Genome-wide association study identifies new loci associated with OCD

To date, four genome-wide association studies (GWAS) of obsessive-compulsive disorder (OCD) have been published, reporting a high single-nucleotide polymorphism (SNP)-heritability of 28% but finding only one significant SNP. A substantial increase in sample size will likely lead to further identification of SNPs, genes, and biological pathways mediating the susceptibility to OCD. We conducted a GWAS meta-analysis with a 2-3-fold increase in case sample size (OCD cases: N = 37,015, controls: N = 948,616) compared to the last OCD GWAS, including six previously published cohorts (OCGAS, IOCDF-GC, IOCDF-GC-trio, NORDiC-nor, NORDiC-swe, and iPSYCH) and unpublished self-report data from 23andMe Inc. We explored the genetic architecture of OCD by conducting gene-based tests, tissue and celltype enrichment analyses, and estimating heritability and genetic correlations with 74 phenotypes. To examine a potential heterogeneity in our data, we conducted multivariable GWASs with MTAG. We found support for 15 independent genome-wide significant loci (14 new) and 79 protein-coding genes. Tissue enrichment analyses implicate multiple cortical regions, the amygdala, and hypothalamus, while cell type analyses yielded 12 cell types linked to OCD (all neurons). The SNP-based heritability of OCD was estimated to be 0.08. Using MTAG we found evidence for specific genetic underpinnings characteristic of different cohort-ascertainment and identified additional significant SNPs. OCD was genetically correlated with 40 disorders or traits-positively with all psychiatric disorders and negatively with BMI, age at first birth and multiple autoimmune diseases. The GWAS meta-analysis identified several biologically informative genes as important contributors to the aetiology of OCD. Overall, we have begun laying the groundwork through which the biology of OCD will be understood and described.

A Burden of Rare Copy Number Variants in Obsessive-Compulsive Disorder

Current genetic research on obsessive-compulsive disorder (OCD) supports contributions to risk specifically from common single nucleotide variants (SNVs), along with rare coding SNVs and small insertion-deletions (indels). The contribution to OCD risk from large, rare copy number variants (CNVs), however, has not been formally assessed at a similar scale. Here we describe an analysis of rare CNVs called from genotype array data in 2,248 deeply phenotyped OCD cases and 3,608 unaffected controls from Sweden and Norway. We found that in general cases carry an elevated burden of large (>30kb, at least 15 probes) CNVs (OR=1.12, P=1.77×10-3). The excess rate of these CNVs in cases versus controls was around 0.07 (95% CI 0.02-0.11, P=2.58×10-3). This signal was largely driven by CNVs overlapping protein-coding regions (OR=1.19, P=3.08×10-4), particularly deletions impacting loss-of-function intolerant genes (pLI>0.995, OR=4.12, P=2.54×10-5). We did not identify any specific locus where CNV burden was associated with OCD case status at genome-wide significance, but we noted non-random recurrence of CNV deletions in cases (permutation P = 2.60×10-3). In cases where sufficient clinical data were available (n=1612) we found that carriers of neurodevelopmental duplications were more likely to have comorbid autism (P<0.001), and that carriers of deletions overlapping neurodevelopmental genes had lower treatment response (P=0.02). The results demonstrate a contribution of large, rare CNVs to OCD risk, and suggest that studies of rare coding variation in OCD would have increased power to identify risk genes if this class of variation were incorporated into formal tests.

Sociodemographic and Clinical Characteristics of Treated and Untreated Adults with Bulimia Nervosa and/or Binge-eating Disorder Recruited for a Large-Scale Research Study

