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Zucker NL, La Via M, Craske MG, Foukal M, Harris A, Datta N, Savereide E, Maslow G. Feeling and body investigators (FBI): ARFID division-An acceptance-based interoceptive exposure treatment for children with ARFID. Int J Eat Disord 2019; 52:466-472. [PMID: 30597590 PMCID: PMC6511273 DOI: 10.1002/eat.22996] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Individuals with Avoidant Restrictive Food Intake Disorder (ARFID) experience impairing health consequences from insufficient nutritional variety and/or quantity. Early medical conditions and/or somatic symptoms such as abdominal pain may lead some with ARFID to experience somatic sensations as aversive. As such, food avoidance may be part of a broader behavioral repertoire aimed at suppressing bodily sensations. Avoiding these necessary and informative signals (e.g., growls of hunger) may subvert the emergence of healthy self-awareness and self-regulation. Teaching children with ARFID to engage adaptively with bodily sensations may help decrease aversiveness, increase self-awareness, and increase approach behaviors. METHOD Drawing from interventions for panic disorder and irritable bowel syndrome, we developed an acceptance-based interoceptive exposure treatment for young children with ARFID, Feeling and Body Investigators (FBI)-ARFID Division. Using playful cartoons and developmentally sensitive exposures, we teach young children how to map interoceptive sensations onto meanings (e.g., emotions) and actions (e.g., if I feel nervous, I'll hold someone's hand). RESULTS We present a case study of a 4-year old child with lifelong poor appetite/food indifference. DISCUSSION Some individuals with ARFID may avoid food to avoid internal sensations. Developmentally appropriate interoceptive exposures may decrease ARFID symptoms while increasing more general self-regulation skills.
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Affiliation(s)
- Nancy L. Zucker
- Department of Psychology and Neuroscience, Duke University, United States,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, United States
| | - Maria La Via
- Department of Psychiatry, University of North Carolina, Chapel Hill, United States,Veritas Collaborative, LLC, United States
| | - Michelle G. Craske
- Department of Psychology, University of California Los Angeles, United States,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Molly Foukal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, United States
| | - Adrianne Harris
- Department of Psychology and Neuroscience, Duke University, United States,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, United States
| | - Nandini Datta
- Department of Psychology and Neuroscience, Duke University, United States
| | - Erik Savereide
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, United States
| | - Gary Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, United States
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Levinson CA, Zerwas SC, Brosof LC, Thornton LM, Strober M, Pivarunas B, Crowley JJ, Yilmaz Z, Berrettini WH, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, La Via M, Mitchell J, Rotondo A, Woodside DB, Kaye WH, Bulik CM. Associations between dimensions of anorexia nervosa and obsessive-compulsive disorder: An examination of personality and psychological factors in patients with anorexia nervosa. Eur Eat Disord Rev 2018; 27:161-172. [PMID: 30136346 DOI: 10.1002/erv.2635] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/25/2018] [Accepted: 07/01/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are highly comorbid. However, the factors that account for this comorbidity are poorly understood. We examined the core dimensions of AN and OCD and psychological and personality factors shared by both disorders. METHOD In path analyses (N = 732 women with either current AN or recovered from AN), we examined which factors were uniquely and independently associated with the core dimensions of AN and OCD. We also examined recovery from AN as a moderator. RESULTS When individuals with AN reported greater concern over mistakes, they endorsed more severity in both AN and OCD core dimensions. These unique associations existed above and beyond all other transdiagnostic personality and psychological factors and regardless of AN recovery status. CONCLUSIONS Concern over mistakes partially accounts for severity in the core dimensions of both AN and OCD. Concern over mistakes may represent an important target in the aetiology of AN and OCD.
