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Anorexia nervosa [keywords]
- Cognitive deficits as an endophenotype for anorexia nervosa: An accepted fact or a need for re-examination? [JOURNAL ARTICLE]
- Int J Eat Disord 2014 Jul 21.
To investigate whether impaired set shifting and weak central coherence represent state or trait characteristics and, therefore, candidate endophenotypes of anorexia nervosa (AN).Forty-nine individuals with lifetime AN (24 acutely unwell, 10 weight recovered, and 15 fully recovered) and 43 healthy controls completed the Wisconsin Card Sorting Test (WCST), the Matching Familiar Figures Test, and the Rey Complex Figure Task measuring cognitive flexibility, local processing, and global processing, respectively. Participants also completed questionnaires assessing eating disorder, anxiety and depressive symptoms, obsessional traits, interpersonal functioning, and quality of life. Body mass index was calculated from height and weight measurements.Participants with lifetime AN demonstrated poorer set shifting ability than healthy controls as evidenced by a greater number of perseverative errors on the WCST. When participants were grouped according to illness status, only those in the two recovered groups demonstrated poorer set shifting ability than healthy controls while patients with acute AN performed comparably to all other groups. There were no significant differences between groups on measures of local and global processing. No relationship was found between specific clinical features of AN and cognitive performance.The results of this study are consistent with a global trend toward set shifting difficulties in patients with AN but do not support weak central coherence as a candidate endophenotype for AN. These findings have clinical implications in terms of treatment selection and planning, particularly in relation to the use of cognitive remediation therapy with patients with AN. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014).
- Weight Suppression and Body Mass Index Interact to Predict Long-Term Weight Outcomes in Adolescent-Onset Anorexia Nervosa. [JOURNAL ARTICLE]
- J Consult Clin Psychol 2014 Jul 21.
Research on anorexia nervosa (AN) has emphasized the importance of low absolute body weight, but emerging research suggests the importance of also considering low body weight relative to an individual's highest premorbid weight (weight suppression; WS). Objective: We investigated whether body mass index and WS at lowest weight (BMI-LW and WS-LW) among adolescents with AN predicted BMI at 6-, 10-, or 18-year follow-up, duration of AN, or total eating disorder duration, including time during which criteria were met for bulimia nervosa or eating disorder not otherwise specified. Method: Forty-seven cases of AN identified through community screening in Sweden were included. Weight and height data were collected from medical records, school nurse charts, and study follow-up assessments. Results: Higher WS-LW was associated with higher BMI at 6-year and 10-year follow-up, and this effect was strongest among those with the lowest BMI-LW values. BMI-LW and WS-LW were positively associated with BMI at 18-year follow-up, but there was no significant interaction. There was no significant association between WS-LW and AN duration or eating disorder duration, although eating disorder duration was longer among those with higher BMI-LW, controlling for WS-LW. Conclusions: Absolute and relative weight status interact to predict weight outcomes in AN over the long term. Results suggest that BMI and WS may be more relevant to the prediction of long-term weight outcomes than to the persistence of other eating disorder symptoms. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
- Treatment of adolescents with anorexia nervosa--authors' reply. [Comment, Letter]
- Lancet 2014 Jul 19; 384(9939):230-1.
- Treatment of adolescents with anorexia nervosa. [Comment, Letter]
- Lancet 2014 Jul 19; 384(9939):229-30.
- The Effects of Dehydroepiandrosterone (DHEA) in the Treatment of Depression and Depressive Symptoms in Other Psychiatric and Medical Illnesses: a Systematic Review. [JOURNAL ARTICLE]
- Curr Drug Targets 2014 Jul 17.
