Factors Influencing Research Drug Trials in Adolescents With Anorexia Nervosa

This study examined factors that contributed to patient's eligibility and participation in a randomized controlled trial involving olanzapine for the adjunctive treatment of anorexia nervosa (AN). Factors involving patient eligibility and willingness to participate were systematically recorded for all patients approached to participate. Of the 92 patients that were assessed and treated over the study timeframe, only 27 patients (29%) met full criteria for inclusion, of which just 7 enrolled (26%). The most common reasons for study refusal related to fears associated with medication effects and refusal to consider medication as a treatment option (70%). Factors affecting recruitment in psychopharmacological studies involving AN in youth are discussed.     

Adolescent Anorexia Nervosa: Cognitive performance after weight recovery

Objective

Although there is no definitive consensus on the impairment of neuropsychological functions, most studies of adults with Anorexia Nervosa (AN) find impaired functioning in cognitive domains such as visual–spatial abilities. The objective of this study is to assess the cognitive functions in adolescents with AN before and after weight recovery and to explore the relationship between cognitive performance and menstruation.

Methods

Twenty-five female adolescents with AN were assessed by a neuropsychological battery while underweight and then following six months of treatment and weight recovery. Twenty-six healthy female subjects of a similar age were also evaluated at both time points.

Results

Underweight patients with AN showed worse cognitive performance than control subjects in immediate recall, organization and time taken to copy the Rey's Complex Figure Test (RCFT). After weight recovery, AN patients presented significant improvements in all tests, and differences between patients and controls disappeared. Patients with AN and persistence of amenorrhea at follow-up (n = 8) performed worse on Block Design, delayed recall of Visual Reproduction and Stroop Test than patients with resumed menstruation (n = 14) and the control group, though the two AN groups were similar in body mass index, age and psychopathological scale scores.

Conclusion

Weight recovery improves cognitive functioning in adolescents with AN. The normalization of neuropsychological performance is better in patients who have recovered at least one menstrual cycle. The normalization of hormonal function seems to be essential for the normalization of cognitive performance, even in adolescents with a very short recovery time.     

Assumptions and Beliefs in Adolescents With Anorexia Nervosa and Their Mothers

A pilot study examined the specific cognitive content of female adolescents with anorexia nervosa. The relationship between daughter and mother concerns, and concerns in mothers, also were investigated. All participants completed a measure of assumptions and negative self-beliefs related to eating disorders. Adolescents with anorexia nervosa scored more highly on all subscales of the measure than nonclinical adolescent controls. There were significant daughter mother relationships on two subscales in the clinical, but not the nonclinical, group. However, the two groups of mothers did not differ on any subscale. Possible explanations for the findings, and implications for treatment and research, are briefly considered.     

Family-Based Treatment for Adolescents With Anorexia Nervosa: A Dissemination Study

This open trial of Family-Based Treatment for Anorexia Nervosa was completed in order to assess the dissemination of this treatment, including effectiveness, fidelity, and acceptability. Fourteen adolescents with Anorexia Nervosa were recruited with mean age 14.0+1.5 years (range 12–17 years). Therapists were trained using a workshop, manual and weekly supervision. Sessions were videotaped and rated for treatment fidelity. Pre- and post- treatment assessments were compared. Weight was significantly increased by an average of 7.8 kg. Dietary restraint showed significant improvement, as did interoceptive deficits and maturity fears. Of the 9 participants who had secondary amenorrhea at baseline, 8 had regained menstrual function. Treatment fidelity was rated as at least considerable 72% of the time in phase I of the treatment. Adolescents and parents found the treatment to be acceptable. This preliminary investigation of the dissemination of Family-Based Treatment for adolescents with Anorexia Nervosa indicates that this treatment is effective not only for weight restoration, but also in improving some psychological symptoms including dietary restraint, interoceptive deficits, and maturity fears. In addition, this treatment was adopted with considerable fidelity and was acceptable to adolescents and parents.     

Childhood Risk Factors for Lifetime Anorexia Nervosa by Age 30 Years in a National Birth Cohort

ObjectiveTo examine whether previously identified childhood risk factors for anorexia nervosa (AN) predict self-reported lifetime AN by age 30 years in a prospective birth cohort.MethodUsing data from the 1970 British Cohort Study, at birth, 5, 10, and 30 years, we examined associations between suggested childhood risk factors and self-reported lifetime AN at 30 years, adjusted for sex and socioeconomic status.ResultsAnorexia nervosa was independently predicted by female sex (odds ratio [OR] 22.1), infant feeding problems (OR 2.6), maternal depressive symptoms (OR 1.8), and a history of undereating (OR 2.7). High self-esteem (OR 0.3) and higher maternal body mass index (OR 0.91) were protective.ConclusionsOf 22 suggested risk factors for AN, only four risk and two protective factors were confirmed in this prospective cohort study. We did not identify a role for perinatal factors, parenting, childhood body mass index, childhood emotional or sleep problems, academic ability, or exercise.     

