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Riedlinger C, Mazurak N, Schäffeler N, Stengel A, Giel KE, Zipfel S, Enck P, Mack I. Gastrointestinal complaints in patients with anorexia nervosa in the timecourse of inpatient treatment. Front Psychiatry 2022; 13:962837. [PMID: 36061281 PMCID: PMC9436028 DOI: 10.3389/fpsyt.2022.962837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In patients with anorexia nervosa (AN), gastrointestinal (GI) symptoms are common and usually improve during or after nutritional rehabilitation. It is unclear when exactly GI symptoms change in the timecourse of treatment and to which extent. In this study, we analyzed the timecourse of GI symptoms and their relation to disease-specific, demographic, anthropometric, and psychological factors in inpatients with AN. METHODS In weekly intervals, the Gastrointestinal Symptom Rating Scale (GSRS) was completed, and body weight was measured over a mean of 9.5 weeks in inpatients with AN. A total of four self-report questionnaires assessing psychological factors were completed before and after inpatient treatment. Data from 38 inpatients with AN were analyzed using mixed linear models. RESULTS Abdominal pain and constipation improved significantly in the timecourse with 0.085 (p = 0.002) and 0.101 (p = 0.004) points per week on the GSRS and were predicted to normalize after 13 (p = 0.002) and 17 (p = 0.004) weeks, respectively. Total GI symptoms tended to normalize after 25 weeks (p = 0.079). Indigestion (borborygmus, abdominal distension, eructation, flatulence) was the most severely pathological symptom at admission and did not improve significantly (p = 0.197). Diarrhea and reflux were, on average, not pathological at admission and remained stable during treatment. In addition to treatment time, the strongest predictors were ED pathology at admission for the development of abdominal pain, constipation, reflux, and total GI symptoms; stress for the development of constipation and total GI symptoms; and depression for constipation. CONCLUSIONS Informing patients with AN about the course of GI symptoms and their improvement during weight rehabilitation may help support compliance during treatment.
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Affiliation(s)
- Caroline Riedlinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany.,Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
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2
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Ahamed SK, Barek MA, Roy UK, Kouser M, Reza MS, Mannan AB, Alam MA, Uddin SMN. A review on association and correlation of genetic variants with eating disorders and obesity. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021. [DOI: 10.1186/s43094-021-00250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Now, eating disorders and obesity and their correlations are danger signal in worldwide which is caused by multifactor and associated with significant mortality and morbidity.
Main body
Every aspect of a patient’s life is influenced by eating disorders and obesity and their correlations. Due to frequent seeing of obese patients, eating disorders have been included in the review as they can sometimes be associated with obesity. However, it should be noted that most patients having eating disorder are at risk to be obese or overweight. This research explores the risk factors for the two disorders, as well as the assessment of medical complications and treatment recommendations for the disorders. In these two disorders, there is also a correlation. The essential consideration is that eating disorders are impulse-control disorders which are similar to addictive behaviors in some aspects. So it is a crying need to treat a patient with obesity and eating disorders simultaneously to ensure success. Genome-wide association studies (GWASs) have increased our knowledge of the pathophysiology of eating disorders (EDs) and obesity and their correlation.
Conclusion
This review enlightens on the summary of eating disorder, obesity, genotypic traits, molecular relations, interaction, correlation, and effect of eating disorder and obesity which outline potential future directions and clinical implications for patients with EDs and obesity.
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Jafri S, Frykas TL, Bingemann T, Phipatanakul W, Bartnikas LM, Protudjer JL. Food Allergy, Eating Disorders and Body Image. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 6. [PMID: 36381295 PMCID: PMC9665877 DOI: 10.1016/j.jadr.2021.100197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background/Introduction: Food allergy (FA) management involves avoiding allergenic foods to prevent an adverse reaction. Affected individuals spend substantial amounts of time thinking about food and the impact it has on their bodies. As such, we posit sustained awareness of food choices may contribute to distorted body image and disordered eating. We performed a narrative review to glean insight into associations between FA, body image and eating disorders. Methods: A literature search of Scopus, PsycINFO, PubMed and Google Scholar was conducted connecting terms for “food allergy” with terms for “body image” and “eating disorders”. Title and abstract screening were independently performed by two reviewers, with relevant abstracts carried forward to full text screening. Results: 159 articles were eligible for full text screening and a total of 12 publications were ultimately included in this narrative review, and 1 article from the grey literature. Adolescents and adults both reported feeling as though their bodies were “defective” and were found to have integrated their FA as a stable facet of their identities. In addition, FA was overwhelmingly associated with prevalence of eating disorders and eating disorder-like symptoms. Disturbed body image was found to be a mediating variable for the development of disordered patterns of eating in food allergic individuals. Limitations: Few studies appeared to consider comorbidities as confounders. Also, many studies employed convenience sampling, which does limit generalizability of conclusions. Discussion/Conclusion: Based on a small body of literature, there appears to be a potential association between FA and distorted body image and disordered eating.
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Affiliation(s)
- Syeda Jafri
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Tara Lynn Frykas
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Theresa Bingemann
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- Department of Medicine, and Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Wanda Phipatanakul
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- Division of Immunology, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Lisa M. Bartnikas
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- Division of Immunology, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Jennifer L.P. Protudjer
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada
- Centre for Healthcare Innovation, Winnipeg, MB, Canada
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Food and Human Nutritional Sciences, The University of Manitoba, Winnipeg, MB, Canada
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Corresponding author: Jennifer L.P. Protudjer, 501G-715 McDermot Ave, Winnipeg, MB, R3E 3P4, Canada, 1 (204) 480 1384, (J.L.P. Protudjer)
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4
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Translating Virtual Reality Cue Exposure Therapy for Binge Eating into a Real-World Setting: An Uncontrolled Pilot Study. J Clin Med 2021; 10:jcm10071511. [PMID: 33916374 PMCID: PMC8038593 DOI: 10.3390/jcm10071511] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023] Open
Abstract
Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.
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Brown T, Nauman Vogel E, Adler S, Bohon C, Bullock K, Nameth K, Riva G, Safer DL, Runfola CD. Bringing Virtual Reality From Clinical Trials to Clinical Practice for the Treatment of Eating Disorders: An Example Using Virtual Reality Cue Exposure Therapy. J Med Internet Res 2020; 22:e16386. [PMID: 32324145 PMCID: PMC7206518 DOI: 10.2196/16386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/07/2019] [Accepted: 12/15/2019] [Indexed: 12/11/2022] Open
Abstract
Novel treatment options for eating disorders (EDs) are critically needed to enhance treatment outcomes and reduce the rates of treatment dropouts. On average, only 50% of individuals receiving evidence-based care remit, whereas 24% drop out before treatment completion. One particularly promising direction involves integrating virtual reality (VR) with existing evidence-based treatments (EBTs) such as cue exposure therapy (CET). Across psychiatric disorders, VR-based interventions are demonstrating at least preliminary efficacy and noninferiority to traditional treatments. Furthermore, VR technology has become increasingly portable, resulting in improved acceptance, increased access, and reductions in cost. However, more efficient research processes may be needed to uncover the potential benefits of these rapid technological advances. This viewpoint paper reviews existing empirical support for integrating VR with EBTs (with a focus on its use with EDs) and proposes key next steps to more rapidly bring this innovative technology-based intervention into real-world clinic settings, as warranted. VR-CET for EDs is used to illustrate a suggested process for developing such treatment enhancements. We recommend following a deployment-focused model of intervention development and testing to enable rapid implementation of robust, practice-ready treatments. In addition, our review highlights the need for a comprehensive clinical protocol that supports clinicians and researchers in the implementation and testing of VR-CET and identifies key missing protocol components with rationale for their inclusion. Ultimately, this work may lead to a more complete understanding of the full potential of the applications and integrations of VR into mental health care globally.