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Stephanie C Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Leigh C Brosof
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Strober
- UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | | | - James J Crowley
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Zeynep Yilmaz
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wade H Berrettini
- Center of Neurobiology and Behavior, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harry Brandt
- Center for Eating Disorders, Sheppard Pratt Health System, Towson, Maryland
| | - Steven Crawford
- Center for Eating Disorders, Sheppard Pratt Health System, Towson, Maryland
| | - Manfred M Fichter
- Klinik Roseneck, Hospital for Behavioral Medicine and University of Munich (LMU), Munich, Germany
| | - Katherine A Halmi
- Weill Cornell Medical College, New York Presbyterian Hospital - Westchester Division, White Plains, New York
| | | | - Allan S Kaplan
- Program for Eating Disorders, Toronto General Hospital and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maria La Via
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James Mitchell
- Department of Clinical Neuroscience and Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Alessandro Rotondo
- Department of Psychiatry, Pharmacology and Biotechnologies, University of Pisa, Pisa, Italy
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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3
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Duncan L, Yilmaz Z, Gaspar H, Walters R, Goldstein J, Anttila V, Bulik-Sullivan B, Ripke S, Thornton L, Hinney A, Daly M, Sullivan PF, Zeggini E, Breen G, Bulik CM, Duncan L, Yilmaz Z, Gaspar H, Walters R, Goldstein J, Anttila V, Bulik-Sullivan B, Ripke S, Adan R, Alfredsson L, Ando T, Andreassen O, Aschauer H, Baker J, Barrett J, Bencko V, Bergen A, Berrettini W, Birgegård A, Boni C, Perica VB, Brandt H, Burghardt R, Carlberg L, Cassina M, Cesta C, Cichon S, Clementi M, Cohen-Woods S, Coleman J, Cone R, Courtet P, Crawford S, Crow S, Crowley J, Danner U, Davis O, de Zwaan M, Dedoussis G, Degortes D, DeSocio J, Dick D, Dikeos D, Dina C, Ding B, Dmitrzak-Weglarz M, Docampo E, Egberts K, Ehrlich S, Escaramís G, Esko T, Espeseth T, Estivill X, Favaro A, Fernández-Aranda F, Fichter M, Finan C, Fischer K, Floyd J, Föcker M, Foretova L, Forzan M, Fox C, Franklin C, Gaborieau V, Gallinger S, Gambaro G, Giegling I, Gonidakis F, Gorwood P, Gratacos M, Guillaume S, Guo Y, Hakonarson H, Halmi K, Harrison R, Hatzikotoulas K, Hauser J, Hebebrand J, Helder S, Hendriks J, Herms S, Herpertz-Dahlmann B, Herzog W, Hilliard C, Huckins L, Hudson J, Huemer J, Imgart H, Inoko H, Jall S, Jamain S, Janout V, Jiménez-Murcia S, Johnson C, Jordan J, Julià A, Juréus A, Kalsi G, Kaplan A, Kaprio J, Karhunen L, Karwautz A, Kas M, Kaye W, Kennedy M, Kennedy J, Keski-Rahkonen A, Kiezebrink K, Kim YR, Klareskog L, Klump K, Knudsen GP, Koeleman B, Koubek D, La Via M, Landén M, Le Hellard S, Leboyer M, Levitan R, Li D, Lichtenstein P, Lilenfeld L, Lissowska J, Lundervold A, Magistretti P, Maj M, Mannik K, Marsal S, Kaminska D, Martin N, Mattingsdal M, McDevitt S, McGuffin P, Merl E, Metspalu A, Meulenbelt I, Micali N, Mitchell J, Mitchell K, Monteleone P, Monteleone AM, Montgomery G, Mortensen P, Munn-Chernoff M, Müller T, Nacmias B, Navratilova M, Nilsson I, Norring C, Ntalla I, Ophoff R, O’Toole J, Palotie A, Pantel J, Papezova H, Parker R, Pinto D, Rabionet R, Raevuori A, Rajewski A, Ramoz N, Rayner NW, Reichborn-Kjennerud T, Ricca V, Ripatti S, Ritschel F, Roberts M, Rotondo A, Rujescu D, Rybakowski F, Santonastaso P, Scherag A, Scherer S, Schmidt U, Schork N, Schosser A, Scott L, Seitz J, Slachtova L, Sladek R, Slagboom PE, ’t Landt MSO, Slopien A, Smith T, Soranzo N, Sorbi S, Southam L, Steen V, Strengman E, Strober M, Szatkiewicz J, Szeszenia-Dabrowska N, Tachmazidou I, Tenconi E, Tortorella A, Tozzi F, Treasure J, Tschöp M, Tsitsika A, Tziouvas K, van Elburg A, van Furth E, Wade T, Wagner G, Walton E, Watson H, Wichmann HE, Widen E, Woodside DB, Yanovski J, Yao S, Zerwas S, Zipfel S, Thornton L, Hinney A, Daly M, Sullivan PF, Zeggini E, Breen G, Bulik CM. Significant Locus and Metabolic Genetic Correlations Revealed in Genome-Wide Association Study of Anorexia Nervosa. Am J Psychiatry 2017; 174:850-858. [PMID: 28494655 PMCID: PMC5581217 DOI: 10.1176/appi.ajp.2017.16121402] [Citation(s) in RCA: 297] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The authors conducted a genome-wide association study of anorexia nervosa and calculated genetic correlations with a series of psychiatric, educational, and metabolic phenotypes. METHOD Following uniform quality control and imputation procedures using the 1000 Genomes Project (phase 3) in 12 case-control cohorts comprising 3,495 anorexia nervosa cases and 10,982 controls, the authors performed standard association analysis followed by a meta-analysis across cohorts. Linkage disequilibrium score regression was used to calculate genome-wide common variant heritability (single-nucleotide polymorphism [SNP]-based heritability [h2SNP]), partitioned heritability, and genetic correlations (rg) between anorexia nervosa and 159 other phenotypes. RESULTS Results were obtained for 10,641,224 SNPs and insertion-deletion variants with minor allele frequencies >1% and imputation quality scores >0.6. The h2SNP of anorexia nervosa was 0.20 (SE=0.02), suggesting that a substantial fraction of the twin-based heritability arises from common genetic variation. The authors identified one genome-wide significant locus on chromosome 12 (rs4622308) in a region harboring a previously reported type 1 diabetes and autoimmune disorder locus. Significant positive genetic correlations were observed between anorexia nervosa and schizophrenia, neuroticism, educational attainment, and high-density lipoprotein cholesterol, and significant negative genetic correlations were observed between anorexia nervosa and body mass index, insulin, glucose, and lipid phenotypes. CONCLUSIONS Anorexia nervosa is a complex heritable phenotype for which this study has uncovered the first genome-wide significant locus. Anorexia nervosa also has large and significant genetic correlations with both psychiatric phenotypes and metabolic traits. The study results encourage a reconceptualization of this frequently lethal disorder as one with both psychiatric and metabolic etiology.
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Affiliation(s)
- Laramie Duncan
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Zeynep Yilmaz
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Helena Gaspar
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Raymond Walters
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Jackie Goldstein
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Verneri Anttila
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Brendan Bulik-Sullivan
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Stephan Ripke
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Laura Thornton
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Anke Hinney
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Mark Daly
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Patrick F. Sullivan
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Eleftheria Zeggini
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Gerome Breen
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
| | - Cynthia M. Bulik
- From the UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, N.C.; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston; the Social, Genetic, and Developmental Psychiatry Research Centre and Biomedical Research Centre for Mental Health at King's College London and South London
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Abstract
In the USA, binge eating disorder (BED) is the most common eating disorder, with a lifetime prevalence of ~3.5 % in adult women, 2.0 % in adult men, and 1.6 % in adolescents. BED is characterized by frequent episodes of binge eating that are accompanied by a sense of loss of control over eating and result in marked psychological distress. BED is highly co-morbid with obesity and with depression and other psychiatric conditions, and it is associated with substantial role impairment. Currently, there are no US FDA-approved pharmacological treatments for BED. Animal and human studies implicate underlying dysregulation in dopamine, opioid, acetylcholine, and serotonin neurocircuitry within brain reward regions in the pathogenesis and maintenance of BED. To date, the efficacy of various agents that target these and other neurotransmitter systems involved in motivated feeding behavior, mood regulation, and impulse control have been investigated in the treatment of BED. Several antidepressant and anticonvulsant agents have demonstrated efficacy in reducing binge eating frequency, but only in limited cases have these effects resulted in patients achieving abstinence, which is the primary goal of treatment; they also range from less (fluvoxamine) to more (topiramate) effective in achieving weight loss that is both clinically meaningful and significantly greater than placebo. Collectively, the literature on pharmacological treatment approaches to BED is limited in that very few agents have been studied in multiple, confirmatory trials with adequate follow up, and almost none have been evaluated in large patient samples that are diverse with respect to age, sex, and ethnicity. In addition, prior trials have not adequately addressed, through study design, the high placebo response commonly observed in this patient population. Several novel agents are in various phases of testing, and recent animal studies focusing on glutamate-signaling circuits linking the amygdala to the lateral hypothalamus offer new avenues for exploration and potential therapeutic development. Studies of newly FDA-approved medications for long-term obesity treatment and further explorations of dietary supplements and neutraceuticals with appetite- and mood-altering properties may also be worthwhile.