Background: Eating disorders affect millions of people worldwide, but most never receive treatment. The majority of clinical research on eating disorders has focused on individuals recruited from treatment settings, which may not represent the broader population of people with eating disorders. This study compared the characteristics of individuals with eating disorders based on whether they self-reported accessing treatment or not, to identify potential differences and contribute to a better understanding of the diverse needs and experiences of individuals with eating disorders. Methods: The study population included 762 community-recruited individuals (85% female, M ± SD age = 30 ± 7 y) with bulimia nervosa and/or binge eating disorder (BN/BED) enrolled in the Binge-Eating Genetics Initiative (BEGIN) United States study arm. Participants completed self-report surveys on demographics, treatment history, past and current eating disorder symptoms, weight history, and current mental health and gastrointestinal comorbidity. Untreated participants ( n = 291, 38%) were compared with treated participants ( n = 471, 62%) who self-reported accessing BN/BED treatment at some point in their lives. Results: Untreated participants disproportionately self-identified as male and as a racial or ethnic minority compared with treated participants. Treated participants reported a more severe illness history, specifically, an earlier age at onset, more longstanding and frequent ED symptoms over their lifetime, and higher body dissatisfaction and comorbid mental health symptoms (i.e., depression, anxiety, ADHD) at the time of the study. Those who reported a history of inpatient or residential treatment displayed the most severe illness history, whereas those who reported outpatient treatment had a less severe illness history, and untreated individuals had the mildest illness history. Conclusions: Individuals from historically overlooked or marginalized populations were less likely to access treatment. Those who accessed treatment had more severe ED and comorbid symptoms, which may have motivated them to seek treatment. Clinic-based recruitment samples may not accurately represent all individuals with EDs, particularly those with milder symptoms and those with gender or racial/ethnic diversity. The results of this study indicate that community-based recruitment is crucial for improving the ability to apply research findings to broader populations and to reduce disparities in medical research. Trial Registration : ClinicalTrials.gov NCT04162574 (https://clinicaltrials.gov/ct2/show/NCT04162574).

Anonymous Online Survey on Disordered Eating, Drive for Muscularity, Sexual Orientation, and Satisfaction with Life in Young Swedish Males

Psychiatric conditions in general, including eating disorders, are stigmatizing conditions. The stigma of eating disorders is even more pronounced among males. We conducted an anonymous, online survey to explore the feasibility of recruiting participants for collecting sensitive information, and the relation among eating disorders, drive for muscularity, satisfaction with life, and sexual preference in males (N = 824) aged 15-30 years in Sweden. Internet survey method was a feasible way of recruiting males and obtaining sensitive information. Drive for muscularity was positively related to eating psychopathology. Interestingly, only the attitudinal aspect of the drive for muscularity was negatively related to satisfaction with life, whereas the behavioral component of the drive for muscularity was unrelated to quality of life. Drive for muscularity and disordered eating were not significantly different across participants with various sexual orientations. Our findings corroborate and extend previous research by using an anonymous Internet-based survey that may be less contaminated by social desirability or reporting bias due to the sensitivity of some of the questions.

The Gut Microbiota and Short-Chain Fatty Acids in Association With Glycemia and Adiposity in Young Adults With Type 1 Diabetes: The ACT1ON Ancillary Gut Microbiome Pilot Study

Objectives

Co-managing glycemia and adiposity is the cornerstone of cardiometabolic risk reduction among people with type 1 diabetes (T1D) but targets are often not met. The gut microbiota and microbiota-derived short-chain fatty acids (SFCA) influence glycemia and adiposity but have not been sufficiently investigated in longstanding T1D. We hypothesized that an increased abundance of SCFA-producing gut microbes, fecal SCFA, and gut microbial diversity were associated with improved glycemia but increased adiposity among young adults with longstanding T1D.

Methods

Participants provided stool samples at up to four time points. 16S rRNA gene sequencing determined the abundance of SCFA-producing gut microbes. Gas-chromatography mass-spectrometry determined total and specific SCFA (acetate, butyrate, and propionate). Dual-energy x-ray absorptiometry (% body fat or lean mass) and anthropometrics (body mass index [BMI]) measured adiposity. Continuous glucose monitoring (time in range [70–180 mg/dl], above range [>180 mg/dl], and below range [54–69 mg/dl]) and hemoglobin A1c assessed glycemia. Adjusted and Bonferroni-corrected generalized estimating equations modeled the associations of SCFA-producing gut microbes, fecal SCFA, and gut microbial diversity with glycemia and adiposity. COVID-19 interrupted data collection, so models were repeated with restriction to pre-COVID visits.

