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Suzuki Y, Nagamitsu S, Eshima N, Inoue T, Otani R, Sakuta R, Iguchi T, Ishii R, Uchida S, Okada A, Kitayama S, Koyanagi K, Suzuki Y, Sumi Y, Takamiya S, Fujii C, Fukai Y. Body weight and eating attitudes influence improvement of depressive symptoms in children and pre-adolescents with eating disorders: a prospective multicenter cohort study. BMC Pediatr 2024; 24:551. [PMID: 39192238 PMCID: PMC11348658 DOI: 10.1186/s12887-024-05024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Pediatric patients with eating disorders in a multicenter joint study on 11 facilities were enrolled and prospectively investigated to determine whether improvement in body weight, eating attitudes, and psychosocial factors in children with eating disorders would also improve depressive symptoms. METHODS In this study, 91 patients were enrolled between April 2014 and March 2016. The severity of underweight was assessed using the body mass index-standard deviation score (BMI-SDS), eating behavior was assessed using the children's eating attitude test (ChEAT26), the outcome of childhood eating disorders was assessed using the childhood eating disorder outcome scale, and depressive symptoms were assessed using the Children's Depression Inventory (CDI) score. RESULTS After 12 months of treatment, depressive symptoms were evaluated in 62 of the 91 cases where it was evaluated at the initial phase. There was no difference in background characteristics between the included patients and the 29 patients who dropped out. A paired-sample t-test revealed a significant decrease in CDI scores after 12 months of treatment (p < 0.001, 95% CI: 2.401-7.373) and a significant increase in the BMI-SDS (p < 0.001, 95% CI: - 2.41973-1.45321). Multiple regression analysis revealed that BMI-SDS and ChEAT26 scores at the initial phase were beneficial in CDI recovery. In addition, BMI-SDS at the initial phase was useful for predicting BMI-SDS recovery after 12 months of treatment. CONCLUSIONS Depressive symptoms in children with eating disorders improved with therapeutic intervention on body weight and eating attitudes. TRIAL REGISTRATION The Clinical Trial Number for this study is UMIN000055004.
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Affiliation(s)
- Yuichi Suzuki
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima, Fukushima, 960-1295, Japan.
| | - Shinichiro Nagamitsu
- Department of Pediatrics, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Nobuoki Eshima
- Department of Pediatrics, Kurume University School of Medicine, Fukuoka, Japan
- Center for Education and Research of Disaster Risk Reduction and Redesign, Oita, Japan
| | - Takeshi Inoue
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Ryoko Otani
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Ryoichi Sakuta
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Toshiyuki Iguchi
- Department of Pediatrics, Hoshigaoka Maternity Hospital, Aichi, Japan
| | - Ryuta Ishii
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Soh Uchida
- Karamun`S Forest Children`S Clinic, Tokyo, Japan
| | - Ayumi Okada
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Kenshi Koyanagi
- Nagasaki Prefectural Center of Medicine and Welfare for Children, Nagasaki, Japan
| | - Yuki Suzuki
- Department of Pediatrics, National Hospital Organization Mie National Hospital, Mie, Japan
| | - Yoshino Sumi
- Mental and Developmental Clinic for Children "Elm Tree", Hokaido, Japan
| | | | - Chikako Fujii
- Department of Pediatrics/Child Psychosomatic Medicine, Okayama University Hospital, Okayama, Japan
| | - Yoshimitsu Fukai
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
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Kühnen P, Argente J, Clément K, Dollfus H, Dubern B, Farooqi S, de Groot C, Grüters A, Holm JC, Hopkins M, Kleinendorst L, Körner A, Meeker D, Rydén M, von Schnurbein J, Tschöp M, Yeo GSH, Zorn S, Wabitsch M. IMPROVE 2022 International Meeting on Pathway-Related Obesity: Vision of Excellence. Clin Obes 2024; 14:e12659. [PMID: 38602039 DOI: 10.1111/cob.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/08/2024] [Indexed: 04/12/2024]
Abstract
Nearly 90 clinicians and researchers from around the world attended the first IMPROVE 2022 International Meeting on Pathway-Related Obesity. Delegates attended in person or online from across Europe, Argentina and Israel to hear the latest scientific and clinical developments in hyperphagia and severe, early-onset obesity, and set out a vision of excellence for the future for improving the diagnosis, treatment, and care of patients with melanocortin-4 receptor (MC4R) pathway-related obesity. The meeting co-chair Peter Kühnen, Charité Universitätsmedizin Berlin, Germany, indicated that change was needed with the rapidly increasing prevalence of obesity and the associated complications to improve the understanding of the underlying mechanisms and acknowledge that monogenic forms of obesity can play an important role, providing insights that can be applied to a wider group of patients with obesity. World-leading experts presented the latest research and led discussions on the underlying science of obesity, diagnosis (including clinical and genetic approaches such as the role of defective MC4R signalling), and emerging clinical data and research with targeted pharmacological approaches. The aim of the meeting was to agree on the questions that needed to be addressed in future research and to ensure that optimised diagnostic work-up was used with new genetic testing tools becoming available. This should aid the planning of new evidence-based treatment strategies for the future, as explained by co-chair Martin Wabitsch, Ulm University Medical Center, Germany.
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Affiliation(s)
- Peter Kühnen
- Department of Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jesús Argente
- Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Karine Clément
- Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France
- INSERM, Nutrition and Obesity: Systemic Approaches, NutriOmics, Research Unit, Sorbonne Université, Paris, France
| | - Hélène Dollfus
- CARGO and Department of Medical Genetics, University of Strasbourg, Strasbourg, France
| | - Béatrice Dubern
- INSERM, Nutrition and Obesity: Systemic Approaches, NutriOmics, Research Unit, Sorbonne Université, Paris, France
- Sorbonne Université, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sadaf Farooqi
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Corjan de Groot
- Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annette Grüters
- Department of Pediatric Endocrinology and Diabetes, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jens-Christian Holm
- The Children's Obesity Clinic, accredited European Centre for Obesity Management, Department of Pediatrics, Copenhagen University Hospital Holbæk, Copenhagen, Denmark
| | - Mark Hopkins
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Lotte Kleinendorst
- Department of Clinical Genetics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Antje Körner
- Center for Pediatric Research, Department of Pediatrics, LIFE Research Center for Civilization Diseases, University Hospital Leipzig, Leipzig, Germany
| | - David Meeker
- Rhythm Pharmaceuticals, Boston, Massachusetts, USA
| | - Mikael Rydén
- Department of Medicine H7, Karolinska Institute, Stockholm, Sweden
- Department of Endocrinology and Metabolism, Karolinska University Hospital, Stockholm, Sweden
| | - Julia von Schnurbein
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Matthias Tschöp
- Institute for Diabetes and Obesity, Helmholtz Zentrum, Munich, Germany
| | - Giles S H Yeo
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stefanie Zorn
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Martin Wabitsch
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
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Sternheim LC, Bijsterbosch JM, Wever MCM, van Elburg AA, Frank GKW. Examining anxious temperament in anorexia nervosa: Behavioural inhibition and intolerance of uncertainty and their contribution to trait anxiety in adolescents with anorexia nervosa. J Affect Disord 2024; 348:116-123. [PMID: 38110154 DOI: 10.1016/j.jad.2023.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious and complex psychiatric disorder yet treatment results are suboptimal. Insight into the etiology of this illness is much needed. Research highlights the implication of anxiety-related traits in the development and maintenance of AN. This study investigates firstly, behavioural inhibition and intolerance for uncertainty (IU) in adolescents with and without AN, and secondly relations between these traits. METHODS In a cross-sectional study, 165 adolescent girls (AN = 94, HC = 71) completed questionnaires measuring behavioural inhibition, IU and trait anxiety. ANOVAs tested differences between AN and HC groups, and mediation models with IU as a mediator between behavioural inhibition and trait anxiety were run. RESULTS AN adolescents reported significantly higher levels of behavioural inhibition, IU and trait anxiety compared to their peers. In both AN and HC, a direct and a total effect of behavioural inhibition on trait anxiety was found. However, only in the AN group IU partially mediated the relation between behavioural inhibition and trait anxiety. LIMITATIONS Data is cross-sectional and longitudinal studies are required. A mean illness duration of nearly 2 years may mean early effects of malnourishment and habituation and future studies should include patients with shorter illness duration. CONCLUSIONS Results highlight that behavioural inhibition and IU may contribute to anxiety in AN whilst their peers may have developed better executive and social-emotional skills to manage uncertainty. Adolescents with AN may benefit from interventions targeting behavioural inhibition and IU.
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Affiliation(s)
- Lot C Sternheim
- Department of Clinical Psychology, Utrecht University, the Netherlands.
| | | | - Mirjam C M Wever
- Department of Clinical Psychology, Leiden University, the Netherlands
| | | | - Guido K W Frank
- Department of Psychiatry, University of California San Diego, USA
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Dolan SC, Kambanis PE, Stern CM, Becker KR, Breithaupt L, Gydus J, Smith S, Misra M, Micali N, Lawson EA, Eddy KT, Thomas JJ. Anticipatory and consummatory pleasure in avoidant/restrictive food intake disorder. J Eat Disord 2023; 11:198. [PMID: 37950288 PMCID: PMC10638737 DOI: 10.1186/s40337-023-00921-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Recent research suggests that individuals with eating disorders (EDs) report elevated anhedonia, or loss of pleasure. Although individuals with avoidant/restrictive food intake disorder (ARFID) often express that they do not look forward to eating, it is unclear whether they experience lower pleasure than those without EDs. Thus, identifying whether individuals with ARFID experience anhedonia may yield important insights that inform clinical conceptualization and treatment. METHODS A sample of 71 participants ages 10-23 with full and subthreshold ARFID and 33 healthy controls (HCs) completed the Pica, ARFID, and Rumination Disorder Interview, a diagnostic interview to assess ARFID profile severity (lack of interest in food, sensory sensitivity, fear of aversive consequences) and the Temporal Experience of Pleasure Scale (TEPS), a self-report measure of consummatory and anticipatory pleasure. Statistical analyses were performed using the full TEPS and also the TEPS with food-related items removed. RESULTS The ARFID group reported significantly lower anticipatory and consummatory pleasure compared to HCs, but these differences were no longer significant after controlling for depression, nor after removing food items from the TEPS. Within the ARFID sample, greater ARFID severity was associated with lower anticipatory pleasure across analyses, and greater endorsement of the lack of interest in food profile was related to lower anticipatory pleasure. ARFID severity was also associated with lower consummatory pleasure using the full TEPS, but this relationship was no longer significant with food items removed. CONCLUSIONS These results provide initial evidence for lower pleasure before potentially pleasurable events in individuals with more severe ARFID, particularly those with the lack of interest phenotype. Our findings also suggest that depression is likely to contribute low pleasure in this population. Future research should seek to further characterize how dimensions of pleasure relate to the maintenance and treatment of ARFID symptoms.
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Affiliation(s)
- Sarah C Dolan
- Department of Psychology, Hofstra University, Hempstead, NY, USA
| | - P Evelyna Kambanis
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Casey M Stern
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Julia Gydus
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Smith
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Madhusmita Misra
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
- Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
- Eating Disorders Research Unit, Mental Health Center Ballerup, Ballerup, Denmark
| | - Elizabeth A Lawson
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Baj J, Bargieł J, Cabaj J, Skierkowski B, Hunek G, Portincasa P, Flieger J, Smoleń A. Trace Elements Levels in Major Depressive Disorder-Evaluation of Potential Threats and Possible Therapeutic Approaches. Int J Mol Sci 2023; 24:15071. [PMID: 37894749 PMCID: PMC10606638 DOI: 10.3390/ijms242015071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
The multifactorial etiology of major depressive disorder (MDD) includes biological, environmental, genetic, and psychological aspects. Recently, there has been an increasing interest in metallomic studies in psychiatry, aiming to evaluate the role of chosen trace elements in the MDD etiology as well as the progression of symptoms. This narrative review aims to summarize the available literature on the relationship between the concentration of chosen elements in the serum of patients with MDD and the onset and progression of this psychiatric condition. The authors reviewed PubMed, Web of Science, and Scopus databases searching for elements that had been investigated so far and further evaluated them in this paper. Ultimately, 15 elements were evaluated, namely, zinc, magnesium, selenium, iron, copper, aluminium, cadmium, lead, mercury, arsenic, calcium, manganese, chromium, nickel, and phosphorus. The association between metallomic studies and psychiatry has been developing dynamically recently. According to the results of current research, metallomics might act as a potential screening tool for patients with MDD while at the same time providing an assessment of the severity of symptoms. Either deficiencies or excessive amounts of chosen elements might be associated with the progression of depressive symptoms or even the onset of the disease among people predisposed to MDD.
