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Mariani R, Marini I, Di Trani M, Catena C, Patino F, Riccioni R, Pasquini M. Emotional dysregulation and linguistic patterns as a defining feature of patients in the acute phase of anorexia nervosa. Eat Weight Disord 2022; 27:3267-3277. [PMID: 35939211 PMCID: PMC9358383 DOI: 10.1007/s40519-022-01456-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/20/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE This research aims to analyze the relationship between emotional regulation and the symbolic process in autobiographical narratives of a group of individuals diagnosed with restrictive anorexia nervosa (AN), compared to a non-clinical group. The study is framed within multiple code theory (MCT) (Bucci, 1997; 2021), which considers mind-body integration. The purposes of this study are to investigate whether participants of the AN group will show greater alexithymia and emotional dysregulation than the non-clinical group; and whether the specific linguistic and symbolic features, such as somato-sensory words, affect words, and difficulty in the symbolizing process will predict the AN group. METHODS Twenty-nine female participants hospitalized with AN during an acute phase (mean age 19.8 ± 4.1) and 36 non-clinical female participants (mean age 21 ± 2.4) were selected through snow-ball sampling. The participants completed the Toronto Alexithymia Scale (TAS-20), the Profile of Mood of State (POMS), the Emotion Regulation Questionnaire (ERQ), and the Relationship Anecdotes Paradigm Interview (RAP). The RAP interview was audio-recorded and transcribed to apply the Referential Process (RP) Linguistic Measures. A T test for paired samples and a logistic binary regression was performed. RESULTS AN presented a significantly higher emotional dysregulation through the ERQ, TAS20 and POMS measures. Specifically, AN showed higher ER expression/suppression strategies, fewer functional cognitive strategies, higher alexithymia, and higher mood dysregulation. Specific linguistic features such as sensory-somatic, word affect, and difficulty in RP symbolizing predict the AN group (R2 = 0.349; χ2 = 27,929; df = 3; p = .001). CONCLUSIONS Emotional dysregulation is connected to AN symptoms and autobiographical narratives. The results can help a clinical assessment phase showing specific linguistic features in AN patients. LEVEL OF EVIDENCE Level II, controlled trial without randomization.
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Affiliation(s)
- Rachele Mariani
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.
| | - Isabella Marini
- Azienda Ospedaliera-Universitaria, Policlinico Umberto I, Rome, Italy
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Carlotta Catena
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Francesca Patino
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | | | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University, Rome, Italy
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2
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Robinson LD, Kelly PJ, Larance BK, Griffiths S, Deane FP. Eating Disorder Behaviours and Substance Use in Women Attending Treatment for Substance Use Disorders: a Latent Class Analysis. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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3
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Gutierrez E, Birmingham CL. Editorial: New Perspectives to Unlock the Current Impasse in Treating Anorexia Nervosa. Front Psychol 2020; 11:207. [PMID: 32132954 PMCID: PMC7040163 DOI: 10.3389/fpsyg.2020.00207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/29/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emilio Gutierrez
- Departamento de Psicología Clínica y Psicobiología and Unidad Venres Clínicos, Facultad de Psicología, Universidad de Santiago, Santiago de Compostela, Spain
| | - C Laird Birmingham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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4
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Spettigue W, Aldaqqaq Z, Isserlin L, Bishop B, Norris ML, Valois D, Obeid N. A Brief Modified Family-Based Treatment Intervention for Youth With Mild Eating Disorders: A Case Series. Front Psychiatry 2020; 11:105. [PMID: 32210848 PMCID: PMC7066491 DOI: 10.3389/fpsyt.2020.00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family-based treatment (FBT), an outpatient treatment which is typically offered for 6-12 months by specially trained therapists, is currently the first line treatment for adolescent anorexia nervosa and bulimia nervosa. The success of FBT for adolescents with moderate to severe eating disorders indicates a potential use for a short course of modified FBT which could be offered as an early intervention by nonspecialized community mental health counselors to adolescents with mild or subsyndromal eating disorders. METHODS In 2016, seven adolescents with mild eating disorders underwent a brief intervention in the form of five FBT-inspired therapy sessions (called 'DREAMS' sessions). The DREAMS sessions consisted of five replicable family sessions given over 6 weeks, each with a specific area of focus for treatment, such as nutrition and eating disorder symptoms, mood, relationships and anxiety. Charts of these seven patients were reviewed in 2019 to determine whether this treatment might be worthy of further study. RESULTS Based on a review of the progress notes, all seven patients reported an improvement in intake, a decrease in ED symptoms and an improvement in mood by the end of the sessions. All seven families reported that the sessions had been beneficial. CONCLUSION Early intervention is recommended for adolescents who present in the early stages of an eating disorder, yet there are no guidelines to recommend which treatment should be offered to this population. Further research is required to determine whether a short course of modified FBT, such as these five FBT-inspired 'DREAMS' sessions, may be an effective intervention to offer to youth who present with mild eating disorders.
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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
| | - Zizo Aldaqqaq
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Leanna Isserlin
- 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
| | - Brittany Bishop
- Department of Psychiatry, Queen's University, Kingston, 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
| | - Darcie Valois
- 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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5
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Abstract
Anorexia nervosa, one of the more frequent and severe eating disorders, is a chronic psychiatric disease with potentially serious somatic consequences. This behavioral symptomatology leads to weight loss, undernutrition, and more or less severe-potentially life-threatening-somatic complications including respiratory, hepatic, digestive and cardiac features, electrolyte disturbances, endocrine and bone impairment, immunodepression, and related opportunistic infections. In this review, the authors report an overview of cardiac diseases in this disease.