Results

Data were available for up to 45 participants at 101 visits, including 40 participants at 54 visits pre-COVID. The abundance of Eubacterium hallii was associated inversely with BMI (all data). Pre-COVID, increased fecal propionate was associated with increased time above range and reduced time in target and below range; and the increased abundance of four SCFA-producing intestinal microbes (Ruminococcus gnavus, Ruminococcus 2, Eubacterium ventriosum, and Lachnospira) was associated with reduced adiposity (% body fat or BMI), of which two microbes were also associated with increased % lean mass.

Conclusions

Unexpectedly, fecal propionate was associated with detriment to glycemia, while several SCFA-producing gut microbes were associated with benefit to adiposity. Future mechanistic studies may determine whether these associations have causal linkages in T1D.

Funding Sources

National Institute of Diabetes and Digestive and Kidney Diseases.

Associations of Diet With the Intestinal Microbiota and Short-Chain Fatty Acids Among Young Adults With Type 1 Diabetes: The ACT1ON Ancillary Gut Microbiome Pilot Study

Objectives

Diet, a key component of type 1 diabetes (T1D) management, modulates the intestinal microbiota and its metabolically active byproducts, short-chain fatty acids (SCFA), via fermentation of dietary carbohydrates such as fiber. The relationships among diet, the intestinal microbiota, and SCFA have been studied proximal to T1D onset, but remain largely unexplored in longstanding T1D. We hypothesized that increased carbohydrate intake, including fiber, was associated with increased SCFA-producing microbes, fecal SCFA, and gut microbial diversity among adults with longstanding T1D and overweight or obesity.

Methods

Participants provided stool samples at up to four time points. Trained interviewers collected 24-hour dietary recalls. 16S rRNA gene sequencing determined the abundance of SCFA-producing intestinal microbes. Gas-chromatography mass-spectrometry computed total and specific fecal SCFA (acetate, butyrate, and propionate) levels. Adjusted and Bonferroni-corrected generalized estimating equations modeled the associations of dietary fiber and carbohydrate with the abundance of SCFA-producing microbes, fecal SCFA, and gut microbial diversity. Data collection was interrupted by COVID-19; therefore, analyses were repeated with restriction to pre-COVID visits.

Results

Data were available for 44 participants at 99 visits, including 42 participants with 57 visits pre-COVID. Intake of soluble fiber (all data) and available carbohydrates (pre-COVID) were inversely associated with the genus Bacteroides and Eubacterium alistipes. Pre-COVID, total and soluble fiber and available carbohydrates were positively associated with total SCFA and acetate levels, and available carbohydrates were positively associated with the genus Roseburia and Eubacterium ventriosum.

Conclusions

In our sample of young adults with longstanding T1D, increased carbohydrate intake, including fiber, was associated with both reduced and increased SCFA-producing microbes but increased total fecal SCFA and acetate, which might influence lipid metabolism and weight. Mechanistic studies may examine how a diet designed to modulate the SCFA-producing capacity of the intestinal microbiota influences metabolism and energy balance in the metabolically unique setting of T1D.

Funding Sources

National Institute of Diabetes and Digestive and Kidney Diseases.

Psychosocial and financial impacts for carers of those with eating disorders in New Zealand

BACKGROUND

Eating disorders (ED) can have profound effects on family members and carers. These impacts can be experienced across multiple domains and may contribute to the maintenance of ED symptoms. In the absence of any New Zealand studies quantifying this, and given country-specific differences in access to care and treatment, this study explores the psychosocial and economic impacts on those caring for someone with an ED in New Zealand.

METHODS

Carers (N = 121) of those who had, or still had, a self-reported ED (82.6% anorexia nervosa) completed an online survey open between December 2016 and October 2020, adapted to the New Zealand context. Questions addressed ED recency and recovery status of the individual cared for, treatment access, and the financial and psychosocial impact on the carer. Data analysis included descriptive statistics, with financial cost data converted to the equivalent of 2020 New Zealand dollars.