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Affiliation(s)
- Jacek Baj
- Department of Anatomy, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland
| | - Julia Bargieł
- Student Research Group of Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland; (J.B.); (J.C.); (B.S.)
| | - Justyna Cabaj
- Student Research Group of Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland; (J.B.); (J.C.); (B.S.)
| | - Bartosz Skierkowski
- Student Research Group of Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland; (J.B.); (J.C.); (B.S.)
| | - Gabriela Hunek
- Student Research Group of Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland;
| | - Piero Portincasa
- Clinica Medica “A. Murri”, Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, 70124 Bari, Italy;
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland;
| | - Agata Smoleń
- Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, 20-080 Lublin, Poland;
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Oshukova S, Suokas J, Nordberg M, Ålgars M. Effects of family-based treatment on adolescent outpatients treated for anorexia nervosa in the Eating Disorder Unit of Helsinki University Hospital. J Eat Disord 2023; 11:154. [PMID: 37697396 PMCID: PMC10496370 DOI: 10.1186/s40337-023-00879-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Family therapy for adolescent anorexia nervosa (AN) has stronger evidence of efficacy in comparison with individual therapy, and family-based treatment (FBT) is the most evaluated in numerous randomized clinical trials. However, few studies have focused on how FBT performs outside of research settings. The current study is the first to assess clinical outcomes of FBT for adolescent AN in Finland, in a specialized outpatient clinic. AIM The naturalistic outcome of outpatient FBT for adolescent AN was investigated. METHODS Fifty-two female patients and their families who received FBT at a tertiary eating disorders unit participated in the study. Data on their pre-treatment parameters, treatment details, and condition at the end of treatment (EOT) was collected from their medical records. RESULTS At EOT, a majority (61.5%) had achieved a full weight restoration [percentage of expected body weight (%EBW) ≥ 95%]. Participants with an %EBW ≥ 95 at EOT had a significantly higher pre-treatment %EBW than those with an EBW < 95% at EOT. Participants with an EBW ≥ 95% at EOT showed significantly higher total weight gain during the treatment period, a higher rate of regular menstrual periods at EOT, significantly lower rates of dietary restrictions, and less cognitive or behavioral symptoms of the eating disorder overall, compared to participants who did not achieve a normal body weight. In 22 cases (42.3%), there was no need for further treatment at the end of FBT. Participants who needed further treatment after FBT, compared to those who did not, showed significantly higher rates of psychiatric comorbidity, history of mental health treatment, and need for psychopharmacological treatment. CONCLUSIONS In this naturalistic study, and in line with previous studies, FBT for AN appeared to be an effective and sometimes sufficient intervention, especially for patients with milder weight deficit and less severe psychiatric comorbidities. The results show that FBT can be successfully implemented in Finland and suggest that training more ED clinicians in FBT would be beneficial. TRIAL REGISTRATION The study was retrospectively registered on February 8th, 2023, in ClinicalTrials.gov Protocol Registration and Results System, identifier: NCT05734573.
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Affiliation(s)
- Svetlana Oshukova
- Department of Psychiatry, Eating Disorder Unit, University of Helsinki and Helsinki University Hospital (HUS), P.O. Box 282, 00029, Helsinki, Finland.
| | - Jaana Suokas
- Department of Psychiatry, Eating Disorder Unit, University of Helsinki and Helsinki University Hospital (HUS), P.O. Box 282, 00029, Helsinki, Finland
| | - Mai Nordberg
- Psychiatric Hospital, City of Helsinki, Nordenskiöldinkatu 20, 00250, Helsinki, Finland
| | - Monica Ålgars
- Department of Psychiatry, Eating Disorder Unit, University of Helsinki and Helsinki University Hospital (HUS), P.O. Box 282, 00029, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, P.O. Box 63 00014, Helsinki, Finland
- Department of Psychology, Åbo Akademi University, Arken, Tehtaankatu 2, 20500, Turku, Finland
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von Schnurbein J, Remy M, Brandt S, Manzoor J, Kohlsdorf K, Mahmood S, Hebebrand J, Wabitsch M. Positive effect of leptin substitution on mood and behaviour in patients with congenital leptin deficiency. Pediatr Obes 2023; 18:e13057. [PMID: 37226403 DOI: 10.1111/ijpo.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND States of starvation are characterized by reduced physical activity and social withdrawal. This has been suggested to be mediated at least in part via reduced leptin concentrations. OBJECTIVE We therefore aimed to ascertain if leptin substitution in patients with congenital leptin deficiency (CLD) can improve physical activity and mood. METHODS Seven patients with CLD were filmed prior to and after short- and long-term substitution (2-21 days; 3-4 months) in a play situation. Six independent, blinded investigators ranked each video according to specifically developed scales concerning motor activity, social interaction, emotionality, and mood with higher scores representing improvements. RESULTS Short term metreleptin substitution significantly increased mean total score from 17.7 ± 4.1 to 22.6 ± 6.6 (p = 0.039), and mean scores for motor activity (4.1 ± 1.1 to 5.1 ± 1.5, p = 0.023) and social interaction (4.6 ± 1.1 to 6.2 ± 1.7, p = 0.016). After long term substitution means of all four single scales and of total score were even higher than at short-term follow-up. During a treatment pause of 3 months in two children, all four scale scores fell below substitution levels and rose again after restart. CONCLUSIONS Metreleptin substitution improved indices of physical activity and psychological wellbeing in patients with CLD. This suggests that reduced leptin concentrations might be in part responsible for emotional and behavioural changes seen during starvation.
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Affiliation(s)
- Julia von Schnurbein
- Department for Paediatrics and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetes, University Ulm Medical Centre, Ulm, Germany
| | - Miriam Remy
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, Essen, Germany
| | - Stephanie Brandt
- Department for Paediatrics and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetes, University Ulm Medical Centre, Ulm, Germany
| | - Jaida Manzoor
- The Children's Hospital, University of Child Health Sciences, Lahore, Pakistan
| | - Katja Kohlsdorf
- Department for Paediatrics and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetes, University Ulm Medical Centre, Ulm, Germany
| | - Saqib Mahmood
- Human Genetics & Molecular Biology, University of Health Sciences, Lahore, Pakistan
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, Essen, Germany
| | - Martin Wabitsch
- Department for Paediatrics and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetes, University Ulm Medical Centre, Ulm, Germany
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Keeler JL, Peters-Gill G, Treasure J, Himmerich H, Tchanturia K, Cardi V. Difficulties in retrieving specific details of autobiographical memories and imagining positive future events in individuals with acute but not remitted anorexia nervosa. J Eat Disord 2022; 10:172. [PMID: 36401319 PMCID: PMC9675114 DOI: 10.1186/s40337-022-00684-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The factors that contribute to the maintenance of anorexia nervosa (AN) are not fully understood, although it is generally accepted that depression is a core feature and contributes to poor prognosis. Individuals with depression tend to have difficulties in producing specific details of autobiographical memories and future episodes. Our aim was to investigate autobiographical memory and episodic future thinking (EFT) in individuals with AN (n = 46), people recovered from AN (recAN; n = 40), and non-affected controls (n = 35). METHOD Using a remotely administered computerised version of the autobiographical memory test and episodic future thinking task, we measured six aspects of memory retrieval and EFT generation: specificity, detailedness, difficulty in remembering/imagining, positivity, vividness and realism. Memory and EFT cue valence was manipulated; cues were either positive, neutral, or disorder-related/negative. As the production of EFTs is theoretically linked to the ability to retrieve autobiographical memories, the relationship between autobiographical memory specificity and EFT specificity was explored. To investigate whether autobiographical memory and EFT performance were independent of performance on other forms of cognition, working memory, verbal fluency and cognitive flexibility were measured. RESULTS People with AN had difficulties retrieving specific details of autobiographical memories and rated autobiographical memories as less positive overall, and less vivid when primed by positive cues. People with a lifetime diagnosis (currently ill or recovered) reported greater difficulty in retrieving memories. The AN group generated less positive EFTs, particularly to positive and neutral cues. Comorbid depressive symptoms had some contribution to the observed findings. Lastly, in all groups autobiographical memory specificity predicted EFT specificity. DISCUSSION Problems with retrieving specific details of autobiographical memories and simulating positive EFTs may be a state feature of AN. Treatments targeted at alleviating depressive symptoms, as well those targeted towards facilitating memory retrieval or reconsolidation, and the construction of positive EFTs, may contribute to hope for recovery and strengthen the sense of self beyond the disorder.
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Affiliation(s)
- Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.
| | | | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Kate Tchanturia
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK.,Illia State University, Tbilisi, Georgia.,Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,Department of General Psychology, University of Padova, Padua, Italy
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Jérolon A, Perduca V, Delsedime N, Abbate-Daga G, Marzola E. Mediation models of anxiety and depression between temperament and drive for thinness and body dissatisfaction in anorexia nervosa. Eat Weight Disord 2022; 27:2569-2581. [PMID: 35460450 PMCID: PMC9556361 DOI: 10.1007/s40519-022-01397-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/25/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Anorexia nervosa (AN) is a life-threatening condition in which temperament, anxiety, depression, and core AN body-related psychopathology (drive for thinness, DT, and body dissatisfaction, BD) are intertwined. This relationship has not been to date disentangled; therefore, we performed a multiple mediation analysis aiming to quantify the effect of each component. METHODS An innovative multiple mediation statistical method has been applied to data from 184 inpatients with AN completing: Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Eating Disorders Inventory-2, State-Trait Anxiety Inventory, and Beck Depression Inventory. RESULTS All affective temperaments but the hyperthymic one were involved in the relationship with DT and BD. Only the anxious temperament had a significant unmediated direct effect on DT after the strictest correction for multiple comparisons, while the depressive temperament had a significant direct effect on DT at a less strict significance level. State anxiety was the strongest mediator of the link between affective temperament and core AN body-related psychopathology. Depression showed intermediate results while trait anxiety was not a significant mediator at all. CONCLUSION Affective temperaments had a relevant impact on body-related core components of AN; however, a clear direct effect could be identified only for the anxious and depressive temperaments. Also, state anxiety was the strongest mediator thus entailing interesting implications in clinical practice. LEVEL OF EVIDENCE V, cross-sectional study.
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Affiliation(s)
- Allan Jérolon
- CNRS, MAP5 UMR 8145, Université de Paris, F-75006 Paris, France
| | | | - Nadia Delsedime
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
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Birla M, Choudhary C, Singh G, Gupta S, Bhawana, Vavilala P. The Advent of Nutrigenomics: A Narrative Review with an Emphasis on Psychological Disorders. Prev Nutr Food Sci 2022; 27:150-164. [PMID: 35919568 PMCID: PMC9309077 DOI: 10.3746/pnf.2022.27.2.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 05/26/2022] [Indexed: 11/06/2022] Open
Abstract
A new research field is emerging that combines nutrition and genetics at the molecular level, namely nutrigenomics. Several aspects of nutrigenomics are examined in this review, with a particular focus on psychological disorders. The origin of this field in the 20th century and its modern developments have been investigated. Various studies have reported the impact of genetic factors and diet on various chronic disorders, elucidating how the deficiency of several macronutrients results in significant ailments, including diabetes, cancer, cardiovascular disorders, and others. Furthermore, the application of nutrigenomics to diet and its impact on the global disease rate and quality of life have been discussed. The relationship between diet and gene expression can facilitate the classification of diet-gene interactions and the diagnosis of polymorphisms and anomalies. Numerous databases and research tools for the study of nutrigenomics are essential to the medical application of this field. The nutrition-gene interrelationships can be utilized to study brain development, impairment, and diseases, which could be a significant medical breakthrough. It has also been observed that psychological conditions are exacerbated by the interaction between gut microbes and the prevalence of malnutrition. This article focuses on the impact of nutrition on genes involved in various psychological disorders and the potential application of nutrigenomics as a revolutionary treatment method.
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Affiliation(s)
- Meghna Birla
- Shaheed Rajguru College of Applied Sciences for Women, University of Delhi, New Delhi 110096, India
| | - Chanchal Choudhary
- Shaheed Rajguru College of Applied Sciences for Women, University of Delhi, New Delhi 110096, India
| | - Garima Singh
- Shaheed Rajguru College of Applied Sciences for Women, University of Delhi, New Delhi 110096, India
| | - Salvi Gupta
- Shaheed Rajguru College of Applied Sciences for Women, University of Delhi, New Delhi 110096, India
| | - Bhawana
- Shaheed Rajguru College of Applied Sciences for Women, University of Delhi, New Delhi 110096, India
| | - Pratyusha Vavilala
- Shaheed Rajguru College of Applied Sciences for Women, University of Delhi, New Delhi 110096, India
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11
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Wei Y, Peng S, Lian C, Kang Q, Chen J. Anorexia nervosa and gut microbiome: implications for weight change and novel treatments. Expert Rev Gastroenterol Hepatol 2022; 16:321-332. [PMID: 35303781 DOI: 10.1080/17474124.2022.2056017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Host-microbiota interactions may be involved in many physical and psychological functions ranging from the digestion of food, maintenance of immune homeostasis, to the regulation of mood and cognition. Microbiome dysbiosis has been consistently described in many diseases. The pathogenesis and weight regulation mechanism in anorexia nervosa (AN) also seem to be implicated in the dynamic bidirectional adjustment of the microbiota-gut-brain axis. This review aims at elucidating this relationship. AREA COVERED This review starts with a description of pathogenic gut-brain pathways. Next, we focus on the latest research on the associations between gut microbiota and weight change in the condition of AN. The strategies to alter the intestinal microbiome for the treatment of this disorder are discussed, including dietary, probiotics, prebiotics, synbiotics, and fecal microbiota transplantation. EXPERT OPINION Gut microbiome is inextricably linked to AN. It may regulate weight gain in the process of refeeding via the microbiota-gut-brain axis, while the specific mechanism has yet to be clearly established. In the future, a better understanding of gut microbiome could have implications for developing microbiome-based prevention, diagnostics and therapies.