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Affiliation(s)
- Kimberly A Brownley
- Department of Psychiatry, CB #7175, University of North Carolina, Chapel Hill, NC, 27599-7175, USA,
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Brownley KA, Von Holle A, Hamer RM, La Via M, Bulik CM. A double-blind, randomized pilot trial of chromium picolinate for binge eating disorder: results of the Binge Eating and Chromium (BEACh) study. J Psychosom Res 2013; 75:36-42. [PMID: 23751236 PMCID: PMC4358897 DOI: 10.1016/j.jpsychores.2013.03.092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 10/30/2012] [Revised: 03/20/2013] [Accepted: 03/26/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Chromium treatment has been shown to improve mood, appetite, and glucose regulation in various psychiatric and medical patient populations. The authors propose that chromium may be useful in the treatment of binge eating disorder (BED). METHOD Twenty-four overweight adults with BED were enrolled in a 6-month double-blind placebo-controlled trial and randomly assigned to receive either 1000mcg chromium/day ("high dose"; n=8) or 600mcg chromium/day ("moderate dose"; n=9) as chromium picolinate or placebo (n=7). Mixed linear regression models were used to estimate mean change in binge frequency and related psychopathology, weight, symptoms of depression, and fasting glucose. RESULTS Fasting glucose was significantly reduced in both chromium groups compared to the placebo group; similarly, numerically, but not significantly, greater reductions in binge frequency, weight, and symptoms of depression were observed in those treated with chromium versus placebo, although statistical power was limited in this pilot trial. For fasting glucose, the findings suggest a dose response with larger effects in the high dose compared to moderate dose group. CONCLUSION These initial findings support further larger trials to determine chromium's efficacy in maintaining normal glucose regulation, reducing binge eating and related psychopathology, promoting modest weight loss, and reducing symptoms of depression in individuals with BED. Studies designed to link the clinical effects of chromium with changes in underlying insulin, serotonin, and dopamine pathways may be especially informative. If efficacious, chromium supplementation may provide a useful, low-cost alternative to or augmentation strategy for selective serotonin reuptake inhibitors, which have partial efficacy in BED. ClinicalTrials.gov NCT00904306.
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Affiliation(s)
- Kimberly A Brownley
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Zerwas S, Lund BC, Von Holle A, Thornton LM, Berrettini WH, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, La Via M, Mitchell J, Rotondo A, Strober M, Woodside DB, Kaye WH, Bulik CM. Factors associated with recovery from anorexia nervosa. J Psychiatr Res 2013; 47:972-9. [PMID: 23535032 PMCID: PMC3682792 DOI: 10.1016/j.jpsychires.2013.02.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [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: 06/22/2012] [Revised: 02/20/2013] [Accepted: 02/24/2013] [Indexed: 11/20/2022]
Abstract
Previous studies of prognostic factors of anorexia nervosa (AN) course and recovery have followed clinical populations after treatment discharge. This retrospective study examined the association between prognostic factors--eating disorder features, personality traits, and psychiatric comorbidity--and likelihood of recovery in a large sample of women with AN participating in a multi-site genetic study. The study included 680 women with AN. Recovery was defined as the offset of AN symptoms if the participant experienced at least one year without any eating disorder symptoms of low weight, dieting, binge eating, and inappropriate compensatory behaviors. Participants completed a structured interview about eating disorders features, psychiatric comorbidity, and self-report measures of personality. Survival analysis was applied to model time to recovery from AN. Cox regression models were used to fit associations between predictors and the probability of recovery. In the final model, likelihood of recovery was significantly predicted by the following prognostic factors: vomiting, impulsivity, and trait anxiety. Self-induced vomiting and greater trait anxiety were negative prognostic factors and predicted lower likelihood of recovery. Greater impulsivity was a positive prognostic factor and predicted greater likelihood of recovery. There was a significant interaction between impulsivity and time; the association between impulsivity and likelihood of recovery decreased as duration of AN increased. The anxiolytic function of some AN behaviors may impede recovery for individuals with greater trait anxiety.
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Affiliation(s)
- Stephanie Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160, USA.
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7
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Abstract
Ms. Z, a 35-year-old African-American single woman with a body mass index (BMI) of 37.8 kg/m2 (height 5 feet, 5.5 inches, weight 238 lb.), presents for an evaluation for bulimia nervosa. She was referred to the eating disorders program by her primary care physician who knew about her eating disorder, but was primarily concerned about her weight and blood pressure. Ms. Z has an advanced degree and is employed full time. She has struggled with her eating, weight, and body image since childhood and began binge eating regularly (1–2× week) at age 15. Fasting and self-induced vomiting began in her early twenties, when she achieved her lowest adult BMI of 21.6 kg (weight 130 lb. at age 23). She gained 100 pounds in the past 7 years and currently binges and purges 1–2 times a day. A typical binge consists of a box of cookies, a pint of ice cream, 7 oz. of cheese, two bowls of cereal with 2 cups of milk, and 4 pickles. Ms. Z has seen five therapists to address her eating behaviors and weight concerns and participated in numerous commercial weight loss programs. She states binge eating has always served a self-soothing purpose for her. Ms. Z has a demanding university-related job that absorbs most of her time. She has few friends and has not been in a romantic relationship for the past five years believing that no one would be interested in a woman of her size. She also claimed that food is more reliable than any man because “it’s always there when you need it and you don’t have to take care of it or stoke its ego.” She spends evenings at home working until she is completely exhausted, heads to the kitchen for an all-out binge, vomits everything up, and then cries herself to sleep. She has never smoked and does not drink alcohol. Current medications prescribed by her primary care physician include Fluoxetine (20 mg), Norvasc (5 mg), and Clonazepam (prn). What are Ms. Z’s treatment goals? What are her primary care physician’s? Is her medication for bulimia nervosa adequate? How well would cognitive-behavioral therapy for bulimia nervosa address her personal treatment goals? Her physician’s? What challenges might a therapist face having Ms. Z in group therapy for bulimia?
