Comorbidité et chronologie d’apparition des troubles anxieux dans les troubles du comportement alimentaire

The objectives of the study were to assess lifetime prevalence of specific anxiety disorders, and their age of onset relative to that of the Eating Disorder (ED), in a French sample of patients with Anorexia Nervosa (AN) or Bulimia Nervosa (BN).Method. - We assessed frequencies of seven anxiety disorders and childhood historyof separation anxiety disorder among 63 subjects with a current DSM-IV diagnosis of an ED, using the Composite International Diagnostic Interview (CIDI).Results. - Eighty three of subjects with AN and 71% of those with BN had at least one lifetime diagnosis of an anxiety disorder. By far, the most frequent was social phobia (55% of the anorexics and 59% of the bulimics). When present, the comorbid anxiety disorder had predated the onset of the ED in 75% of subjects with AN, and 88% of subjects with BN.Conclusion. - Our results are consistent with those of studies conducted in other countries, and show that an anxiety disorder frequently pre-exists to an ED. This has to be taken in consideration for successful treatment of patients with AN or BN.     

Low serum BDNF and food intake regulation: A possible new explanation of the pathophysiology of eating disorders

Background

Several lines of evidence suggest that brain-derived neurotrophic factor (BDNF) plays an important role in weight regulation and eating behavior, and poorly balanced diets lead to a decrease in blood BDNF levels. However, studies regarding BDNF blood levels in eating disorders (ED) have yielded inconsistent results. We measured serum concentrations of BDNF and assessed behavior and cognition related to eating in ED patients and control subjects.

Methods

Forty female drug-free patients [19 with anorexia nervosa (AN), 21 with bulimia nervosa (BN)], who did not meet the diagnostic criteria for depressive disorder, and 24 age-matched normal control subjects were enrolled in the current study. We evaluated eating-related psychopathology and depressive symptoms using the Eating Disorder Inventory-2 (EDI-2), Eating Attitude Test-26 (EAT-26) and the Hamilton Depression Rating Scale (HDRS), and measured serum BDNF levels by an enzyme-linked immunosorbent assay.

Results

Compared to normal controls, serum levels of BDNF were significantly reduced in AN, but not in BN. There was a significant positive correlation between serum BDNF levels and BMI in both AN patients (r = .649, p = .003) and BN patients (r = .626, p = .002). However, no correlation between serum BDNF levels and BMI was detected in the controls. Furthermore, there was a significant negative correlation between serum BDNF levels and the oral control subscale scores of EAT in both AN patients (r = − .506, p = .027) and BN patients (r = − .511, p = .018); whereas, no correlation was detected in normal controls.

Conclusion

Our study demonstrated that individuals showing more extreme food intake regulation were those with lower serum BDNF levels. This finding is contrary to that in mice where mice with reduced BDNF levels showed aberrant eating behavior. This result suggests that BDNF is no longer functioning appropriately in ED patients, which could be an important factor in the pathophysiological of ED.     

Marital status and eating disorders: An analysis of its relevance

Objectives: This study attempts to understand the clinical impact of marital status on the psychopathology and symptomatology of anorexia (AN) and bulimia nervosa (BN) patients. Method: Eating disorder (ED) patients (n=332, 198 BN and 134 AN) consecutively admitted to our unit participated in the study. All subjects met DSM-IV criteria for those pathologies and were female. Our sample was divided retrospectively into three subgroups based on their marital status. For the assessment, commonly applied questionnaires in the field of ED were used [Eating Attitudes Test (EAT-40), Eating Disorder Inventory (EDI), Bulimic Investigatory Test Edinburgh (BITE), Body Shape Questionnaire (BSQ), Beck Depression Inventory (BDI) and Social Avoidance and Distress Scale (SAD)]. Results: 2×3 (Diagnostic×Marital status) ANOVA and ANCOVA (with age as covariance) designs were applied in the current study. Our results suggested that ED patients who lived with a partner were significantly different with respect to the other ED patients in the following variables: higher age (P<.0001), higher motivation for change (P<.004), perfectionism (P<.03) and purging behavior (P<.04). Discussion: The main finding in this study is that ED patients who live with a partner are those who presented greater eating symptomatology and psychopathology but even higher motivation for change. Interpersonal functionality has to be considered in the development and maintenance of ED.     

Eating disorder symptoms and comorbid psychopathology among male and female veterans

Objective

Eating disorder (ED) symptoms have gone mostly unexamined among veterans. The current study assessed rates of bulimia nervosa (BN) and binge eating disorder (BED) symptoms and diagnoses and their associations with common comorbidities among male and female veterans.

