Integrated psychodynamic therapy for bulimia nervosa and binge eating disorder: theory,practice and preliminary findings

While there is a substantial evidence base for the use of more recently developed therapeutic approaches, there is very little evidence that psychodynamically based treatments are effective in treating bulimia nervosa or binge‐eating disorder. Clinicians have suggested that such an approach should be supplemented with behavioural foci and that it should be time‐limited. This paper outlines an integrative approach to the outpatient treatment of these eating disorders, where psychodynamic principles and practice are used in tandem with behavioural strategies, and presents preliminary data on behavioural changes among patients who undertake this programme. A case series design was used, employing this approach with a selected group of 21 female patients. Data are presented on failure to complete the programme, as well as changes in body mass index and frequency of bingeing and vomiting. All of the 21 patients completed the programme, though 5 were lost to the study by the last follow‐up point. Those who completed the programme had a stable body mass index, but showed clinically and statistically significant reductions in bulimic symptoms. These preliminary findings indicate that the bulimic disorders can be treated effectively using a psychodynamic approach that is integrated with behavioural techniques and that has time limits. While further research is needed to support this conclusion, it appears to be important to use a more integrative psychodynamic approach than is commonly used. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Cognitive‐behavioural therapy for adolescents with bulimia nervosa

Psychological and pharmacological treatments for bulimia nervosa (BN) have been studied extensively in adults, but there are no published controlled treatment studies of adolescents with BN. One option for treating adolescents with BN is to adapt cognitive‐behavioural therapy (CBT) for younger individuals. The rationale for developing CBT for adolescents with BN is three‐fold: the efficacy of CBT for adult patients with BN, the efficacy of CBT in treating adolescents with other clinical disorders, and the conceptual fit between CBT and adolescent eating disorders. CBT should be tailored to the treatment of adolescents, with particular focus on domains of development, including: motivation, cognitive processing, interpersonal functioning, and family involvement. A recently described new version of CBT for BN (Fairburn, Cooper, & Shafran, 2003 ) is well‐suited for adapting manual‐based CBT from adults to adolescents. Future research should evaluate the efficacy of CBT for the treatment of adolescents with BN and related eating disorders. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.     

Cognitive‐behavioural therapy for individuals with bulimia nervosa and a co‐occurring substance use disorder

A significant percentage of individuals with bulimia nervosa (BN) also can be diagnosed with a co‐occurring substance use disorder (SUD). Although studies have addressed the frequency of overlap between the disorders, etiology and shared personality traits, limited research is available about the treatment of these comorbid patients. Adapting cognitive‐behaviour therapy (CBT) to serve as an integrated treatment for patients with both BN and a SUD is a viable option, as studies of CBT suggest that this form of treatment is efficacious for both disorders independently. The shared strategies in CBT for BN and SUDs facilitate the development of a combined treatment for individuals with both disorders with the addition of modules designed to address some common features of these disorders, such as motivation, difficulty with interpersonal relationships, reward sensitivity and impulsivity. Future research should begin to evaluate the efficacy of an integrated CBT in treating individuals with BN and a SUD. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.     

Cognitive behavioural therapy for individuals with longstanding anorexia nervosa: adaptations, clinician survival and system issues

Despite recent advances in the treatment of anorexia nervosa, some individuals will progress to a severe and enduring illness, with associated physical, psychological and social consequences. Working with these patients, however, may leave clinicians feeling overwhelmed, risking difficulties in the therapeutic relationship including disengagement or despair. Cognitive behaviour therapy has shown some promise in the treatment of eating disorders, yet some features may not be appropriate for this group. In this paper, we outline the ways in which we have adapted cognitive behaviour therapy to best meet the complex and challenging needs of this group. We stress the importance of maintaining a reassuring, accepting and motivational approach in combination with clear goal setting and boundaries.     

Comorbid depressive symptoms and self‐esteem improve after either cognitive‐behavioural therapy or family‐based treatment for adolescent bulimia nervosa

This study examined the effect of family‐based treatment for bulimia nervosa (FBT‐BN) and cognitive behavioral therapy for adolescents (CBT‐A) on depressive symptoms and self‐esteem in adolescents with BN. Data were collected from 110 adolescents, ages 12–18, who met Diagnostic and Statistical Manual of Mental Disorders‐Fourth Edition, text revision criteria for BN or partial BN. Participants were randomly assigned to FBT‐BN or CBT‐A and completed measures of depressive symptoms and self‐esteem before and after treatment and at 6‐ and 12‐month follow‐up assessments. Depressive symptoms and self‐esteem significantly improved in both treatments, and neither treatment appeared superior on these clinical outcomes. Parents often worry whether FBT‐BN addresses comorbid depressive symptoms and low self‐esteem. Our findings address this concern, as they demonstrate that FBT‐BN does not differ from CBT‐A in improving depressive symptoms and self‐esteem, and both treatments result in symptom improvement. These findings can help clinicians guide families to choose a treatment that addresses BN and depressive symptoms and low self‐esteem.     