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Root TL, Szatkiewicz JP, Jonassaint CR, Thornton LM, Pinheiro AP, Strober M, Bloss C, Berrettini W, Schork NJ, Kaye WH, Bergen AW, Magistretti P, Brandt H, Crawford S, Crow S, Fichter MM, Goldman D, Halmi KA, Johnson C, Kaplan AS, Keel PK, Klump KL, La Via M, Mitchell JE, Rotondo A, Treasure J, Woodside DB, Bulik CM. Association of candidate genes with phenotypic traits relevant to anorexia nervosa. Eur Eat Disord Rev 2011; 19:487-93. [PMID: 21780254 DOI: 10.1002/erv.1138] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 05/06/2011] [Accepted: 05/15/2011] [Indexed: 11/09/2022]
Abstract
This analysis is a follow-up to an earlier investigation of 182 genes selected as likely candidate genetic variations conferring susceptibility to anorexia nervosa (AN). As those initial case-control results revealed no statistically significant differences in single nucleotide polymorphisms, herein, we investigate alternative phenotypes associated with AN. In 1762 females, using regression analyses, we examined the following: (i) lowest illness-related attained body mass index; (ii) age at menarche; (iii) drive for thinness; (iv) body dissatisfaction; (v) trait anxiety; (vi) concern over mistakes; and (vii) the anticipatory worry and pessimism versus uninhibited optimism subscale of the harm avoidance scale. After controlling for multiple comparisons, no statistically significant results emerged. Although results must be viewed in the context of limitations of statistical power, the approach illustrates a means of potentially identifying genetic variants conferring susceptibility to AN because less complex phenotypes associated with AN are more proximal to the genotype and may be influenced by fewer genes.
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Affiliation(s)
- Tammy L Root
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
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9
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Jonassaint CR, Szatkiewicz JP, Bulik CM, Thornton LM, Bloss C, Berrettini W, Kaye WH, Bergen AW, Magistretti P, Strober M, Keel PK, Brandt H, Crawford S, Crow S, Fichter MM, Goldman D, Halmi KA, Johnson C, Kaplan AS, Klump KL, La Via M, Mitchell J, Rotondo A, Treasure J, Woodside DB. Absence of association between specific common variants of the obesity-related FTO gene and psychological and behavioral eating disorder phenotypes. Am J Med Genet B Neuropsychiatr Genet 2011; 156B:454-61. [PMID: 21438147 PMCID: PMC3249222 DOI: 10.1002/ajmg.b.31182] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [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] [Received: 09/09/2010] [Accepted: 02/24/2011] [Indexed: 11/08/2022]
Abstract
Extensive population-based genome-wide association studies have identified an association between the FTO gene and BMI; however, the mechanism of action is still unknown. To determine whether FTO may influence weight regulation through psychological and behavioral factors, seven single-nucleotide polymorphisms (SNPs) of the FTO gene were genotyped in 1,085 individuals with anorexia nervosa (AN) and 677 healthy weight controls from the international Price Foundation Genetic Studies of Eating Disorders. Each SNP was tested in association with eating disorder phenotypes and measures that have previously been associated with eating behavior pathology: trait anxiety, harm-avoidance, novelty seeking, impulsivity, obsessionality, compulsivity, and concern over mistakes. After appropriate correction for multiple comparisons, no significant associations between individual FTO gene SNPs and eating disorder phenotypes or related eating behavior pathology were identified in cases or controls. Thus, this study found no evidence that FTO gene variants associated with weight regulation in the general population are associated with eating disorder phenotypes in AN participants or matched controls.