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Affiliation(s)
- Theresa Brown
- PGSP-Stanford PsyD Consortium, Palo Alto, CA, United States
| | | | - Sarah Adler
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Katherine Nameth
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy.,Centro Studi e Ricerche di Psicologia della Comunicazione, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Debra L Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Cristin D Runfola
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
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6
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Naturalistic follow-up of subjects affected with anorexia nervosa 8 years after multimodal treatment: Personality and psychopathology changes and predictors of outcome. Eur Psychiatry 2020; 45:198-206. [DOI: 10.1016/j.eurpsy.2017.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 11/19/2022] Open
Abstract
AbstractBackground:Eating disorders (EDs) are serious mental illnesses of growing clinical and social impact. Despite their severity, there is still no satisfactory evidence-based treatment. Follow-up investigations are the most reliable studies to enlighten long-term outcome predictors and modifiers.Methods:In total, 59 subjects affected with anorexia nervosa were assessed 8 years after their admission into an outpatient multimodal treatment program for eating disorders. The follow-up changes in diagnostic criteria were compared with Chi-square test. Improved and not-improved subjects were compared. Clinical, personality and psychopathology features between T0 and T1 were compared with t-test for repeated measures. Correlation between T0 features and changes at T1 in personality and psychopathology features were assessed.Results:The rate of complete remission was 42%, an overall rate of 67.8% improved, a rate of 18.6% worsened. Concerning personality, a significant decrease of harm avoidance and increase in self-directedness were evidenced. Interoceptive awareness, drive for thinness, bulimia were significantly reduced at follow-up. Many T0 personality facets were related to personality and psychopathology improvement at follow-up.Conclusion:Multimodal treatment encompassing psychiatric, nutritional and psychological approaches is at the moment the most reliable approach for the treatment of moderate to severe anorexia nervosa with a discrete rate of improvement. Some personality and psychopathology characteristics may represent specific factors which favor resistance and impair improvement. Future approaches should consider the personalization of therapeutic approach according to these features.
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7
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Abstract
BACKGROUND Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. OBJECTIVES To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa. DATA COLLECTION AND ANALYSIS Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures. MAIN RESULTS We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I2 = 37%) and at long-term follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up. AUTHORS' CONCLUSIONS There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or other psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted trials.
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Affiliation(s)
- Caroline A Fisher
- Royal Melbourne Hospital, Melbourne HealthAllied Health ‐ PsychologyParkvilleVictoriaAustralia3050
| | - Sonja Skocic
- HealthscopeThe Melbourne ClinicRichmondVictoriaAustralia
| | | | - Sarah E Hetrick
- University of AucklandDepartment of Psychological MedicineAucklandNew Zealand
- University of MelbourneThe Centre of Youth Mental HealthMelbourneVictoriaAustralia
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8
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Abstract
BACKGROUND Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. OBJECTIVES To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa. DATA COLLECTION AND ANALYSIS Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures. MAIN RESULTS We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I2 = 37%) and at long-term follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up. AUTHORS' CONCLUSIONS There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted trials.
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Affiliation(s)
- Caroline A Fisher
- Royal Melbourne Hospital, Melbourne HealthAllied Health ‐ PsychologyParkvilleAustralia3050
| | - Sonja Skocic
- HealthscopeThe Melbourne ClinicRichmondAustralia
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9
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Kim DY, Yu J, Mui RK, Niibori R, Taufique HB, Aslam R, Semple JW, Cordes SP. The tyrosine kinase receptor Tyro3 enhances lifespan and neuropeptide Y (Npy) neuron survival in the mouse anorexia ( anx) mutation. Dis Model Mech 2017; 10:581-595. [PMID: 28093506 PMCID: PMC5451163 DOI: 10.1242/dmm.027433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/12/2016] [Indexed: 01/01/2023] Open
Abstract
Severe appetite and weight loss define the eating disorder anorexia nervosa, and can also accompany the progression of some neurodegenerative disorders such as amyotrophic lateral sclerosis (ALS). Although acute loss of hypothalamic neurons that produce appetite-stimulating neuropeptide Y (Npy) and agouti-related peptide (Agrp) in adult mice or in mice homozygous for the anorexia (anx) mutation causes aphagia, our understanding of the factors that help maintain appetite regulatory circuitry is limited. Here we identify a mutation (C19T) that converts an arginine to a tryptophan (R7W) in the TYRO3 protein tyrosine kinase 3 (Tyro3) gene, which resides within the anx critical interval, as contributing to the severity of anx phenotypes. Our observation that, like Tyro3-/- mice, anx/anx mice exhibit abnormal secondary platelet aggregation suggested that the C19T Tyro3 variant might have functional consequences. Tyro3 is expressed in the hypothalamus and other brain regions affected by the anx mutation, and its mRNA localization appeared abnormal in anx/anx brains by postnatal day 19 (P19). The presence of wild-type Tyro3 transgenes, but not an R7W-Tyro3 transgene, doubled the weight and lifespans of anx/anx mice and near-normal numbers of hypothalamic Npy-expressing neurons were present in Tyro3-transgenic anx/anx mice at P19. Although no differences in R7W-Tyro3 signal sequence function or protein localization were discernible in vitro, distribution of R7W-Tyro3 protein differed from that of Tyro3 protein in the cerebellum of transgenic wild-type mice. Thus, R7W-Tyro3 protein localization deficits are only detectable in vivo Further analyses revealed that the C19T Tyro3 mutation is present in a few other mouse strains, and hence is not the causative anx mutation, but rather an anx modifier. Our work shows that Tyro3 has prosurvival roles in the appetite regulatory circuitry and could also provide useful insights towards the development of interventions targeting detrimental weight loss.
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Affiliation(s)
- Dennis Y Kim
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, 1 King's Crescent, Toronto, ON M5S 1A8, Canada
| | - Joanna Yu
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, 1 King's Crescent, Toronto, ON M5S 1A8, Canada
| | - Ryan K Mui
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, 1 King's Crescent, Toronto, ON M5S 1A8, Canada
| | - Rieko Niibori
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
| | - Hamza Bin Taufique
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, 1 King's Crescent, Toronto, ON M5S 1A8, Canada
| | - Rukhsana Aslam
- Keenan Research Centre for Biomedical Science, St. Michaels Hospital, Toronto, ON M5B 1W8, Canada
- Canadian Blood Services, 67 College Street, Toronto, ON M5G 2M1, Canada
| | - John W Semple
- Keenan Research Centre for Biomedical Science, St. Michaels Hospital, Toronto, ON M5B 1W8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
- Canadian Blood Services, 67 College Street, Toronto, ON M5G 2M1, Canada
| | - Sabine P Cordes
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, 1 King's Crescent, Toronto, ON M5S 1A8, Canada
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ITO HIROYUKI, MURAYAMA YASUO, KATAGIRI MASATOSHI, NAKAJIMA SYUNJI, HAMADA MEGUMI, TANAKA YOSHIHIRO, NODA WATARU, TAKAYANAGI NOBUYA, TSUJII MASATSUGU. Abnormal Eating Behavior in Elementary and Junior High School Students : Relation to Mental Health and Social Maladjustment. ACTA ACUST UNITED AC 2016. [DOI: 10.5926/jjep.64.170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tennoune N, Legrand R, Ouelaa W, Breton J, Lucas N, Bole-Feysot C, do Rego JC, Déchelotte P, Fetissov SO. Sex-related effects of nutritional supplementation of Escherichia coli: relevance to eating disorders. Nutrition 2014; 31:498-507. [PMID: 25701341 DOI: 10.1016/j.nut.2014.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The biological background of sex-related differences in the development of eating disorders (EDs) is unknown. Recent data showed that gut bacteria Escherichia coli induce autoantibodies against anorexigenic α-melanocyte-stimulating hormone (α-MSH) associated with psychopathology in ED. The aim of this study was to compare the effects of E. coli on feeding and autoantibodies against α-MSH and adrenocorticotropic hormone (ACTH), between female and male rats. METHODS Commensal E. coli K12 were given in a culture medium daily to adult Wistar rats by intragastric gavage over a 3-wk period; control rats received culture medium only. RESULTS Before gavage, E. coli K12 DNA was detected in feces of female but not male rats. E. coli provision was accompanied by an increase in body weight gain in females, but a decrease in body weight gain and food intake in males. Independent of E. coli treatment, plasma levels of anti-α-MSH and ACTH immunoglobulin (Ig)G were higher in female than male rats. Females responded to E. coli by increasing α-MSH IgG levels and affinity, but males by increasing α-MSH IgM levels. Affinity of IgG for ACTH was increased in both E. coli-treated females and males, although with different kinetics. IgG from females stimulated more efficiently α-MSH-induced cyclic adenosine monophosphate production by melanocortin 4 receptor-expressing cells compared with IgG from males. DISCUSSION Sex-related response to how E. coli affects feeding and anti-melanocortin hormone antibody production may depend on the presence of these bacteria in the gut before E. coli supplementation. These data suggest that sex-related presence of certain gut bacteria may represent a risk factor for ED development.