RESULTS

Most (88.6%) recruited carers reported still caring for someone with ED symptoms of varying severity. A majority reported difficulty accessing treatment for the person they cared for, with a sizable minority (45%) paying for private treatment, despite few having private insurance. Carer losses typically included reduced income and productivity, travel costs, and other miscellaneous costs. Carers reported significant psychosocial impacts across a range of dimensions including family life, interpersonal relationships, and their own personal well-being.

CONCLUSIONS

Carers in New Zealand report impacts which are far reaching and longstanding, covering their own personal and interpersonal well-being and that of those around them. While most of those they care for get access to public (free) treatment at some time or another, the wider financial and economic impacts on carers are significant, and likely to take years to recoup. Though not unique to EDs, interventions and supports for carers are much needed in New Zealand, alongside more comprehensive research methodology to further determine positive and other impacts of EDs over the long course of the caregiving role.

HIGHLIGHTS

A majority reported difficulty accessing treatment for the person they cared for 45% paid for private treatment, despite few having private insurance Carers reported reduced income and productivity, travel costs, and other costs. Carers reported significant psychosocial impacts on family life, interpersonal relationships, and their own personal well-being. Carers provide a pivotal role in supporting treatment and recovery in their family member with the These findings will be relevant for funders and service providers in developing further approaches to address barriers and gaps in service provision to reduce impacts on carers, and as a result, those with eating disorders.

Suicide attempts in bulimia nervosa: Personality and psychopathological correlates

Background

Little evidence exists about suicidal acts in eating disorders and its relation with personality. We explored the prevalence of lifetime suicide attempts (SA) in women with bulimia nervosa (BN), and compared eating disorder symptoms, general psychopathology, impulsivity and personality between individuals who had and had not attempted suicide. We also determined the variables that better correlate with of SA.

Method

Five hundred sixty-six BN outpatients (417 BN purging, 47 BN non-purging and 102 subthreshold BN) participated in the study.

Results

Lifetime prevalence of suicide attempts was 26.9%. BN subtype was not associated with lifetime SA (p = 0.36). Suicide attempters exhibited higher rates on eating symptomatology, general psychopathology, impulsive behaviors, more frequent history of childhood obesity and parental alcohol abuse (p < 0.004). Suicide attempters exhibited higher scores on harm avoidance and lower on self-directedness, reward dependence and cooperativeness (p < 0.002). The most strongly correlated variables with SA were: lower education, minimum BMI, previous eating disorder treatment, low self-directedness, and familial history of alcohol abuse (p < 0.006).

Conclusion

Our results support the notion that internalizing personality traits combined with impulsivity may increase the probability of suicidal behaviors in these patients. Future research may increase our understanding of the role of suicidality to work towards rational prevention of suicidal attempts.

Body dissatisfaction in adolescent boys

Body dissatisfaction is a significant mental health symptom present in adolescent girls and boys. However, it is often either disregarded in adolescent boys or examined using assessments that may not resonate with males. The present study addresses these issues, examining the manifestation, etiology, and correlates of 3 facets of body dissatisfaction in adolescent boys. Adolescent male twins aged 16- to 17-years-old from the Swedish Twin Study of Child and Adolescent Development were included along with a female comparison group: 915 monozygotic and 671 dizygotic same-sex twins. Body dissatisfaction was defined using measures of height dissatisfaction, muscle dissatisfaction, and the body dissatisfaction subscale of the Eating Disorder Inventory (EDI-BD). We examined the prevalence of body dissatisfaction, whether the facets of body dissatisfaction were phenotypically and etiologically distinct, and associations with specific externalizing and internalizing symptoms. For boys, muscle dissatisfaction scores were greater than height dissatisfaction scores. Results also indicated that height and muscle dissatisfaction were phenotypically and etiologically distinct from the EDI-BD. Unique associations were observed with externalizing and internalizing symptoms: muscle dissatisfaction with symptoms of bulimia nervosa and the EDI-BD with internalizing symptoms, body mass index, and drive for thinness. The facets of body dissatisfaction were also largely distinct in girls and unique between-sex associations with externalizing and internalizing symptoms emerged. Overall, male-oriented aspects of body dissatisfaction are distinct from female-oriented aspects of body dissatisfaction. To capture the full picture of male body dissatisfaction, multiple facets must be addressed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Autism spectrum disorder in individuals with anorexia nervosa and in their first- and second-degree relatives: Danish nationwide register-based cohort-study

BACKGROUND

Clinical and population-based studies report increased prevalence of autism spectrum disorders (ASD) in individuals with anorexia nervosa and in their relatives. No nationwide study has yet been published on co-occurrence of these disorders.