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Affiliation(s)
| | - Jin Peng Szatkiewicz
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cinnamon Bloss
- Scripps Genomic Medicine, The Scripps Research Institute, La Jolla, California
| | - Wade Berrettini
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Walter H. Kaye
- Department of Psychiatry, University of California at San Diego, San Diego, CA
| | | | - Pierre Magistretti
- Brain Mind Institute EPFL – Lausanne and Center for Psychiatric Neuroscience, Department of Psychiatry, University of Lausanne Medical School, Lausanne, Switzerland
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Harry Brandt
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Steve Crawford
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Scott Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Manfred M. Fichter
- Roseneck Hospital for Behavioral Medicine, Prien, Germany and Department of Psychiatry, University of Munich (LMU), Munich, Germany
| | - David Goldman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
| | - Katherine A. Halmi
- New York Presbyterian Hospital-Westchester Division, Weill Medical College of Cornell University, White Plains, NY
| | | | - Allan S. Kaplan
- Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada,Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, MI
| | - Maria La Via
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - James Mitchell
- Neuropsychiatric Research Institute, Fargo, North Dakota,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Alessandro Rotondo
- Neuropsychiatric Research Biotechnologies, University of Pisa, Pisa, Italy
| | - Janet Treasure
- Eating Disorders Section, Institute of Psychiatry, King’s College, University of London, England
| | - D. Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto, Canada,Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, Canada
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10
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Pinheiro AP, Bulik CM, Thornton LM, Sullivan PF, Root TL, Bloss CS, Berrettini WH, Schork NJ, Kaye WH, Bergen AW, Magistretti P, Brandt H, Crawford S, Crow S, Fichter MM, Goldman D, Halmi KA, Johnson C, Kaplan AS, Keel PK, Klump KL, La Via M, Mitchell JE, Strober M, Rotondo A, Treasure J, Woodside DB. Association study of 182 candidate genes in anorexia nervosa. Am J Med Genet B Neuropsychiatr Genet 2010; 153B:1070-80. [PMID: 20468064 PMCID: PMC2963154 DOI: 10.1002/ajmg.b.31082] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We performed association studies with 5,151 SNPs that were judged as likely candidate genetic variations conferring susceptibility to anorexia nervosa (AN) based on location under reported linkage peaks, previous results in the literature (182 candidate genes), brain expression, biological plausibility, and estrogen responsivity. We employed a case-control design that tested each SNP individually as well as haplotypes derived from these SNPs in 1,085 case individuals with AN diagnoses and 677 control individuals. We also performed separate association analyses using three increasingly restrictive case definitions for AN: all individuals with any subtype of AN (All AN: n = 1,085); individuals with AN with no binge eating behavior (AN with No Binge Eating: n = 687); and individuals with the restricting subtype of AN (Restricting AN: n = 421). After accounting for multiple comparisons, there were no statistically significant associations for any individual SNP or haplotype block with any definition of illness. These results underscore the importance of large samples to yield appropriate power to detect genotypic differences in individuals with AN and also motivate complementary approaches involving Genome-Wide Association (GWA) studies, Copy Number Variation (CNV) analyses, sequencing-based rare variant discovery assays, and pathway-based analysis in order to make up for deficiencies in traditional candidate gene approaches to AN.
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Affiliation(s)
- Andrea Poyastro Pinheiro
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Correspondence to: Dr. Cynthia M. Bulik, Ph.D., Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599 -7160.
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Patrick F. Sullivan
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tammy L. Root
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cinnamon S. Bloss
- Scripps Genomic Medicine, The Scripps Research Institute, La Jolla, California
| | - Wade H. Berrettini
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas J. Schork
- Scripps Genomic Medicine, The Scripps Research Institute, La Jolla, California
| | - Walter H. Kaye
- Department of Psychiatry, University of California at San Diego, San Diego, California,Correspondence to: Dr. Walter H. Kaye, M.D., Department of Psychiatry, University of California San Diego, 8950 Villa La Jolla Dr., Suite C207, La Jolla, CA 92037.