International interest on the benefits of using the steroid hormone Dehydroepiandrosterone (DHEA) on various aspects of human health, including the regulation of mood, is increasing. This study aimed to review the scientific literature on the use of DHEA in the treatment of depression and depressive symptoms in other psychiatric and medical illnesses. PubMed, ISI Web of Knowledge and Virtual Health Library (VHL) databases were independently searched by two researchers using the following terms: Depression, treatment, DHEA, and mood. Clinical studies were considered eligible when subjects were treated with DHEA and psychological assessments of depression were conducted. No time limits or language for this research were imposed. One 183 references were identified, and 22 references were selected to compose this review. Significant improvements related to the use of DHEA in patients with depression were observed, in addition to improvements in depressive symptoms in patients with schizophrenia, anorexia nervosa, HIV and adrenal insufficiency. No significant improvements were observed regarding depressive symptoms in patients with fibromyalgia; the results observed in patients with autoimmune diseases and healthy individuals remain contradictory. Although the selected studies demonstrated good methodological applications, most studies consisted of small samples, and only 3 studies were conducted in a young population. Therefore, we concluded that the studies published to date indicate promising results regarding the use of DHEA in the treatment of depression and depressive symptoms, especially in depression that is mild or resistant to conventional therapy.
- [Siblings of prepubesecent anorexic children.] [JOURNAL ARTICLE]
- Arch Pediatr 2014 Jul 14.
As professionals working in a specialised unit for prepubescent anorexic children, we are very often concerned with the siblings of our young patients who are daily faced with anorexia nervosa. Although it is an undeniable subject of prevention, research on the topic remains scarce. Based on our clinical experience, this article thus proposes to give a few landmarks to health professionals likely to support these siblings in order to prevent anxious and depressive disorders as well as eating disorders. If guided, supported and informed on anorexia nervosa, siblings can adopt adequate coping strategies when confronted to their sibling's anorexic cognitions and behaviours. We also encourage parents to pay close attention to the needs of their other children, especially to remain receptive to the youngest ones or, if unavailable to find adult carers (grandparents, family, friends). We also guide these children, who are eager to help their anorexic sibling, to remain in a brotherly role. Siblings must be informed about anorexia nervosa. Such information enables them to have a better understanding of their sister's thoughts and attitudes. It also leads to a better understanding of the reasons why anorexia has such a significant impact on family routine, among other things by reducing parental availability. Beyond enabling siblings to adopt adequate coping strategies, such provision of support also contributes to the prevention of mental illness and the maintenance of adequate sibling and family relationships.
- Association between resting energy expenditure, psychopathology and HPA-axis in eating disorders. [Journal Article]
- World J Clin Cases 2014 Jul 16; 2(7):257-64.
To investigate the complex relationships between resting energy expenditure (REE), eating psychopathology, and Hypothalamus Pituitary Adrenal axis functioning in patients with eating disorders.The study was designed as a cross-sectional survey, and it was planned by the Clinic for Eating Disorders of the University of Florence (Italy). The protocol was approved by the Ethics Committee of the Institution. Twenty two anorexia nervosa and twenty one Bulimia Nervosa patients were assessed by means of a clinical interview and the structured clinical interview for diagnostic and statistical manual of mental disorders, fourth edition. Eating attitudes and behaviour were specifically investigated by means of the eating disorder examination questionnaire (EDE-Q). Patients were also evaluated by means of the symptom checklist (SCL 90-R), REE was measured by means of indirect calorimetry, and blood cortisol morning levels were evaluated.Both anorexia nervosa and bulimia nervosa patients showed a reduced REE as compared with predicted REE. Body mass index (BMI) was positively associated with resting energy expenditure in Bulimics, whereas a strong, negative association between BMI and REE was observed in Anorectics. The pattern of associations between variables supported a mediation model, where shape concern accounted for variations in REE and cortisol levels (mediator), and variations in the mediator significantly accounted for variations in REE. When these associations where taken into account together, the relationship between shape concern and REE was no longer significant, whereas the association between cortisol levels and REE retained its significance, showing strong evidence for a single, dominant mediator. Anorectics and Bulimics showed an opposite pattern of association between BMI and REE. In Anorectics only, a higher REE was associated with a more severe eating disorder specific psychopathology, and cortisol levels represent a possible mediating factor for this relationship.The data supported a mediation model where cortisol levels mediated the relationship between eating psychopathology (concern about body shape) and REE.