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Affiliation(s)
- Naouel Tennoune
- Inserm UMR1073, Nutrition, Gut and Brain Laboratory, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Normandy University, Rouen, France
| | - Romain Legrand
- Inserm UMR1073, Nutrition, Gut and Brain Laboratory, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Normandy University, Rouen, France
| | - Wassila Ouelaa
- Inserm UMR1073, Nutrition, Gut and Brain Laboratory, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Normandy University, Rouen, France
| | - Jonathan Breton
- Inserm UMR1073, Nutrition, Gut and Brain Laboratory, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Normandy University, Rouen, France
| | - Nicolas Lucas
- Inserm UMR1073, Nutrition, Gut and Brain Laboratory, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Normandy University, Rouen, France
| | - Christine Bole-Feysot
- Inserm UMR1073, Nutrition, Gut and Brain Laboratory, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Normandy University, Rouen, France
| | - Jean-Claude do Rego
- Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Normandy University, Rouen, France; Animal behavior platform (SCAC), Rouen, France
| | - Pierre Déchelotte
- Inserm UMR1073, Nutrition, Gut and Brain Laboratory, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Normandy University, Rouen, France; Rouen University Hospital, CHU Charles Nicolle, Rouen, France
| | - Sergueï O Fetissov
- Inserm UMR1073, Nutrition, Gut and Brain Laboratory, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Normandy University, Rouen, France.
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12
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Butt I, Hong A, Di J, Aracena S, Banerjee P, Shen CH. The effects of serotonin1A receptor on female mice body weight and food intake are associated with the differential expression of hypothalamic neuropeptides and the GABAA receptor. Neuropeptides 2014; 48:313-8. [PMID: 25130282 DOI: 10.1016/j.npep.2014.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 07/01/2014] [Accepted: 07/23/2014] [Indexed: 11/29/2022]
Abstract
Both common eating disorders anorexia nervosa and bulimia nervosa are characteristically diseases of women. To characterize the role of the 5-HT1A receptor (5-HT1A-R) in these eating disorders in females, we investigated the effect of saline or 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT) treatment on feeding behavior and body weight in adult WT female mice and in adult 5-HT1A-R knockout (KO) female mice. Our results showed that KO female mice have lower food intake and body weight than WT female mice. Administration of 8-OH-DPAT decreased food intake but not body weight in WT female mice. Furthermore, qRT-PCR was employed to analyze the expression levels of neuropeptides, γ-aminobutyric acid A receptor subunit β (GABAA β subunits) and glutamic acid decarboxylase in the hypothalamic area. The results showed the difference in food intake between WT and KO mice was accompanied by differential expression of POMC, CART and GABAA β2, and the difference in body weight between WT and KO mice was associated with significantly different expression levels of CART and GABAA β2. As such, our data provide new insight into the role of 5-HT1A-R in both feeding behavior and the associated expression of neuropeptides and the GABAA receptor.
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Affiliation(s)
- Isma Butt
- Department of Biology, College of Staten Island, City University of New York, Staten Island, NY 10314, USA
| | - Andrew Hong
- Department of Biology, College of Staten Island, City University of New York, Staten Island, NY 10314, USA
| | - Jing Di
- Department of Biology, College of Staten Island, City University of New York, Staten Island, NY 10314, USA
| | - Sonia Aracena
- Department of Chemistry, College of Staten Island, City University of New York, Staten Island, NY 10314, USA
| | - Probal Banerjee
- Institute for Macromolecular Assemblies, City University of New York, Staten Island, NY 10314, USA; Department of Chemistry, College of Staten Island, City University of New York, Staten Island, NY 10314, USA
| | - Chang-Hui Shen
- Department of Biology, College of Staten Island, City University of New York, Staten Island, NY 10314, USA; Institute for Macromolecular Assemblies, City University of New York, Staten Island, NY 10314, USA.
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13
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Abstract
Disordered eating behavior is the core symptom of the complex disorders anorexia nervosa and bulimia nervosa. Twin and family studies derive high heritability estimates. Hence, substantial genetic influences on the etiology can be assumed for both. Initially, candidate gene studies pertaining to the monoaminergic neurotransmitter systems and to body weight regulation comprised the core of the genetic analyses. Unfortunately, confirmed, solid findings substantiated in meta-analyses are rare, so that eventually none of these associations is unequivocal. Thus, systematic, genome-wide approaches emerged to identify genes with no a priori evidence for their involvement in eating disorders. Genome-wide association studies have hinted to formerly unknown genetic regions. However, significant genome-wide findings have not yet been reported.
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14
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Cui H, Moore J, Ashimi SS, Mason BL, Drawbridge JN, Han S, Hing B, Matthews A, McAdams CJ, Darbro BW, Pieper AA, Waller DA, Xing C, Lutter M. Eating disorder predisposition is associated with ESRRA and HDAC4 mutations. J Clin Invest 2013; 123:4706-13. [PMID: 24216484 PMCID: PMC3809805 DOI: 10.1172/jci71400] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/08/2013] [Indexed: 12/22/2022] Open
Abstract
Anorexia nervosa and bulimia nervosa are common and severe eating disorders (EDs) of unknown etiology. Although genetic factors have been implicated in the psychopathology of EDs, a clear biological pathway has not been delineated. DNA from two large families affected by EDs was collected, and mutations segregating with illness were identified by whole-genome sequencing following linkage mapping or by whole-exome sequencing. In the first family, analysis of twenty members across three generations identified a rare missense mutation in the estrogen-related receptor α (ESRRA) gene that segregated with illness. In the second family, analysis of eight members across four generations identified a missense mutation in the histone deacetylase 4 (HDAC4) gene that segregated with illness. ESRRA and HDAC4 were determined to interact both in vitro in HeLa cells and in vivo in mouse cortex. Transcriptional analysis revealed that HDAC4 potently represses the expression of known ESRRA-induced target genes. Biochemical analysis of candidate mutations revealed that the identified ESRRA mutation decreased its transcriptional activity, while the HDAC4 mutation increased transcriptional repression of ESRRA. Our findings suggest that mutations that result in decreased ESRRA activity increase the risk of developing EDs.
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Affiliation(s)
- Huxing Cui
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jarrette Moore
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sunbola S. Ashimi
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brittany L. Mason
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jordan N. Drawbridge
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shizhong Han
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin Hing
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Abigail Matthews
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Carrie J. McAdams
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin W. Darbro
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew A. Pieper
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David A. Waller
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chao Xing
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Lutter
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics and
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Avena NM, Murray S, Gold MS. Comparing the effects of food restriction and overeating on brain reward systems. Exp Gerontol 2013; 48:1062-7. [PMID: 23535488 PMCID: PMC4013785 DOI: 10.1016/j.exger.2013.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 02/20/2013] [Accepted: 03/18/2013] [Indexed: 11/16/2022]
Abstract
Both caloric restriction and overeating have been shown to affect neural processes associated with reinforcement. Both preclinical and some clinical studies have provided evidence that food restriction may increase reward sensitivity, and while there are mixed findings regarding the effects of overeating on reward sensitivity, there is strong evidence linking this behavior with changes in reward-related brain regions. Evidence of these changes comes in part from findings that show that such eating patterns are associated with increased drug use. The data discussed here regarding the differential effects of various eating patterns on reward systems may be particularly relevant to the aging population, as this population has been shown to exhibit altered reward sensitivity and decreased caloric consumption. Moreover, members of this population appear to be increasingly affected by the current obesity epidemic. Food, like alcohol or drugs, can stimulate its own consumption and produce similar neurochemical changes in the brain. Age-related loss of appetite, decreased eating, and caloric restriction are hypothesized to be associated with changes in the prevalence of substance misuse, abuse, and dependence seen in this cohort.
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Affiliation(s)
- Nicole M Avena
- University of Florida, Department of Psychiatry, Gainesville, FL 32610, USA.
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16
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Salvioli B, Pellicciari A, Iero L, Di Pietro E, Moscano F, Gualandi S, Stanghellini V, De Giorgio R, Ruggeri E, Franzoni E. Audit of digestive complaints and psychopathological traits in patients with eating disorders: a prospective study. Dig Liver Dis 2013; 45:639-44. [PMID: 23582347 DOI: 10.1016/j.dld.2013.02.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/14/2013] [Accepted: 02/27/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Esophago-gastrointestinal symptoms are frequently reported by patients with eating disorders. Scanty data exist on the relationship between psychopathological traits and digestive complaints. AIMS To prospectively analyze (i) prevalence of digestive symptoms; (ii) psychopathological traits; (iii) relationship between symptom scores and psychopathological profiles. METHODS Psychopathological and digestive symptom questionnaires were completed at baseline, at discharge, at 1 and 6 months' follow-up in 48 consecutive patients (85.4% female, median age, 15 years) hospitalized for eating disorders. RESULTS The most frequently reported symptoms were postprandial fullness (96%) and abdominal distention (90%). Pooled esophageal (4; IQR 0-14) and gastrointestinal (34; IQR 19-53) symptoms significantly decreased at 6 months' follow-up (1; IQR 0-3 and 10; IQR 4-34; p<0.0001 and p<0.005, respectively). Pooled gastrointestinal symptoms significantly correlated with hypochondriasis (r=0.42, p<0.01). Both esophageal and gastrointestinal symptoms improved in patients with normal values of hypochondriasis and hysteria scales (p<0.05 and p<0.005, respectively) compared to those with pathological traits. CONCLUSIONS Digestive symptoms are frequently reported by patients with eating disorders with their expression and outcome being influenced by psychopathological profiles. Hypochondriasis and hysteria traits are predictive factors for symptomatic improvement.