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Affiliation(s)
- Yaohui Wei
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sufang Peng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng Lian
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Kang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jue Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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12
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Calvo-Rivera MP, Navarrete-Páez MI, Bodoano I, Gutiérrez-Rojas L. Comorbidity Between Anorexia Nervosa and Depressive Disorder: A Narrative Review. Psychiatry Investig 2022; 19:155-163. [PMID: 35330562 PMCID: PMC8958208 DOI: 10.30773/pi.2021.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Anorexia nervosa (AN) is a disorder with a significantly high prevalence. Affective disorders, including depressive disorder (DD), often coexist with this eating disorder (ED). In this review we will focus on its prevalence, associated vulnerability factors, clinical manifestations, possible etiological factors and its prognosis. METHODS A bibliographic search was carried out in the PubMed database selecting those articles that approached the subject of comorbidity between AN and DD. The search was limited to articles published from January 1990 to December 2021. RESULTS Of the 1891 abstracts reviewed, 33 studies met inclusion criteria. The prevalence of this comorbidity was extremely variable between studies, which exposed their heterogeneity. As to symptomatology this comorbidity presents itself with more severity, greater expression of psychological traits and greater cognitive impairment. Certain personality traits are postulated as vulnerability factors. Genetic factors such as neurochemicals seem to be involved in its pathogenesis. CONCLUSION The comorbidity between DD and ED have important influence in its symptomatic expression, severity and prognosis. Some of the analyzed studies provide consistent data, but there are others that are contradictory. It would be necessary to increase the number of studies and use a unified methodology.
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Affiliation(s)
| | | | - Isabel Bodoano
- Psychiatry Service, Hospital Virgen de las Nieves, Granada, Spain
| | - Luis Gutiérrez-Rojas
- Psychiatry Service, Hospital Universitario San Cecilio, Granada, Spain.,Department of Psychiatry, University of Granada, Granada, Spain
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13
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Dolan SC, Khindri R, Franko DL, Thomas JJ, Reilly EE, Eddy KT. Anhedonia in eating disorders: A meta-analysis and systematic review. Int J Eat Disord 2022; 55:161-175. [PMID: 34811779 DOI: 10.1002/eat.23645] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Anhedonia, or loss of pleasure, is related to deficits in reward processing across a variety of psychiatric disorders. In light of research suggesting abnormal reward processing in eating disorders (EDs), the study of anhedonia in EDs may yield important insights into the role of reward in eating pathology. This meta-analysis and review aimed to provide both a quantitative and qualitative synthesis of the existing literature on this topic. METHOD We conducted this research (or these meta-analyses) according to PRISMA guidelines. We searched four databases for both peer-reviewed and unpublished literature, and included studies only if a self-report or clinical interview measure of anhedonia was administered to a sample with an ED diagnosis. RESULTS We included 21 studies in the systematic review, and 10 studies in two meta-analyses that compared anhedonia between ED and control samples (n = 9 studies) and within different ED diagnoses (n = 5 studies). Meta-analyses revealed that anhedonia was significantly higher in ED groups compared to healthy controls, but there was no significant difference in anhedonia between ED diagnostic groups. A qualitative review of the literature also suggested that anhedonia may be correlated with increased ED symptom severity. DISCUSSION Findings indicated that anhedonia is elevated in EDs and may be a relevant treatment target. Future research should examine how self-reported anhedonia may correlate with components of reward processing in EDs in order to improve theoretical models as well as targeted interventions.
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Affiliation(s)
- Sarah C Dolan
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Ruchika Khindri
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Debra L Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Erin E Reilly
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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14
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Inpatient Weight Restoration Treatment Is Associated with Decrease in Post-Meal Anxiety. J Pers Med 2021; 11:jpm11111079. [PMID: 34834431 PMCID: PMC8621034 DOI: 10.3390/jpm11111079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: Anorexia nervosa (AN) is characterized by weight loss, distorted body image with fear of becoming fat and associated with anxiety, especially in relation to food intake. Anxiety in relation to meals and weight restoration remains a major challenge in the treatment of AN. We examined the effects of inpatient weight restoration treatment on levels of post-meal anxiety using visual analogue scale (VAS) ratings in patients with AN. Materials: Thirty-two patients with AN, all part of the PROspective Longitudinal all-comer inclusion study on Eating Disorders (PROLED) were followed over eight weeks with baseline psychometric measures and weekly VAS anxiety self-scoring. Methods: Apart from the weekly body mass index (BMI) and VAS, patients were characterized at baseline using the Eating Disorder Examination Questionnaire (EDE-Q), Eating Disorder Inventory (EDI), Symptom Check List 92 (SCL-92), Major Depression Inventory (MDI), and Autism Quotient (AQ). Results: The results showed a significant time effect, Wilks Lambda = 0.523, F = 3.12, p < 0.05 (power of 0.862), indicating a reduction in VAS scores of anxiety from baseline to week 8. There was no effect of baseline medication or scores of MDI on the results. BMI increased from a mean of 15.16 (week 1) to 17.35 (week 8). In comparison, patients dropping out after only three weeks (n = 31) also had a trend toward a reduction in VAS anxiety (ns). Conclusions: Inpatient weight restoration treatment is associated with a decrease in post-meal anxiety in AN, an effect that occurs early and becomes clinically significant in patients who stay in treatment.
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15
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Pedram P, Patten SB, Bulloch AGM, Williams JVA, Dimitropoulos G. Self-Reported Lifetime History of Eating Disorders and Mortality in the General Population: A Canadian Population Survey with Record Linkage. Nutrients 2021; 13:3333. [PMID: 34684334 PMCID: PMC8538567 DOI: 10.3390/nu13103333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 02/04/2023] Open
Abstract
Eating disorders (EDs) are often reported to have the highest mortality of any mental health disorder. However, this assertion is based on clinical samples, which may provide an inaccurate view of the actual risks in the population. Hence, in the current retrospective cohort study, mortality of self-reported lifetime history of EDs in the general population was explored. The data source was the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), linked to a national mortality database. The survey sample was representative of the Canadian household population (mean age = 43.95 years, 50.9% female). The survey inquired about the history of professionally diagnosed chronic conditions, including EDs. Subsequently, the survey dataset was linked to the national mortality dataset (for the date of death) up to 2017. Cox proportional hazards models were used to explore the effect of EDs on mortality. The unadjusted-hazard ratio (HR) for the lifetime history of an ED was 1.35 (95% CI 0.70-2.58). However, the age/sex-adjusted HR increased to 4.5 (95% CI 2.33-8.84), which was over two times higher than age/sex-adjusted HRs for other mental disorders (schizophrenia/psychosis, mood-disorders, and post-traumatic stress disorder). In conclusion, all-cause mortality of self-reported lifetime history of EDs in the household population was markedly elevated and considerably higher than that of other self-reported disorders. This finding replicates prior findings in a population-representative sample and provides a definitive quantification of increased risk of mortality in EDs, which was previously lacking. Furthermore, it highlights the seriousness of EDs and an urgent need for strategies that may help to improve long-term outcomes.
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Affiliation(s)
- Pardis Pedram
- Department of Psychiatry, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- Mathison Centre for Mental Health Research & Education, Foothills Medical Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (S.B.P.); (A.G.M.B.)
- Hotchkiss Brain Institute, University of Calgary Foothills, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Scott B. Patten
- Mathison Centre for Mental Health Research & Education, Foothills Medical Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (S.B.P.); (A.G.M.B.)
- Hotchkiss Brain Institute, University of Calgary Foothills, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- O’Brien Institute for Public Health, University of Calgary Foothills, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Cuthbertson & Fischer Chair in Pediatric Mental Health, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Andrew G. M. Bulloch
- Mathison Centre for Mental Health Research & Education, Foothills Medical Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (S.B.P.); (A.G.M.B.)
- Hotchkiss Brain Institute, University of Calgary Foothills, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- O’Brien Institute for Public Health, University of Calgary Foothills, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Jeanne V. A. Williams
- Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
| | - Gina Dimitropoulos
- Department of Psychiatry, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- Mathison Centre for Mental Health Research & Education, Foothills Medical Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (S.B.P.); (A.G.M.B.)
- Hotchkiss Brain Institute, University of Calgary Foothills, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- O’Brien Institute for Public Health, University of Calgary Foothills, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Faculty of Social Work, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
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16
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Dissociation and Suicidality in Eating Disorders: The Mediating Function of Body Image Disturbances, and the Moderating Role of Depression and Anxiety. J Clin Med 2021; 10:jcm10174027. [PMID: 34501475 PMCID: PMC8432476 DOI: 10.3390/jcm10174027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/22/2022] Open
Abstract
In patients with eating disorders (EDs), elevated dissociation may increase the risk of suicide. Bodily related disturbances, depression, and anxiety may intervene in the association between dissociation and suicidality. In this study we aimed to examine the influence of bodily related disturbances, depression, anxiety, severity of ED symptoms, body mass index (BMI), and type and duration of the ED on the relationship between elevated dissociation and elevated suicidality. The study included 172 inpatients: 65 with anorexia nervosa restricting type, 60 with anorexia nervosa binge/purge type, and 37 with bulimia nervosa. Participants were assessed using self-rating questionnaires for dissociation, suicidality, bodily related parameters, and severity of ED symptomatology, depression, and anxiety. We found that dissociation and suicidality were directly associated. In addition, depression and anxiety moderated the mediating role of body image parameters in the association between increased dissociation and increased suicidality. Thus, only in inpatients with high depression and anxiety, i.e., above the median range, body image disturbances were found to mediate the association between dissociation and suicidality. ED-related parameters did not moderate these relationships. Our study demonstrates that in inpatients with EDs, increased dissociation may be significantly associated with increased suicidality, both directly and via the intervening influence of body image, depression, and anxiety.
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17
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Riquin E, Raynal A, Mattar L, Lalanne C, Hirot F, Huas C, Duclos J, Berthoz S, Godart N. Is the Severity of the Clinical Expression of Anorexia Nervosa Influenced by an Anxiety, Depressive, or Obsessive-Compulsive Comorbidity Over a Lifetime? Front Psychiatry 2021; 12:658416. [PMID: 34279519 PMCID: PMC8280337 DOI: 10.3389/fpsyt.2021.658416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/29/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: The relationship between anxiety or depressive comorbidities, their chronology of onset, and the severity of anorexia nervosa (AN) is not well-studied. We hypothesize that the existence of a comorbidity, particularly before the onset of AN, is associated with greater severity of AN. Methods: One hundred seventy-seven subjects were assessed. The prevalence of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and social phobia (SP) as well as their chronology of onset were studied. The assessment criteria of AN severity were the overall clinical condition, body mass index (BMI) on admission, lowest BMI, intensity of the eating symptoms, age at the onset of AN, illness duration, number of hospitalizations, and quality of life. Results: Patients with AN had the greatest clinical severity when they had a comorbid disorder over their lifetime, such as MDD, GAD, or SP. These comorbidities along with OCD were associated with a higher level of eating symptoms and a more altered quality of life. A profile of maximum severity was associated with a higher prevalence of MDD and GAD. Concerning the chronology of onset, the age at the start of AN was later in cases of MDD or GAD prior to AN. Conclusion: There seems to be an association between severity of AN and both MDD and GAD. The chronology of onset of the comorbidity did not seem to be associated with the severity.