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Affiliation(s)
- Abdallah Fayssoil
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France. .,Service de neurologie, Institut de Myologie, boulevard de l'hôpital, 75013, Paris, France. .,Pitié Salpetrière Hospital, APHP, boulevard de l'hôpital, 75013, Paris, France.
| | - Jean Claude Melchior
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France
| | - Mouna Hanachi
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France
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6
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Grellety E, Golden MH. Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: I. Empirical data demonstrates Simpson's paradox. Nutr J 2018; 17:79. [PMID: 30217205 PMCID: PMC6138885 DOI: 10.1186/s12937-018-0384-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/25/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND According to WHO childhood severe acute malnutrition (SAM) is diagnosed when the weight-for-height Z-score (WHZ) is <-3Z of the WHO2006 standards, the mid-upper-arm circumference (MUAC) is < 115 mm, there is nutritional oedema or any combination of these parameters. Recently there has been a move to eliminate WHZ as a diagnostic criterion on the assertion that children meeting the WHZ criterion are healthy, that MUAC is universally a superior prognostic indicator of mortality and that adding WHZ to the assessment does not improve the prediction; these assertions have lead to a controversy concerning the role of WHZ in the diagnosis of SAM. METHODS We examined the mortality experience of 76,887 6-60 month old severely malnourished children admitted for treatment to in-patient, out-patient or supplementary feeding facilities in 18 African countries, of whom 3588 died. They were divided into 7 different diagnostic categories for analysis of mortality rates by comparison of case fatality rates, relative risk of death and meta-analysis of the difference between children admitted using MUAC and WHZ criteria. RESULTS The mortality rate was higher in those children fulfilling the WHO2006 WHZ criterion than the MUAC criterion. This was the case for younger as well as older children and in all regions except for marasmic children in East Africa. Those fulfilling both criteria had a higher mortality. Nutritional oedema increased the risk of death. Having oedema and a low WHZ dramatically increased the mortality rate whereas addition of the MUAC criterion to either oedema-alone or oedema plus a low WHZ did not further increase the mortality rate. The data were subject to extreme confounding giving Simpson's paradox, which reversed the apparent mortality rates when children fulfilling both WHZ and MUAC criteria were included in the estimation of the risk of death of those fulfilling either the WHZ or MUAC criteria alone. CONCLUSIONS Children with a low WHZ, but a MUAC above the SAM cut-off point are at high risk of death. Simpson's paradox due to confounding from oedema and mathematical coupling may make previous statistical analyses which failed to distinguish the diagnostic groups an unreliable guide to policy. WHZ needs to be retained as an independent criterion for diagnosis of SAM and methods found to identify those children with a low WHZ, but not a low MUAC, in the community.
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Affiliation(s)
- Emmanuel Grellety
- Research Center Health Policy and Systems - International Health, School of Public Health, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Michael H. Golden
- Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, Scotland
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7
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Lian Q, Zuo X, Mao Y, Luo S, Zhang S, Tu X, Lou C, Zhou W. Anorexia nervosa, depression and suicidal thoughts among Chinese adolescents: a national school-based cross-sectional study. Environ Health Prev Med 2017; 22:30. [PMID: 29165137 PMCID: PMC5664580 DOI: 10.1186/s12199-017-0639-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/25/2017] [Indexed: 12/05/2022] Open
Abstract
Background Although there is much literature on adolescent suicide, combined effects of depression and anorexia nervosa on suicide were rarely investigated. The aims of this study are to examine the association between anorexia nervosa and suicidal thoughts and explore the interaction between anorexia nervosa and depression. Methods This is a cross-sectional study, in the study, a sample of 8,746 Chinese adolescents was selected by multistage stratified method in 2012/2013 from 20 middle schools in 7 provinces across China Mainland. Multilevel logistic model was introduced to explore association between anorexia nervosa and suicidal thoughts. And subgroup analyses were conducted on participants with or without depression. Results Multilevel logistic model revealed that demographic variables, including academic achievement, were not the predictive risk factors of suicidal thoughts. Those who suffered from worse severity of perceived anorexia nervosa were at increased risk of thinking about suicide. The interaction between depression and anorexia nervosa was significant, however, subgroup analyses showed that the associations were significant only among the adolescents without depression. Conclusions Our results indicate that all levels of anorexia nervosa serve as predictable indicators of suicidal thoughts in Chinese adolescents, and the effects of anorexia nervosa are modified by depression status.
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Affiliation(s)
- Qiguo Lian
- School of Public Health, Fudan University, Shanghai, China.,Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China
| | - Xiayun Zuo
- Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China
| | - Yanyan Mao
- School of Public Health, Fudan University, Shanghai, China.,Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China
| | - Shan Luo
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shucheng Zhang
- National Research Institute for Family Planning, Beijing, China
| | - Xiaowen Tu
- Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China
| | - Chaohua Lou
- Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China.
| | - Weijin Zhou
- Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China
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8
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Errichiello L, Iodice D, Bruzzese D, Gherghi M, Senatore I. Prognostic factors and outcome in anorexia nervosa: a follow-up study. Eat Weight Disord 2016; 21:73-82. [PMID: 26253365 DOI: 10.1007/s40519-015-0211-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 07/27/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND AIMS Anorexia nervosa is an eating disorder characterized by food restriction, irrational fear of gaining weight and consequent weight loss. High mortality rates have been reported, mostly due to suicide and malnutrition. Good outcomes largely vary between 18 and 42%. We aimed to assess outcome and prognostic factors of a large group of patients with anorexia nervosa. Moreover we aimed to identify clusters of prognostic factors related to specific outcomes. METHODS We retrospectively reviewed data of 100 patients diagnosed with anorexia nervosa previously hospitalized in a tertiary level structure. Then we performed follow-up structured telephone interviews. RESULTS We identified four dead patients, while 34% were clinically recovered. In univariate analysis, short duration of inpatient treatment (p = 0.003), short duration of disorder (p = 0.001), early age at first inpatient treatment (p = 0.025) and preserved insight (p = 0.029) were significantly associated with clinical recovery at follow-up. In multiple logistic regression analysis, duration of first inpatient treatment, duration of disorder and preserved insight maintained their association with outcome. Moreover multiple correspondence analysis and cluster analysis allowed to identify different typologies of patients with specific features. Notably, group 1 was characterized by two or more inpatient treatments, BMI ≤ 14, absence of insight, history of long-term inpatient treatments, first inpatient treatment ≥30 days. While group 4 was characterized by preserved insight, BMI ≥ 16, first inpatient treatment ≤14 days, no more than one inpatient treatment, no psychotropic drugs intake, duration of illness ≤4 years. CONCLUSIONS We confirmed the association between short duration of inpatient treatment, short duration of disorder, early age at first inpatient treatment, preserved insight and clinical recovery. We also differentiated patients with anorexia nervosa in well-defined outcome groups according to specific clusters of prognostic factors. Our study might help clinicians to evaluate prognosis of patients with anorexia nervosa.