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Back-Brito GN, da Mota AJ, de Souza Bernardes LÂ, Takamune SS, Prado EDFGB, Cordás TA, Balducci I, da Nobrega FG, Koga-Ito CY. Effects of eating disorders on oral fungal diversity. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 113:512-7. [PMID: 22668429 DOI: 10.1016/j.oooo.2011.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 09/25/2011] [Accepted: 10/03/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND The eating disorders anorexia and bulimia nervosa can cause several systemic and oral alterations related to poor nutrition and induced vomiting; however, the oral microflora of these patients is poorly studied. OBJECTIVE The aim of this study was to evaluate fungal microflora in the oral cavity of these patients by culture-dependent and culture-independent methods. STUDY DESIGN Oral rinse samples were cultured to assess the prevalence of Candida species, and the isolates were identified by API system. Microorganism counts were compared by the Mann-Whitney test (5%). Ribotyping, a type of molecular analysis, was performed by sequencing the D1/D2 regions of 28S rRNA. RESULTS Our results demonstrated that the eating disorder group showed higher oral Candida spp. prevalence with culture-dependent methods and higher species diversity with culture-independent methods. CONCLUSIONS Eating disorders can lead to an increased oral Candida carriage. Culture-independent identification found greater fungal diversity than culture-dependent methods.
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Affiliation(s)
- Graziella Nuernberg Back-Brito
- Department of Biosciences and Oral Diagnosis, São José dos Campos Dental School, University Estadual Paulista, São José dos Campos, Brazil.
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Teufel M, Giel KE, Lehr J, Becker S, Muthig M, Zipfel S, Kuprion J. Thyroxine, shape, and weight: interaction of Graves' disease and bulimia nervosa. Eat Weight Disord 2013; 18:99-101. [PMID: 23757259 DOI: 10.1007/s40519-013-0013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 11/16/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE A case of a 25-year-old woman with bulimia nervosa and Graves' disease is presented. Graves' disease is the cause of 50-80 % of hyperthyroidism. The disease is characterized by increases of thyroid hormone production, activation of the metabolism, and successive weight loss. Bulimia nervosa is characterized by purging behavior after binge eating episodes. METHOD AND RESULTS We report a patient suffering from both entities. A pronounced non-compliance to the intake of antithyroid drugs (Carbimazole) correlated with eating disorder symptoms like negative evaluation of the body and fear of weight gain. Thus, elevated hyperthyroidism due to Graves' disease served as a purging method. During 8 weeks of inpatient psychotherapy, the patient adapted to a structured eating behavior. Self-esteem was less influenced by body shape and body weight, and compliance to endocrinological recommendations improved. CONCLUSION Non-compliance to antithyroid drugs may be a symptom of an eating disorder. A careful and primarily non-confronting interdisciplinary diagnostic and treatment approach is required.
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Affiliation(s)
- Martin Teufel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstrasse 5, 72076, Tübingen, Germany,
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Chaki B, Pal S, Bandyopadhyay A. Exploring scientific legitimacy of orthorexia nervosa: a newly emerging eating disorder. JOURNAL OF HUMAN SPORT AND EXERCISE 2013. [DOI: 10.4100/jhse.2013.84.14] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Slof-Op ‘t Landt MCT, van Furth EF, Meulenbelt I, Slagboom PE, Bartels M, Boomsma DI, Bulik CM. Eating Disorders: From Twin Studies to Candidate Genes and Beyond. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.8.5.467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractSubstantial effort has been put into the exploration of the biological background of eating disorders, through family, twin and molecular genetic studies. Family studies have shown that anorexia (AN) and bulimia nervosa (BN) are strongly familial, and that familial etiologic factors appear to be shared by both disorders. Twin studies often focus on broader phenotypes or subthreshold eating disorders. These studies consistently yielded moderate to substantial heritabilities. In addition, there has been a proliferation of molecular genetic studies that focused on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) AN and BN. Seven linkage regions have been identified in genome-wide screens. Many genetic association studies have been performed, but no consistent association between a candidate gene and AN or BN has been reported. Larger genetic association studies and collaborations are needed to examine the involvement of several candidate genes and biological pathways in eating disorders. In addition, twin studies should be designed to assist the molecular work by further exploring genetic determinants of endophenotypes, evaluating the magnitude of contribution to liability of measured genotypes as well as environmental risk factors related to eating disorders. In this manner twin and molecular studies can move the field forward in a mutually informative way.
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Activity-based anorexia in C57/BL6 mice: effects of the phytocannabinoid, Delta9-tetrahydrocannabinol (THC) and the anandamide analogue, OMDM-2. Eur Neuropsychopharmacol 2010; 20:622-31. [PMID: 20471226 DOI: 10.1016/j.euroneuro.2010.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 03/27/2010] [Accepted: 04/02/2010] [Indexed: 01/08/2023]
Abstract
The activity-based anorexia (ABA) paradigm is one of the few animal models of human anorexia nervosa. We present here the translation of this approach to C57/BL6 mice, a common background for genetically modified mice, and investigate the effects of the cannabinoid agonist, Delta(9)-tetrahydrocannabinol (THC) and the endocannabinoid uptake inhibitor, OMDM-2 in this model. The ABA paradigm was optimised so that food-restricted wheel-running mice displayed anorexia, reduced body weight and disrupted activity and circadian cycles. These conditions produced a murine ABA model with a defined stage and stability to allow for pharmacological intervention. Daily Delta(9)-THC (0.5 mg/kg) decreased survival in the ABA animals but increased feeding in the survivors, OMDM-2 (3 mg/kg) increased food intake, but not sufficiently to reverse weight loss. The effects of this model on endocannabinoid tone in the brain remain to be determined. Since the endocannabinoid system may be implicated in anorexia nervosa and in view of the positive modulation by cannabinoids of some aspects of ABA in this study, further investigation of the effects of cannabinoids in ABA is warranted.
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Wehkalampi K, Hovi P, Strang-Karlsson S, Räikkönen K, Pesonen AK, Heinonen K, Mäkitie O, Järvenpää AL, Eriksson JG, Andersson S, Kajantie E. Reduced body size and shape-related symptoms in young adults born preterm with very low birth weight: Helsinki study of very low birth weight adults. J Pediatr 2010; 157:421-7, 427.e1. [PMID: 20400106 DOI: 10.1016/j.jpeds.2010.02.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 01/20/2010] [Accepted: 02/23/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the hypothesis that being born prematurely with very low birth weight (VLBW) (birth weight<or=1500 g) is associated with subphenotypes of eating disorders (dissatisfaction with body shape and pursuit of thinness) in young adulthood. STUDY DESIGN Preterm-born VLBW subjects (n=163) and controls (n=189) born at term completed 3 subscales of Eating Disorder Inventory-2 questionnaire (EDI): Drive for Thinness, Body Dissatisfaction, and Bulimia. Data were analyzed with multiple linear regression adjusted for confounders. RESULTS Among both sexes, EDI total scores were lower in VLBW subjects than in controls. The fully adjusted difference was -11.0% (95% CI, -18.4%, -2.2%) for women and -11.2% (95% CI, -20.2%, -1.3%) for men. Among women the lower scores in VLBW adults were observed in each EDI subscale. Results were similar when adjusted also for fat percentage, measured by dual-energy x-ray absorptiometry. Of the covariates, higher body mass index and higher score in Beck Depression Inventory contributed significantly to a higher EDI total score. CONCLUSIONS Young adults, particularly women, born prematurely with VLBW have fewer body size and shape-related symptoms and possibly lower risk for eating disorders than their term-born peers.
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Affiliation(s)
- Karoliina Wehkalampi
- Department of Health Promotion and Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
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Bilali A, Galanis P, Velonakis E, Katostaras T. Factors associated with abnormal eating attitudes among Greek adolescents. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2010; 42:292-298. [PMID: 20591741 DOI: 10.1016/j.jneb.2009.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 06/03/2009] [Accepted: 06/04/2009] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To estimate the prevalence of abnormal eating attitudes among Greek adolescents and identify possible risk factors associated with these attitudes. DESIGN Cross-sectional, school-based study. SETTING Six randomly selected schools in Patras, southern Greece. PARTICIPANTS The study population consisted of 540 Greek students aged 13-18 years, and the response rate was 97%. MAIN OUTCOME MEASURE The dependent variable was scores on the Eating Attitudes Test-26, with scores > or = 20 indicating abnormal eating attitudes. ANALYSIS Bivariate analysis included independent Student t test, chi-square test, and Fisher's exact test. Multivariate logistic regression analysis was applied for the identification of the predictive factors, which were associated independently with abnormal eating attitudes. A 2-sided P value of less than .05 was considered statistically significant. RESULTS The prevalence of abnormal eating attitudes was 16.7%. Multivariate logistic regression analysis demonstrated that females, urban residents, and those with a body mass index outside normal range, a perception of being overweight, body dissatisfaction, and a family member on a diet were independently related to abnormal eating attitudes. CONCLUSIONS AND IMPLICATIONS The results indicate that a proportion of Greek adolescents report abnormal eating attitudes and suggest that multiple factors contribute to the development of these attitudes. These findings are useful for further research into this topic and would be valuable in designing preventive interventions.
