounced "coincide-ence"), two items that match on one dimension but have a large difference on another dimension receive a higher similarity rating than do two items that have only modest differences on both dimensions. We conducted five experiments in order to examine commonalities between similarity and choice processes with respect to coincidence. Four types of tasks were given: similarity ratings, desirability ratings, forced choice similarities (which of two items is most similar to a target), and forced choice preferences (which of two items one would prefer, given a target). We found a main effect for ratings as opposed to forced choices, with ratings showing greater coincidence effects than did choices. Similarity measures tended to produce more coincidence than did preference measures. The overall pattern of results suggests the presence of dimensional weighting processes sensitive to task characteristics and operating somewhat differently for similarity and decision making.
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Affiliation(s)
- A S Kaplan
- Northwestern University, Evanston, Illinois, USA.
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36
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Levitan RD, Kaplan AS, Joffe RT, Levitt AJ, Brown GM. Hormonal and subjective responses to intravenous meta-chlorophenylpiperazine in bulimia nervosa. Arch Gen Psychiatry 1997; 54:521-7. [PMID: 9193192 DOI: 10.1001/archpsyc.1997.01830180027004] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several lines of evidence point to serotonergic abnormalities in patients with bulimia nervosa (BN). Our goal was to further examine central serotonergic function in bulimic patients using neuroendocrine and subjective responses to the postsynaptic serotonin receptor agonist meta-chlorophenylpiperazine (mCPP). METHOD Using a double-blind, randomized, placebo-controlled design, we assessed neuroendocrine and subjective responses to intravenous mCPP (0.1 mg/kg) and placebo in 16 patients with BN, free of medication, and 14 normal control subjects. Plasma prolactin and cortisol levels were used as neuroendocrine measures, whereas subjective responses were measured using a visual analog scale of 10 different mood states. RESULTS Compared with controls, the BN group exhibited blunted prolactin and net cortisol responses following mCPP challenge. Subjective responses, while preliminary, also differed between groups on items related to anxiety, calmness, and altered self-awareness. CONCLUSION Evidence of dysfunction at or downstream of central serotonergic receptors in BN confirms and extends findings of prior research.
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Affiliation(s)
- R D Levitan
- Eating Disorders Center, Toronto Hospital, Ontario
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37
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Kaplan AS. History and examination of the orofacial pain patient. Dent Clin North Am 1997; 41:155-66. [PMID: 9142477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The clinician should recognize the importance of screening examinations for all patients seen in the dental office. The elements of a brief screening history and examination have been reviewed. In addition, the indications and elements of a comprehensive history and examination have been described. A discussion of current opinion on available diagnostic testing was also presented.
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Affiliation(s)
- A S Kaplan
- Mount Sinai School of Medicine, New York, New York, USA
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38
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Abstract
Despite clinical observations that many veterans have multiple sources of war-related guilt, many problematic guilt issues are commonly not treated or even detected by clinicians. We describe development of a survey that systematically assesses idiosyncratic sources of guilt across the spectrum of events that are potential sources of trauma-related guilt from the war-zone. A multimethod strategy was used to develop a survey with strong content validity-Results indicate the survey is temporally stable, substantially correlated with other measures of guilt, and highly correlated with measures of posttraumatic stress disorder (PTSD) and depression. Findings confirm that many Vietnam veterans have multiple sources of severe war-related guilt. The survey may have important clinical utility for problem identification, treatment planning, and evaluating treatment efficacy.