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Affiliation(s)
- Elise Riquin
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire d'Angers [Angers University Hospital], Angers, France
- Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France
- Adolescent and Young Adult University Hospital Department of the Health Foundation of Students of France, Centre Pierre Daguet, Sablé-sur-Sarthe, France
| | - Agathe Raynal
- Department of Child and Adolescent Psychiatry, CH du Rouvray-CHU de Rouen, Rouen, France
| | - Lama Mattar
- Nutrition Division, Department of Natural Sciences, School of Arts and Sciences-Lebanese American University, Beirut, Lebanon
| | - Christophe Lalanne
- Université Paris Diderot [Paris Diderot University], Paris Sorbonne Cité, Paris, France
| | - France Hirot
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], Paris, France
- Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
| | - Caroline Huas
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], Paris, France
- Adolescent and Young Adult University Hospital Department of the Health Foundation of Students of France, Paris, France
| | - Jeanne Duclos
- Univ. Lille, CNRS, CHU Lille, UMR 9193—SCALab—Cognitive and Affective Sciences, Lille, France
- Hôpital Saint Vincent de Paul, GHICL, Département de Psychiatrie, Paris, France
| | - Sylvie Berthoz
- Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
- Univ. Bordeaux INCIA CNRS UMR 5287, Bordeaux, France
| | - Nathalie Godart
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], Paris, France
- Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
- Adolescent and Young Adult University Hospital Department of the Health Foundation of Students of France, Paris, France
- UFR des Sciences de la Santé Simone Veil [Simone Veil Health Science Training and Research Unit], Université de Versailles Saint-Quentin-en-Yvelines [Versailles Saint-Quentin-en-Yvelines University], Versailles, France
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18
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Lin JA, Jhe G, Vitagliano JA, Milliren CE, Spigel R, Woods ER, Forman SF, Richmond TK. The Association of Malnutrition, illness duration, and pre-morbid weight status with anxiety and depression symptoms in adolescents and young adults with restrictive eating disorders: a cross-sectional study. J Eat Disord 2021; 9:60. [PMID: 34001260 PMCID: PMC8127488 DOI: 10.1186/s40337-021-00415-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/28/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Restrictive eating disorders (EDs) are often comorbid with anxiety and depression symptoms, placing patients at risk for more severe disease, worse treatment outcomes, and higher rates of mortality. To identify risks for developing such co-morbidities, we assessed the association of malnutrition, ED illness duration, and pre-morbid weight status with symptoms of anxiety and depression in adolescents/young adults (AYAs) with EDs. METHODS 145 participants with restrictive EDs (anorexia nervosa [AN], other specified feeding and eating disorders [OSFED], avoidant restrictive food intake disorder [ARFID]) were included from the RECOVERY study, a longitudinal web-based registry of AYAs with EDs. We measured malnutrition as percent of expected body mass index (%eBMI), based on participants' pre-morbid growth trajectory. Outcomes were anxiety and depression scores from the Generalized Anxiety Disorder 7-item (GAD-7) and Center for Epidemiologic Studies Depression (CES-D) scales. We used multiple linear regression to examine the association of malnutrition, ED duration, and pre-morbid weight status with symptoms of anxiety and depression. RESULTS Mean (SD) age was 16.4(3.0) years; 87% were female; 89% white; 85% had AN, 6% OSFED, 10% ARFID. Of these, 2/3 had ED symptoms ≥1 year, 1/3 had previous higher level of ED care (HLOC), and half were taking psychiatric medications. Mean %eBMI was 90% (range 57-112%). Mean GAD-7 was 9.4(5.9) and CES-D was 24(13.8), indicating most participants had clinically significant anxiety and/or depression. Degree of malnutrition was not significantly associated with anxiety or depression adjusting for age, sex, sexual orientation, ED diagnosis, and use of psychiatric medication. Those with longer duration of ED symptoms had higher depression scores after adjusting for malnutrition, HLOC, length of ED symptoms, and time in our care (p = 0.038). Patients with pre-morbid BMIs ≥75th percentile had lower depression scores than those with pre-morbid BMIs <75th percentile (p = 0.014). CONCLUSIONS We find high degree of clinically relevant anxiety and depression symptoms in a population of AYAs with EDs. Our findings suggest that factors beyond malnutrition play a role in the co-morbid mood and anxiety disorders in this population. Overall, rapid ED diagnosis and comprehensive treatment for patients with EDs across the weight spectrum-and especially those with psychiatric co-morbidities-will likely aid in recovery.
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Affiliation(s)
- Jessica A Lin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Grace Jhe
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Julia A Vitagliano
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Rebecca Spigel
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Sara F Forman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Tracy K Richmond
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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19
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Comparison between inpatients with anorexia nervosa with and without major depressive disorder: Clinical characteristics and outcome. Psychiatry Res 2021; 297:113734. [PMID: 33486276 DOI: 10.1016/j.psychres.2021.113734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/14/2021] [Indexed: 11/22/2022]
Abstract
Anorexia Nervosa (AN) and Major Depressive Disorder (MDD) are frequent comorbid conditions. It is unclear how MDD affects intensive emergency treatment and outcome. Eighty-seven AN inpatients were analyzed, twenty-two suffered also from MDD. Individuals with AN and MDD at admission had no remarkable differences in psychopathology, but a full diagnosis of MDD - and not just the presence of depressive symptoms - was associated with longer length of stay and worse clinical outcome (weight restoration, increase of caloric intake). Health care policies might consider that MDD comorbidity, regardless of AN clinical severity, affects the efficacy and timing of acute treatments.
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Muthuvattur Pallath M, Ahirwar AK, Chandra Tripathi S, Asia P, Sakarde A, Gopal N. COVID-19 and nutritional deficiency: a review of existing knowledge. Horm Mol Biol Clin Investig 2021; 42:77-85. [PMID: 33544528 DOI: 10.1515/hmbci-2020-0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/20/2021] [Indexed: 12/22/2022]
Abstract
COVID-19 has resulted in an ongoing global pandemic, which spread largely among people who have had close contact with the infected person. The immunopathology of the SARS-CoV-2 virus includes the production of an excess amount of pro-inflammatory cytokines "a cytokine-storm". The respiratory system (main), cardiovascular system and the gastrointestinal tract are the most affected body systems during viral infection. It has been found that most of the patients who require admission to hospital are elderly or have chronic underlying diseases. Higher cases of malnutrition and co-morbidities like diabetes mellitus and cardiovascular diseases are reported in elderly patients due to which, the immune system weakens and hence, the response to the virus is diminished in magnitude. A deficiency of micronutrients results in impaired immune responses leading to improper secretion of cytokines, alterations in secretory antibody response and antibody affinity which increases susceptibility to viral infection. The deficiency of various micronutrients in COVID-19 patient can be treated by appropriate nutritional supplements, prescribed after evaluating the patients' nutritional status. Here we aim to highlight the role of a few particular nutrients namely Vitamin D, Vitamin C, Omega-3 fatty acids, Zinc and Magnesium along with the synergistic roles they play in enhancing immunity and thus, maintaining homeostasis.
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Affiliation(s)
| | - Ashok Kumar Ahirwar
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | | | - Priyanka Asia
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Apurva Sakarde
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Niranjan Gopal
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
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21
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Nutritional status and anxious and depressive symptoms in anorexia nervosa: a prospective study. Sci Rep 2021; 11:771. [PMID: 33436652 PMCID: PMC7804178 DOI: 10.1038/s41598-020-79410-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
The interweaving of malnutrition and symptoms of anxiety and depression in anorexia Nervosa (AN) is mentioned without any consensus regarding the course of anxious-depressive symptoms in relation to nutritional status in the course of treatment of patients with AN. The objectives of the current study in a large sample of AN inpatients were to assess the relationships between anxiety and depression symptoms and nutritional status both over the course of inpatient treatment and at discharge. 222 consecutive inpatients with AN (DSM-IV TR) were assessed (entrance and discharge) for duration of illness, psychiatric treatments, sociodemographic data and with psychometric scales for different psychopathological symptoms [depressive (BDI), anxiety and depressive (HAD scale), obsessive-compulsive (MOCI) and social phobia (LSAS fear score)]. Nutritional status was assessed with Body Mass Index (BMI) and body composition by bioelectrical impedance. The Fat free mass index [FFMI = FFM (kg)/height (m2)] was considered for the analysis. Two models were developed where the dependent variables were each psychopathological score at discharge (BDI, HAD anxiety, MOCI, and LSAS fear) in the cross-sectional model, and their variation in the longitudinal model (where a positive score reflected symptom decrease at discharge). A fixed set of predictors, defined on presumed clinical and statistical relevance (FFMI in the cross-sectional model and Variation of FFMI in the longitudinal model), were considered in each model, without any model selection procedure. This is the first study to confirm a positive relationship between the course of eating disorder symptoms and that of anxious-depressive symptoms during inpatient treatment of AN even after adjustment on a vast array of possibly confounding factors.
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22
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The challenges of keeping psychiatric patients safe in rehabilitation centers during coronavirus outbreak. Arch Psychiatr Nurs 2020; 34:580-581. [PMID: 33280683 PMCID: PMC7370907 DOI: 10.1016/j.apnu.2020.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/04/2020] [Accepted: 07/17/2020] [Indexed: 11/20/2022]
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23
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[Comorbid major depressive disorder of anorexia nervosa in adolescence: A scoping review of treatment strategies]. Encephale 2020; 47:72-78. [PMID: 32933763 DOI: 10.1016/j.encep.2020.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/28/2020] [Accepted: 05/17/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Psychiatric comorbidities are frequent in anorexia nervosa, with the highest rate of suicidal lethality among psychiatric disorders. Major depressive disorder is one of the most life-threatening comorbidities of anorexia nervosa, exacerbating the risk of suicide, aphagia, and pervasive refusal syndrome. The aim of this study is to conduct a systematic review of studies exploring strategies for the treatment of severe depression in the acute phase of anorexia nervosa in adolescence. METHODS We conducted a scoping review of the publications dealing with the treatment of depressive comorbidities in adolescents suffering from anorexia nervosa published between 2005 and 2019. An electronic search in Pubmed and Medline for relevant studies used the following keywords adolescent, youth, anorexia nervosa, depress*, suicide*, "melancholic depression", treat*, therapy*, care. Included studies were dealing with 10-18-year-old inpatient or outpatient adolescents presenting an anorexia nervosa complicated by a major depressive disorder. RESULTS Of 562 studies identified, eight were included in the final sample. Regarding psychiatric treatments, four studies concerned the prescription of antidepressants, one case-study was described a treatment by electroconvulsive therapy and another was dealt with light therapy. Finally, the two last studies evaluated the effect of nutritional treatment on psychiatric symptoms but found no significant direct association between weight gain and improvement of depressive symptoms. DISCUSSION There is a need to identify faster severe depressive disorders in adolescents with anorexia nervosa in order to provide, along with refeeding, a more intensive treatment of mood symptoms. A multidisciplinary and coordinated approach must be initiated at the beginning of the trouble. There is a need for more systematic studies on the therapeutic approaches of mood disorder comorbidities in adolescents suffering from anorexia nervosa.
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24
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Price T, Zebitz M, Giraldi A, Lokind TS, Treasure J, Sjögren JM. Sexual function and dysfunction among women with anorexia nervosa: A systematic scoping review. Int J Eat Disord 2020; 53:1377-1399. [PMID: 32449544 DOI: 10.1002/eat.23299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research suggests that a variety of biological and psychosocial factors are associated with the sexual health of women diagnosed with anorexia nervosa (AN). This systematic scoping review, conducted in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines, synthesizes the current literature concerning sexual function and dysfunction in women with AN. METHOD We searched PubMed, EMBASE, and PsychInfo for literature published until April 2020. All study designs were eligible for inclusion, providing they focused on sexual function and dysfunction in women with AN. Studies that only included outcomes related to gender identity or sexual orientation were excluded. RESULTS N = 28 studies met criteria for inclusion in the review. All studies were conducted in Western countries and the majority employed either a cohort or cross-sectional design. Although measures of sexual function and dysfunction varied markedly across studies, most studies adopted a biopsychosocial framework. Libido may be linked to body mass index (BMI), while other aspects of sexual functioning and behavior might not be specifically associated with weight status. Limited data are available on evidence-based interventions. DISCUSSION Sexual dysfunction in women with AN is common. Although some of the variance is explained by low BMI, associated physiological sequelae and other psychosocial factors are also involved. Sexual dysfunction is a relevant clinical problem and clinicians should sensitively incorporate questions related to sexual function into their eating disorder assessments. Future research, using more robust designs and validated outcome measures, is needed to better understand causal pathways between the biological and psychosocial correlates of AN and sexual dysfunction. Identifying predictors of sexual function and dysfunction in more diverse groups of people with AN will support the development of evidence-based therapies.