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Affiliation(s)
- Luca Errichiello
- Section of Psychotherapy, Section of Psychiatry, Department of Neurosciences, "Federico II" University, Naples, Italy.
| | - Davide Iodice
- Local Health Authority of Matera, Operating Unit Adult Mental Health, Policoro Hospital, Policoro (Matera), Italy
| | - Dario Bruzzese
- Department of Public Health, "Federico II" University, Naples, Italy
| | - Marco Gherghi
- Department of Economics and Statistics, "Federico II" University, Naples, Italy
| | - Ignazio Senatore
- Section of Psychotherapy, Section of Psychiatry, Department of Neurosciences, "Federico II" University, Naples, Italy
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9
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Risk of suicide among female adolescents with eating disorders: a longitudinal population-based study. Eat Weight Disord 2015; 20:295-300. [PMID: 25596926 DOI: 10.1007/s40519-015-0176-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Suicide is a major cause of death among individuals with eating disorders. This study examined risk of suicide among females with eating disorders based on population-based military data. METHODS Data on diagnoses of eating disorders from the pre-induction screening for psychopathology and diagnoses assigned during military service were merged with data on later suicide from the nationwide Israeli Death Registry. We identified 1,356 females with eating disorders and compared their risk of suicide to a population-based control group of females without eating disorders over a mean follow-up period of 8.5 ± 5.34 years. RESULTS Females with eating disorders had a higher rate of suicide (0.22 %, n = 3) compared to females without eating disorders (0.03 %, n = 166). Having a moderate-severe eating disorder was associated with increased risk of suicide (RR = 12.50, 95 % CI = 3.86-38.09), whereas none of the females diagnosed as having a mild eating disorder died by suicide. CONCLUSIONS Females with moderate-severe eating disorders are at risk of suicide and should be monitored for suicidal intent.
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10
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Dold M, Aigner M, Klabunde M, Treasure J, Kasper S. Second-Generation Antipsychotic Drugs in Anorexia Nervosa: A Meta-Analysis of Randomized Controlled Trials. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 84:110-116. [PMID: 25722106 DOI: 10.1159/000369978] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022]
Abstract
Background: Second-generation antipsychotic drugs (SGAs) are increasingly administered to achieve weight gain in anorexia nervosa. In this meta-analysis, we aimed to determine if any evidence for this treatment option can be derived from randomized controlled trials (RCTs). Methods: Based on the 'World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Eating Disorders', a systematic update literature search was applied to identify all RCTs investigating the efficacy, acceptability, and tolerability of SGAs in anorexia nervosa in comparison to placebo/no treatment. The primary outcome was weight gain measured by mean change in body mass index (BMI). Secondary outcomes were mean changes in Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS) total score and Eating Disorders Inventory (EDI) total score and premature discontinuation of treatment. Employing a random-effects model standardized mean differences based on Hedges's g and Mantel-Haenszel risk ratios were calculated. Results: Seven RCTs (n = 201) investigating olanzapine (N = 4), quetiapine (N = 2), and risperidone (N = 1) were included. We found no statistically significant between-group differences for mean BMI change when pooling the SGAs (N = 7, n = 161; Hedges's g = 0.13, 95% CI: -0.17 to 0.43; p = 0.4) and when examining the individual drugs. Furthermore, the SGAs failed to differentiate statistically significantly from placebo/no treatment for all secondary outcomes. Conclusions: Based on the current evidence, pharmacological treatment of anorexia nervosa with SGAs cannot be generally recommended although some individuals or subgroups of patients might benefit from an antipsychotic medication. Further research is required to identify which patients will likely benefit from such a treatment option. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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11
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Spettigue W, Maras D, Obeid N, Henderson KA, Buchholz A, Gomez R, Norris ML. A psycho-education intervention for parents of adolescents with eating disorders: a randomized controlled trial. Eat Disord 2015; 23:60-75. [PMID: 25090010 DOI: 10.1080/10640266.2014.940790] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study evaluated the efficacy of a 2-hour psycho-education session combined with bi-weekly telephone support in increasing parent/caregiver knowledge about eating disorders, increasing self-efficacy by empowering parents to support their child's recovery, and decreasing the impact of eating disorder symptoms on the family. The intervention was targeted at parents/caregivers whose child was waiting to be assessed for an eating disorder. Participants included 51 parents/caregivers and 36 youths. The brief intervention successfully increased parent/caregiver knowledge of the illness, feelings of self-efficacy, and help-seeking behaviors. These findings are clinically useful as waiting lists are common in Canada.
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Affiliation(s)
- Wendy Spettigue
- a Department of Psychiatry, Children's Hospital of Eastern Ontario , University of Ottawa , Ottawa , Ontario , Canada
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12
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Keshaviah A, Edkins K, Hastings ER, Krishna M, Franko DL, Herzog DB, Thomas JJ, Murray HB, Eddy KT. Re-examining premature mortality in anorexia nervosa: a meta-analysis redux. Compr Psychiatry 2014; 55:1773-84. [PMID: 25214371 DOI: 10.1016/j.comppsych.2014.07.017] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022] Open
Abstract
Anorexia nervosa (AN) is reported to have the highest premature mortality of any psychiatric disorder, but recent meta-analyses may have inflated estimates. We sought to re-estimate mortality after methodological corrections and to identify predictors of mortality. We included 41 cohorts from 40 peer-reviewed studies published between 1966 and 2010. Methods included double data extraction, log-linear regression with an over-dispersed Poisson model, and all-cause and suicide-specific standardized mortality ratios (SMRs), with 95% Poisson confidence intervals. Participants with AN were 5.2 [3.7-7.5] times more likely to die prematurely from any cause, and 18.1 [11.5-28.7] times more likely to die by suicide than 15-34 year old females in the general population. Our estimates were 10% and 49% lower, respectively, than previously reported SMRs. Risk of premature mortality was highest in studies with older participants, although confounding by treatment was present. Gender, ascertainment, and diagnostic criteria also impacted risk.
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Affiliation(s)
- Aparna Keshaviah
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine Edkins
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth R Hastings
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; The Amundsen Group, Burlington, MA, USA
| | - Meera Krishna
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Debra L Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Northeastern University, Boston, MA, USA
| | - David B Herzog
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Helen B Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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13
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Welch E, Ghaderi A. Mortality in anorexia nervosa – a look back at and beyond one of the most cited papers in the field. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/21662630.2014.968177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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14
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Kostro K, Lerman JB, Attia E. The current status of suicide and self-injury in eating disorders: a narrative review. J Eat Disord 2014; 2:19. [PMID: 26034603 PMCID: PMC4450853 DOI: 10.1186/s40337-014-0019-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 06/23/2014] [Indexed: 11/14/2022] Open
Abstract
The aim of this paper is to review recent literature on suicide and self-injury in eating disorders (ED) including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Among psychiatric diagnoses, EDs are associated with increased mortality rates, even when specialized treatment is available. Of the mortalities that are reported in individuals with EDs, suicide is among the most commonly reported causes of death. Additionally, suicidal and non-suicidal self-injurious behaviors occur frequently in this clinical population. A literature search was undertaken using the databases of Medline/PubMed and PsycInfo to identify papers describing suicidality in individuals with ED diagnoses. The authors identified studies and review articles published between 2005-2013 (inclusive) that describe the relationship between EDs and suicide, and associated behaviors including self-injurious behaviors, or non-suicidal self-injury (NSSI). The initial search resulted in 1095 papers that met the a priori search criteria. After careful review, 66 papers were included. The majority of papers described clinical cohorts that were studied longitudinally. The diagnosis described most frequently in selected studies was AN. There are limited current data about the prevalence of suicide and NSSI among individuals with EDs. Among the published studies that focus specifically on the relationship between EDs and suicidality, most describe AN in more detail than other EDs. Nonetheless, rates of mortality, and specifically rates of suicide, are undeniably high in ED populations, as are the rates of self-harm. Therefore, it is critical for clinicians and caretakers to carefully evaluate these patients for suicide risk and to refer promptly for appropriate treatment.