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Affiliation(s)
- E S Kubany
- Pacific Center for PTSD, Department of Veterans Affairs, Honolulu, Hawaii 96813, USA
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39
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Levitan RD, Kaplan AS, Brown GM, Joffe RT, Levitt AJ, Vaccarino FJ, Kennedy SH. Low plasma cortisol in bulimia nervosa patients with reversed neurovegetative symptoms of depression. Biol Psychiatry 1997; 41:366-8. [PMID: 9024959 DOI: 10.1016/s0006-3223(96)00432-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R D Levitan
- Clarke Institute of Psychiatry, University of Toronto, Canada
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40
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Abstract
This article addresses the effect of managed care on the treatment of eating disorders. We review strategies for negotiating limitations that managed care reviewers place on treatment. Finally, this article reviews the experiences of a Canadian program that has 10 years of experience in providing low-cost day treatment. While change is frustrating and difficult, it is inevitable and can be rejuvenating. These changes offer opportunities for creative development of quality low-cost care. If we do not adjust to these conditions, patients will not get treatment that they need.
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Affiliation(s)
- W H Kaye
- University of Pittsburgh School of Medicine, Pennsylvania, USA
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41
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Abstract
OBJECTIVE To evaluate differences in resting energy expenditure (REE) of black and white prepubertal children. SUBJECTS The study subjects were 34 prepubertal children 5 to 12 years of age and weighing 90% to 206% ideal body weight. Girls represented 59% of the study subjects; 44% were white children and 56% were black children. METHODS Fat-free mass (FFM), fat mass, and the percentage of body fat were determined by total body electrical conductivity. Fasting REE was measured by open-circuit indirect calorimetry. RESULTS Although weight, height, FFM, fat mass, percentage of body fat, and age were similar between the ethnic groups (black vs. white children), the black subjects had a significantly lower REE (1312 +/- 38 kcal/day) compared with the white subjects (1524 +/- 43 kcal/day) after adjusting for age, gender, weight, FFM, and fat mass. Fat-free mass and ethnic group were the only significant predictors of REE (R2 = 0.70). CONCLUSION Resting energy expenditure is significantly higher in this sample of white children compared with the black children after adjusting for body size and composition. Both FFM and ethnic background were significant determinants of REE in prepubertal children.
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Affiliation(s)
- A S Kaplan
- Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA
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42
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Abstract
OBJECTIVE Recent consensus on the subclassification of the eating disorder bulimia nervosa into purging and nonpurging forms is examined in the context of a large psychiatric epidemiological survey in Ontario, Canada. METHOD Among a sample of 8,116 individuals, 62 met criteria for bulimia nervosa. Of these, the 17 who were of the purging subtype could be distinguished from the nonpurging group on a variety of parameters of comorbidity, family history, and childhood environment. RESULTS The purging subtype was distinguishable on the basis of early age of onset, and high rates of affective disorders and anxiety and alcoholism, sexual abuse, and parental discord. DISCUSSION The data support the taxonomy and point to the need for better understanding of the meaning of purging behavior.
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Affiliation(s)
- P E Garfinkel
- Department of Psychiatry, Clarke Institute of Psychiatry, Toronto, Ontario, Canada
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43
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Kubany ES, McKenzie WF, Owens JA, Leisen MB, Kaplan AS, Pavich E. PTSD among women survivors of domestic violence in Hawaii. Hawaii Med J 1996; 55:164-5. [PMID: 8885521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Empirical evidence suggests that between 33% and 83% of Hawaii women receiving services from programs that serve battered women meet diagnostic criteria for posttraumatic stress disorder (PTSD). In addition, PTSD symptom severity is associated with depression severity, lowered self-esteem, and diminished quality of life. Combined with evidence that domestic violence often goes on for years, these findings provide additional compelling reasons why domestic violence screening should be conducted routinely in medical settings.