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Affiliation(s)
- Tom Price
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Martin Zebitz
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Rigshospitalet Capitol Region of Denmark Psychiatry Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thea Stine Lokind
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Jan Magnus Sjögren
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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25
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Binge eating and social anxiety in treatment-seeking adolescents with eating disorders or severe obesity. Eat Weight Disord 2020; 25:787-793. [PMID: 31020481 DOI: 10.1007/s40519-019-00689-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/09/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Binge eating is a common behavior in children and adolescents who suffer from either eating disorders (EDs) or from severe obesity. The purpose of the current study was to explore the association between social anxiety and binge eating and compare prevalence rates of social anxiety between youth with severe obesity or EDs who did or did not engage in binge eating. METHODS Retrospective data on treatment-seeking youth's (n = 490) eating behaviors and social anxiety at assessment were analyzed. RESULTS Results indicate that those who engage in binge eating have higher rates of social anxiety; frequency of binges does not predict severity of social anxiety, though social anxiety predicts presence of binge eating. Adolescents with EDs had higher rates of social anxiety than those with obesity, and for both groups, rates of social anxiety were highest in those who binge. CONCLUSIONS Clinicians who treat youth with EDs and with obesity should be aware of the relationship between binge eating and social anxiety and of the need for treatment to address both these disorders. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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26
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Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr 2020; 74:871-875. [PMID: 32322046 PMCID: PMC7175450 DOI: 10.1038/s41430-020-0642-3] [Citation(s) in RCA: 218] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES To evaluate the prevalence of malnutrition and its related factors in elderly patients with COVID-19 in Wuhan, China. SUBJECTS/METHODS In a cross-sectional study, we evaluated the nutritional status of elderly inpatients with COVID-19 using the Mini Nutritional Assessment (MNA). Based on MNA scores, patients were divided into non-malnutrition group (MNA ≥ 24), the group with risk of malnutrition (MNA 17-23.5) and malnutrition group (MNA score < 17). Regression analysis was conducted to screen for risk factors for malnutrition. RESULTS A total of 182 patients were included in the study, of which 27.5% were in the group with malnutrition risk and 52.7% were in the malnutrition group. There were statistical differences in the incidence of comorbid diabetes mellitus, body mass index (BMI), calf circumference,albumin, hemoglobin, and lymphocyte counts among the three groups. Further regression analysis suggested that combined diabetes, low calf circumference, and low albumin were independent risk factors for malnutrition. CONCLUSIONS The prevalence of malnutrition in elderly patients with COVID-19 was high, and nutritional support should be strengthened during treatment, especially for those with diabetes mellitus, low calf circumference, or low albumin.
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27
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Marzola E, Porliod A, Panero M, De-Bacco C, Abbate-Daga G. Affective temperaments and eating psychopathology in anorexia nervosa: Which role for anxious and depressive traits? J Affect Disord 2020; 266:374-380. [PMID: 32056902 DOI: 10.1016/j.jad.2020.01.142] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/09/2019] [Accepted: 01/25/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a severe mental illness. Personality traits and comorbidity with affective and anxiety disorders are key-aspects of its pathogenesis but little attention has been paid so far to affective temperaments in AN. Also, childhood anxiety is proposed to impact on AN clinical severity. Therefore, we aimed to investigate if affective temperaments could be related to AN eating psychopathology also clarifying if those with low versus high scores on depressive and anxious temperaments could differ in AN clinical current and lifetime severity. METHODS One-hundred and forty-seven inpatients with AN were consecutively recruited. All participants completed: Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire, Eating Disorder Examination Questionnaire, State Trait Anxiety Inventory, Beck Depression Inventory. Clinical data were collected upon admission. RESULTS Regression models showed that all affective temperaments were associated with eating psychopathology (eating restraint and eating, shape, and weight concerns); however, when controlling for confounders, only the anxious temperament remained significant. Also, those patients with higher scores on depressive and anxious temperaments reported higher current and lowest lifetime body mass index (BMI). LIMITATIONS Only inpatients were recruited; self-report assessments were used and follow-up data are lacking. CONCLUSIONS Results from this study support the association between affective (anxious in particular) temperament traits and the presence of altered eating psychopathology in AN. Also, higher traits of depressive and anxious temperaments reported higher current and lowest lifetime BMI. Should these findings be confirmed, the assessment of the anxious temperament could fruitfully inform prevention and treatment interventions for AN.
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Affiliation(s)
- Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Alain Porliod
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Matteo Panero
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Carlotta De-Bacco
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
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28
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Paszynska E, Dmitrzak-Weglarz M, Roszak M, Boucher Y, Dutkiewicz A, Tyszkiewicz-Nwafor M, Gawriolek M, Otulakowska-Skrzynska J, Rzatowski S, Slopien A. Salivary opiorphin levels in anorexia nervosa: A case-control study. World J Biol Psychiatry 2020; 21:212-219. [PMID: 30179071 DOI: 10.1080/15622975.2018.1517948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives: Opiorphin is a physiological inhibitor of peptidases inactivating endogenous opioids displaying strong analgesic properties without undesirable side effects, antidepressant properties or hormonal dependency. It might therefore play an important role in patients with painful diseases related to neuro-hormonal dysregulation of the nervous system, affecting saliva secretion and composition such as anorexia nervosa (AN). The main objective aim of this study was to compare the level of opiorphin in saliva of patients with AN to matched subjects free of eating disorders.Methods: A case-control clinical trial was conducted in 68 AN patients and 43 healthy matched control subjects. Depression symptoms were assessed with the self-scored questionnaire Beck Depression Inventory (BDI) and salivary samples were taken during the acute stage of AN (BMI <15 kg/m2) for measuring opiorphin. Opiorphin levels were measured with a quantitative assay using a commercial immunoenzymatic Elisa kit (cat no. EH1927, Wuchan, Hubei, China).Results: No statistically significant difference was found in salivary opiorphin levels between the AN and control groups, (P = 0.499, Mann-Whitney U-test). Positive correlations to duration of the disease, BDI and bodyweight in AN patients were evidenced.Conclusions: Measurement of salivary opiorphin levels cannot be used as a marker of AN but may allow new perspectives in monitoring AN in its early stages.
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Affiliation(s)
- Elzbieta Paszynska
- Department of Integrated Dentistry, Poznan University of Medical Sciences (PUMS), Poznań, Poland
| | | | - Magdalena Roszak
- Department of Computer Science and Statistics, PUMS, Poznań, Poland
| | - Yves Boucher
- Groupe Hospitalier Pitié Salpêtrière, UFR Odontologie Université Paris Diderot, Paris, France
| | - Agata Dutkiewicz
- Department of Child and Adolescent Psychiatry, PUMS, Poznań, Poland
| | | | - Maria Gawriolek
- Department of Integrated Dentistry, Poznan University of Medical Sciences (PUMS), Poznań, Poland
| | | | - Szymon Rzatowski
- Department of Integrated Dentistry, Poznan University of Medical Sciences (PUMS), Poznań, Poland
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Abstract
OBJECTIVE Assessment of mood in eating disorders (EDs) has important clinical implications, but the current standard psychiatric classification (DSM-5) has limitations. The aim of the current study is to broaden the evaluation of depressive symptomatology by providing a comprehensive and innovative assessment approach in EDs through instruments that capture clinical phenomena of demoralization, subclinical distress, and psychological well-being. METHODS Seventy-nine patients who met diagnostic criteria for EDs of the Diagnostic and Statistical Manual of Mental Disorders - Fifth edition (DSM-5) were evaluated for depressive symptoms through Paykel's Clinical Interview for Depression, the Structured Clinical Interview for DSM-5 for major depressive episode and persistent depressive disorder, and the Diagnostic Criteria for Psychosomatic Research (DCPR) interview for demoralization. Further, self-report inventories encompassing psychological well-being and distress were used. RESULTS Guilt, abnormal reactivity to social environment, and depressed mood were the most common depressive symptoms in the sample. DSM-defined depressive disorders were found in 55.7% of patients. The DCPR-demoralization criteria identified an additional 20.3% of the sample that would have been undetected with DSM criteria. Both DSM and DCPR diagnostic categories were associated with compromised psychological well-being and distress. Demoralization, unlike depression, was not associated with the severity of ED symptomatology. CONCLUSION The findings indicate that a standard psychiatric approach, DSM-5-based, captures only a narrow part of the spectrum of mood disturbances affecting patients with EDs. A broadened clinimetric assessment unravels the presence of demoralization and yields clinical distinctions that may entail prognostic and therapeutic differences among patients who would be otherwise simply labeled as depressed.
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30
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Spettigue W, Norris ML, Douziech I, Henderson K, Buchholz A, Valois DD, Hammond NG, Obeid N. Feasibility of Implementing a Family-Based Inpatient Program for Adolescents With Anorexia Nervosa: A Retrospective Cohort Study. Front Psychiatry 2019; 10:887. [PMID: 31849732 PMCID: PMC6901823 DOI: 10.3389/fpsyt.2019.00887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Manualized Family Based Therapy (FBT) is the treatment of choice for adolescent anorexia nervosa, but it is an outpatient treatment. Very little research has examined whether or how the principles of FBT might be successfully adapted to an inpatient setting, and there is little other evidence in the literature to guide us on how to best treat children and adolescents with eating disorders (EDs) while in hospital. This paper describes and provides treatment outcomes for an intensive inpatient program that was designed for the treatment of adolescents less than 18 years of age with severe anorexia nervosa, based on the principles of FBT. Each patient's family was provided with FBT adapted for an inpatient setting for the duration of the admission. Parents were encouraged to provide support for all meals in hospital and to plan meal passes out of hospital. Methods: A retrospective cohort study was conducted that examined the outcomes of 153 female patients admitted over a 5-year period. Outcome data focused primarily on weight change as well as psychological indicators of health (i.e., depression, anxiety, ED psychopathology). Results: Paired t-tests with Bonferroni corrections showed significant weight gain associated with a large effect size. In addition, patients showed improvements in scores of mood, anxiety, and ED psychopathology (associated with small to medium effect sizes), though they continued to display high rates of body dissatisfaction and some ongoing suicidality at the time of discharge. Conclusion: This study shows that a specialized inpatient program for adolescents with severe EDs that was created using the principles of FBT results in positive short-term medical and psychological improvements as evidenced by improved weight gain and decreased markers of psychological distress.
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Affiliation(s)
- Wendy Spettigue
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Mark L. Norris
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Ingrid Douziech
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | | | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Darcie D. Valois
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicole G. Hammond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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31
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Cornelissen KK, Widdrington H, McCarty K, Pollet TV, Tovée MJ, Cornelissen PL. Are attitudinal and perceptual body image the same or different? Evidence from high-level adaptation. Body Image 2019; 31:35-47. [PMID: 31430603 DOI: 10.1016/j.bodyim.2019.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 12/16/2022]
Abstract
We used a high-level adaptation paradigm to distinguish between two hypotheses: (1) perceptual and attitudinal body image measurements reflect conceptually different mechanisms which are statistically independent of each other; (2) attitudinal (e.g., questionnaire) and perceptual (e.g., visual yes-no) body image tasks represent two different ways of measuring exactly the same construct. Forty women, with no history of eating disorders, carried out the experiment. Each participant carried out five adaptation blocks, with adapting stimuli representing female bodies at: extreme-low body mass index (BMI), mid-low BMI, actual BMI of the observer, mid-high BMI, and extreme-high BMI. Block order was randomized across participants. The main outcome variable was percentage error in participants' self-estimates of body size, measured post-adaption. In regressions of this percentage error on the strength of the adapting stimuli together with observers' attitudinal body image as a covariate, we found positive regression slopes and no evidence for any interaction between the fixed effects. Therefore, we conclude that perceptual and attitudinal body image mechanisms are indeed independent of each other. In the light of this evidence, we discuss how people with eating disorders, like anorexia nervosa, may come to over-estimate their body size.
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Affiliation(s)
- Katri K Cornelissen
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Helena Widdrington
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Kristofor McCarty
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Thomas V Pollet
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Martin J Tovée
- School of Psychology, College of Social Science, University of Lincoln, Lincolnshire, LN6 7TS, UK
| | - Piers L Cornelissen
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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32
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Voderholzer U, Hessler-Kaufmann JB, Lustig L, Läge D. Comparing severity and qualitative facets of depression between eating disorders and depressive disorders: Analysis of routine data. J Affect Disord 2019; 257:758-764. [PMID: 31400734 DOI: 10.1016/j.jad.2019.06.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/03/2019] [Accepted: 06/29/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND While it is know that depressive symptoms are common in eating disorders (EDs), it is unclear whether these symptoms differ from those in depressive disorders (DDs) with regard to severity and quality. METHODS Beck Depression Inventory II (BDI-II) scores at admission to treatment of 4.895 inpatients with a unipolar DD and 3.302 inpatients with an ED were compared by means of independent t-tests and Cohen's d effect sizes with regard to: (1) overall severity (BDI-II total score), (2) six facets of depression identified by non-metric multidimensional scaling of the German BDI-II validation sample, and (3) individual items. RESULTS (1) The two groups did not differ with regard to the BDI-II total score. (2) There was no difference in the facet Depressive Core Symptoms. Patients with DDs had higher scores for Diminished Activation (d = 0.40) and patients with EDs had higher scores for Negative View of Self (d = 0.40). (3) Patients with DDs showed higher score on the item Loss of Energy (d = 0.48), while patients with EDs sored higher on Self-Dislike (d = 0.48) and Changes of Appetite (d = 0.48). CONCLUSIONS Depression in EDs seems to be as severe as in DDs and may show similar core aspects (e.g., Sadness, Loss of Pleasure). Qualitative differences suggested that individual additional symptoms of depression need to be differently addressed in therapy. The pronounced Negative View of Self in EDs is in line with the "core low self-esteem", a central component of the prevalent transdiagnostic model of EDs.