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Affiliation(s)
| | | | - Evelyn Attia
- Columbia University Medical Center, New York, NY USA ; Weill Cornell Medical College, New York, NY USA
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15
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Long-term effects of enteral feeding on growth and mental health in adolescents with anorexia nervosa—results of a retrospective German cohort study. Eur J Clin Nutr 2013; 68:171-7. [DOI: 10.1038/ejcn.2013.244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/10/2013] [Accepted: 10/18/2013] [Indexed: 11/08/2022]
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16
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Abstract
In numerous pathological states, the brain can restrict food intake to a lethal level despite mounting requirements for energy as seen in adolescents with anorexia nervosa. How the brain reduces food intake to the point of death while eating is a cornerstone of survival that remains just as ‘cryptic’ as the association between anorexia and overeating. This review provides a recent snapshot of the neural underpinnings of the rewarding effects of anorexia that may compete with the adaptive decision-making process to eat, and with survival instinct. Among a plethora of factors, impaired activity of the serotonin receptors in the reward system underlies the ability of animals to self-impose food restriction, and the transition from under- to over-eating. However, the triumvirate association between serotonin, overeating and addiction appears unlikely. Considering the implication of the serotonin receptors in the hypothalamus, anorexia and bulimia nervosa could result from an impairment of a ‘synchronic activity’ between the autonomic and voluntary nervous systems.
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Affiliation(s)
- Valérie Compan
- Centre National de la Recherche Scientifique, UnitéMixte de Recherche-5203, Institut de Génomique Fonctionnelle, Montpellier, F-34094, France and Institut National de la Santé et de la Recherche Médicale, U661, Montpellier, F-34094, France and Universités de Montpellier 1 & 2, UMR-5203, Montpellier, F-34094, France and Université de Nîmes, Nîmes, F-30000, France
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17
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Abstract
Anorexia nervosa (AN) and, to a much lesser extent, bulimia nervosa (BN) are psychiatric illnesses that carry the highest mortality rates compared to other psychiatric illnesses. They tend to be chronic disorders with many acute fair-ups that have profound negative impact on the body as a whole. Many medical complications can arise acutely and chronically following excessive dieting, purging, over exercising, abuse of medications such as diuretics and laxatives or any combination of these. In contrast to the profound effects eating disorders can have, the postmortem findings and testing can be subtle to nonexistent and may be overshadowed by trauma (in the case of suicides), natural disease (in the case of diabetes and alcoholism) and postmortem shifts (in electrolyte testing and toxicology). A full understanding of how eating disorders affect the body in the acute, chronic, and refeeding stages is needed to properly certify these deaths.
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Affiliation(s)
- Kristen Landi
- Office of the Chief Medical Examiner for the City of New York New York School of Medicine
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18
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Bonaccorsi G, Bassetti A, Chiari S, Dirindelli P, Lorini C, Menicalli C, Santomauro F, Martinetti MG. Body composition in subjects with anorexia nervosa: bioelectrical impedance analysis and dual-energy X-ray absorptiometry. Eat Weight Disord 2012; 17:e298-303. [PMID: 23152083 DOI: 10.3275/8722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the applicability and validity of bioelectrical impedance analysis (BIA) compared with dual-energy X-ray absorptiometry (DXA) in a population of girls with restrictive anorexia nervosa (AN). METHODS A total of 30 girls (11-19 years old) with AN were enrolled. DXA and BIA (BIA software and the Deurenberg equations) were used to estimate the body composition. The correlation between the methods was assessed by Pearson's correlation coefficient and the Bland-Altman method. RESULTS The mean FFM estimates were 33.2 kg (BIA software), 32.8 kg (BIA, Deurenberg equation) and 33.1 kg (DXA). The mean FM values were 5.6 kg (BIA software), 6.2 kg (BIA, Deurenberg equation) and 6.4 kg (DXA). There was a high correlation between the FFM values estimated with the two methods (BIA software vs DXA r=0.917, p<0.001; Deurenberg equation vs DXA r=0.931, p<0.001). For the FFM, the limits of agreement were equal to ±3.34 kg for the BIA software and ±2.96 kg for the Deurenberg equation. For the FM, the limits of agreement were equal to ±4.60 kg for the BIA software and ±3.82 kg for the Deurenberg equation. CONCLUSION The results show a good correlation between DXA and BIA. BIA seems to be a valid alternative for epidemiological and clinical evaluations.
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Affiliation(s)
- G Bonaccorsi
- Dipartimento di Sanità Pubblica, Università degli Studi di Firenze, Viale GB Morgagni 48, 50134 Firenze, Italy
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19
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Deep-brain stimulation for anorexia nervosa. World Neurosurg 2012; 80:S29.e1-10. [PMID: 22743198 DOI: 10.1016/j.wneu.2012.06.039] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/25/2012] [Accepted: 06/21/2012] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a complex and severe, sometimes life-threatening, psychiatric disorder with high relapse rates under standard treatment. After decades of brain-lesioning procedures offered as a last resort, deep-brain stimulation (DBS) has come under investigation in the last few years as a treatment option for severe and refractory AN. METHODS AND RESULTS In this jointly written article, Sun et al. (the Shanghai group) report an average of 65% increase in body weight in four severe and refractory patients with AN after they underwent the DBS procedure (average follow-up: 38 months). All patients weighed greater than 85% of expected body weight and thus no longer met the diagnostic criteria of AN at last follow-up. Nuttin et al. (the Leuven group) describe other clinical studies that provide evidence for the use of DBS for AN and further discuss patient selection criteria, target selection, and adverse event of this evolving therapy. CONCLUSION Preliminary results from the Shanghai group and other clinical centers showed that the use of DBS to treat AN may be a valuable option for weight restoration in otherwise-refractory and life-threatening cases. The nature of this procedure, however, remains investigational and should not be viewed as a standard clinical treatment option. Further scientific investigation is essential to warrant the long-term efficacy and safety of DBS for AN.