Assessment of tumor necrosis factor superfamily member 10 (TNFSF10) gene variants in systemic lupus erythematosus patients

Aim of the workTo investigate the association between tumor necrosis factor (TNF) related apoptosis-inducing ligand (TRAIL) 1525 G > A (TNF supefamily member 10; TNFSF10, rs1131568) and 1595 C > T (TNFSF10 rs1131580) genetic variants and systemic lupus erythematosus (SLE) susceptibility in Egyptian patients and their relationship with clinical and laboratory outcomes of the disease.Patients and methodsA total of 123 SLE patients and 110 age- and sex-matched healthy control subjects were tested for TRAIL 1525 G > A and 1595 C > T genotyping by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP), followed by confirmation of random samples from each genotype by direct sequencing technique. Disease activity was determined using the SLE Disease Activity Index (SLEDAI).ResultsThe patients were 107 females and 16 males with mean age 32.87 ± 9.6 years. The median value of SLEDAI of the patients was 18 (12–27). The two genetic variants of TRAIL, 1525 G > A and 1595 C > T, were in complete linkage disequilibrium. There was a significant increase in the frequencies of combined genotypes (GA + AA)/(CT + TT) and A/T alleles of TRAIL 1525/1595 variants among SLE cases when compared with the control group (OR = 1.7, 95 % CI = 1.0 – 2.98, p = 0.048; OR = 1.7, 95 % CI = 1.1 – 2.8, p = 0.02, respectively). Additionally, the A/T variants of TRAIL 1525/1595 were associated with higher risks of developing lupus nephritis (OR = 2.6, 95 % CI = 1.2 – 5.7, p = 0.015) and higher disease activity (OR = 3.8, 95 % CI = 1.3 – 10.9, p = 0.010).ConclusionTRAIL 1525 G > A and 1595 C > T gene variants confer susceptibility to SLE, which is significantly related to the clinical phenotypes of SLE and associated with higher disease activity.     

Differential lipid metabolism outcomes associated with ADRB2 gene polymorphisms in response to two dietary interventions in overweight/obese subjects

Background and aims

A precise nutrigenetic management of hypercholesterolemia involves the understanding of the interactions between the individual's genotype and dietary intake. The aim of this study was to analyze the response to two dietary energy-restricted interventions on cholesterol changes in carriers of two ADRB2 polymorphisms.

A pilot evaluation of a novel First Episode and Rapid Early Intervention service for Eating Disorders (FREED)

This pilot study assesses the impact of FREED (First Episode Rapid Early Intervention for Eating Disorders [ED]), a novel transdiagnostic service for emerging adults with recent ED onset, on clinical outcomes. Data were collected from 56 patients and 19 carers for 12 months following enrolment. FREED patients showed significant improvements in ED and other symptoms across time. Carers also showed psychological improvements. For FREED anorexia nervosa (AN) patients, body mass index (BMI) at initial clinical assessment was similar to that of comparable patients (audit cohort) seen in our service before (16.4 vs 16.1 kg/m²). By start of treatment, because of their shorter wait, FREED‐AN had gained weight whereas audit patients had lost (16.7 vs 15.8 kg/m²). This difference continued throughout treatment, and at 12 months, nearly 60% FREED‐AN patients returned to a BMI of 18.5 or greater. FREED shows promise as a service model for emerging adults with EDs.     

Assessment of the Relationship Between Ulcerative Colitis and Forkhead Box P3 Polymorphisms

BackgroundUlcerative colitis (UC) is a chronic disease that does not have a definitive treatment and causes repetitive inflammation of the colon and impaired quality of life. The FOXP3 gene codes FOXP3 protein responsible for the development and function of regulatory T (Treg) cells. The rs2232365 A/G and the rs3761548 A/C polymorphisms of the FOXP3 gene were indicated to be associated with inflammation-related diseases such as UC. The effectiveness of Treg cells, which act as immune-suppressors in the control of inflammation, can be affected by these polymorphisms. The present study aimed to evaluate the association between these polymorphisms with UC.MethodsThe current study researched the FOXP3 gene polymorphisms in 146 patients with UC and in 292 healthy individuals by a real-time polymerase chain reaction (RT-PCR).ResultsThe patients with rs2232365 G allele had a 1.44-fold higher UC risk than patients carrying other alleles (P = .013), and had significantly a 2.56-fold higher risk for the extent of UC (P = .001). Contrary, rs3761548 polymorphism did not reach statistically significant in any analysis.ConclusionThis is the first study to reveal the relationship of the rs2232365 and the rs3761548 polymorphisms with UC in the Caucasian population. The rs2232365 has an important effect on the risk of UC. The current study suggests that these polymorphisms should be explored together with the FOXP3 expression and FOXP3⁺ Treg cell count in blood and colon tissue of UC patients to clarify the exact effect of FOXP3 polymorphisms on UC risk.     