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Affiliation(s)
- E S Kubany
- Pacific Center for PTSD Department of Veterans Affairs VAM&ROC, Honolulu, Hawaii 96813, USA
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44
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Garfinkel PE, Lin E, Goering P, Spegg C, Goldbloom D, Kennedy S, Kaplan AS, Woodside DB. Should amenorrhoea be necessary for the diagnosis of anorexia nervosa? Evidence from a Canadian community sample. Br J Psychiatry 1996; 168:500-6. [PMID: 8730948 DOI: 10.1192/bjp.168.4.500] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study compares the characteristics of women with anorexia nervosa with those of women who have all the diagnostic features of that disorder except amenorrhoea. METHOD The study uses data from a large community epidemiological survey of the mental health status of household residents in Ontario, Canada. A multi-stage stratified sampling design generated a sample of 4285 females aged 15-64. DSM-III-R diagnoses were made using the Composite International Diagnostic interview. RESULTS Eighty-four out of 4285 female respondents met full or partial-syndrome criteria for anorexia nervosa. Comparison of these two groups revealed few statistically significant differences in terms of demographics, psychiatric comorbidity, family history or early experiences. CONCLUSIONS Amenorrhoea did not discriminate between women with anorexia nervosa and women with all the features except amenorrhoea across a number of relevant variables. The authors question the utility of amenorrhoea as a diagnostic criterion.
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Affiliation(s)
- P E Garfinkel
- Health Systems Research Unit, Clarke Institute of Psychiatry, University of Toronto, Toronto Ontario, Canada
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45
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Abstract
OBJECTIVE The purpose of the study was to examine patterns of response to treatment in bulimia nervosa and to consider the utility of differentiating rapid from slower responders. METHOD Participants were 166 female patients with bulimia nervosa who received specialized day hospital treatment for their eating disorder and provided complete data on symptom frequencies over the course of treatment. Symptoms and psychological functioning were assessed at the beginning and end of treatment and 2-year follow-up information was available for a subsample of 57 patients. RESULTS A large subgroup (41%) of patients responded rapidly to treatment (i.e., symptom frequencies of three or less during the first 4 weeks of treatment) and a smaller subgroup (31%) were considered slower responders (i.e., symptom frequencies of four or more over the first 4 weeks of treatment and three or less over the last 4 weeks of treatment). The remaining patients were either partial responders (18%) or nonresponders (10%). Rapid responders tended to be older, less symptomatic, and less preoccupied with binging before treatment (all ps < .05), but the differences were not strong. Rapid responders also had better symptom control at the end of treatment (p < .00001), were less likely to receive antidepressant/antibulimic medication during the program (p < .04), and were significantly less likely to relapse within 2 years of attending the program (p < .005). DISCUSSION These findings demonstrate that a significant subgroup of severely ill bulimia nervosa patients had a rapid, strong, and enduring response to intensive treatment, but could not be well identified with the available measures before treatment.
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Affiliation(s)
- M P Olmsted
- Toronto Hospital Toronto General Division, Eating Disorder Centre, Ontario
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46
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Abstract
OBJECTIVE To determine whether bulimia nervosa (BN) patients who experience marked fall/winter worsening in eating behavior and/or mood are otherwise distinct from nonseasonal BN patients. METHODS We empirically identified "seasonal" and "nonseasonal" groups from a sample of 208 consecutive BN patients completing the Seasonal Pattern Assessment Questionnaire (SPAQ). t Tests were performed to determine if seasonal patients differed from nonseasonal patients with respect to demographic and weight variables, age of onset of symptoms, illness severity, and attitudes and beliefs. RESULTS Seasonal BN patients exhibited a greater discrepancy between maximum lifetime and current weight, an earlier age of onset of binging, and a higher current monthly binge frequency than did the nonseasonal group. Seasonal patients also scored significantly higher on the Bulimia and Interoceptive Awareness (reflecting lower self-awareness) subscales of the Eating Disorders Inventory (EDI). DISCUSSION The results suggest that seasonal BN patients may represent a distinct subgroup characterized by a low threshold for binging behavior, greater preoccupation with bulimic behaviors, poor awareness of moods and feelings, and a unique course of illness. More research is needed to confirm these initial findings and to further assess the effectiveness of light therapy for these patients.