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Affiliation(s)
- Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien, Germany; Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Germany.
| | | | - Lukas Lustig
- Institute of Psychology, University of Zurich, Switzerland.
| | - Damian Läge
- Institute of Psychology, University of Zurich, Switzerland.
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33
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Nickel K, Tebartz van Elst L, Holovics L, Feige B, Glauche V, Fortenbacher T, Endres D, Zeeck A, Tüscher O, Joos A, Maier S. White Matter Abnormalities in the Corpus Callosum in Acute and Recovered Anorexia Nervosa Patients-A Diffusion Tensor Imaging Study. Front Psychiatry 2019; 10:490. [PMID: 31338044 PMCID: PMC6628864 DOI: 10.3389/fpsyt.2019.00490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 06/21/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: Severe malnutrition in patients with anorexia nervosa (AN) as well as possible trait-related aberrations lead to pronounced structural brain changes whose reversibility after recovery is currently unclear. Previous diffusion tensor imaging (DTI) studies investigating white matter (WM) microstructure alterations in AN are inconsistent. Methods: In this so far largest DTI study in adults, we investigated 33 AN patients, 20 recovered (REC), and 33 healthy women. DTI data were processed using the "DTI and Fiber tools," and the Computational Anatomy Toolbox. WM integrity, both in terms of fractional anisotropy (FA) and mean diffusivity (MD), was assessed. Results: We found a significant FA decrease in the corpus callosum (body) and an MD decrease in the posterior thalamic radiation in the AN group. The REC group displayed FA decrease in the corpus callosum in comparison to HC, whereas there were no MD differences between the REC and HC groups. Conclusion: Despite prolonged restoration of weight in the REC group, no significant regeneration of WM integrity in terms of FA could be observed. Transient changes in MD likely represent a reversible consequence of the acute state of starvation or result from dehydration. Reduction of FA either may be due to WM damage resulting from malnutrition or may be considered a pre-morbid marker.
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Affiliation(s)
- Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Holovics
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volkmar Glauche
- Department of Neurology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tina Fortenbacher
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University of Mainz, Mainz, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychotherapeutic Neurology, Kliniken Schmieder, Gailingen, Germany
| | - Simon Maier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Hanachi M, Dicembre M, Rives-Lange C, Ropers J, Bemer P, Zazzo JF, Poupon J, Dauvergne A, Melchior JC. Micronutrients Deficiencies in 374 Severely Malnourished Anorexia Nervosa Inpatients. Nutrients 2019; 11:nu11040792. [PMID: 30959831 PMCID: PMC6520973 DOI: 10.3390/nu11040792] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: Anorexia nervosa (AN) is a complex psychiatric disorder, which can lead to specific somatic complications. Undernutrition is a major diagnostic criteria of AN which can be associated with several micronutrients deficiencies. Objectives: This study aimed to determinate the prevalence of micronutrients deficiencies and to compare the differences between the two subtypes of AN (restricting type (AN-R) and binge-eating/purging type (AN-BP)). Methods: We report a large retrospective, monocentric study of patients hospitalized in a highly specialized nutrition unit between January 2011 and August 2017 for severe malnutrition treatment in the context of anorexia nervosa. Results: Three hundred and seventy-four patients (360 (96%) women, 14 (4%) men), age: 31.3 ± 12.9 years, Body Mass Index (BMI): 12.5 ± 1.7 kg/m2 were included; 253 (68%) patients had AN-R subtype while, 121 (32%) had AN-BP. Zinc had the highest deficiency prevalence 64.3%, followed by vitamin D (54.2%), copper (37.1%), selenium (20.5%), vitamin B1 (15%), vitamin B12 (4.7%), and vitamin B9 (8.9%). Patients with AN-BP type had longer disease duration, were older, and had a lower left ventricular ejection fraction (LVEF) (p < 0.001, p = 0.029, p = 0.009), when compared with AN-R type, patients who instead, had significantly higher Alanine Aminotransferase (ALT) and Brain Natriuretic Peptide (BNP) levels (p < 0.001, p < 0.021). In the AN-BP subgroup, as compared to AN-R, lower selenium (p < 0.001) and vitamin B12 plasma concentration (p < 0.036) were observed, whereas lower copper plasma concentration was observed in patients with AN-R type (p < 0.022). No significant differences were observed for zinc, vitamin B9, vitamin D, and vitamin B1 concentrations between the two types of AN patients. Conclusion: Severely malnourished AN patients have many micronutrient deficiencies. Differences between AN subtypes are identified. Micronutrients status of AN patients should be monitored and supplemented to prevent deficiencies related complications and to improve nutritional status. Prospective studies are needed to explore the symptoms and consequences of each deficiency, which can aggravate the prognosis during recovery.
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Affiliation(s)
- Mouna Hanachi
- Nutrition Unit, Raymond Poincaré University Hospital (Assistance Publique⁻Hôpitaux de Paris), 92380 Garches, France.
- Versailles Saint Quentin-en-Yvelines University, 78180 Montigny-le-Bretonneux, France.
| | - Marika Dicembre
- Nutrition Unit, Raymond Poincaré University Hospital (Assistance Publique⁻Hôpitaux de Paris), 92380 Garches, France.
| | - Claire Rives-Lange
- Nutrition Unit, Georges Pompidou University Hospital (Assistance Publique⁻Hôpitaux de Paris), 75015 Paris, France.
- Paris Descartes University, 75006 Paris, France.
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpêtrière University Hospital, (Assistance Publique⁻Hôpitaux de Paris, 75013 Paris, France.
| | - Pauline Bemer
- Nutrition Unit, Raymond Poincaré University Hospital (Assistance Publique⁻Hôpitaux de Paris), 92380 Garches, France.
| | - Jean-Fabien Zazzo
- Nutrition Unit, Raymond Poincaré University Hospital (Assistance Publique⁻Hôpitaux de Paris), 92380 Garches, France.
| | - Joël Poupon
- Laboratory of Biological Toxicology, Saint Louis⁻Lariboisiere, University Hospital Paris France, 75010 Paris, France.
| | - Agnès Dauvergne
- Laboratory of Biochemistry, Beaujon University Hospital (Assistance Publique⁻Hôpitaux de Paris), 92110 Clichy, France.
| | - Jean-Claude Melchior
- Nutrition Unit, Raymond Poincaré University Hospital (Assistance Publique⁻Hôpitaux de Paris), 92380 Garches, France.
- Versailles Saint Quentin-en-Yvelines University, 78180 Montigny-le-Bretonneux, France.
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Decline of Plasma Concentrations of Interleukin-18 in Severely Malnourished Patients with Anorexia Nervosa: Exploratory Analysis. Nutrients 2019; 11:nu11030540. [PMID: 30832404 PMCID: PMC6471691 DOI: 10.3390/nu11030540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/17/2022] Open
Abstract
Multiple studies on the dynamics of inflammatory cytokines in patients with anorexia nervosa (AN) have been published, although results are not consistent among reports. Thus the pathophysiologic roles of these cytokines are not clear. We performed an exploratory analysis that included (1) comparisons of plasma interleukin-18 (IL-18) concentrations between patients with AN (n = 21) and healthy controls (n = 39), and (2) correlations between body mass index (BMI) and IL-18 concentrations in both groups, exploring the relationship between malnourishment and IL-18. Plasma IL-18 levels were significantly decreased in patients with AN compared with controls. Plasma IL-18 levels correlated to BMI in controls, but not in patients with AN. These results suggest that a decline in plasma IL-18 levels in patients with AN is not only due to malnourishment, but other pathophysiologic changes as well. IL-18 has a role in the brain’s reaction to sadness and chronic stress. Therefore, decreased levels of IL-18 may commonly occur in patients with chronic AN.
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Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews. J Clin Med 2019; 8:jcm8020278. [PMID: 30823566 PMCID: PMC6406645 DOI: 10.3390/jcm8020278] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 12/12/2022] Open
Abstract
Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.
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Kezelman S, Crosby RD, Rhodes P, Hunt C, Anderson G, Clarke S, Touyz S. Anorexia Nervosa, Anxiety, and the Clinical Implications of Rapid Refeeding. Front Psychol 2018; 9:1097. [PMID: 30022961 PMCID: PMC6040228 DOI: 10.3389/fpsyg.2018.01097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/08/2018] [Indexed: 11/13/2022] Open
Abstract
The current study aimed to examine the temporal relationship between anxiety symptoms and weight gain for adolescents with anorexia nervosa over the course of an inpatient admission targeting weight restoration through rapid refeeding. Participants were 31 females presenting to a specialist inpatient unit. Psychometric assessments using standardized procedures were conducted to assess co-morbid anxiety diagnoses, and eating disorder symptom severity at admission and discharge. Study protocols were completed on a weekly basis over the course of their admission and were compared with weekly BMI change. Multiple mixed-effects linear models with random intercepts were used to assess change in weight status and psychological variables. Results indicated a reduction in anxiety over the course of hospitalization; however, there was no evidence to support a relationship between anxiety change and weight restoration. The clinical implications of these results are discussed and directions for future research recommended.
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Affiliation(s)
- Sarah Kezelman
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, ND, United States
- School of Medicine & Health Sciences, University of North Dakota, Fargo, ND, United States
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Gail Anderson
- Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Simon Clarke
- Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, NSW, Australia
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Frank GKW, Favaro A, Marsh R, Ehrlich S, Lawson EA. Toward valid and reliable brain imaging results in eating disorders. Int J Eat Disord 2018; 51:250-261. [PMID: 29405338 PMCID: PMC7449370 DOI: 10.1002/eat.22829] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/13/2018] [Accepted: 01/14/2018] [Indexed: 12/14/2022]
Abstract
Human brain imaging can help improve our understanding of mechanisms underlying brain function and how they drive behavior in health and disease. Such knowledge may eventually help us to devise better treatments for psychiatric disorders. However, the brain imaging literature in psychiatry and especially eating disorders has been inconsistent, and studies are often difficult to replicate. The extent or severity of extremes of eating and state of illness, which are often associated with differences in, for instance hormonal status, comorbidity, and medication use, commonly differ between studies and likely add to variation across study results. Those effects are in addition to the well-described problems arising from differences in task designs, data quality control procedures, image data preprocessing and analysis or statistical thresholds applied across studies. Which of those factors are most relevant to improve reproducibility is still a question for debate and further research. Here we propose guidelines for brain imaging research in eating disorders to acquire valid results that are more reliable and clinically useful.
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Affiliation(s)
- Guido K. W. Frank
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado,Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Angela Favaro
- Department of General Psychology, University of Padova, Padova, Italy
| | - Rachel Marsh
- Department of Psychiatry, The New York State Psychiatric Institute and the College of Physicians and Surgeons at Columbia University, New York, New York
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neuroscience, Technische Universität Dresden, Dresden, Germany,Department of Child and Adolescent Psychiatry, Eating Disorder Treatment and Research Center, Technische Universität Dresden, Dresden, Germany
| | - Elizabeth A. Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
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Boehm I, Flohr L, Steding J, Holzapfel L, Seitz J, Roessner V, Ehrlich S. The Trajectory of Anhedonic and Depressive Symptoms in Anorexia Nervosa: A Longitudinal and Cross-Sectional Approach. EUROPEAN EATING DISORDERS REVIEW 2017; 26:69-74. [DOI: 10.1002/erv.2565] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/30/2017] [Accepted: 10/11/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Ilka Boehm
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine; Technische Universität Dresden; Dresden Germany
| | - Luisa Flohr
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine; Technische Universität Dresden; Dresden Germany
| | - Julius Steding
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine; Technische Universität Dresden; Dresden Germany
| | - Larissa Holzapfel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine; Technische Universität Dresden; Dresden Germany
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; RWTH Aachen University; Aachen Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine; Technische Universität Dresden; Dresden Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine; Technische Universität Dresden; Dresden Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine; Technische Universität Dresden; Dresden Germany
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40
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Ranta K, Väänänen J, Fröjd S, Isomaa R, Kaltiala-Heino R, Marttunen M. Social phobia, depression and eating disorders during middle adolescence: longitudinal associations and treatment seeking. Nord J Psychiatry 2017; 71:605-613. [PMID: 28868945 DOI: 10.1080/08039488.2017.1366548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Longitudinal associations between social phobia (SP), depression and eating disorders (EDs), and the impact of antecedent SP and depression on subsequent treatment seeking for EDs have rarely been explored in prospective adolescent population studies. AIM We aimed to examine these associations in a large-scale follow-up study among middle adolescents. METHOD We surveyed 3278 Finnish adolescents with a mean age of 15 years for these disorders. Two years later, 2070 were reached and again surveyed for psychopathology and treatment seeking. Longitudinal associations between the self-reported disorders and treatment-seeking patterns for self-acknowledged ED symptoms were examined in multivariate analyses, controlling for SP/depression comorbidity and relevant socioeconomic covariates. RESULTS Self-reported anorexia nervosa (AN) at age 15 years predicted self-reported depression at age 17 years. Furthermore, self-reported SP at age 15 years predicted not seeking treatment for bulimia nervosa (BN) symptoms, while self-reported depression at age 15 years predicted not seeking treatment for AN symptoms during the follow-up period. CONCLUSIONS Adolescents with AN should be monitored for subsequent depression. Barriers caused by SP to help seeking for BN, and by depression for AN, should be acknowledged by healthcare professionals who encounter socially anxious and depressive adolescents, especially when they present with eating problems.