AIMS

To investigate comorbidity of ASD in individuals with anorexia nervosa, and aggregation of ASD and anorexia nervosa in their relatives.

METHOD

In Danish registers we identified all individuals born in 1981-2008, their parents, and full and half siblings, and linked them to data on hospital admissions for psychiatric disorders.

RESULTS

Risk of comorbidity of ASD in probands with anorexia nervosa and aggregation of ASD in families of anorexia nervosa probands were increased. However, the risk of comorbid and familial ASD did not differ significantly from comorbid and familial major depression or any psychiatric disorder in anorexia nervosa probands.

CONCLUSIONS

We confirm aggregation of ASD in probands with anorexia nervosa and in their relatives; however, the relationship between anorexia nervosa and ASD appears to be non-specific.

Adolescent Girls and Their Mothers Talk About Experiences of Binge and Loss of Control Eating

Evidence suggests that adolescents' experience of binge eating (BE) might differ in important ways from that of adults. Moreover, although BE appears more common in African American women than other disordered eating behaviors, little is known about the influence of cultural factors on this behavior in adolescents. The current investigation used qualitative methodology to examine the perceptions of White and African American adolescent girls and their mothers regarding experiences of binge and loss of control eating. Five focus groups were completed with 19 adolescent girls (aged 13-17, 58 % African American, 41 % White) who endorsed loss of control eating behaviors. Their mothers (N = 19) also completed separate, concurrent focus groups addressing food and eating behaviors. Responses to focus group questions were analyzed using thematic qualitative analysis. Adolescents' awareness of their eating behaviors varied greatly. Girls reported some awareness of how emotions influence their eating behaviors, and described using food to achieve autonomy. Mothers evidenced awareness of their daughters' problematic eating behaviors, the effects of emotions on eating for both their daughters and themselves, and sociocultural factors influencing diet. Data from these focus groups can inform the development of innovative interventions for adolescent girls engaging in loss of control eating.

Parents of children with eating disorders: developing theory-based health communication messages to promote caregiver well-being

Parents of children with eating disorders experience extreme emotional burden because of the intensity and duration of the recovery process. While parental involvement in a child's eating disorder treatment improves outcomes, parents often neglect their own well-being, which can impede their child's recovery. This study extends the research on caregivers and on health theory in practice by conducting formative research to develop a theory-based communication intervention encouraging parents to engage in adaptive coping and self-care behaviors. The Transactional Model of Stress and Coping and the Transtheoretical Model guided qualitative assessments of the determinants of parents' coping behaviors. Three focus groups with 19 parents of children with eating disorders and 19 semi-structured interviews with experts specializing in eating disorders were conducted. Findings indicate that parents and experts see parents' need for permission to take time for themselves as the main barrier to self-care. The main motivator for parents to engage in coping behaviors is awareness of a connection between self-care and their child's health outcomes. Participant evaluation of six potential messages for main themes and effectiveness revealed that theory-based elements, such as certain processes of change within the Transtheoretical Model, were important to changing health behavior.

Eating disorders and trauma history in women with perinatal depression

OBJECTIVE

Although the prevalence of perinatal depression (depression occurring during pregnancy and postpartum) is 10%, little is known about psychiatric comorbidity in these women. We examined the prevalence of comorbid eating disorders (ED) and trauma history in women with perinatal depression.

METHODS

A research questionnaire was administered to 158 consecutive patients seen in a perinatal psychiatry clinic during pregnancy (n=99) or postpartum (n=59). Measures included Structured Clinical Interview for DSM (SCID) IV-based questions for lifetime eating psychopathology and assessments of comorbid psychiatric illness including the State/Trait Anxiety Inventory (STAI), Patient Health Questionnaire (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS), and Trauma Inventory.

