1
|
Rösch SA, Schmidt R, Wimmer J, Lührs M, Ehlis AC, Hilbert A. Mechanisms underlying fNIRS-neurofeedback over the prefrontal cortex for participants with binge-eating disorder. Clin Neurophysiol 2023; 156:57-68. [PMID: 37871494 DOI: 10.1016/j.clinph.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/24/2023] [Accepted: 09/22/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE Despite the increasing popularity of neurofeedback (NF), aiming at voluntary modulation of dysfunctional prefrontal cortex (PFC) signals in the treatment of binge-eating disorder (BED) and/or overweight, mechanisms remain poorly understood. METHODS Based on a randomized-controlled trial offering 12 food-specific real-time functional near-infrared spectroscopy (rtfNIRS)-NF sessions to participants with BED (n = 22), this preregistered study examined (1) online regulation success as predictor for offline regulation success, defined by PFC signals during regulation versus watch, and subjective regulation success, and (2) changes in loss of control (LOC) eating after vs. before and across 12 rtfNIRS-NF-sessions. RESULTS Higher online regulation success expectedly predicted better subjective, but worse offline regulation success. LOC eating decreased after vs. before, but not over rtfNIRS-NF-sessions, and was not associated with subjective or offline regulation success. CONCLUSIONS The association between online and subjective regulation success confirmed the presumed mechanism of operant conditioning underlying rtfNIRS-NF-learning. The contrary association between online and offline regulation indicated differential PFC involvement upon subtraction of automatic food-specific responses from regulation signals for offline success. Decreased LOC eating after food-specific rtfNIRS-NF-sessions suggested the potential of NF in BED treatment. SIGNIFICANCE Results may guide the optimization of future NF studies in larger samples with BED.
Collapse
Affiliation(s)
- Sarah A Rösch
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Stephanstrasse 9a, 04103 Leipzig, Germany; International Max Planck Research School NeuroCom, Leipzig, Germany.
| | - Ricarda Schmidt
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Stephanstrasse 9a, 04103 Leipzig, Germany
| | - Jytte Wimmer
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Stephanstrasse 9a, 04103 Leipzig, Germany
| | - Michael Lührs
- Brain Innovation B.V, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands; Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Calwerstrasse 14, 72076 Tübingen, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Stephanstrasse 9a, 04103 Leipzig, Germany
| |
Collapse
|
2
|
Grilo CM, Lydecker JA, Fineberg SK, Moreno JO, Ivezaj V, Gueorguieva R. Naltrexone-Bupropion and Behavior Therapy, Alone and Combined, for Binge-Eating Disorder: Randomized Double-Blind Placebo-Controlled Trial. Am J Psychiatry 2022; 179:927-937. [PMID: 36285406 PMCID: PMC9722598 DOI: 10.1176/appi.ajp.20220267] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Binge-eating disorder, the most prevalent eating disorder, is a serious public health problem associated with obesity, psychiatric and medical comorbidities, and functional impairments. Binge-eating disorder remains underrecognized and infrequently treated, and few evidence-based treatments exist. The authors tested the effectiveness of naltrexone-bupropion and behavioral weight loss therapy (BWL), alone and combined, for binge-eating disorder comorbid with obesity. METHODS In a randomized double-blind placebo-controlled trial conducted from February 2017 to February 2021, using a 2×2 balanced factorial design, 136 patients with binge-eating disorder (81.6% women; mean age, 46.5 years; mean BMI, 37.1) were randomized to one of four 16-week treatments: placebo (N=34), naltrexone-bupropion (N=32), BWL+placebo (N=35), or BWL+naltrexone-bupropion (N=35). Overall, 81.7% of participants completed independent posttreatment assessments. RESULTS Intention-to-treat binge-eating remission rates were 17.7% in the placebo group, 31.3% in the naltrexone-bupropion group, 37.1% in the BWL+placebo group, and 57.1% in the BWL+naltrexone-bupropion group. Logistic regression of binge-eating remission revealed that BWL was significantly superior to no BWL, and that naltrexone-bupropion was significantly superior to placebo, but there was no significant interaction between BWL and medication. Mixed models of complementary measures of binge-eating frequency also indicated that BWL was significantly superior to no BWL. The rates of participants attaining 5% weight loss were 11.8% in the placebo group, 18.8% in the naltrexone-bupropion group, 31.4% in the BWL+placebo group, and 38.2% in the BWL+naltrexone-bupropion group. Logistic regression of 5% weight loss and mixed models of percent weight loss both revealed that BWL was significantly superior to no BWL. Mixed models revealed significantly greater improvements for BWL than no BWL on secondary measures (eating disorder psychopathology, depression, eating behaviors, and cholesterol and HbA1c levels). CONCLUSIONS BWL and naltrexone-bupropion were associated with significant improvements in binge-eating disorder, with a consistent pattern of BWL being superior to no BWL.