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20
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Compan V, Laurent L, Jean A, Macary C, Bockaert J, Dumuis A. Serotonin signaling in eating disorders. ACTA ACUST UNITED AC 2012. [DOI: 10.1002/wmts.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Warren CS, Schafer KJ, Crowley ME, Olivardia R. A qualitative analysis of job burnout in eating disorder treatment providers. Eat Disord 2012; 20:175-95. [PMID: 22519896 DOI: 10.1080/10640266.2012.668476] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although job burnout is common in mental health care settings, almost no research has examined burnout in eating disorder treatment providers. Using qualitative methodology, this study examined a) perceived contributors of burnout, b) efforts to manage burnout, and c) recommendations for avoiding burnout in a sample of professional eating disorder treatment providers. Recruited via professional organizations, 298 participants completed an online questionnaire designed by the authors. Qualitative responses were coded and grouped into themes. Results indicated that almost all participants worried about their patients' health, which frequently resulted in negative affect (e.g., anxiety, sadness). The most frequently cited contributors to burnout were common characteristics of eating pathology (e.g., chronicity, relapse, symptom severity); patient characteristics (e.g., personality conflict); work-related factors (e.g., time demands); and, financial issues (e.g., inadequate compensation). To avoid burnout, over 90% of participants engaged in self-care behaviors (e.g., exercise, social support). Early-career practitioners were encouraged to utilize supervision, create a work/life balance, engage in self-care, and limit caseloads. These results suggest that supervision and training of eating disorder treatment providers should include burnout management.
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Affiliation(s)
- Cortney S Warren
- Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Parkway, Las Vegas, NV 89154, USA.
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22
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Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. ACTA ACUST UNITED AC 2011; 68:724-31. [PMID: 21727255 DOI: 10.1001/archgenpsychiatry.2011.74] [Citation(s) in RCA: 1505] [Impact Index Per Article: 115.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
CONTEXT Morbidity and mortality rates in patients with eating disorders are thought to be high, but exact rates remain to be clarified. OBJECTIVE To systematically compile and analyze the mortality rates in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). DATA SOURCES A systematic literature search, appraisal, and meta-analysis were conducted of the MEDLINE/PubMed, PsycINFO, and Embase databases and 4 full-text collections (ie, ScienceDirect, Ingenta Select, Ovid, and Wiley-Blackwell Interscience). STUDY SELECTION English-language, peer-reviewed articles published between January 1, 1966, and September 30, 2010, that reported mortality rates in patients with eating disorders. DATA EXTRACTION Primary data were extracted as raw numbers or confidence intervals and corrected for years of observation and sample size (ie, person-years of observation). Weighted proportion meta-analysis was used to adjust for study size using the DerSimonian-Laird model to allow for heterogeneity inclusion in the analysis. DATA SYNTHESIS From 143 potentially relevant articles, we found 36 quantitative studies with sufficient data for extraction. The studies reported outcomes of AN during 166 642 person-years, BN during 32 798 person-years, and EDNOS during 22 644 person-years. The weighted mortality rates (ie, deaths per 1000 person-years) were 5.1 for AN, 1.7 for BN, and 3.3 for EDNOS. The standardized mortality ratios were 5.86 for AN, 1.93 for BN, and 1.92 for EDNOS. One in 5 individuals with AN who died had committed suicide. CONCLUSIONS Individuals with eating disorders have significantly elevated mortality rates, with the highest rates occurring in those with AN. The mortality rates for BN and EDNOS are similar. The study found age at assessment to be a significant predictor of mortality for patients with AN. Further research is needed to identify predictors of mortality in patients with BN and EDNOS.
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Affiliation(s)
- Jon Arcelus
- Loughborough University Centre for Research into Eating Disorders, Loughborough University England.
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23
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Aigner M, Treasure J, Kaye W, Kasper S. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of eating disorders. World J Biol Psychiatry 2011; 12:400-43. [PMID: 21961502 DOI: 10.3109/15622975.2011.602720] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The treatment of eating disorders is a complex process that relies not only on the use of psychotropic drugs but should include also nutritional counselling, psychotherapy and the treatment of the medical complications, where they are present. In this review recommendations for the pharmacological treatment of eating disorders (anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED)) are presented, based on the available literature. METHODS The guidelines for the pharmacological treatment of eating disorders are based on studies published between 1977 and 2010. A search of the literature included: anorexia nervosa bulimia nervosa, eating disorder and binge eating disorder. Many compounds have been studied in the therapy of eating disorders (AN: antidepressants (TCA, SSRIs), antipsychotics, antihistaminics, prokinetic agents, zinc, Lithium, naltrexone, human growth hormone, cannabis, clonidine and tube feeding; BN: antidepressants (TCA, SSRIs, RIMA, NRI, other AD), antiepileptics, odansetron, d-fenfluramine Lithium, naltrexone, methylphenidate and light therapy; BED: antidepressants (TCA, SSRIs, SNRIs, NRI), antiepileptics, baclofen, orlistat, d-fenfluramine, naltrexone). RESULTS In AN 20 randomized controlled trials (RCT) could be identified. For zinc supplementation there is a grade B evidence for AN. For olanzapine there is a category grade B evidence for weight gain. For the other atypical antipsychotics there is grade C evidence. In BN 36 RCT could be identified. For tricyclic antidepressants a grade A evidence exists with a moderate-risk-benefit ratio. For fluoxetine a category grade A evidence exists with a good risk-benefit ratio. For topiramate a grade 2 recommendation can be made. In BED 26 RCT could be identified. For the SSRI sertraline and the antiepileptic topiramate a grade A evidence exists, with different recommendation grades. CONCLUSIONS Additional research is needed for the improvement of the treatment of eating disorders. Especially for anorexia nervosa there is a need for further pharmacological treatment strategies.
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Affiliation(s)
- Martin Aigner
- Department of Psychiatry and Psychotherapy, Medical University Vienna (MUW), Vienna, Austria.