RESULTS

In this cohort, 37.1% reported a putative lifetime ED history; 10.1% reported anorexia nervosa (AN), 10.1% reported bulimia nervosa (BN), 10.1% reported ED not otherwise specified-purging subtype (EDNOS-P), and 7.0% reported binge eating disorder (BED). Women with BN reported more severe depression (EPDS score, 19.1, standard deviation [SD 4.3], p=0.02; PHQ-severity 14.5, SD 7.4, p=0.02) than the referent group of women with perinatal depression and no ED history (EPDS 13.3, SD=6.1; PHQ 9.0, SD=6.2). Women with AN were more likely to report sexual trauma history than the referent group (62.5% vs. 29.3%, p<0.05), and those with BN were more likely report physical (50.0%, p<0.05) and sexual (66.7%, p<0.05) trauma histories.

CONCLUSIONS

ED histories were present in over one third of admissions to a perinatal psychiatry clinic. Women with BN reported more severe depression and histories of physical and sexual trauma. Screening for histories of eating psychopathology is important in women with perinatal depression.

Redefining phenotypes in eating disorders based on personality: a latent profile analysis

To conduct a latent profile analysis (LPA) in eating disorder (ED) patients using temperament and character (TCI-R) measures as indicators. 1312 ED patients including those with anorexia nervosa (AN), bulimia nervosa (BN) and EDNOS were assessed. The final LPA solution was validated using demographics, clinical variables, ED symptomatology (EDI-2) and impulsive behaviors. The best-fitting model consisted of a six-profile solution using the seven subscales of the TCI-R. These profiles were labeled: "self-focused", "inhibited", "average", "impulsive", "adaptive" and "maladaptive". Validation analyses indicated that the "inhibited" and "maladaptive" profiles generally presented with the highest values for ED symptomatology and impulsive behaviors. Whereas high levels of Harm Avoidance and low levels of Novelty Seeking and Persistence characterized the "inhibited" profile, the "maladaptive" profile presented with low levels of Reward Dependence, Self-Directedness and Cooperativeness. The most favorable results on the other hand were exhibited by the "adaptive" profile, characterized by high scores on Reward Dependence, Self-Directedness, Cooperativeness and low levels on Novelty Seeking. Finally, when our six-profile solution was compared with the DSM-IV ED diagnoses, significant differences among profiles and ED diagnoses were observed. Our study shows that ED patients can be meaningfully grouped according to temperament and character.

Lifetime substance abuse, family history of alcohol abuse/dependence and novelty seeking in eating disorders: comparison study of eating disorder subgroups

AIM

To assess lifetime substance abuse, family history of alcohol abuse/dependence, and novelty seeking in three different eating disorder groups (anorexia nervosa-restrictive; anorexia nervosa-binge eating/purging; anorexia nervosa to bulimia nervosa).

METHOD

A total sample of 371 eating disorder patients participated in the current study. Assessment measures included the prevalence of substance abuse and family history of alcohol abuse/dependence as well as the novelty-seeking subscale of the Temperament and Character Inventory-Revised.

RESULTS

Significant differences across groups were detected for lifetime substance abuse, with anorexia nervosa-restrictive individuals exhibiting a significant lower prevalence than the anorexia nervosa to bulimia nervosa and anorexia nervosa-binge eating/ purging patients (P < 0.01). For family history of alcohol abuse/dependence the same pattern was observed (P = 0.04). Novelty seeking was associated with substance abuse (P = 0.002), with the anorexia nervosa to bulimia nervosa group exhibiting significantly higher scores on the novelty-seeking scale than the other two groups (P < 0.001). But family history of alcohol abuse/dependence was not related to novelty seeking (P = 0.092).

CONCLUSION

Lifetime substance abuse appears to be more prevalent in anorexia nervosa patients with bulimic features. Higher novelty-seeking scores may be associated with diagnosis cross-over.