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Affiliation(s)
- R D Levitan
- Mood and Seasonal Affective Disorders Clinic, Clarke Institute of Psychiatry, Toronto, Canada
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47
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Kaplan AS. New perspectives on the eating disorders. J Psychiatry Neurosci 1996; 21:7-8. [PMID: 8580120 PMCID: PMC1188727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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48
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Abstract
OBJECTIVE To demonstrate how an integrative approach to psychiatric treatment can confer specific advantages. METHOD The impact of conceptual models on clinical information processing and therapeutic intervention, and the potential benefits resulting from the incorporation of multiple treatment modalities are outlined. These principles are applied using anorexia nervosa (AN) as a prototypical disorder. RESULTS A brief, structured review of the broad range of models which have been applied to AN illustrates the impact of conceptualization on outcome. The opportunity for positive integrative effects in the treatment of AN are demonstrated. They are seen to be related to 6 factors: flexibility, patient-treatment matching, stage-treatment matching, facilitation, complementarity, and synergism. CONCLUSION Integrative methods can address some limitations in clinical information processing associated with the exclusive application of a single conceptual model. Positive integrative effects are demonstrated in the context of AN; however, the approach is recommended for more general application.
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Affiliation(s)
- D H Greben
- Department of Psychiatry, University of Toronto, Ontario
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49
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Abstract
OBJECTIVE To highlight developments in the taxonomy of eating disorders since Russell's original description of bulimia nervosa (BN) in 1979 and through 3 versions of the Diagnostic and Statistical Manual. METHOD Criteria for anorexia nervosa (AN), BN and binge eating disorder (BED) are systematically described. RESULTS While criteria for AN remain largely unchanged between DSM-III-R and DSM-IV, the subclassification of binge/purge and restricter subgroups endorses previous research findings. For BN, the definition of "binge" has occupied considerable attention both in quantitative and qualitative terms. The arbitrary choice of 2 episodes per week as a minimum frequency is also discussed in light of recent data from the Ontario Health Supplement. A third eating disorder, BED, is now included in the appendix of DSM-IV under Eating Disorders--Not Otherwise Specified category. The potential overlap between this disorder and nonpurging BN is discussed. Finally, the relationship between eating disorders and other psychiatric disorders including depression, schizophrenia, obsessional, and conversion disorders is considered as well as the continuum from preoccupation with weight to eating disorder. CONCLUSION While significant advances have been made in understanding and classifying eating disorders during the past 15 years, further empirical work is necessary to clarify areas of uncertainty.
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Affiliation(s)
- P E Garfinkel
- Department of Psychiatry, University of Toronto, Ontario
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50
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Abstract
OBJECTIVE To evaluate the use of resting energy expenditure (REE) prediction equations compared with measured REE in children referred for REE to aid clinical care. SUBJECTS One hundred two patients, aged 0.2 to 20.5 years, 55% female, with a nutritional diagnosis of failure to thrive (76%), obesity (19%), or other (5%). METHODS We measured REE by indirect calorimetry and compared with prediction equations: Food and Agriculture/World Health Organization/United Nations University (FAO/WHO/UNU) equation, Harris-Benedict (H-B) equation, and two equations from Schofield, one using weight (SCHO-WT) and one using weight and height (SCHO-HTWT). RESULTS The SCHO-HTWT equation more closely predicted measured REE (100% +/- 19%), compared with the WHO equation (99% +/- 22%), the SCHO-WT equation, (99% +/- 21%), and the H-B equation (92% +/- 25%). The SCHO-HTWT equation was the best at predicting REE for obese subjects (95% +/- 17%), for those with failure to thrive (101% +/- 20%), and for children from birth to 3 years of age (101% +/- 23%). Nevertheless, the prediction equations closely predicted REE in only about 40% of subjects. CONCLUSION These findings suggest that the SCHO-HTWT equation predicts REE in children with clinical nutritional problems better than equations that use weight alone. In view of the wide variability in REE measurements, however, we believe that REE should be measured in patients for whom knowledge of caloric expenditure is required for clinical care.
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Affiliation(s)
- A S Kaplan
- Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, PA 19104
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