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Affiliation(s)
- Aggeliki Bilali
- Laboratory of Demography, Faculty of Nursing, University of Athens, Athens, Greece
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24
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Eating disorders: the current status of molecular genetic research. Eur Child Adolesc Psychiatry 2010; 19:211-26. [PMID: 20033240 PMCID: PMC2839487 DOI: 10.1007/s00787-009-0085-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 12/04/2009] [Indexed: 12/31/2022]
Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are complex disorders characterized by disordered eating behavior where the patient's attitude towards weight and shape, as well as their perception of body shape, are disturbed. Formal genetic studies on twins and families suggested a substantial genetic influence for AN and BN. Candidate gene studies have initially focused on the serotonergic and other central neurotransmitter systems and on genes involved in body weight regulation. Hardly any of the positive findings achieved in these studies were unequivocally confirmed or substantiated in meta-analyses. This might be due to too small sample sizes and thus low power and/or the genes underlying eating disorders have not yet been analyzed. However, some studies that also used subphenotypes (e.g., restricting type of AN) led to more specific results; however, confirmation is as yet mostly lacking. Systematic genome-wide linkage scans based on families with at least two individuals with an eating disorder (AN or BN) revealed initial linkage regions on chromosomes 1, 3 and 4 (AN) and 10p (BN). Analyses on candidate genes in the chromosome 1 linkage region led to the (as yet unconfirmed) identification of certain variants associated with AN. Genome-wide association studies are under way and will presumably help to identify genes and pathways involved in these eating disorders. The elucidation of the molecular mechanisms underlying eating disorders might improve therapeutic approaches.
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25
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Hinney A, Scherag S, Hebebrand J. Genetic findings in anorexia and bulimia nervosa. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2010; 94:241-70. [PMID: 21036328 DOI: 10.1016/b978-0-12-375003-7.00009-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are complex disorders associated with disordered eating behavior. Heritability estimates derived from twin and family studies are high, so that substantial genetic influences on the etiology can be assumed for both. As the monoaminergic neurotransmitter systems are involved in eating disorders (EDs), candidate gene studies have centered on related genes; additionally, genes relevant for body weight regulation have been considered as candidates. Unfortunately, this approach has yielded very few positive results; confirmed associations or findings substantiated in meta-analyses are scant. None of these associations can be considered unequivocally validated. Systematic genome-wide approaches have been performed to identify genes with no a priori evidence for their relevance in EDs. Family-based scans revealed linkage peaks in single chromosomal regions for AN and BN. Analyses of candidate genes in one of these regions led to the identification of genetic variants associated with AN. Currently, an international consortium is conducting a genome-wide association study for AN, which will hopefully lead to the identification of the first genome-wide significant markers.
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Affiliation(s)
- Anke Hinney
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany
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26
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Affiliation(s)
- David R Thomas
- Division of Geriatric Medicine, Saint Louis, Missouri 63104, USA.
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27
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Weight change and appetite disturbance as symptoms of adolescent depression: toward an integrative biopsychosocial model. Clin Psychol Rev 2009; 29:260-73. [PMID: 19250729 DOI: 10.1016/j.cpr.2009.01.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 01/22/2009] [Accepted: 01/29/2009] [Indexed: 11/22/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.] lists weight change and appetite disturbance as a single compound symptom of depression at all ages. Nonetheless, assessment of these symptoms is complicated during adolescence by normative increases in body weight and appetitive drive as well as heightened rates of body dissatisfaction, dieting, and eating disorders. This review outlines biological and psychological mechanisms that may change the relation of weight change and appetite disturbance to depression during adolescence. We propose a developmental model of the relation of these symptoms to the disorder and use the model as a framework to summarize findings, limitations, and future directions of research. Although the literature suggests that weight change and appetite disturbance are related to adolescent depression, preliminary evidence suggests that interpretation of weight and appetite symptoms may depend on developmental level.
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28
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Franzoni E, Monti M, Pellicciari A, Muratore C, Verrotti A, Garone C, Cecconi I, Iero L, Gualandi S, Savarino F, Gualandi P. SAFA: A new measure to evaluate psychiatric symptoms detected in a sample of children and adolescents affected by eating disorders. Correlations with risk factors. Neuropsychiatr Dis Treat 2009; 5:207-14. [PMID: 19557115 PMCID: PMC2695231 DOI: 10.2147/ndt.s4874] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In order to evaluate the psychiatric symptoms associated with a diagnosis of eating disorders (ED) we have administered a new psychometric instument: the Self Administrated Psychiatric Scales for Children and Adolescents (SAFA) test. SAFA was administered to a cohort of 97 patients, aged from 8.8 to 18, with an ED diagnosis. Age, body mass index (BMI) and BMI standard deviation score were analyzed. Furthermore, while looking for linkable risk factors, we evaluated other data that took an influence over the SAFA profile, like parental separation and family components' number. Compared to the range of statistical normality (based on Italian population), patients with bulimia nervosa or binge-eating disorder showed higher and pathologic values in specific subscales. When analyzing sex, males showed more pathologic values in most anxiety-related, obsessiveness-compulsiveness-related and insecurity subscales. A correlation among age, BMI and specific subscales (low self esteem, psychological aspects) emerged in participants with anorexia nervosa. In order to plan more appropriate diagnostic and therapeutic approaches in children or adolescents suffering from ED, the SAFA test can be an important instrument to evaluate psychiatric symptoms. Therefore, we propose to include this useful, simple self-administered test as a new screening tool for ED diagnosis.
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Affiliation(s)
- Emilo Franzoni
- Child Neuropsychiatry Unit, Clinical Pediatrics, University of Bologna, 40138 Bologna, Italy.
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29
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Schneider N, Frieler K, Ehrlich S, Pfeiffer E, Lehmkuhl U, Salbach-Andrae H. Persönlichkeitsstile und dimensionale Diagnostik bei jugendlichen Patientinnen mit Anorexia und Bulimia nervosa. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2008. [DOI: 10.1026/1616-3443.37.4.236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Persönlichkeitsvariablen können bidirektional mit Essstörungsdiagnosen in Zusammenhang stehen: als Risikofaktor für die Entstehung und/oder als Folge der Störung. Gesicherte „essstörungstypische” Persönlichkeitsmerkmale sind relevant für Diagnostik und Therapie. Fragestellung: Es wird der Frage nach Unterschieden hinsichtlich der Persönlichkeitsstile bei adoleszenten Patientinnen mit Anorexia (AN) und Bulimia nervosa (BN) nachgegangen. Methode: 104 konsekutiv erfasste Patientinnen (65 AN – restriktiver Typus, 19 AN – binge-purging Typus, 20 BN; MAlter = 16.4 ± 1.7) wurden mittels dimensionaler Persönlichkeitsdiagnostik untersucht. Ergebnisse: Restriktive AN-Patientinnen tendierten deutlicher zu einem zwanghaften Persönlichkeitsstil, während BN-Patientinnen stärkere Ausprägungen von negativistischen und Borderline-Merkmalen aufwiesen. Schlussfolgerungen: Zwischen den Essstörungsformen bestehen deutliche Unterschiede hinsichtlich der Persönlichkeitsstile. Dies weist auf einen psychopathologischen Zusammenhang zwischen Essstörungsform und Persönlichkeit hin, der für Pathogenese, Aufrechterhaltung und Therapie der Essstörung von Relevanz ist.