Method

Participants were US military veterans who screened positive for trauma histories and/or a probable Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) posttraumatic stress disorder (PTSD) diagnosis (n= 499). Symptoms of PTSD were assessed using the Clinician-Administered PTSD Scale, and symptoms of EDs, mood, and substance use disorders were assessed using the Structured Clinical Interview for the DSM-IV.

Results

Lifetime rates of BN and BED diagnoses were comparable to civilian populations, and a considerable range of lifetime and current BN and BED symptoms were identified. In multivariate models, PTSD and depression severity were most consistently associated with BN and BED symptom severity, with depression most strongly associated with EDs for women.

Conclusions

Findings highlight the importance of screening for ED symptoms among male and female veterans, particularly those that present with PTSD and depression symptomatology. Future examinations of the temporal order of such relationships and the degree to which ED symptoms and associated symptoms impact veteran functioning are warranted.     

A five-item screening version of the Eating Disorder Inventory (EDI-3)

Objective

The Eating Disorder Inventory (EDI) is used worldwide in research and treatment of eating disorders (EDs). Using the latest version (EDI-3: 91 items), we extracted the best screening items for a diagnosis of anorexia (AN) and bulimia (BN) nervosa.

Method

A patient sample of 561 women was recruited from an ED treatment centre in Denmark, and a comparison group of 878 women was randomly selected from the general population. An ED diagnosis was determined according to the Eating Disorder Examination Interview, yielding 84 AN and 202 BN patients.

Results

Only two EDI items (Cronbach's α = .79) were needed to achieve a superior screening capability of BN (sensitivity = .94, specificity = .94). An adequate screening of AN was possible by using three items (α = .71; sensitivity = .91, specificity = .86).

Discussion

The present study provides an even more economical and reliable screening of AN and BN compared with existing screening instruments. Implications for DSM-5 are also discussed.     

Understanding catastrophic worry in eating disorders: process and content characteristics

Background and objectives

The majority of people with eating disorders (ED) experience high levels of comorbid anxiety and depression, yet the maintenance processes of these in ED remain largely unknown. Worry, a defining cognitive feature and important maintenance factor of anxiety, has not been well-studied amongst people with ED. This is the first study to explore both the process and content characteristics of catastrophic worry in ED.

Methods

Twenty-nine patients with anorexia nervosa (AN), 15 patients with bulimia nervosa (BN) and 37 healthy controls (HC) completed measures assessing anxiety, depression, worry and eating disorder pathology. Catastrophic worry was assessed using the Catastrophizing Interview and catastrophic worry content was explored using qualitative Thematic Analysis.

Results

Compared to HCs, ED groups had higher levels of anxiety, depression and worry and they generated a greater number of catastrophic worry steps. Worry was further found associated with depressive symptomatology in those with ED. Worry content for the ED groups included ED themes, but also themes reflecting broader inter and intrapersonal concerns.

Limitations

The degree to which worry is driven by depressive versus anxious symptomatology remains unclear. The current study does not include an anxious or depressed control group, and results should be considered in the light of relatively small samples sizes.

Conclusion

Findings indicate that interventions that target worry processes may be a useful adjunct to treatment for those ED patients with clinical worry levels.     

Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA): clinical norms and functional impairment in male and female adults with eating disorders

Aim: The aim of the current study was to collect clinical normative data for the Clinical Impairment Assessment questionnaire (CIA) and the Eating Disorder Examination Questionnaire (EDE-Q) from adult patients with eating disorders (EDs). This study also examined unique contributions of eating disorder (ED) symptoms on levels of ED-related impairment.

Methods: A sample of 667 patients, 620 females and 47 males, was recruited from six specialist centres across Norway. The majority of the sample (40.3%) was diagnosed with eating disorder not otherwise specified (EDNOS), 34.5% had bulimia nervosa (BN), and 25.2% were diagnosed with anorexia nervosa (AN).

Results: There were significant differences for global EDE-Q and CIA scores between females and males. In the female sample, significant differences were found on several EDE-Q sub-scales between the AN and BN group, and between the AN and EDNOS group. No significant differences were found between the diagnostic groups on the CIA. In the male sample, no significant differences were found between diagnostic groups on the EDE-Q or CIA. A multiple regression analysis revealed that 46.8% of the variance in impairment as measured by the CIA was accounted for by ED symptoms.

Conclusions: Body mass index, Eating Concern, Shape/Weight Concern, and binge eating served as significant, unique predictors of impairment. The results from the present study contribute to the interpretation of EDE-Q and CIA scores in ED samples.     