Collapse
Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry (Grilo, Lydecker, Ivezaj, Fineberg) and Department of Internal Medicine (Moreno), Yale University School of Medicine, New Haven; Department of Biostatistics, Yale School of Public Health, New Haven (Gueorguieva)
| | - Janet A Lydecker
- Department of Psychiatry (Grilo, Lydecker, Ivezaj, Fineberg) and Department of Internal Medicine (Moreno), Yale University School of Medicine, New Haven; Department of Biostatistics, Yale School of Public Health, New Haven (Gueorguieva)
| | - Sarah K Fineberg
- Department of Psychiatry (Grilo, Lydecker, Ivezaj, Fineberg) and Department of Internal Medicine (Moreno), Yale University School of Medicine, New Haven; Department of Biostatistics, Yale School of Public Health, New Haven (Gueorguieva)
| | - Jorge O Moreno
- Department of Psychiatry (Grilo, Lydecker, Ivezaj, Fineberg) and Department of Internal Medicine (Moreno), Yale University School of Medicine, New Haven; Department of Biostatistics, Yale School of Public Health, New Haven (Gueorguieva)
| | - Valentina Ivezaj
- Department of Psychiatry (Grilo, Lydecker, Ivezaj, Fineberg) and Department of Internal Medicine (Moreno), Yale University School of Medicine, New Haven; Department of Biostatistics, Yale School of Public Health, New Haven (Gueorguieva)
| | - Ralitza Gueorguieva
- Department of Psychiatry (Grilo, Lydecker, Ivezaj, Fineberg) and Department of Internal Medicine (Moreno), Yale University School of Medicine, New Haven; Department of Biostatistics, Yale School of Public Health, New Haven (Gueorguieva)
| |
Collapse
|
3
|
Linnet J, Jensen ES, Runge E, Hansen MB, Hertz SPT, Mathiasen K, Lichtenstein MB. Text based internet intervention of Binge Eating Disorder (BED): Words per message is associated with treatment adherence. Internet Interv 2022; 28:100538. [PMID: 35480237 PMCID: PMC9035730 DOI: 10.1016/j.invent.2022.100538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Some evidence suggests that in internet-based cognitive behavioral therapy (iCBT) the likelihood of adherence is increased when patients write longer messages to the therapist in the program. This association has not previously been investigated in iCBT for Binge Eating Disorder (BED). OBJECTIVE In this study, we hypothesized that the number of words written by patients with mild to moderate BED was associated with increased likelihood of treatment completion in a text-based iCBT program. MATERIAL AND METHODS We compared 143 BED patients (92 completers and 51 non-completers) on the number of messages and words written to their therapist during the treatment. RESULTS Completers wrote significantly more words per message (words/message) than non-completers. The results remained significant after controlling for gender, age, educational level, marital status, children, source of income and intake measures of BED, BMI and depression symptoms (Wald = 14.48, p < .001). The odds ratio of completion increased by 1.5% for each additional word patients wrote per message (OR = 1.015). The model showed a 72.4% classification accuracy, and an optimal cut-off point of 68.99 words/message for differentiating completers and non-completers. The model accurately identified 80.9% of completers (sensitivity) and 54.9% of non-completers (specificity). CONCLUSIONS The number of words/message patients write may have important implications for ascertaining likelihood of adherence and improving adherence rates. From a clinical perspective, therapists should encourage patients to use the option of writing messages to the therapist. Words/message may prove to be a transdiagnostic predictor of treatment adherence in text based iCBT.
Collapse
Affiliation(s)
- Jakob Linnet
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Denmark,Clinic on Gambling- and Binge Eating Disorder, Department of Occupational and Environmental Medicine, Odense University Hospital, Denmark,Corresponding author at: Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Heden 11, 5000 Odense C, Denmark.