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Affiliation(s)
- Nora Schneider
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité – Universitätsmedizin Berlin
| | - Katja Frieler
- Institut für Biometrie und klinische Epidemiologie, Charité – Universitätsmedizin Berlin
| | - Stefan Ehrlich
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité – Universitätsmedizin Berlin
| | - Ernst Pfeiffer
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité – Universitätsmedizin Berlin
| | - Ulrike Lehmkuhl
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité – Universitätsmedizin Berlin
| | - Harriet Salbach-Andrae
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité – Universitätsmedizin Berlin
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30
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Lo Russo L, Campisi G, Di Fede O, Di Liberto C, Panzarella V, Lo Muzio L. Oral manifestations of eating disorders: a critical review. Oral Dis 2008; 14:479-84. [DOI: 10.1111/j.1601-0825.2007.01422.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Silva ASF. The relationship between personality traits and eating pathology in adolescent girls. Arch Womens Ment Health 2008; 10:285-92. [PMID: 18040598 DOI: 10.1007/s00737-007-0199-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Accepted: 07/03/2007] [Indexed: 11/30/2022]
Abstract
This research investigated the relationship between personality and the tendency towards developing eating disorders in adolescent females Personality traits were assessed using the High School Personality Questionnaire (HSPQ) and dysfunctional eating attitudes and behaviours were assessed using the Eating Attitudes Test (EAT-26) and the Eating Disorder Inventory (EDI). The sample consisted of 244 students from a high school in Johannesburg, South Africa. Significant relationships were found between certain personality traits and eating dysfunction. Reservation, emotional instability, excitability, opportunism, shyness, individualism, proneness to guilt feelings, self-sufficiency and high tension were the personality factors that were significant in relation to eating dysfunction. This thus suggests that personality appears to influence the tendency towards developing eating disorders.
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Affiliation(s)
- A S F Silva
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.
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32
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Torsello A, Brambilla F, Tamiazzo L, Bulgarelli I, Rapetti D, Bresciani E, Locatelli V. Central dysregulations in the control of energy homeostasis and endocrine alterations in anorexia and bulimia nervosa. J Endocrinol Invest 2007; 30:962-76. [PMID: 18250619 DOI: 10.1007/bf03349245] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In the last decades we have come to understand that the hypothalamus is a key region in controlling energy homeostasis. A number of control models have been proposed to explain the regulation of feeding behavior in physiological and pathological conditions, but all those based on imbalances of single factors fail to explain the disrupted regulation of energy supply in eating disorders such as anorexia nervosa and bulimia nervosa, as well as other psychiatric disorders. A growing amount of evidence demonstrates that many signaling molecules originated within the brain or coming from the adipose tissue or the gastro-enteric tract are involved in the highly complex process controlling food intake and energy expenditure. The recent discovery of leptin, ghrelin, and other factors have made it possible to penetrate in the still undefined pathophysiology of eating disorders with the hope of finding effective treatments for such diseases.
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Affiliation(s)
- A Torsello
- Department of Experimental Medicine, University of Milano-Bicocca, 20052 Monza, Italy.
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33
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Cox D, Donohue P, Costa V. A swallowed toothbrush causing perforation 2 years after ingestion. Br J Hosp Med (Lond) 2007; 68:559. [PMID: 17974307 DOI: 10.12968/hmed.2007.68.10.27330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David Cox
- Emergency Department, Charing Cross Hospital, London
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34
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Mercader JM, Ribasés M, Gratacòs M, González JR, Bayés M, de Cid R, Badía A, Fernández-Aranda F, Estivill X. Altered brain-derived neurotrophic factor blood levels and gene variability are associated with anorexia and bulimia. GENES BRAIN AND BEHAVIOR 2007; 6:706-16. [PMID: 17376155 DOI: 10.1111/j.1601-183x.2007.00301.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Murine models and association studies in eating disorder (ED) patients have shown a role for the brain-derived neurotrophic factor (BDNF) in eating behavior. Some studies have shown association of BDNF -270C/T single-nucleotide polymorphism (SNP) with bulimia nervosa (BN), while BDNF Val66Met variant has been shown to be associated with both BN and anorexia nervosa (AN). To further test the role of this neurotrophin in humans, we screened 36 SNPs in the BDNF gene and tested for their association with ED and plasma BDNF levels as a quantitative trait. We performed a family-based association study in 106 ED nuclear families and analyzed BDNF blood levels in 110 ED patients and in 50 sib pairs discordant for ED. The rs7124442T/rs11030102C/rs11030119G haplotype was found associated with high BDNF levels (mean BDNF TCG haplotype carriers = 43.6 ng/ml vs. mean others 23.0 ng/ml, P = 0.016) and BN (Z = 2.64; P recessive = 0.008), and the rs7934165A/270T haplotype was associated with AN (Z =-2.64; P additive = 0.008). The comparison of BDNF levels in 50 ED discordant sib pairs showed elevated plasma BDNF levels for the ED group (mean controls = 41.0 vs. mean ED = 52.7; P = 0.004). Our data strongly suggest that altered BDNF levels modulated by BDNF gene variability are associated with the susceptibility to ED, providing physiological evidence that BDNF plays a role in the development of AN and BN, and strongly arguing for its involvement in eating behavior and body weight regulation.
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Affiliation(s)
- J M Mercader
- Genes and Disease Program, Center for Genomic Regulation, Barcelona Biomedical Research Park, Barcelona, Catalonia, Spain
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35
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Tchanturia K, Liao PC, Uher R, Lawrence N, Treasure J, Campbell IC. An investigation of decision making in anorexia nervosa using the Iowa Gambling Task and skin conductance measurements. J Int Neuropsychol Soc 2007; 13:635-41. [PMID: 17521482 DOI: 10.1017/s1355617707070798] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2006] [Revised: 02/03/2007] [Accepted: 02/05/2007] [Indexed: 11/07/2022]
Abstract
The objective of this study is to determine (a) if decision making ability is impaired in patients with anorexia nervosa (AN) and in people with good recovery from AN and (b) whether any impairment in decision making is associated with alterations in skin conductance responses (SCR). Patients with AN (n = 29), healthy controls comparable in age and IQ (HC, n = 29), and women long term recovered from AN (n = 14), completed the Iowa Gambling Task (IGT) while their SCR were measured. AN patients performed poorly in the IGT compared to the HC and to the recovered AN participants. AN patients had decreased anticipatory SCR prior to choosing cards and reduced SCR after losses compared to HC. IGT performance and the SCR of recovered AN participants did not differ from the HC. Decision making ability is impaired in AN. It is associated with a significantly attenuated SCR. Neither of these features are found in recovered AN. The association between impaired decision making ability and a decreased autonomic response is consistent with the predictions of the Somatic Marker Hypothesis.
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Affiliation(s)
- Kate Tchanturia
- Institute of Psychiatry, Kings College, London, United Kingdom.
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36
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Miotto P, Preti A. Eating disorders and suicide ideation: the mediating role of depression and aggressiveness. Compr Psychiatry 2007; 48:218-24. [PMID: 17445514 DOI: 10.1016/j.comppsych.2007.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 11/28/2006] [Accepted: 01/22/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Symptoms of depression and aggressiveness are important antecedents and correlates of suicide ideation and completion in adolescents and adults. Among adolescents, eating disorder symptoms were also found to associate with suicidal behavior. This study was aimed at investigating the role of depression and aggressiveness as mediators in the links between eating disorder symptoms and suicide ideation among adolescents, taking into account age and sex as covariates. METHOD Data from the Conegliano Eating Disorders Survey were used to investigate the role of depression and aggressiveness in the links between eating disorder symptoms and suicide ideation, resorting to a bootstrapped sampling distribution model. RESULTS In a mixed male-female sample of 930 adolescents, eating disorder symptoms were positively related to suicide ideation, taking age and sex into account. Depression and aggressiveness acted as full mediators in the links between eating disorder symptoms and suicidality, and virtually abolished any direct influence of eating disorders on suicide ideation. CONCLUSION Because of the cross-sectional nature of this study and the resorting to self-report scales, no firm statement about causal association can be made. However, both suicidal behavior and eating disorder symptoms are a rather widespread occurrence among adolescents, hence the investigation on suicidal tendencies in young people might benefit from the inclusion of measures of eating disorders to prevent the worst outcomes of minor psychological distress.
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Affiliation(s)
- Paola Miotto
- Department of Mental Health, ULSS 7, 31015 Conegliano (TV), Italy
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37
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Senra C, Seoane G, Vilas V, Sánchez-Cao E. Comparison of 10- to 12-year-old boys and girls using a Spanish version of the children’s eating attitudes test. PERSONALITY AND INDIVIDUAL DIFFERENCES 2007. [DOI: 10.1016/j.paid.2006.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Treasure JL. Getting beneath the phenotype of anorexia nervosa: the search for viable endophenotypes and genotypes. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:212-9. [PMID: 17500301 DOI: 10.1177/070674370705200402] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment for anorexia nervosa has changed little from that described by Gull over a century ago. To focus merely on symptomatic relief from "not eating," as occurs with some forms of hospital care, is primitive. The evidence base to guide treatment is thin. Nevertheless, there is hope that better understanding of the causes and maintaining factors may translate into more sophisticated treatments. This review aims to look beyond the overt and startling "not eating" phenotype of anorexia nervosa and consider eating disorder endophenotypes. The first part of the review sets the eating behaviour, clinical, and psychopathological features into the context of what is now understood about the central control of appetite. The evidence base for a framework of potential eating disorder endophenotypes follows. Finally, ideas about how to translate endophenotypes into treatment are introduced.