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24
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Preti A, Rocchi MBL, Sisti D, Camboni MV, Miotto P. A comprehensive meta-analysis of the risk of suicide in eating disorders. Acta Psychiatr Scand 2011; 124:6-17. [PMID: 21092024 DOI: 10.1111/j.1600-0447.2010.01641.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Past meta-analyses on suicide in eating disorders included few available studies. METHOD PubMed/Medline search for papers including sample n ≥40 and follow-up ≥5 years: 40 studies on anorexia nervosa (AN), 16 studies on bulimia nervosa (BN), and three studies on binge eating disorder (BED) were included. RESULTS Of 16,342 patients with AN, 245 suicides occurred over a mean follow-up of 11.1 years (suicide rate=0.124 per 100 person-years). Standardized mortality ratio (SMR) was 31.0 (Poisson 95% CI=21.0-44.0); a clear decrease in suicide risk over time was observed in recent decades. Of 1768 patients with BN, four suicides occurred over a mean follow-up of 7.5 years (suicide rate=0.030 per 100 person-years): SMR was 7.5 (1.6-11.6). No suicide occurred among 246 patients with BED (mean follow-up=5.3 years). CONCLUSION AN and BN share many risk factors for suicide: the factors causing lower suicide rates per person-year in BN compared to AN should be investigated.
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Affiliation(s)
- A Preti
- Centro Medico Genneruxi, Via Costantinopoli 42, Cagliari, Italy.
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25
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Yamashita S, Kawai K, Yamanaka T, Inoo T, Yokoyama H, Morita C, Takii M, Kubo C. BMI, body composition, and the energy requirement for body weight gain in patients with anorexia nervosa. Int J Eat Disord 2010; 43:365-71. [PMID: 19459214 DOI: 10.1002/eat.20700] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Theories abound about the energy requirements for body weight gain in anorexia nervosa (AN). We hypothesized that malnutrition status affects the energy requirements. METHOD On admission, 97 AN patients were measured for body composition by dual-energy X-ray absorptiometry. The relationship between body mass index (BMI) and body composition was investigated. In addition, 21 patients who completed our treatment program were tested for energy intake and body weight. RESULTS The relationship between BMI and both fat-free mass and fat mass (FM) on admission was curvilinear. The weight gain per excess energy was greater in the group of patients with FM < 4 kg or BMI < 14 kg/m(2) than in the group with FM > or = 4 kg or BMI > or = 14 kg/m(2) (p = .037, p = .055, respectively). DISCUSSION The energy requirements for weight gain in AN patients are related to the initial FM and BMI.
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Affiliation(s)
- Sakino Yamashita
- Department of Psychosomatic Medicine, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
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26
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Welch E, Miller JL, Ghaderi A, Vaillancourt T. Does perfectionism mediate or moderate the relation between body dissatisfaction and disordered eating attitudes and behaviors? Eat Behav 2009; 10:168-75. [PMID: 19665100 DOI: 10.1016/j.eatbeh.2009.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 04/06/2009] [Accepted: 05/13/2009] [Indexed: 11/27/2022]
Abstract
A link between perfectionism and disordered eating has been documented in previous studies. The purpose of the current study was to expand our knowledge of the specific role of perfectionism in disordered eating by examining perfectionism as a mediator or a moderator in the relation between body dissatisfaction and disordered eating (assessed using the EAT-26 and its subscales, and the Binge Scale). We sampled a large ethnically diverse sample of university women (N=520) using two measures of perfectionism: the Eating Disorder Inventory Perfectionism subscale (EDI-P) and the Multidimensional Perfectionism Scale (H-MPS). In general, socially prescribed and self-oriented perfectionism, but not other-oriented perfectionism, were correlated with disordered eating attitudes and behaviors, except binge eating. Furthermore, perfectionism was found to partially mediate and moderate the relation between body dissatisfaction and disordered eating, however the strength of these associations differed depending on both the particular measure of perfectionism (EDI-P versus H-MPS) and the specific dimension of perfectionism (self-oriented, socially prescribed, other-oriented) used in the analyses. The findings are discussed in relation to the need for more informed and theoretically sound models of the development and maintenance of disordered eating.
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Affiliation(s)
- Elisabeth Welch
- Department of Psychology, Uppsala University, 751 42 Uppsala, Sweden.
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27
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Pediatric body composition analysis with dual-energy X-ray absorptiometry. Pediatr Radiol 2009; 39:647-56. [PMID: 19415261 DOI: 10.1007/s00247-009-1247-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 02/13/2009] [Accepted: 03/12/2009] [Indexed: 10/20/2022]
Abstract
Pediatric applications of body composition analysis (BCA) have become of increased interest to pediatricians and other specialists. With the increasing prevalence of morbid obesity and with an increased awareness of anorexia nervosa, pediatric specialists are utilizing BCA data to help identify, treat, and prevent these conditions. Dual-energy X-ray absorptiometry (DXA) can be used to determine the fat mass (FM) and lean tissue mass (LTM), as well as bone mineral content (BMC). Among the readily available BCA techniques, DXA is the most widely used and it has the additional benefit of precisely quantifying regional FM and LTM. This review evaluates the strengths and limitations of DXA as a pediatric BCA method and considers the utilization of DXA to identify trends and variations in FM and LTM measurements in obese and anorexic children.
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28
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Abstract
Pediatric applications of body composition analysis (BCA) have become of increased interest to pediatricians and other specialists. With the increasing prevalence of morbid obesity and with an increased awareness of anorexia nervosa, pediatric specialists are utilizing BCA data to help identify, treat, and prevent these conditions. Dual-energy X-ray absorptiometry (DXA) can be used to determine the fat mass (FM) and lean tissue mass (LTM), as well as bone mineral content (BMC). Among the readily available BCA techniques, DXA is the most widely used and it has the additional benefit of precisely quantifying regional FM and LTM. This review evaluates the strengths and limitations of DXA as a pediatric BCA method and considers the utilization of DXA to identify trends and variations in FM and LTM measurements in obese and anorexic children.
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Affiliation(s)
- Maura Helba
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Way, Columbus, OH 43205, USA
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29
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Klump KL, Bulik CM, Kaye WH, Treasure J, Tyson E. Academy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord 2009; 42:97-103. [PMID: 18951455 DOI: 10.1002/eat.20589] [Citation(s) in RCA: 277] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan 48824-1116, USA.