Cigarettes and oral snuff use in Sweden: Prevalence and transitions

AIMS

To investigate the prevalence and patterns of transitions between cigarette and snus use.

DESIGN

Cross-sectional study within the population-based Swedish Twin Registry.

SETTING AND PARTICIPANTS

A total of 31 213 male and female twins 42-64 years old.

MEASUREMENTS

Age-adjusted prevalence odds ratios (POR) and 95% confidence intervals (CIs) described the association between gender and tobacco use, while Kaplan-Meier survival methods produced cumulative incidence curves of age at onset of tobacco use. Life-time tobacco use histories were constructed using ages at onset of tobacco use and current tobacco use status.

FINDINGS

Although more males reported ever smoking (64.4%) than females (61.7%), more males were former smokers (POR: 1.33, 95% CI: 1.27-1.39). Males were far more likely to use snus than females (POR: 18.0, 95% CI: 16.17-20.04). Age at onset of cigarette smoking occurred almost entirely before age 25, while the age at onset of snus use among males occurred over a longer time period. Most men began using cigarettes first, nearly one-third of whom switched to using cigarettes and snus in combination. While 30.6% of these combined users quit tobacco completely, only 7.4% quit snus and currently use cigarettes, while 47.7% quit cigarettes and currently use snus.

CONCLUSIONS

Current cigarette smoking is more prevalent among Swedish women than men, while snus use is more prevalent among men. Among men who reported using both cigarettes and snus during their life-time, it was more common to quit cigarettes and currently use snus than to quit snus and currently use cigarettes. Once snus use was initiated, more men continued using snus rather than quit tobacco completely.

A group parent-training program: a novel approach for eating disorder management

OBJECTIVE

To describe the rationale, development, and preliminary acceptability of a Group Parent Training Program (GPT) as an alternative approach for the treatment of adolescent eating disorders.

METHOD

Sixteen families participated in a 16-session group treatment. After four months, parents were administered a treatment satisfaction questionnaire.

RESULTS

Parent response to the intervention was positive. All parents indicated GPT was essential for the management of their child, improved general parenting skills, improved their own self-care, and decreased the burden they experienced as a result of managing their child's illness.

DISCUSSION

Given the magnitude of task demands placed on a family for the management of adolescent eating disorders, there is the need for the development of effective intervention strategies that ease the stress of illness management for parents. Preliminary satisfaction data from GPT are promising and argue for a more systematic test of this intervention.

The types of regular cigarette smokers: A latent class analysis

The present study sought to refine cigarette smoking exposure by examining whether individuals with a history of regular cigarette smoking could be classified into meaningful subgroups based on their smoking habits, nicotine dependence, and quit attempts. Data were obtained from 3,025 male and female twins aged 22-59 years who participated in two longitudinal studies based on the Virginia Twin Registry. Latent class analysis was used to identify the number and nature of subgroups of smokers reporting similar smoking habits based on 18 characteristics. Estimates of prevalence for different classes of smoking were obtained along with expected frequencies of endorsements for each smoking behavior by class. Distributions of demographic characteristics, psychopathology, and personality were examined as external validators. The results demonstrated considerable heterogeneity and revealed eight classes of smokers who differed in their degree of nicotine dependence, cessation attempts, and ability to quit smoking. Smoking classes ranged from individuals who were all former smokers with low nicotine dependence who attempted to quit once and were successful, to individuals who were all current smokers with little desire to quit, to individuals with high nicotine dependence with multiple quit attempts, only a subset of which were successful. Estimates of prevalence for each class were 9%-20%. Our findings support the idea that regular cigarette smokers are highly heterogeneous and highlight the need for smoking exposure refinement in future studies. Acknowledging the complexity of cigarette smoking and classifying smokers into more specific subgroups based on their smoking behavior in future studies will enable more accurate evaluation of disease etiology and risk and could lead to more appropriate smoking cessation interventions.