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Affiliation(s)
- Janet L Treasure
- Department of Academic Psychiatry, Kings College London, Institute of Psychiatry, London, England.
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Erol A, Toprak G, Yazici F. Psychological and physical correlates of disordered eating in male and female Turkish college students. Psychiatry Clin Neurosci 2006; 60:551-7. [PMID: 16958937 DOI: 10.1111/j.1440-1819.2006.01557.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to examine the relationship between disordered eating and three psychological variables (obsessive and depressive symptoms, self-esteem) and body mass index (BMI) in a sample of male and female college students in Turkey. Maudsley Obsessive-Compulsive Inventory (MOCI), Beck Depression Inventory (BDI), Rosenberg Self Esteem Scale (RSES), Eating Attitude Test (EAT), and Bulimic Investigatory Test, Edinburgh (BITE) scales were administered to 408 college students (279 women; 129 men). By multiple regression analysis, the scales of MOCI, BDI, RSES and BMI were used as potential predictors of EAT and BITE scores for each gender. Obsessionality and BMI were the strongest predictors of bulimic and anorexic symptoms in women. In men, while the strongest predictors of bulimic symptoms were the depressive and obsessive symptoms, the best predictor of anorexic symptoms was obsession scores. There were significant differences and some similarities between male and female Turkish college students.
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Affiliation(s)
- Atila Erol
- Department of Psychiatry, Osmangazi University Faculty of Medicine, Eskisehir, Turkey.
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40
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Nakazato M, Hashimoto K, Yoshimura K, Hashimoto T, Shimizu E, Iyo M. No change between the serum brain-derived neurotrophic factor in female patients with anorexia nervosa before and after partial weight recovery. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:1117-21. [PMID: 16753247 DOI: 10.1016/j.pnpbp.2006.04.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is a member of the nerve growth factor family. Several lines of evidence indicate that BDNF plays a role in the pathophysiology of eating disorders (ED). We found that serum BDNF levels in patients with ED were significantly lower than in normal controls. The aim of this longitudinal study was to compare serum BDNF levels in patients with anorexia nervosa (AN) before (n=13, initial mean body mass index (BMI)=14.2 kg/m(2)+/-0.7) and after partial recovery (mean BMI=16.2 kg/m(2)+/-1.7, mean weight gain 5.0 kg+/-2.0), with age-matched normal control subjects (n=17, mean BMI=20.4 kg/m(2)+/-1.5). METHODS Eating related psychopathology and depressive symptoms were evaluated before and after partial weight recovery, using the Eating Disorder Inventory-2 (EDI-2) and the 17-item Hamilton Depression Rating Scale (HDRS). Serum BDNF levels were measured using a sandwich enzyme-linked immunosorbent assay. RESULTS Serum BDNF levels with the AN patients (14.5+/-4.4 ng/ml) were significantly (p<0.01) lower than in control subjects (22.1+/-8.9 ng/ml). There were no significant differences in serum BDNF levels between the patients with AN before (14.5+/-4.4 ng/ml) and after (17.2+/-6.9 ng/ml) partial weight recovery. In all subjects, there was a positive correlation (r=0.5, p<0.01) between the baseline BDNF levels and the EDI-2 scores (n=30). Furthermore, in all subjects there was a positive correlation (r=0.4, p<0.05) between the BDNF levels and the BMI. CONCLUSIONS Serum BDNF levels did not change after partial weight recovery in AN patients. Our results suggest that an alteration of the serum BDNF in AN patients is not due to changes in body weight. Thus, other possible mechanisms that could be related to low serum BDNF levels in AN patients should be evaluated.
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Affiliation(s)
- Michiko Nakazato
- Department of Psychiatry, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chiba City, Chiba, 260-8670, Japan.
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Abstract
Although foreign body ingestion is relatively common, toothbrush swallowing is rare. We report a case of a swallowed toothbrush which passed through the ileocecal valve and perforated the proximal transverse colon, then the liver. To our knowledge, this is the first case to be reported.
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Affiliation(s)
- Min-Ro Lee
- Department of Surgery, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk 561-180, South Korea
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Michaelovsky E, Frisch A, Leor S, Stein D, Danziger Y, Carel C, Fennig S, Mimouni M, Klauck SM, Benner A, Poustka A, Apter A, Weizman A. Haplotype analysis of the COMT-ARVCF gene region in Israeli anorexia nervosa family trios. Am J Med Genet B Neuropsychiatr Genet 2005; 139B:45-50. [PMID: 16118784 DOI: 10.1002/ajmg.b.30230] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Anorexia nervosa (AN) is a severe and complex psychiatric disorder with a significant genetic contribution. Previously, we found an association between AN and the 158Val/Met polymorphism of the catechol-O-methyltransferase (COMT) gene in a family-based study of 51 Israeli AN trios. In the present study, we extended the original sample to include 85 family trios [66 AN restricting (AN-R) and 19 bingeing/purging (AN-BP) subtype] and performed a family-based transmission disequilibrium test (TDT) analysis for five SNPs in the COMT and two in the adjacent ARVCF gene. Association was found between AN-R and several SNPs in the COMT-ARVCF region including the 158Val/Met polymorphism. TDT analysis of 5-SNP haplotypes in AN-R trios revealed an overall statistically significant transmission disequilibrium (P < 0.001). Specifically, haplotype B [COMT-186C-408G-472G(158Val)-ARVCF-659C(220Pro)-524T(175Val)] was preferentially transmitted (P < 0.001) from parents of AN-R patients to their affected daughters, while haplotype A [COMT-186T-408C-472A(158Met)-ARVCF-659T(220Leu)-524C(175Ala)] was preferentially (P = 0.01) not transmitted. Haplotype B was associated with increased risk (RR 3.38; 0.95CI 1.98-6.43) while haplotype A exhibited a protective effect (RR 0.40; 0.95CI 0.21-0.70) for AN-R. Preferential transmission of the risk alleles and haplotypes from the parents was mostly contributed by the fathers. No significant transmission disequilibrium of alleles or haplotypes was found for AN-BP trios. The risk and protective haplotypes may carry molecular variations in the COMT gene or its vicinity that are relevant to the pathophysiology of restrictive anorexia nervosa in the Israeli-Jewish population.
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Affiliation(s)
- Elena Michaelovsky
- Felsenstein Medical Research Center, Rabin Medical Center, Petah-Tikva, Israel
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Frank GK, Kaye WH. Positron emission tomography studies in eating disorders: multireceptor brain imaging, correlates with behavior and implications for pharmacotherapy. Nucl Med Biol 2005; 32:755-61. [PMID: 16243652 DOI: 10.1016/j.nucmedbio.2005.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 06/06/2005] [Indexed: 10/25/2022]
Abstract
Modern imaging techniques that visualize disease-specific organ neurotransmitter or protein receptor sites are increasingly able to define pathological processes on a molecular level. One of those imaging modalities, positron emission tomography (PET), for the assessment of brain neuroreceptor binding has revolutionized the in vivo assessment of biologic markers that may be related to human behavior. Such studies may help identify chemical targets that may be directly related to psychiatric pathology and, thus, opportunities for pharmacological intervention. In this review, we describe results from PET studies in eating disorders (EDs). Eating disorders are frequently debilitating illnesses that are quite homogeneous in their presentation. Those studies that identified particular serotonin and dopamine receptor alterations can distinguish recovered ED subjects from controls as well as ED subgroups. Furthermore, correlations of receptor binding with behavioral constructs, such as harm avoidance or novelty seeking, could be found. These recognized receptors may now help us to move away from rather nonspecific treatment approaches in psychiatric research and clinic to the possibility of more syndrome- and symptom-specific treatment approaches.