- Predicting clinical outcome using brain activation associated with set-shifting and central coherence skills in Anorexia Nervosa. [JOURNAL ARTICLE]
- J Psychiatr Res 2014 Jul 3.
Patients with Anorexia Nervosa (AN) have neuropsychological deficits in Set-Shifting (SS) and central coherence (CC) consistent with an inflexible thinking style and overly detailed processing style, respectively. This study investigates brain activation during SS and CC tasks in patients with AN and tests whether this activation is a biomarker that predicts response to treatment..FMRI data were collected from 21 females with AN while performing an SS task (the Wisconsin Card Sort) and a CC task (embedded figures), and used to predict outcome following 16 weeks of treatment (either 16 weeks of cognitive behavioral therapy or 8 weeks cognitive remediation therapy followed by 8 weeks of cognitive behavioral therapy).Significant activation during the SS task included bilateral dorsolateral and ventrolateral prefrontal cortex and left anterior middle frontal gyrus. Higher scores on the neuropsychological test of SS (measured outside the scanner at baseline) were correlated with greater DLPFC and VLPFC/insula activation. Improvements in SS following treatment were significantly predicted by a combination of low VLPFC/insula and high anterior middle frontal activation (R squared = .68, p = .001). For the CC task, visual and parietal cortical areas were activated, but were not significantly correlated with neuropsychological measures of CC and did not predict outcome.Cognitive flexibility requires the support of several prefrontal cortex resources. As previous studies suggest that the VLPFC is important for selecting context-appropriate responses, patients who have difficulties with this skill may benefit the most from cognitive therapy with or without cognitive remediation therapy. The ability to sustain inhibition of an unwanted response, subserved by the anterior middle frontal gyrus, is a cognitive feature that predicts favorable outcome to cognitive treatment. CC deficits may not be an effective predictor of clinical outcome.
- Mothers' Experiences of Home Treatment for Adolescents With Anorexia Nervosa: An Interpretative Phenomenological Analysis. [JOURNAL ARTICLE]
- Eat Disord 2014 Jul 14.:1-19.
Home treatment (HT) is emerging as an alternative to admission for adolescents with anorexia nervosa. It relies heavily on parental (often maternal) input to be effective. Given the high levels of carer stress reported by mothers, the current study aimed to explore mothers' experience of HT. A qualitative study using purposeful sampling was conducted. Nine interviews were analyzed using interpretative phenomenological analysis. Two contextual themes described the mother-daughter relationship and maternal stress and distress prior to HT. The third theme, "experience of help," included sub-themes of when help is needed, the need for containment, gaining strength and skills, and how HT met families' philosophy and values. The results support previous research on the stress that mothers particularly are under when their adolescent daughters have anorexia nervosa, and provides rich data on their experiences. HT is perceived as having both helpful and unhelpful aspects. Further research on its effectiveness is needed.
- Body size estimation in anorexia nervosa: A brief review of findings from 2003 through 2013. [REVIEW]
- Psychiatry Res 2014 Jun 26.
Body size overestimation is a fundamental feature in anorexia nervosa (AN). The extent or even existence of body size overestimation in AN is controversial. The most recent review (Farrell et al., 2005) found that only half the studies reported overestimation of body size in individuals diagnosed with AN. The remaining studies found no overestimation or in some instances underestimation. The discrepancy in these findings has been attributed to the wide variety of assessment techniques that are used, including many with questionable psychometric properties. We review all 9 contemporary studies conducted in this area since the last review in 2005. For each study we describe the number of participants, methodology, reliability/validity data, amount of whole body distortion, effect sizes, and a summary of findings. In all studies that included a healthy control group, individuals with AN overestimated their whole body size more than healthy controls did. The difference was significant in all except two studies. Based on these contemporary findings, we conclude that individuals with AN overestimate their body size and that the greater consistency of findings in the studies conducted over the last decade is attributable to the use of improved methodologies and assessment tools with documented psychometric properties.