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30
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Warren CS, Crowley ME, Olivardia R, Schoen A. Treating patients with eating disorders: an examination of treatment providers' experiences. Eat Disord 2009; 17:27-45. [PMID: 19105059 DOI: 10.1080/10640260802570098] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patients with eating disorders bring unique challenges to treatment providers. The purpose of this study was to explore treatment providers' experiences working with patients with eating disorders. Specifically, we investigated 1) the frequency and management of commentary about the treatment providers' appearance from patients, 2) personal changes in affect, vigilance around appearance, and eating behaviors in treatment providers, and 3) feedback and suggestions about effectively working with these patients. Using quantitative and qualitative methods, 43 professional eating disorder treatment providers attending the Multiservice Eating Disorder Association (MEDA) annual conference completed a questionnaire created for this study. Results suggest that most treatment providers experienced direct and indirect commentary about their appearance from patients and experienced notable changes in their view of food, eating behaviors, and vigilance of their own and others' appearance while working with these patients. Recommendations and suggestions from treatment providers about effectively treating these patients and managing personal changes are explored.
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Affiliation(s)
- Cortney S Warren
- Department of Psychology, University of Nevada, Las Vegas, Nevada 89154, USA.
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31
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Papadopoulos FC, Ekbom A, Brandt L, Ekselius L. Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry 2009; 194:10-7. [PMID: 19118319 DOI: 10.1192/bjp.bp.108.054742] [Citation(s) in RCA: 267] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Anorexia nervosa is a mental disorder with high mortality. AIMS To estimate standardised mortality ratios (SMRs) and to investigate potential prognostic factors. METHOD Six thousand and nine women who had in-patient treatment for anorexia nervosa were followed-up retrospectively using Swedish registers. RESULTS The overall SMR for anorexia nervosa was 6.2 (95% CI 5.5-7.0). Anorexia nervosa, psychoactive substance use and suicide had the highest SMR. The SMR was significantly increased for almost all natural and unnatural causes of death. The SMR 20 years or more after the first hospitalisation remained significantly high. Lower mortality was found during the last two decades. Younger age and longer hospital stay at first hospitalisation was associated with better outcome, and psychiatric and somatic comorbidity worsened the outcome. CONCLUSIONS Anorexia nervosa is characterised by high lifetime mortality from both natural and unnatural causes. Assessment and treatment of psychiatric comorbidity, especially alcohol misuse, may be a pathway to better long-term outcome.
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32
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Lozano GA. Obesity and sexually selected anorexia nervosa. Med Hypotheses 2008; 71:933-40. [DOI: 10.1016/j.mehy.2008.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 05/30/2008] [Accepted: 07/04/2008] [Indexed: 11/16/2022]
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33
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Abstract
PURPOSE OF REVIEW The quality of life is in essence, the patients' subjective view of their own health status and can add another dimension to the evaluation of a treatment as the enteral nutrition.The recent clinical investigations on this topic are critically summarized in this review. RECENT FINDINGS Three areas of potential impact of enteral nutrition on quality of life of patients have been identified: elderly and neurological patients, cancer patients and patients with anorexia nervosa.A major problem is the difficulty to define quality of life, due to the holistic and subjective nature of this dimension. Moreover, many patients require help to complete the forms of the questionnaire. Finally, many factors besides the enteral nutrition can affect the quality of life of these patients, namely the basic condition and the primary disease of the patients. SUMMARY Although the enteral nutrition often represents a life-saving procedure, this does not necessarily translate in an appreciation of a better quality of life by the patients.Additional factors as the gustatory deprivation and the loss of social contacts usually associated with eating and the frequent problems related to tube function and tube-feeding represent severe limitations to a good quality of life of these patients.
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Harris AM, McAlpine DE, Shirbhate R, Manohar CU, Levine JA. Measurement of daily activity in restrictive type anorexia nervosa. Int J Eat Disord 2008; 41:280-3. [PMID: 18004719 PMCID: PMC2705949 DOI: 10.1002/eat.20486] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The assessment of daily activity in patients with restrictive type anorexia nervosa is limited by an absence of accurate and precise technology. We wanted to test a daily activity detecting device named, the physical activity monitoring system (PAMS). METHOD Women participants with restrictive type anorexia nervosa (n = 8, 36 +/- 11 years, 17 +/- 2 kg/m(2)) and healthy women participants (n = 8, 30 +/- 11 years, 27 +/- 7 kg/m(2)) were asked to lie, sit, and stand motionless, and walk at 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 mph while wearing PAMS. RESULTS For all restrictive type anorexia nervosa and healthy participants, body posture was correctly detected for all measurements (300/300). There was excellent correlation of an individual's body acceleration with walking velocity and walking energy expenditure (r(2) > .99). CONCLUSION The PAMS technology could serve as a tool for lending insight into the pathophysiology of restrictive type anorexia nervosa; and potentially measuring compliance with activity recommendations for medical professionals treating individuals with restrictive type anorexia nervosa.
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Affiliation(s)
- Ann M. Harris
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota 55905
| | | | - Rashmi Shirbhate
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota 55905
| | | | - James A. Levine
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota 55905
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35
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Jean A, Conductier G, Manrique C, Bouras C, Berta P, Hen R, Charnay Y, Bockaert J, Compan V. Anorexia induced by activation of serotonin 5-HT4 receptors is mediated by increases in CART in the nucleus accumbens. Proc Natl Acad Sci U S A 2007; 104:16335-40. [PMID: 17913892 PMCID: PMC2042207 DOI: 10.1073/pnas.0701471104] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Anorexia nervosa is a growing concern in mental health, often inducing death. The potential neuronal deficits that may underlie abnormal inhibitions of food intake, however, remain largely unexplored. We hypothesized that anorexia may involve altered signaling events within the nucleus accumbens (NAc), a brain structure involved in reward. We show here that direct stimulation of serotonin (5-hydroxytryptamine, 5-HT) 4 receptors (5-HT(4)R) in the NAc reduces the physiological drive to eat and increases CART (cocaine- and amphetamine-regulated transcript) mRNA levels in fed and food-deprived mice. It further shows that injecting 5-HT(4)R antagonist or siRNA-mediated 5-HT(4)R knockdown into the NAc induced hyperphagia only in fed mice. This hyperphagia was not associated with changes in CART mRNA expression in the NAc in fed and food-deprived mice. Results include that 5-HT(4)R control CART mRNA expression into the NAc via a cAMP/PKA signaling pathway. Considering that CART may interfere with food- and drug-related rewards, we tested whether the appetite suppressant properties of 3,4-N-methylenedioxymethamphetamine (MDMA, ecstasy) involve the 5-HT(4)R. Using 5-HT(4)R knockout mice, we demonstrate that 5-HT(4)R are required for the anorectic effect of MDMA as well as for the MDMA-induced enhancement of CART mRNA expression in the NAc. Directly injecting CART peptide or CART siRNA into the NAc reduces or increases food consumption, respectively. Finally, stimulating 5-HT(4)R- and MDMA-induced anorexia were both reduced by injecting CART siRNA into the NAc. Collectively, these results demonstrate that 5-HT(4)R-mediated up-regulation of CART in the NAc triggers the appetite-suppressant effects of ecstasy.