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Affiliation(s)
- Guido K Frank
- Department of Child and Adolescent Psychiatry, Center for Eating Disorders Research, School of Medicine, University of California San Diego, 92123, USA
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Fetissov SO, Harro J, Jaanisk M, Järv A, Podar I, Allik J, Nilsson I, Sakthivel P, Lefvert AK, Hökfelt T. Autoantibodies against neuropeptides are associated with psychological traits in eating disorders. Proc Natl Acad Sci U S A 2005; 102:14865-70. [PMID: 16195379 PMCID: PMC1253594 DOI: 10.1073/pnas.0507204102] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Previously, we identified that a majority of patients with anorexia nervosa (AN) and bulimia nervosa (BN) as well as some control subjects display autoantibodies (autoAbs) reacting with alpha-melanocyte-stimulating hormone (alpha-MSH) or adrenocorticotropic hormone, melanocortin peptides involved in appetite control and the stress response. In this work, we studied the relevance of such autoAbs to AN and BN. In addition to previously identified neuropeptide autoAbs, the current study revealed the presence of autoAbs reacting with oxytocin (OT) or vasopressin (VP) in both patients and controls. Analysis of serum levels of identified autoAbs showed an increase of IgM autoAbs against alpha-MSH, OT, and VP as well as of IgG autoAbs against VP in AN patients when compared with BN patients and controls. Further, we investigated whether levels of these autoAbs correlated with psychological traits characteristic for eating disorders. We found significantly altered correlations between alpha-MSH autoAb levels and the total Eating Disorder Inventory-2 score, as well as most of its subscale dimensions in AN and BN patients vs. controls. Remarkably, these correlations were opposite in AN vs. BN patients. In contrast, levels of autoAbs reacting with adrenocorticotropic hormone, OT, or VP had only few altered correlations with the Eating Disorder Inventory-2 subscale dimensions in AN and BN patients. Thus, our data reveal that core psychobehavioral abnormalities characteristic for eating disorders correlate with the levels of autoAbs against alpha-MSH, suggesting that AN and BN may be associated with autoAb-mediated dysfunctions of primarily the melanocortin system.
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Affiliation(s)
- Sergueï O Fetissov
- Department of Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden.
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Tchanturia K, Campbell IC, Morris R, Treasure J. Neuropsychological studies in anorexia nervosa. Int J Eat Disord 2005; 37 Suppl:S72-6; discussion S87-9. [PMID: 15852325 DOI: 10.1002/eat.20119] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neuropsychological findings in eating disorders are somewhat inconsistent. This may be because individual studies have used a broad range of tests on relatively small, heterogeneous clinical groups, thus limiting the detection of subtle neuropsychological differences in these patients. Therefore, rather than using broad assessments of a variety of neuropsychological functions, adoption of a more focused, hypothesis-driven approach based on clinical practice is proposed. This will allow more in-depth investigations of targeted functions and will improve the chances of detecting a problem, of exploring its ecologic validity, and of tailoring a treatment. We have demonstrated this approach using our neuropsychological studies of cognitive flexibility in anorexia nervosa (AN).
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Affiliation(s)
- Kate Tchanturia
- Eating Disorders Unit, Institute of Psychiatry, King's College, London, United Kingdom.
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Hashimoto K, Koizumi H, Nakazato M, Shimizu E, Iyo M. Role of brain-derived neurotrophic factor in eating disorders: recent findings and its pathophysiological implications. Prog Neuropsychopharmacol Biol Psychiatry 2005; 29:499-504. [PMID: 15866349 DOI: 10.1016/j.pnpbp.2005.01.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2005] [Indexed: 02/07/2023]
Abstract
Eating disorders, which include anorexia nervosa (AN) and bulimia nervosa (BN), are disorders characterized by abnormal patterns of weight regulation and eating behaviors, and by disturbances in attitudes and perceptions toward weight and body shape. Brain-derived neurotrophic factor (BDNF) plays a critical role in regulating neural survival, development, function, and plasticity in the brain. Recent findings using heterozygous BDNF (+/-) knock-out (reduced BDNF levels) mice have provided evidence that BDNF plays a role in regulating eating behaviors. Recently, we found that serum levels of BDNF in patients with eating disorders are significantly decreased compared with normal controls. In addition, an association between the BDNF gene polymorphism and eating disorders has been demonstrated. We reviewed the role of BDNF in the pathophysiology of eating disorders and the BDNF gene as a susceptibility gene for eating disorders. Considering the low levels of BDNF in patients with eating disorders, using drugs that increase the BDNF levels and/or BDNF gene therapy are possible novel therapeutic approaches. Providing confirmation that the BDNF gene is the true susceptibility gene for eating disorders could lead to rapid therapeutic progress in treating these disorders. In addition, a more complete understanding of the signal transduction pathway via the p75 neurotrophin receptor (p75NTR) and TrkB receptors would provide new perspectives for treating eating disorders.
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Affiliation(s)
- Kenji Hashimoto
- Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba 260-8670, Japan.
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Bachner-Melman R, Zohar AH, Elizur Y, Nemanov L, Gritsenko I, Konis D, Ebstein RP. Association between a vasopressin receptor AVPR1A promoter region microsatellite and eating behavior measured by a self-report questionnaire (Eating Attitudes Test) in a family-based study of a nonclinical population. Int J Eat Disord 2004; 36:451-60. [PMID: 15558634 DOI: 10.1002/eat.20049] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Considerable evidence including twin and family studies suggests that biologic determinants interact with cultural cues in the etiology of anorexia and bulimia nervosa. A gene that makes "biologic sense" in contributing susceptibility to these disorders, and to our knowledge not previously investigated for this phenotype, is the vasopressin receptor (AVPR1A), which we have tested for association with eating pathology. METHODS We genotyped 280 families with same-sex siblings for two microsatellites in the promoter region of the AVPR1A gene. Siblings completed the 26-item Eating Attitudes Test (EAT) and the Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales of the Eating Disorders Inventory (EDI). The Quantitative Transmission Disequilibrium Test program (QTDT), which employs flexible and powerful variance-components procedures, was used to test for an association between EAT scores and the two AVPR1A promoter region microsatellites, RS1 and RS3. RESULTS A significant association (p = .036) was detected between the RS3 microsatellite and EAT scores. The strongest association was between RS3 and the Dieting subscale of the EAT (p = .011). A significant association was also observed between the EDI-DT and the RS3 microsatellit (p = .0450). CONCLUSIONS We demonstrate for the first time an association between a microsatellite polymorphism in the AVPR1A promoter region and scores on the EAT as well as with the EDI-DT. The strongest association was observed between the RS3 microsatellite and the Dieting subscale of the EAT. The relevant phenotype appears to tap severe dietary restriction for weight loss purposes.
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Master of disguise: Eating disorders in the emergency department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2004. [DOI: 10.1016/j.cpem.2004.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ricca V, Nacmias B, Boldrini M, Cellini E, di Bernardo M, Ravaldi C, Tedde A, Bagnoli S, Placidi GF, Rotella CM, Sorbi S. Psychopathological traits and 5-HT2A receptor promoter polymorphism (-1438 G/A) in patients suffering from Anorexia Nervosa and Bulimia Nervosa. Neurosci Lett 2004; 365:92-6. [PMID: 15245785 DOI: 10.1016/j.neulet.2004.04.057] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2003] [Revised: 04/21/2004] [Accepted: 04/21/2004] [Indexed: 11/15/2022]
Abstract
Various studies have evaluated the possible role of the -1438G/A polymorphism within the 5-HT2A receptor gene in the susceptibility to Eating Disorders (EDs). One hundred and forty-eight ED patients (EDp) and 89 control subjects were interviewed by means of the Eating Disorder Examination (EDE) and analyzed for distribution of the -1438G/A polymorphism. Patients with the AA genotype suffering from Anorexia Nervosa and Bulimia Nervosa showed higher Weight and Shape Concern (P = 0.003 and P = 0.010, respectively) scores and greater overall severity of the ED psychopathology (EDE total score) (P = 0.012). The obtained preliminary data suggest the use of dimensional psychopathological measures in ED genetic studies.
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Affiliation(s)
- Valdo Ricca
- Department of Neurological and Psychiatric Sciences, Psychiatry Unit, University of Florence, Viale Morgagni, 85, 50134, Italy.
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Abstract
The understanding of the eating disorders (EDs) anorexia (AN) and bulimia nervosa (BN) has undergone remarkable advancements in the past decade. Most studies that have been done in AN show brain gray and white matter volume loss during the ill state that, at least in part, remit with recovery. Similar patterns occur for brain phospholipids assessed using magnet resonance spectroscopy (MRS). Imaging studies have been used to provide functional information regarding serotonin neuroreceptor dynamics, regional cerebral blood flow, or cerebral glucose metabolism. Such studies have implicated cingulate, frontal, temporal, and parietal regions in AN. Investigators have found that challenges such as food and body image distortions may activate some of these regions, raising the possibility that such studies may shed light on puzzling AN symptoms, such as body image distortions or extremes of appetitive behaviors. Emerging data suggest these disturbances persist after recovery from AN, suggesting the possibility that these are traits that may create a vulnerability to develop an ED. While fewer studies have been done in BN or binge eating disorder, there may be disturbances of serotonin metabolism in similar brain regions. Taken together, these findings give promise for future investigations with the hope of delineating brain pathways that contribute to the etiology of EDs
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Affiliation(s)
- Guido K Frank
- Department of Eating Disorders Research, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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