Different Patterns of Emotional Eating and Visuospatial Deficits Whereas Shared Risk Factors Related with Social Support between Anorexia Nervosa and Bulimia Nervosa

Objective

Although it is thought that eating disorders result from the interplay of personal and sociocultural factors, a comprehensive model of eating disorders remains to be established. The aim of this study was to determine the extent to which the childhood factors and deficit in visuoperceptual ability contribute to eating disorders.

Methods

A total of 76 participants - 22 women with anorexia nervosa (AN), 28 women with bulimia nervosa (BN), and 26 healthy women of comparable age, IQ, and years of education - were examined. Neuropsychological tasks were applied to measure the visuoperceptual deficits, viz. the Rey-Osterrieth complex figure test and the group embedded figures test (GEFT). A questionnaire designed to obtain retrospective assessments of the childhood risk factors was administered to the participants.

Results

The women with both AN and BN were less likely to report having supportive figures in their childhood and poor copy accuracy in the Rey-Osterrieth test. The women with AN were more likely to report premorbid anxiety, childhood emotional undereating and showed poor performances in the GEFT. In the final model, the factors independently contributing to the case status were less social support in childhood as a common factor for both AN and BN, and childhood emotional undereating and poor ability in the low-level visuospatial processing for AN.

Conclusion

Our results suggest the disturbance in the food-emotion relationship and the deficit in low-level visuospatial processing in people with AN. Lower social support appears to contribute to an increase in vulnerability to both AN and BN.     

Salient Stressors for Mothers of Children and Adolescents With Anorexia Nervosa

To facilitate early recognition of eating disorder (ED) symptoms several organizations in the Netherlands have started to give lessons about risk factors and characteristics of ED in secondary schools. These lessons are given by ex-patients who have received special training. In this paper the results will be presented of an evaluation of a total of 234 lessons presented to 3879 secondary school students. In total 95% of the students evaluated these lessons as very informative: 17 % recognized ED symptoms in others and 9% in themselves. Of the last group 41% would like to discuss their problems with a peer or friend, 39% with their parents, 27% with an ex-patient, 5% with a teacher and 17% with a general practitioner or a therapist. However, 33% of them did not want to talk about their eating problems at all. In total 37% of all students wanted an extra hour for asking questions. Although early recognition can be facilitated by lessons about ED, more activities are necessary to guarantee early help and treatment.     

Investigation of Autism Spectrum Disorder and Autistic Traits in an Adolescent Sample with Anorexia Nervosa

This study aimed to examine the presence of Autism Spectrum Disorder (ASD) in a sample of female adolescents with Anorexia Nervosa (AN) during the acute phase of illness. We also compare the level of autistic traits, social perception skills and obsessive–compulsive symptoms in four groups: AN, ASD, and two gender- and age-matched control groups. Of the 30 AN participants, only three scored above the conventional ADOS-2 threshold for ASD. The AN participants were similar to their controls on autistic trait measures, and to the ASD group on obsessive–compulsive measures, and on theory of mind ability and affect recognition measures. Further longitudinal studies are needed in order to determine the association between these conditions.     

Costs of Remission and Recovery Using Family Therapy for Adolescent Anorexia Nervosa: A Descriptive Report

This paper reports on the costs of overall treatment for a cohort of adolescent patients with AN treated with a similar regimen consisting of inpatient medical stabilization, outpatient family therapy, and psychiatric medications for co-morbid psychiatric conditions. Most of the costs associated with outcome were secondary to medical hospitalization. However, the overall costs per remission varied widely depending on the threshold used. However, compared to costs described for adults with AN, adolescent treatment costs appear to be lower when families are used effectively to aid in treatment.     

神经性厌食症的临床特点及精神科干预对策

神经性厌食症（anorexia nervosa，AN）是严重威胁女性青少年身心健康的伴有内分泌异常的心身疾病。此病的概念在19世纪未首先由Gull提出，但直到20世纪50年代之后，才逐渐引起临床医生的重视。美国精神疾病诊断与统计手册（DSM -Ⅳ）对此病下的定义为：以身体疾病表现，可见严重的摄食限制，其结果以严重的低营养状态为特征，极严重情况下有死亡危险。     

The Treatment of Adolescent Anorexia Nervosa: A Qualitative Study of the Views of Parents

Semi-structured, qualitative interviews with parents of young people treated for anorexia nervosa were conducted to find out their views in relation to treatment received by their children. Parents recalled how they had to adopt a proactive stance in order to ensure that their daughters received appropriate services. They had mixed opinions about the care provided for their children by professionals. Talking to parents of youngsters with anorexia can provide valuable insight into their needs and experiences of treatment.     

Altered White Matter Connectivity in Young Acutely Underweight Patients With Anorexia Nervosa

1. Download : Download high-res image (390KB)
2. Download : Download full-size image