Genetic and Environmental Influences on the Relative Timing of Pubertal Change

A multicategory item-response theory model was developed to characterize developmental changes in three items relating to the assessment of puberty in adolescent twin girls and boys. The model allowed for the fixed effects of age on probability of endorsing the responses and for the random effects of individual differences on the timing of pubertal changes relative to chronological age. In girls, the model was applied three-wave data on twin pairs (N = 414 female monozygotic [MZ] and 197 female dizygotic [DZ] pairs) and female twins from boy-girl pairs (N = 300 twins) from the Virginia Twin Study of Adolescent Behavioral Development. In boys, the data comprised 318 MZ and 185 DZ pairs and 297 male twins from boy-girl pairs. A total of 3172 and 2790 individual twin assessments were available in girls and boys, respectively, spanning ages 8-17 years. The availability of twin data allows the contributions of genes, the shared environment and individual unique environmental experiences to be resolved in the relative timing of pubertal changes. Parameters of the mixed model including fixed effects of age and random effects of genes and environment were estimated by Markov Chain Monte Carlo simulations using the BUGS algorithm for Gibbs sampling. The estimated standard deviation of random differences in the timing of puberty relative to age was 0.96 years in girls and 1.01 years in boys. The estimated intraclass correlations for the relative timing of pubertal changes were 0.99 +/-0.01 in MZ girls, 0.52 +/-0.02 in DZ girls, 0.88 +/-0.04 in MZ boys and 0.44+/-0.02 in DZ boys, indicating a very large contribution of genetic factors to the relative timing of pubertal change in both sexes. Additive genetic factors account for an estimated 96.3+/-3.3% of the total variance in random effects in girls and 88.0+/-3.6% in boys. Shared environmental influences account for 3.6+/-3.4% in girls and 0% in boys. In girls, nonshared environmental effects explain 0.1+/-0.1% of the total residual variance. The comparable figure in boys is 12.0+/-3.6%.

Eating behaviors and attitudes in women with infertility: a controlled study

OBJECTIVE

Infertility arises from a complex pathogenic process in which it is often difficult to identify etiology. Psychological and behavioral factors may play a role in some cases of infertility. The extent to which eating behaviors and attitudes contribute to infertility is unknown.

METHOD

In this study, 120 subjects with infertility, 80 fertile women, and 90 patients suffering from anorexia nervosa, restricting subtype (AN-R), were assessed with the Eating Disorder Inventory (EDI-2).

RESULTS

The EDI-2 highlights differences among patients with AN-R and fertile and infertile subjects. Infertile patients had higher scores on the Interpersonal Distrust, Interoceptive Awareness, and Maturity Fears EDI-2 subscales than fertile subjects. Logistic regression identifies the independent variables of interpersonal distrust, interoceptive awareness, maturity fears, and asceticism as predictors of infertility.

DISCUSSION

Infertile patients without eating disorders share some psychological features of women with AN. These features do not include disturbed eating attitudes and behaviors, but rather feelings of inadequacy, insecurity, and maturity fears.

Exercise and subsequent sleep in male runners: failure to support the slow wave sleep-mood-exercise hypothesis

10 male joggers participated in a 3-week experimental protocol designed to look at the effects of three levels of energy expenditure (no exercise, regular exercise, and double exercise) on mood and subsequent nocturnal sleep focusing on REM sleep and delta sleep parameters. Exercise conditions were well discriminated by daily (F(2,18) = 65.8, p less than 0.0000) mean hip activity counts during monitored field exercise and by the mean weekly body weights (F(2,14) = 7.24, p less than 0.007). Subjects slept for 2 nights in the laboratory following each exercise condition and filled out two brief, clinical self-rating scales each night prior to sleep. These two self-rating instruments together index 105 somatic and psychobiological symptoms that are subsumed by the five major clinical symptom clusters of: Depression, Mania, Anxiety, Cognitive Disorganization, and Organicity. There were no significant differences in manually scored whole-night sleep parameters with the exception of REM latency (F(2,18) = 3.63, p less than 0.05), and there were no significant differences in self-ratings of psychobiological symptoms by night or exercise condition. These results are discussed in the context of failure to support either the slow wave sleep-exercise hypothesis or the exercise-mood elevation hypothesis.