Social perception in people with eating disorders

ObjectiveSocial perception is a key aspect of social cognition which has so far not been investigated in eating disorders (ED). This study aimed to investigate social perception in individuals with anorexia nervosa (AN) and bulimia nervosa (BN).MethodsOutpatients with AN (restricting subtype [AN-R]: n = 51; binge-purge subtype [AN-BP]: n = 26) or BN (n = 57) and 50 healthy control (HC) participants completed the Interpersonal Perception Task (IPT-15). This is an ecologically valid task, which consists of 15 video clips, depicting complex social situations relating to intimacy, status, kinship, competition and deception. The participants have to assess relationships between protagonists’ based on non-verbal cues.ResultsOverall, there was no difference between groups on the IPT total score and subscale scores. Group differences on the Intimacy subscale approached significance so post hoc comparisons were carried out. HCs performed significantly better than AN-R participants in determining the degree of intimacy between others.ConclusionsSocial perception is largely preserved in ED patients. Individuals with AN-R show impairments in identifying intimacy in social situations, this may be due to the lack of relationship experience. Further research into different aspects of social cognition is required to establish the link between interpersonal difficulties and ED psychopathology.     

Expériences dissociatives sévères relevées dans un groupe d'étudiants français : à propos de la dépersonnalisation

Objective. - The link between dissociative experiences and psychical health is not systematic, these experiences have been encountered into general population with many degrees. The authors have studied stern dissociative experiences in a french student sample (subjects which DES. score is over psychiatric level).Method. - Authors used the Dissociative Experiences Scale (DES.) in french version. After extraction of high scores (psychiatric level) from a group made of students, distribution of the components of DES (Imaginative involvement, Depersonalization-derealization, Dissociative amnesia) is studied in order to understand the nature of severe dissociative experiences in this group (34 subjects aged 18 to 25 years).Results. - Results show that Depersonalization-Derealization component appears as a good clinical indication of psychic suffering, comparatively to other dissociative disorders (particularely dissociative amnesia). DES composant ”Imaginative involvement” does not appear to be specific of dissociative disorder.Conclusion. - A reflection is suggested, in the point of view of psychopathology, about the status of depersonalization disorder: is it specific of dissociative disorders or is it an expression of various forms of psychopathology. The psychopathological register of depersonalization disorder is being debated.     

Prevalence of anxiety in adults with diabetes: a systematic review

Background: Anxiety is associated with decreased functioning and quality of life. It may have added importance in diabetes for its potential adverse effects on regimen adherence and glycemic control. Objective: To estimate the prevalence of clinically significant anxiety in adults with diabetes. Research Design and Methods: MEDLINE and PsycINFO databases and published reference lists were searched to identify studies that determined the prevalence of anxiety in diabetes from threshold scores on self-report measures or from diagnostic interviews. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. Results: Eighteen studies having a combined population (N) of 4076 (2584 diabetic subjects, 1492 controls) satisfied the inclusion criteria. Most did not adjust for the effects of moderator variables such as gender, and only one was community-based. Generalized anxiety disorder (GAD) was present in 14% of patients with diabetes. The subsyndromal presentation of anxiety disorder not otherwise specified and of elevated anxiety symptoms were found in 27% and 40%, respectively, of patients with diabetes. The prevalence of elevated symptoms was significantly higher in women compared to men (55.3% vs. 32.9%, P<.0001) and similar in patients with Type 1 vs. Type 2 diabetes (41.3% vs. 42.2%, P=.80). Conclusion: GAD is present in 14% and elevated symptoms of anxiety in 40% of patients with diabetes who participate in clinical studies. Additional epidemiological studies are needed to determine the prevalence of anxiety in the broader population of persons with diabetes.     

Évolution des patients traités dans un centre de jour spécialisé pour les troubles schizophréniques : une étude exploratoire

This exploratory study aims to evaluate the evolution of 25 patients during the time of a treatment in a day hospital specialized for schizophrenic disorders.Method. - In a naturalistic study, eligible patients were evaluated when entering and leaving for clinical profile, psychiatric history, nosognosia and compliance.Results. - The studied population presents a clinical profile indicating illness severity. Psychiatric hospitalizations, violence and suicide attempts diminish during the time of treatment. When leaving, 60 % of patients completed an employment or training project. The overall subjects present a significant decrease in positive symptomatology and a significant improvement in nosognosia and compliance to medication. On the contrary, a subgroup of 4 patients presents little improvement.Conclusion. - The treatment in the day hospital brings positive results for the majority of patients. They present significant possibilities of evolution in several domains. The limits of the study are discussed.     

Diabète insulino-dépendant et troubles des conduites alimentaires : quels progrès ?

Objectives - To review studies on eating disorders (ED) in insulin-dependant diabetes mellitus (IDDM), published after our first review in 1990 and meta-analysis by Nielsen et Mølbak (1998).Results - Prevalence of ED in IDDM does not seem significantly higher than in the general population. Very large IDDM populations would be necessary to give a definitive answer to this question. The last studies on the topic do not give further information. There are no studies to explain the biological and psychopathological association between ED and IDDM. All the studies agree with the fact that ED in IDDM are a risk factor for higher glycosylated hemoglobin (HBA1c) and retinopathy. A new way of work seems to be the relationships between overweight, ED and IDDM. Self-induced glycosuria seems particularly interesting to explain the bad metabolic control. Chronic high levels of HBA1c lead to microvascular complications.Conclusion - We propose a profile of typical IDDM patient with ED. We need studies to assess validity of therapeutic procedures for this special and severe comorbidity.     