| | - Esben Skov Jensen
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Denmark
| | - Eik Runge
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Denmark
| | - Marina Bohn Hansen
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Denmark
| | | | - Kim Mathiasen
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Denmark
| | - Mia Beck Lichtenstein
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Denmark,Department of Clinical Research, University of Southern Denmark, Denmark
| |
Collapse
|
4
|
Grilo CM, McElroy SL, Hudson JI, Tsai J, Navia B, Goldman R, Deng L, Kent J, Loebel A. Efficacy and safety of dasotraline in adults with binge-eating disorder: a randomized, placebo-controlled, fixed-dose clinical trial. CNS Spectr 2021; 26:481-90. [PMID: 32423512 DOI: 10.1017/S1092852920001406] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this fixed-dose study was to evaluate the efficacy and safety of dasotraline in the treatment of patients with binge-eating disorder (BED). METHODS Patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for BED were randomized to 12 weeks of double-blind treatment with fixed doses of dasotraline (4 and 6 mg/d), or placebo. The primary efficacy endpoint was change in number of binge-eating (BE) days per week at week 12. Secondary efficacy endpoints included week 12 change on the BE CGI-Severity Scale (BE-CGI-S) and the Yale-Brown Obsessive-Compulsive Scale Modified for BE (YBOCS-BE). RESULTS At week 12, treatment with dasotraline was associated with significant improvement in number of BE days per week on the dose of 6 mg/d (N = 162) vs placebo (N = 162; -3.47 vs -2.92; P = .0045), but not 4 mg/d (N = 161; -3.21). Improvement vs placebo was observed for dasotraline 6 and 4 mg/d, respectively, on the BE-CGI-S (effect size [ES]: 0.37 and 0.27) and on the YBOCS-BE total score (ES: 0.43 and 0.29). The most common adverse events on dasotraline were insomnia, dry mouth, headache, decreased appetite, nausea, and anxiety. Changes in blood pressure and pulse were minimal. CONCLUSION Treatment with dasotraline 6 mg/d (but not 4 mg/d) was associated with significantly greater reduction in BE days per week. Both doses of dasotraline were generally safe and well-tolerated and resulted in global improvement on the BE-CGI-S, as well as improvement in BE related obsessional thoughts and compulsive behaviors on the YBOCS-BE. These results confirm the findings of a previous flexible dose study.
Collapse
|
5
|
Jung J, Fugh-Berman A. Marketing Messages in Continuing Medical Education (CME) Modules on Binge-Eating Disorder (BED). J Am Board Fam Med 2020; 33:240-51. [PMID: 32179607 DOI: 10.3122/jabfm.2020.02.190129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/27/2019] [Accepted: 10/01/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In 2015, Vyvanse (lisdexamfetamine) became the first Food and Drug Administration (FDA)-approved treatment for binge-eating disorder (BED), a condition first recognized by the DSM-V in 2013. Because pharmaceutical companies use continuing medical education (CME) to help sell drugs, we explored possible bias in CME modules on BED. METHODS We utilized a qualitative thematic analysis research approach to identify and classify patterns in CME activities focusing on BED. RESULTS We identified 27 online CME activities on BED in 2015. All were funded by Shire, which manufactures lisdexamfetamine. Seven of 16 presenters disclosed financial ties with Shire. Twenty-nine slides recurred in at least 2 CME modules, and 12 slides were repeated in 5 or more modules. Diagnosis-related themes included: BED is a real, treatable disease; BED is highly prevalent but often missed; BED can occur in anyone; BED results in poor quality of life; many patients with BED are obese; and BED makes losing weight difficult. Treatment-related themes included: lisdexamfetamine is highly effective; topiramate is limited by substantial adverse effects; and other therapeutic options for BED are inferior to lisdexamfetamine because they do not cause weight loss. Although amphetamines can cause addiction, myocardial infarction, stroke, and death, no module mentioned these serious adverse effects. CONCLUSIONS It seems that CME is being used to promote lisdexamfetamine for weight loss (a contraindicated use) and to highlight benefits of lisdexamfetamine while underplaying the risks.
Collapse
|
6
|
Hawa R, Van Exan J, Sockalingam S, Marcangelo M. Binge-Eating Disorder: An Interactive Self-Learning Module. MedEdPORTAL 2017; 13:10567. [PMID: 30800769 PMCID: PMC6342049 DOI: 10.15766/mep_2374-8265.10567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 03/27/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION This resource is a web-based and self-contained self-learning module (SLM) on binge-eating disorder (BED) that runs utilizing Articulate software. Certain skills and knowledge are required to both interview and manage patients diagnosed with the disorder. Because BED may be encountered by medical students, this module can help inform the learning process. METHODS Software was utilized to develop an SLM for third-year medical students utilizing video clips demonstrating the evolution of a clinical BED case from presentation to follow-up over 10-12 weeks. The focus is on differential diagnosis and management, with intermittent self-assessment quizzes and other evidence-based literature for further study. The module follows the case of Ms. Melanie May, who has been referred for help to lose weight. Further assessment reveals that she has BED. By having her needs therapeutically attended to, she receives help through focused cognitive behavioral therapy, the use of food log monitoring, and medications. RESULTS This SLM on BED has been implemented at the University of Toronto as an optional component of the psychiatry clerkship over the 2015/2016 academic year. Written and verbal feedback from faculty (n = 5) and students (n = 5) has been overwhelmingly positive. DISCUSSION This SLM is intended as a clinical application exercise for third-year medical students who may not encounter patients with BED or who want to increase their clinical understanding of how to help patients who present with obesity and binge-eating complaints.
Collapse
Affiliation(s)
- Raed Hawa
- Associate Professor, Department of Psychiatry, University of Toronto
| | | | | | - Michael Marcangelo
- Associate Professor, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine
| |
Collapse
|