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MESH Headings
- Animals
- Anorexia Nervosa/etiology
- Anorexia Nervosa/genetics
- Anorexia Nervosa/metabolism
- Base Sequence
- Eating
- Male
- Mice
- Mice, Knockout
- N-Methyl-3,4-methylenedioxyamphetamine/pharmacology
- Nerve Tissue Proteins/antagonists & inhibitors
- Nerve Tissue Proteins/genetics
- Nerve Tissue Proteins/metabolism
- Nucleus Accumbens/drug effects
- Nucleus Accumbens/metabolism
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- RNA, Small Interfering/genetics
- Receptors, Serotonin, 5-HT4/deficiency
- Receptors, Serotonin, 5-HT4/genetics
- Receptors, Serotonin, 5-HT4/metabolism
- Signal Transduction
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Affiliation(s)
- Alexandra Jean
- *Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR)5203, Institut National de la Santé et de la Recherche Médicale, U661, Université Montpellier I and II, Institut de Génomique Fonctionnelle, Département de Neurobiologie, 141 Rue de la Cardonille, F-34094 Montpellier Cedex 5, France
- Université Nîmes (JE2425, Team 1, Anorexie, Dépendance, Obésité de Nîmes: ADONîmes), Rue Docteur Georges Salan, F-30021 Nîmes, France
| | - Grégory Conductier
- *Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR)5203, Institut National de la Santé et de la Recherche Médicale, U661, Université Montpellier I and II, Institut de Génomique Fonctionnelle, Département de Neurobiologie, 141 Rue de la Cardonille, F-34094 Montpellier Cedex 5, France
- Université Nîmes (JE2425, Team 1, Anorexie, Dépendance, Obésité de Nîmes: ADONîmes), Rue Docteur Georges Salan, F-30021 Nîmes, France
| | - Christine Manrique
- CNRS, UMR6149, Université Aix-Marseille I, Neurobiologie Intégrative et Adaptative, 3 Place Victor Hugo, F-13331 Marseille Cedex 3, France
| | - Constantin Bouras
- Hôpitaux Universitaires de Genève, Division de Neuropsychiatrie, CH-1225 Chêne-bourg, Switzerland; and
| | - Philippe Berta
- Université Nîmes (JE2425, Team 1, Anorexie, Dépendance, Obésité de Nîmes: ADONîmes), Rue Docteur Georges Salan, F-30021 Nîmes, France
| | - René Hen
- Center of Neurobiology and Behavior, Columbia University, New York, NY 10032
| | - Yves Charnay
- Hôpitaux Universitaires de Genève, Division de Neuropsychiatrie, CH-1225 Chêne-bourg, Switzerland; and
| | - Joël Bockaert
- *Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR)5203, Institut National de la Santé et de la Recherche Médicale, U661, Université Montpellier I and II, Institut de Génomique Fonctionnelle, Département de Neurobiologie, 141 Rue de la Cardonille, F-34094 Montpellier Cedex 5, France
| | - Valérie Compan
- *Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR)5203, Institut National de la Santé et de la Recherche Médicale, U661, Université Montpellier I and II, Institut de Génomique Fonctionnelle, Département de Neurobiologie, 141 Rue de la Cardonille, F-34094 Montpellier Cedex 5, France
- Université Nîmes (JE2425, Team 1, Anorexie, Dépendance, Obésité de Nîmes: ADONîmes), Rue Docteur Georges Salan, F-30021 Nîmes, France
- To whom correspondence should be addressed. E-mail:
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Lawson EA, Miller KK, Mathur VA, Misra M, Meenaghan E, Herzog DB, Klibanski A. Hormonal and nutritional effects on cardiovascular risk markers in young women. J Clin Endocrinol Metab 2007; 92:3089-94. [PMID: 17519306 PMCID: PMC3211045 DOI: 10.1210/jc.2007-0364] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Cardiovascular (CV) risk markers, including high-sensitivity C-reactive protein (hsCRP), are increasingly important in predicting cardiac events. A favorable CV risk profile might be expected in anorexia nervosa (AN) due to low body weight and dietary fat intake. However, women with AN have decreased IGF-I levels reflecting decreased GH action, and IGF-I deficiency is associated with elevated hsCRP. Moreover, oral estrogens, known to increase hsCRP in other populations, are commonly prescribed in AN. To date, hsCRP levels and their physiological determinants have not been reported in women with AN. OBJECTIVE We examined the relationship between CV risk markers, undernutrition, IGF-I, and oral estrogens, specifically hypothesizing that in the setting of undernutrition, AN would be associated with low hsCRP despite low IGF-I levels and that those women taking oral contraceptive pills (OCPs) would have higher hsCRP and lower IGF-I levels. DESIGN AND SETTING We conducted a cross-sectional study at a clinical research center. STUDY PARTICIPANTS Subjects included 181 women: 140 women with AN [85 not receiving OCPs (AN-E) and 55 receiving OCPs (AN+E)] and 41 healthy controls [28 not receiving OCPs (HC-E) and 13 receiving OCPs (HC+E)]. MAIN OUTCOME MEASURES We assessed hsCRP, IL-6, IGF-I, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). RESULTS Despite low weight, more than 20% of AN+E had high-risk hsCRP levels. AN+E had higher hsCRP than AN-E. AN-E had lower mean hsCRP levels than healthy controls (HC+E and HC-E). IL-6 levels were higher in AN+E with elevated hsCRP (>3 mg/liter) than in AN+E with normal hsCRP levels. IGF-I was inversely associated with hsCRP in healthy women, suggesting a protective effect of GH on CV risk. However, this was not seen in AN. Few patients in any group had high-risk LDL or HDL levels. CONCLUSIONS Although hsCRP levels are lower in AN than healthy controls, OCP use puts such women at a greater than 20% chance of having hsCRP in the high-CV-risk (>3 mg/liter) category. The elevated mean IL-6 in women with AN and high-risk hsCRP levels suggests that increased systemic inflammation may underlie the hsCRP elevation in these patients. Although OCP use in AN was associated with slightly lower mean LDL and higher mean HDL, means were within the normal range, and few patients in any group had high-risk LDL or HDL levels. IGF-I levels appear to be important determinants of hsCRP in healthy young women. In contrast, IGF-I does not appear to mediate hsCRP levels in AN.
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Affiliation(s)
- Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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