Self‐Disgust within Eating Disordered Groups: Associations with Anxiety,Disgust Sensitivity and Sensory Processing

This study aimed to assess the relationship between self‐disgust and sensory processing within eating psychopathology. Five hundred and ninety‐one women with a self‐reported diagnosis of anorexia nervosa, bulimia nervosa or who had no previous history of an eating disorder completed a battery of online questionnaires measuring disgust, emotion and sensory variables. Those with an eating disorder reported significantly higher rates of self‐disgust than those with no history of disordered eating. In groups of women with self‐reported bulimia, self‐disgust was associated with sensation avoidance and sensation seeking. Within the group with anorexia nervosa, self‐disgust was associated with low registration and sensation seeking. This report is the first to examine the expression of the emotion self‐disgust within eating psychopathology and examine associations of this factor with sensory processing. The emotion self‐disgust needs to be further examined to understand its possible role in the onset and maintenance of disordered eating. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Association of IL-13 rs20541 and rs1295686 variants with symptomatic asthma in a Saudi Arabian population

Objective: Interleukin 13 (IL-13) plays a critical pro-inflammatory role in asthma. Several single nucleotide polymorphisms (SNPs) are associated with asthma susceptibility in specific populations; however, further replicative studies in other ethnic groups are mandatory. Methods: The association between IL-13 SNPs rs762534, rs20541, rs1295686, and rs1800925 (risk alleles A, A, T, and A, respectively) and asthma predisposition in a Saudi Arabian cohort was examined via a case–control cross-sectional study. Results: The frequencies of alleles between asthmatics and control populations were significantly different for rs20541 and rs1295686 SNPs (p < 0.001), whereas the frequencies of genotypes between asthmatics and controls were significantly different only for rs20541. The association of the risk (minor) alleles with asthma was examined using the dominant genetic model. Individuals with at least one copy of the risk alleles A (for rs20541) and T (for rs1295686) had significantly greater odds of being asthmatic (OR = 2.13, 95% CI = 1.39–3.26, p < 0.0001; OR = 1.69, 95% CI = 1.12–2.54, p = 0.008) relative to their most common homozygous genotypes. On the other hand, the minor A alleles for rs762534 and rs1800925 were not significantly associated with asthma risk. Regarding haplotype association analysis, individuals with at least one copy of the minor “risk” allele for both rs20541 and rs1295686 (CATG and CATA, respectively) had greater odds of being asthmatic relative to CGCG haplotype; however, this trend was not statistically significant (p > 0.3). Conclusions: IL-13 minor T and A alleles for rs1295686 and rs20541, respectively, were associated with significantly higher risk of asthma in the Saudi Arabian population.     

Genetic variability on adiponectin gene affects myocardial infarction risk: The role of endothelial dysfunction

Background

Adiponectin is an adipokine with an important role in cardiovascular system conferring anti-inflammatory and anti-atherogenic effects. Two common single nucleotide polymorphisms (SNP) on adiponectin gene, rs2241766 and rs1501299, have been associated with insulin resistance and diabetes mellitus risk however their effects on cardiovascular risk remain unclear. We examined the impact of rs2241766 and rs1501299 on circulating adiponectin levels, endothelial function and cardiovascular disease risk.

Methods

We recruited in total 594 subjects; 462 patients with angiographically confirmed coronary artery disease (CAD) and 132 controls matched for age and gender. rs2241766 and rs1501299 were genotyped by polymerase chain reaction and restriction endonuclease digestion. Serum adiponectin levels were determined by enzyme-linked immunosorbent assay. Endothelial function was assessed by the flow mediated dilatation (FMD) of the brachial artery.

Results

rs2241766 had no effects on circulating adiponectin levels or FMD. In subjects without CAD, carriers of the T/T alleles at rs1501299 had lower adiponectin levels (p = 0.001) and impaired endothelial function (p < 0.05). After multivariate adjustment none of the SNPs had any effect on CAD risk. However, carriers of the T allele at rs1501299 were at increased myocardial infarction (MI) risk, independently of classic risk factors (OR = 2.558 [95%CI = 1.587–4.123], p = 0.0001). The number of T alleles in both SNPs was strongly associated with MI history (p = 0.0001).

Conclusions

rs1501299 polymorphism of adiponectin gene affects circulating adiponectin levels and endothelial function in subjects without CAD. Presence of the T variant at rs1501299 on adiponectin gene is independently associated with increased myocardial infarction risk.     

CYP4F2基因多态性与冠心病的相关性

目的研究CYP4F2基因多态性与冠心病(CAD)的相关性。方法对285例汉族CAD患者(冠心病组)和264例非CAD患者(对照组)进行问卷调查,采用高温连接酶检测反应技术进行基因扩增和基因分型,分析CYP4F2基因的2个单核苷酸多态性位点rs1558139和rs2108622多态性与CAD的相关性。结果 CAD组吸烟史和体重指数(BMI)均显著高于对照组(P<0.05),高密度脂蛋白胆固醇(HDL-C)CAD组显著低于对照组(P=0.000),CAD组男性患者比例明显高于女性(P=0.001);CAD组CYP4F2基因rs1558139的基因型频率和等位基因频率与对照组无显著差异(P>0.05),rs2108622的CC基因型频率在CAD组和对照组间差异显著(P<0.05)。结论 CAD患者的危险因素是男性、有吸烟史、高BMI;CYP4F2基因rs1558139多态性与CAD无明显相关性,CYP4F2基因rs2108622多态性与CAD相关,携带CC基因型的患者发生CAD的风险增加。