| | - Andrew W. Bergen
- Center for Health Sciences, SRI International, Menlo Park, California
| | - Pierre Magistretti
- Department of Psychiatry, Brain Mind Institute EPFL—Lausanne, Center for Psychiatric Neuroscience, University of Lausanne Medical School, Lausanne, Switzerland
| | - Harry Brandt
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Steve Crawford
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Scott Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Manfred M. Fichter
- Roseneck Hospital for Behavioral Medicine, Prien, Germany, Department of Psychiatry, University of Munich (LMU), Munich, Germany
| | - David Goldman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Katherine A. Halmi
- New York Presbyterian Hospital, Westchester Division, Weill Medical College of Cornell University, White Plains, New York
| | - Craig Johnson
- Laureate Psychiatric Clinic and Hospital, Tulsa, Oklahoma
| | - Allan S. Kaplan
- Center for Addiction and Mental Health, Toronto, Canada, Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Maria La Via
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James E. Mitchell
- Neuropsychiatric Research Institute, Fargo, North Dakota, Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Alessandro Rotondo
- Neuropsychiatric Research Biotechnologies, University of Pisa, Pisa, Italy
| | - Janet Treasure
- Eating Disorders Section, Institute of Psychiatry, King’s College, University of London, London, England
| | - D. Blake Woodside
- Center for Addiction and Mental Health, Toronto, Canada, Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, Canada, Department of Psychiatry, University of Toronto, Toronto, Canada
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11
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Root T, Pinheiro AP, Thornton L, Strober M, Fernandez-Aranda F, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, Klump KL, La Via M, Mitchell J, Woodside DB, Rotondo A, Berrettini WH, Kaye WH, Bulik CM. Substance use disorders in women with anorexia nervosa. Int J Eat Disord 2010; 43:14-21. [PMID: 19260043 PMCID: PMC2807480 DOI: 10.1002/eat.20670] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We examined prevalence of substance use disorders (SUD) in women with: (1) anorexia nervosa (AN) restricting type (RAN); (2) AN with purging only (PAN); (3) AN with binge eating only (BAN); and (4) lifetime AN and bulimia nervosa (ANBN). Secondary analyses examined SUD related to lifetime purging behavior and lifetime binge eating. METHOD Participants (N = 731) were drawn from the International Price Foundation Genetic Studies. RESULTS The prevalence of SUD differed across AN subtypes, with more in the ANBN group reporting SUD than those in the RAN and PAN groups. Individuals who purged were more likely to report substance use than those who did not purge. Prevalence of SUD differed across lifetime binge eating status. DISCUSSION SUD are common in AN and are associated with bulimic symptomatology. Results underscore the heterogeneity in AN, highlighting the importance of screening for SUD across AN subtypes.
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Affiliation(s)
- Tammy Root
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Laura Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael Strober
- Semel Institute for Neuroscience and Human Behavior, and Resnick Neuropsychiatric Hospital, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge, Feixa Llarga s/n, PC: 08907 Barcelona, Spain, Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III,, Hospital Clínico Santiago de Compostela, Choupana s/n, PC: 15706 Santiago de Compostela, Spain
| | - Harry Brandt
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Steve Crawford
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Manfred M. Fichter
- Department of Psychiatry, University of Munich (LMU), Munich, Germany and Roseneck Hospital for Behavioral Medicine, Prien, Germany
| | - Katherine A. Halmi
- New York Presbyterian Hospital-Westchester Division, Weill Medical College of Cornell University, White Plains, NY
| | | | - Allan S. Kaplan
- Department of Psychiatry, The Toronto Hospital, Toronto, Canada
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, MI
| | - Maria La Via
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - James Mitchell
- Department of Psychiatry, Neuropsychiatric Research Institute, Fargo, ND
| | | | | | - Wade H. Berrettini
- Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, PA
| | - Walter H. Kaye
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
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12
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Von Holle A, Pinheiro AP, Thornton LM, Klump KL, Berrettini WH, Brandt H, Crawford S, Crow S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, Keel P, La Via M, Mitchell J, Strober M, Woodside DB, Kaye WH, Bulik CM. Temporal patterns of recovery across eating disorder subtypes. Aust N Z J Psychiatry 2008; 42:108-17. [PMID: 18197505 DOI: 10.1080/00048670701787610] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [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: 01/30/2023]
Abstract
OBJECTIVE To compare patterns of recovery in individuals with index episodes of anorexia nervosa (AN) and bulimia nervosa (BN). METHOD Using Kaplan-Meier methods and Cox proportional hazards models, comparisons were conducted that were conditional on duration of eating disorder from onset and included a conservative recovery criterion of 3 asymptomatic years. Data collection was retrospective and from two of the international Price Foundation genetic studies on 901 individuals with eating disorders. RESULTS Using Kaplan-Meier methods, 11% of those with index AN and 10% of those with index BN met recovery criteria at 10 years. At 15 years, 16% of those with index AN and 25% of those with index BN met recovery criteria. In a Cox proportional hazards model the index BN group had three times the rate of recovery at 10-14 years (p=0.01) than the index AN group. CONCLUSIONS Initially the probability of recovery was greater for those with index AN, but as the duration of the eating disorder lengthened those with BN had higher probabilities of recovery. Replication of these results with prospective data using similarly stringent recovery criteria and methods is required to confirm trends.