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Affiliation(s)
- Klaus Ranta
- a Department of Adolescent Psychiatry , Helsinki University Central Hospital , Helsinki , Finland
| | - Juha Väänänen
- b Department of Adolescent Psychiatry , Tampere University Hospital , Tampere, Finland
| | - Sari Fröjd
- c School of Health Sciences , University of Tampere , Tampere, Finland
| | - Rasmus Isomaa
- d City of Jakobstad, Department of Social Services and Health Care , Jakobstad , Finland
| | - Riittakerttu Kaltiala-Heino
- b Department of Adolescent Psychiatry , Tampere University Hospital , Tampere, Finland.,e Medical School, University of Tampere , Tampere, Finland
| | - Mauri Marttunen
- a Department of Adolescent Psychiatry , Helsinki University Central Hospital , Helsinki , Finland.,f Department of Adolescent Psychiatry , University of Helsinki, Helsinki, Finland.,g Department of Mental Health and Substance Use Services , National Institute for Health and Welfare , Helsinki , Finland
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41
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Fortunato F, Demartini B, Maffoni C, Apicella E, Leonardi V, Mendolicchio L. A disconnection between nutritional status (in terms of body mass index and phase angle) and psychopathology in anorexia nervosa. Psychiatry Res 2017; 252:196-200. [PMID: 28285245 DOI: 10.1016/j.psychres.2017.02.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/19/2017] [Accepted: 02/19/2017] [Indexed: 11/28/2022]
Abstract
The aim of our study was to investigate the relationship between nutritional status (body mass index and phase angle) and psychological symptoms at admission and discharge in a residential population of anorexic patients. We also aimed to determine the evolution of the above psychological symptoms and nutrition rehabilitation from admission to discharge. Thirty-six consecutive patients were included. The evaluation was performed using the following measures at admission and discharge: body mass index, phase angle, Eating Disorders Inventory-3, Multiphasic Personality Inventory-2 and Body Uneasiness. Admission and discharge nutritional status were not correlated with psychometric scores respectively at admission and at discharge. In addition, neither the improvement in the scores on the psychometric scales between admission and discharge was correlated to body mass index, phase angle improvement. For the group as a whole there were significant improvements from admission to discharge in nutritional status, Multiphasic Personality Inventory-2-Depression, Body Uneasiness-Global Score Index and in all the composites of Eating Disorders Inventory-3. Our data showed a disconnection between nutritional status and eating disorders psychopathology and/or psychiatric comorbidities.
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Affiliation(s)
| | - Benedetta Demartini
- Cattedra di Psichiatria, Dipartimento di Scienze della Salute, Universita` degli Studi di Milano, Italy.
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Koizumi M, Kondo Y, Isaka A, Ishigami A, Suzuki E. Vitamin C impacts anxiety-like behavior and stress-induced anorexia relative to social environment in SMP30/GNL knockout mice. Nutr Res 2016; 36:1379-1391. [PMID: 27932080 DOI: 10.1016/j.nutres.2016.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/04/2016] [Accepted: 11/15/2016] [Indexed: 01/21/2023]
Abstract
The role of endogenous vitamin C (VC) in emotion and psychiatric measures has long been uncertain. We aimed to investigate how an individual's VC status impacts his or her mental health. Our hypothesis is that body VC levels modulate anxiety, anorexia, and depressive phenotypes under the influence of psychosocial rearing environments and sex. The VC status of senescence marker protein-30/gluconolactonase knockout mice, which lack the ability to synthesize VC, were continuously shifted from adequate (VC+) to depleted (VC-) by providing a water with or without VC. Despite weight loss in both sexes, suppressed feeding was specifically seen in males only during the VC- phase. Anxiety responses in the novelty-suppressed feeding paradigm were worse during the VC-, especially in females. Sensitivity to the forced swim test as determined by the initial latency was significantly shorter in the socially stable animals compared with socially unstable animals during the VC+ condition. The stress coping underlying depressive phenotypes was assessed by immobility duration in a series of forced swim tests. No significant differences were apparent between contrasting VC status. Homeostatic symptoms following stressful behavioral tests consisted of a great loss of appetite during the VC-. It should be noted that anorexia is extremely serious for the females. We conclude that endogenous VC status is critical for determining vulnerability to anxiety and anorexia in a sex-specific manner.
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Affiliation(s)
- Miwako Koizumi
- Department of Nutrition and Food Science, Ohanomizu University, 2-1-1 Ohtsuka, Bunkyo, Tokyo 112-8610, Japan.
| | - Yoshitaka Kondo
- Molecular Regulation of Aging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo 173-0015, Japan.
| | - Ayumi Isaka
- Department of Nutrition and Food Science, Ohanomizu University, 2-1-1 Ohtsuka, Bunkyo, Tokyo 112-8610, Japan.
| | - Akihito Ishigami
- Molecular Regulation of Aging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo 173-0015, Japan.
| | - Emiko Suzuki
- Department of Nutrition and Food Science, Ohanomizu University, 2-1-1 Ohtsuka, Bunkyo, Tokyo 112-8610, Japan.
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Danielsen YS, Årdal Rekkedal G, Frostad S, Kessler U. Effectiveness of enhanced cognitive behavioral therapy (CBT-E) in the treatment of anorexia nervosa: a prospective multidisciplinary study. BMC Psychiatry 2016; 16:342. [PMID: 27716162 PMCID: PMC5053175 DOI: 10.1186/s12888-016-1056-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/29/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a debilitating psychiatric disorder associated with a wide array of negative health complications and psychiatric comorbidity. Existing evidence for AN treatment in adults is weak, and no empirically supported treatment has been reliably established. The primary objective of this study is to gain knowledge about the effectiveness of enhanced cognitive behavioral therapy (CBT-E) for anorexia nervosa delivered in a public hospital setting. Baseline predictors of treatment outcome and dropout are studied. Furthermore, there will be collected blood and stool samples for a general biobank to be able to initiate research on possible pathophysiological mechanisms underlying AN. METHODS The study will assess the potency of outpatient CBT-E in a sample of patients suffering from AN (age >16) admitted to the Section for Eating Disorders at the Department for Psychosomatic Medicine, Haukeland University Hospital in Bergen, Norway. The study has a longitudinal design with five main assessment time points: before treatment, at 3 months, at the end of treatment, at 20 weeks, and at 12 months follow-up including biobank samples. A control group without an eating disorder will also be recruited. DISCUSSION Treatment research in a public hospital setting is important for gaining knowledge about the transportability of treatments evaluated in research clinics into ordinary clinical practice. Furthermore, biological material from the thoroughly described patient cohort will serve as a basis for further research on the pathophysiological mechanisms in AN. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02745067 . Registered 14 April 2016. .
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Affiliation(s)
- Yngvild S. Danielsen
- Department of Clinical Psychology, University of Bergen, Christiesgt.12, Po.box. 7800, 5021 Bergen, Norway
| | - Guro Årdal Rekkedal
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
| | - Stein Frostad
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
| | - Ute Kessler
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
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Leblé N, Radon L, Rabot M, Godart N. [Depressive symptoms during anorexia nervosa: State of the art and consequences for an appropriate use of antidepressants]. Encephale 2016; 43:62-68. [PMID: 27452149 DOI: 10.1016/j.encep.2016.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/08/2016] [Accepted: 02/01/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Depressive comorbidity is often associated with anorexia nervosa (AN), and antidepressant medication is widely used although it does not rely on any convincing data in the scientific literature. Our objectives were: to summarize the epidemiological, physiological, psychopathological literature about the relation between AN and manifestations of depression, and to focus on the clinical trial data assessing the use of antidepressant medication in AN in order to clarify the strategy for the use of antidepressant in AN during adolescence. METHOD A manual computerised search (Medline) was performed for relevant published studies assessing the association between depressive signs or Major Depressive Disorder (MDD) and AN. Another manual computerised search (Medline) listed clinical trials assessing antidepressant in AN. RESULTS On the one hand, depressive symptoms are common during the course of AN and could have different meaning. Indeed, firstly, we can distinguish symptoms that are inherent to AN and which can be mistaken for depressive signs (for instance: low self-esteem, reduced social contacts). Secondly, long-term undernourishment can be held responsible for numerous psychological distortions, including anxiety and depression symptoms such as insomnia, impaired concentration, or social isolation. Thirdly, the natural course of AN can also lead to "depressive moments", in particular when switching to a "purging type" AN, or when recovery mobilizes control and narcissistic issues. On the other hand, MDD is also highly prevalent among AN patients and is a negative prognosis factor. Thus, it is complex to differentiate MDD from isolated depressive symptoms that could be inherent of the AN symptomatology which raises the question of the role of antidepressant medication in treatment of depression in AN. No significant benefit of antidepressant medication in AN has been shown in clinical trials, and according to international guidelines it should be prescribed only as a second-line treatment, after appropriate refeeding, and in case of an authentic depressive disorder. Those data appear to be in contradiction with the frequent use of those drugs in clinical practice. DISCUSSION Nevertheless, clinical trials assessing antidepressant treatment in AN suffer from methodological weakness concerning the size of the sample, the choice of the population or the evaluation criterion. This lack of proof must raise our vigilance concerning antidepressant medication in AN but should not categorically prevent the clinician from using it when necessary. We do believe that there are some indications for prescribing antidepressant in patients with AN. The clinical challenge lies in the differentiation of the depressive symptoms that are transitory and likely to improve without medication from those that signal the presence of an MDD. Three criterion could be indicative of MDD: familial history of mood disorder, as it is a major risk factor for MDD among relatives; the chronology of appearance of both disorders, when MDD pre-exists AN; a few specific symptoms cannot be attributed to undernourishment or reactive depressive signs, such as morning insomnia, daily variation of depressive symptoms, suicidal attempts or ideation and guilt ideation. Thus, in integrating the data from the literature review, we propose a pragmatic therapeutic strategy for the use of an antidepressant in AN during adolescence that lies in 3 main categories for depressive manifestations in AN: therapeutic emergencies: when an obvious and severe MDD is comorbid to AN, immediate antidepressant would be required; isolated and non-specific depressive sign: no medication would be relevant as they are supposed to improve with refeeding and psychotherapeutic support; intermediary patterns which is probably the most frequent situation. In the last case, it would be relevant to abstain from prescribing medication in first line, but an antidepressant medication should be quickly considered in the presence of one (or several) criterion listed above and its persistence despite refeeding. The general medical state of this fragile population of patients should be evaluated (standard blood test, ECG) before and during treatment.
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Affiliation(s)
- N Leblé
- Hôpital Bichat, 75018 Paris, France.
| | - L Radon
- Département de psychiatrie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - M Rabot
- Centre hospitalier Alpes-Isère, 3, rue de la Gare, 38120 Saint-Egrève, France
| | - N Godart
- Département de psychiatrie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Unité Inserm U1178, 75014 Paris, France
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45
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Tanaka S, Yoshida K, Katayama H, Kohmura K, Kawano N, Imaeda M, Kato S, Ando M, Aleksic B, Nishioka K, Ozaki N. Association of Beck Depression Inventory score and Temperament and Character Inventory-125 in patients with eating disorders and severe malnutrition. J Eat Disord 2015; 3:36. [PMID: 26550476 PMCID: PMC4636062 DOI: 10.1186/s40337-015-0077-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/30/2015] [Indexed: 11/10/2022] Open
Abstract
The authors investigated the association between personality and physical/mental status in malnourished patients with eating disorders. A total of 45 patients with anorexia nervosa, avoidant/restrictive food intake disorder, and other specified feeding or eating disorders were included and compared with 39 healthy controls. Personality characteristics and severity of depression were assessed using the Temperament and Character Inventory-125 and Beck's Depression Inventory. Depression correlated with harm avoidance and self-directedness in both cases and controls. Body mass index did not correlate with personality in either group. These findings should be verified by longitudinal studies with higher weight/weight recovered patients.
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Affiliation(s)
- Satoshi Tanaka
- />Department of Psychiatry, Nagoya University Hospital, 65 Tsurumai, Showa, Nagoya, Aichi 466-8550 Japan
| | - Keizo Yoshida
- />Health Care Promotion Division, DENSO Corporation, 1-1, Showacho, Kariya, Aichi 448-8661 Japan
| | - Hiroto Katayama
- />Minami-Seikyo Hospital, 2-204, Minamioodaka, Midori, Nagoya, Aichi 459-8540 Japan
| | - Kunihiro Kohmura
- />Seichiryo Hospital, 16-27, Tsurumai 4, Showa, Nagoya, Aichi 466-0064 Japan
| | - Naoko Kawano
- />Institute of Innovation for Future Society, Nagoya University, Furocho, Chikusa, Nagoya, Aichi 464-8601 Japan
| | - Miho Imaeda
- />Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi 466-8550 Japan
| | - Saki Kato
- />Saku Central Hospital, 197 Usuda, Saku, Nagano 384-0301 Japan
| | - Masahiko Ando
- />Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, 65 Tsurumai, Showa, Nagoya, Aichi 466-8550 Japan
| | - Branko Aleksic
- />Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi 466-8550 Japan
| | - Kazuo Nishioka
- />Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi 466-8550 Japan
| | - Norio Ozaki
- />Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi 466-8550 Japan
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46
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D'Agata F, Caroppo P, Amianto F, Spalatro A, Caglio MM, Bergui M, Lavagnino L, Righi D, Abbate-Daga G, Pinessi L, Mortara P, Fassino S. Brain correlates of alexithymia in eating disorders: A voxel-based morphometry study. Psychiatry Clin Neurosci 2015; 69:708-16. [PMID: 25967072 DOI: 10.1111/pcn.12318] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 04/24/2015] [Accepted: 05/11/2015] [Indexed: 01/14/2023]
Abstract
AIMS Alexithymia is a personality trait that consists of difficulty in identifying and acknowledging one's own and others' feelings. Recent studies reported that alexithymia is present in both anorexia (AN) and bulimia nervosa (BN). Brain morphological studies on healthy subjects showed that alexithymia correlates with several brain regions involved in emotions processing. The aim of this study was to investigate the anatomical correlates of alexithymia in AN and BN. METHODS We performed a voxel-based morphometry study on 21 patients with AN and 18 with BN. Seventeen healthy subjects were used as a control group. Alexithymia, depression and anxiety were assessed with self-administered questionnaires and correlated to gray matter (GM) density in each group. RESULTS In BN, alexithymia was correlated with the GM of the parietal lobe, in particular of the right angular gyrus. The correlation was predominantly linked with Difficulty Describing Feelings. In AN, we did not find correlations between GM and alexithymia. CONCLUSIONS In BN, our results support the hypothesis that this trait may represent a relevant pathogenic or maintenance factor that contributes to relational difficulties, present in this pathology. In AN, the lack of correlation between GM volume and alexithymia may be influenced by atrophy in several brain regions that in turn can be, as previously reported, a consequence of caloric restriction. Also, the nature of alexithymia may be different from that of BN and controls and this trait could be secondary to a psychopathologic process specific to AN.
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Affiliation(s)
| | - Paola Caroppo
- Department of Neuroscience, University of Turin, Turin, Italy.,Besta Neurological Institute, Milan, Italy
| | | | - Angela Spalatro
- Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Mauro Bergui
- Department of Neuroscience, University of Turin, Turin, Italy.,Radiology Section, AOU Città della Salute e della Scienza, Turin, Italy
| | - Luca Lavagnino
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center (UTHealth), Houston, USA
| | - Dorico Righi
- Radiology Section, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Lorenzo Pinessi
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Paolo Mortara
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Department of Neuroscience, University of Turin, Turin, Italy
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47
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Brockmeyer T, Zimmermann J, Kulessa D, Hautzinger M, Bents H, Friederich HC, Herzog W, Backenstrass M. Me, myself, and I: self-referent word use as an indicator of self-focused attention in relation to depression and anxiety. Front Psychol 2015; 6:1564. [PMID: 26500601 PMCID: PMC4598574 DOI: 10.3389/fpsyg.2015.01564] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/28/2015] [Indexed: 11/13/2022] Open
Abstract
Self-focused attention (SFA) is considered a cognitive bias that is closely related to depression. However, it is not yet well understood whether it represents a disorder-specific or a trans-diagnostic phenomenon and which role the valence of a given context is playing in this regard. Computerized quantitative text-analysis offers an integrative psycho-linguistic approach that may help to provide new insights into these complex relationships. The relative frequency of first-person singular pronouns in natural language is regarded as an objective, linguistic marker of SFA. Here we present two studies that examined the associations between SFA and symptoms of depression and anxiety in two different contexts (positive vs. negative valence), as well as the convergence between pronoun-use and self-reported aspects of SFA. In the first study, we found that the use of first-person singular pronouns during negative but not during positive memory recall was positively related to symptoms of depression and anxiety in patients with anorexia nervosa with varying levels of co-morbid depression and anxiety. In the second study, we found the same pattern of results in non-depressed individuals. In addition, use of first-person singular pronouns during negative memory recall was positively related to brooding (i.e., the assumed maladaptive sub-component of rumination) but not to reflection. These findings could not be replicated in two samples of depressed patients. However, non-chronically depressed patients used more first-person singular pronouns than healthy controls, irrespective of context. Taken together, the findings lend partial support to theoretical models that emphasize the effects of context on self-focus and consider SFA as a relevant trans-diagnostic phenomenon. In addition, the present findings point to the construct validity of pronoun-use as a linguistic marker of maladaptive self-focus.
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Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg Heidelberg, Germany
| | | | - Dominika Kulessa
- Institute of Clinical Psychology, Hospital Stuttgart Stuttgart, Germany ; Department of Clinical Psychology, University of Tübingen Tübingen, Germany
| | - Martin Hautzinger
- Department of Clinical Psychology, University of Tübingen Tübingen, Germany
| | - Hinrich Bents
- Centre for Psychological Psychotherapy, University of Heidelberg Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg Heidelberg, Germany ; LVR-Clinics, Department of Psychosomatic Medicine and Psychotherapy, University Duisburg-Essen Essen, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg Heidelberg, Germany
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48
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Godart N, Radon L, Curt F, Duclos J, Perdereau F, Lang F, Venisse JL, Halfon O, Bizouard P, Loas G, Corcos M, Jeammet P, Flament MF. Mood disorders in eating disorder patients: Prevalence and chronology of ONSET. J Affect Disord 2015; 185:115-22. [PMID: 26162282 DOI: 10.1016/j.jad.2015.06.039] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/01/2015] [Accepted: 06/23/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES In a clinical population, we estimated the frequency of mood disorders among 271 patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in comparison to a control group matched for age and gender. METHOD The frequency of mood disorders was measured using the Mini International Neuropsychiatric Interview (MINI), DSM-IV version. RESULTS Mood disorders were more frequent among eating disorder (ED) patients than among controls, with a global prevalence of the order of 80% for each ED group. The majority of the mood disorders comorbid with ED were depressive disorders (MDD and dysthymia). The relative chronology of onset of these disorders was equivocal, because mood disorders in some cases preceded and in others followed the onset of the eating disorders. LIMITATIONS Our sample was characterized by patients with severe ED and high comorbidities, and thus do not represent the entire population of AN or BN. This also may have resulted in an overestimation of prevalence. CONCLUSION Mood disorders appear significantly more frequently in patients seeking care for ED than in controls. These results have implications for the assessment and treatment of ED patients, and for the aetio-pathogenesis of these disorders.
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Affiliation(s)
- N Godart
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France; Faculty of Medicine, Paris Descartes University, Paris, France; Inserm U669, Paris, France.
| | - L Radon
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France; Inserm U669, Paris, France
| | - F Curt
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France
| | - J Duclos
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France
| | - F Perdereau
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France
| | - F Lang
- University Hospital Centre of Saint Etienne, Psychiatric Services, Saint Etienne, France
| | - J L Venisse
- Saint Jacques Hospital, Addictions Unit, Nantes, France
| | - O Halfon
- University Child and Adolescent Psychiatric Services-SUPEA Department of Research, Lausanne, Switzerland
| | - P Bizouard
- University of Besançon Hospital Centre, Besançon, France
| | - G Loas
- University Hospital Sector, CHS P. Pinel, Amiens, France
| | - M Corcos
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France
| | - Ph Jeammet
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France
| | - M F Flament
- University of Ottawa Research Director, Youth Program, Institute of Mental Health Research Royal Ottawa Hospital, 1145 Carling Ave, Rm CB2111 Ottawa, ON, Canada K1Z 7K4
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49
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Kezelman S, Touyz S, Hunt C, Rhodes P. Does anxiety improve during weight restoration in anorexia nervosa? A systematic review. J Eat Disord 2015; 3:7. [PMID: 25874111 PMCID: PMC4396079 DOI: 10.1186/s40337-015-0046-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/26/2015] [Indexed: 11/10/2022] Open
Abstract
Weight restoration is considered a principal outcome for treatment of Anorexia Nervosa (AN) due to the significant physiological disturbances resultant from acute states of malnutrition. Treatment outcomes for populations with AN are relatively poor, with increasing evidence suggesting that weight restoration alone is insufficient for long-term recovery. Research aimed at understanding the psychological sequaele of AN, in particular during weight restoration, nevertheless remain scarce. This systematic review aimed to evaluate existing research regarding anxiety symptoms during treatment for AN, and the relationship of anxiety symptomology and weight restoration. Twelve articles were identified from a systematic search of three electronic databases (PsycINFO, MEDLINE, and Web of Science), and were eligible for inclusion. Study methodology, results and quality were reviewed. Results regarding change in anxiety symptomology were inconsistent, though evidence did not support a relationship between anxiety change and weight restoration. Reasons for these inconsistencies and limitations of included studies were reviewed. Further research is warranted to elucidate the role of anxiety in AN and its implications for treatment and longer-term outcome.
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Affiliation(s)
- Sarah Kezelman
- School of Psychology, University of Sydney, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, Sydney, Australia
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia
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50
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Steinglass JE, Albano AM, Simpson HB, Wang Y, Zou J, Attia E, Walsh BT. Confronting fear using exposure and response prevention for anorexia nervosa: A randomized controlled pilot study. Int J Eat Disord 2014; 47:174-80. [PMID: 24488838 PMCID: PMC3927538 DOI: 10.1002/eat.22214] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a severe illness with high rates of relapse. Exposure and Response Prevention for AN (AN-EXRP) is a new approach that specifically addresses maladaptive eating behavior by targeting eating-related fear and anxiety. The aim of this study was to evaluate AN-EXRP as an adjunctive strategy to improve eating behavior during weight restoration, at a pivotal moment when treatment goals shift toward relapse prevention. METHOD A randomized controlled trial was conducted to compare AN-EXRP with a comparison condition, Cognitive Remediation Therapy (CRT). Hospitalized patients with AN (n = 32) who had achieved weight restoration to a BMI > 18.5 kg/m(2) received 12 sessions of either AN-EXRP or CRT. Outcome was assessed by change in caloric intake in an objective assessment of eating behavior. RESULTS The average test meal caloric intake of participants who received AN-EXRP increased from 352 ± 263 kcal at baseline to 401 ± 215 kcal post-treatment, while that of participants who received CRT decreased from 501 ± 232 kcal at baseline to 424 ± 221 kcal post-treatment [t(28) = 2.5, p = .02]. Improvement in intake was significantly associated with improvement in eating-related anxiety (Spearman's ρ = 0.40, p = .03). DISCUSSION These data demonstrate that AN-EXRP, compared to a credible comparison intervention, is associated with better caloric intake in a laboratory meal over time in AN. Additional studies are required to determine whether incorporation of these techniques into a longer treatment program leads to enduring and clinically significant change.
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Affiliation(s)
- Joanna E Steinglass
- Columbia University 622 West 168 Street New York, NY 10032,New York State Psychiatric Institute 1051 Riverside Drive New York, NY 10032
| | - Anne Marie Albano
- Columbia University 622 West 168 Street New York, NY 10032,New York State Psychiatric Institute 1051 Riverside Drive New York, NY 10032
| | - H Blair Simpson
- Columbia University 622 West 168 Street New York, NY 10032,New York State Psychiatric Institute 1051 Riverside Drive New York, NY 10032
| | - Yuanjia Wang
- Columbia University 622 West 168 Street New York, NY 10032
| | - Jingjing Zou
- Columbia University 622 West 168 Street New York, NY 10032
| | - Evelyn Attia
- Columbia University 622 West 168 Street New York, NY 10032,New York State Psychiatric Institute 1051 Riverside Drive New York, NY 10032
| | - B. Timothy Walsh
- Columbia University 622 West 168 Street New York, NY 10032,New York State Psychiatric Institute 1051 Riverside Drive New York, NY 10032
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