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Affiliation(s)
- Ann Von Holle
- Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina 27599-7160, USA
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13
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Fernandez-Aranda F, Pinheiro AP, Tozzi F, Thornton LM, Fichter MM, Halmi KA, Kaplan AS, Klump KL, Strober M, Woodside DB, Crow S, Mitchell J, Rotondo A, Keel P, Plotnicov KH, Berrettini WH, Kaye WH, Crawford SF, Johnson C, Brandt H, La Via M, Bulik CM. Symptom profile of major depressive disorder in women with eating disorders. Aust N Z J Psychiatry 2007; 41:24-31. [PMID: 17464678 DOI: 10.1080/00048670601057718] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Based on the well-documented association between eating disorders (EDs) and affective disorders, the patterns of comorbidity of EDs and major depressive disorder (MDD) were investigated. The temporal relation between EDs and MDD onset was analyzed to determine differences in the course and nature of MDD when experienced prior to versus after the onset of the ED. METHOD Lifetime MDD and depressive symptoms were assessed in 1371 women with a history of ED. The prevalence of MDD was first explored across ED subtypes, and ages of onset of MDD and EDs were compared. Depressive symptoms were examined in individuals who developed MDD before and after ED onset. RESULTS The lifetime prevalence of MDD was 72.9%. Among those with lifetime MDD (n =963), 34.5% reported MDD onset before the onset of ED. Those who experienced MDD first reported greater psychomotor agitation (OR =1.53; 95%CI =1.14-2.06), and thoughts of own death (but not suicide attempts or ideation; OR =1.73; 95%CI =1.31-2.30). Among individuals who had MDD before ED, 26.5% had the MDD onset during the year before the onset of ED; 67% of individuals had the onset of both disorders within the same 3 year window. CONCLUSION Clinicians treating individuals with new-onset ED or MDD should remain vigilant for the emergence of additional psychopathology, especially during the initial 3 year window following the onset of the first disorder.
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Abstract
BACKGROUND Recent reports raise the possibility that olanzapine can assist weight gain and improve behavioral symptoms during refeeding in anorexia nervosa. METHOD Seventeen DSM-IV anorexia nervosa subjects hospitalized between May 1999 and October 2000 were enrolled in open-label treatment with olanzapine for up to 6 weeks. Baseline weight and symptoms were compared to patients' status at the end of treatment. RESULTS Olanzapine administration was associated with a significant reduction in depression, anxiety, and core eating disorder symptoms, and a significant increase in weight. A comparison with our historical data suggests that subjects in this study had a significantly greater decrease in depression. CONCLUSION These data lend support to the possibility that olanzapine may be useful in treating anorexia nervosa. However, a controlled trial is necessary to demonstrate that olanzapine is efficacious.
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Affiliation(s)
- Nicole C Barbarich
- Department of Psychiatry, University of Pittsburgh Medical School, Anorexia and Bulimia Nervosa Research Module, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA
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15
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Barbarich NC, McConaha CW, Halmi KA, Gendall K, Sunday SR, Gaskill J, La Via M, Frank GK, Brooks S, Plotnicov KH, Kaye WH. Use of nutritional supplements to increase the efficacy of fluoxetine in the treatment of anorexia nervosa. Int J Eat Disord 2004; 35:10-5. [PMID: 14705152 DOI: 10.1002/eat.10235] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [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: 11/09/2022]
Abstract
OBJECTIVE Selective serotonin reuptake inhibitor (SSRI) medication does not appear to be effective in ill, malnourished anorexia nervosa (AN) patients. However, it may be effective in preventing relapse after weight restoration. The purpose of this study was to determine whether nutritional supplements could potentiate the effects of fluoxetine in underweight AN subjects. METHOD Twenty-six subjects with AN participated in a trial of fluoxetine. In a double-blind, placebo-controlled manner, subjects received either nutritional supplements or a nutritional placebo. The nutritional supplement included tryptophan (the precursor of serotonin), vitamins, minerals, and essential fatty acids believed to influence serotonin pathway function. RESULTS There was no significant difference in weight gain between subjects treated with fluoxetine plus nutritional supplements versus fluoxetine plus a nutritional placebo. Moreover, there were no significant differences between groups on mean changes in anxiety or obsessive and compulsive symptoms. DISCUSSION The results of this study suggest that supplement strategies are not a substitute for adequate nutrition and are ineffective in increasing the efficacy of fluoxetine in underweight AN subjects.
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Affiliation(s)
- Nicole C Barbarich
- Department of Psychiatry, University of Pittsburgh Medical School, Anorexia and Bulimia Nervosa Research Module, Pittsburgh, Pennsylvania 15213, USA
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