An experimental exploration of behavioral and cognitive-emotional aspects of intolerance of uncertainty in eating disorder patients

Objective

Intolerance of uncertainty (IU) is an important concept in eating disorders (ED). Cognitive, emotional, and behavioral features of IU amongst individuals with and without ED were investigated.

Method

Participants completed the intolerance of uncertainty scale (IUS) and four versions of a data-gathering task varying in difficulty/uncertainty, and rated their Beads task experience.

Results

ED groups had significantly higher IUS scores than healthy controls (HC). Bulimia Nervosa (BN) participants requested more cues than HC and Anorexia Nervosa (AN) participants before making decisions. ED groups found the task more distressing than HC participants, with those with BN feeling more uncertain and less confident in their decisions, and those with AN attributing greater importance in making the correct decision.

Discussion

While both ED groups reported raised IUS scores only BN participants engaged in an elevated evidence requirement data gathering style. Future research might benefit from further exploration of the role of perseverative processes in BN.     

Bulimia nervosa and abnormal cardiac repolarization

OBJECTIVE: Eating disorders (ED) are thought to be risk factors for sudden death, and arrhythmias are one of the major causes of sudden death in ED patients. Late potentials (LPs) are a predictor of arrhythmias and can be measured using signal-averaged electrocardiography (SAECG). We examined arryhthmogenicity by LPs in ED patients. METHODS: We performed SAECG on 48 female ED patients [21 with anorexia nervosa (AN) and 27 with bulimia nervosa (BN)] and on 20 healthy women. An LP was judged positive if two or more of the following criteria were fulfilled: QRS duration >120 ms, root-mean-square voltage <20 microV, and a high-frequency, low-amplitude duration >38 ms. We compared the occurrence of LPs among subgroups. RESULTS: Compared with the controls, BN patients with a history of AN had significantly more SAECG abnormalities. CONCLUSIONS: BN patients with a history of AN may be prone to ventricular arrhythmias.     

Influence de la déambulation et des comportements moteurs inadéquats sur la prise en charge des déments à domicile par des aidants informels. L’étude PIXEL

Context. - Prospective study of the complaints, problems and requirements of the main caregiver providing home care for demented patients.Objectives. - To determine the weight of patients’aberrant motor comportment on home natural caregiver.Resources. - Self-administered questionnaire of 42 questions on the patient and caregiver, including socio-demographic information and a list of complaints facing the demented patient’s caring. Patient assessment by a neurologist, or a psychiatrist or a geriatrician.Results. - 408 records were compiled: 236 women (77.1 ± 0.47 years) and 172 demented men (75.7 ± 0.57 years). Inadequate motor comportment are present in 52 % of the cases. They worsen with the course of the disease. They increased the carer’s burden. Patient’consciousness of his troubles limit the risk for motor disorders. The main complaints concern violence, agitation, absence of inhibitions of the patient. In this situation, periods of respite are scarce for the carer.Discussion. - Demented patients with Inadequate motor comportment have more behavioural disorder. Caregivers have difficulties to monitor the home situations, and suffer health problems.Conclusions. - Caregivers need respite and information to monitor home care of demented patients.     

Measuring brain temperature while maintaining brain normothermia in patients with severe traumatic brain injury

The aim of this study was to evaluate the relationship between superficial temporal artery temperature (Tt), rectal temperature (Tr) and intracranial temperature (ICT) when attempting to keep the brain in a normothermic condition in patients with severe traumatic brain injury (TBI). We also compared the incidence of temperature gradient reversal in patients who survived (survivors) and patients who did not (non-survivors) and the difference in temperature gradient reversal between survivors and non-survivors. Tr is normally lower than and ICT and temperature gradient reversal, when Tr exceeds ICT, has been demonstrated to be an early sign of brain death. A total of 28 patients with severe TBI were enrolled retrospectively in our study between November 2008 and February 2010. Each patient’s Tt, Tr and ICT was recorded every hour for 4 days. Our results show that the frequency of brain hyperthermia in our participants (ICT > 38 °C) was 17.7%. Using a paired t-test and Bland-Altman plots, it was shown that a significant temperature difference existed between Tt, Tr and ICT (p < 0.001). The use of Spearman’s correlation method revealed that Tt, Tr and ICT were positively correlated (p < 0.001). Brain death occurred in five patients at a mean of 9.6 hours (range: 8-12 hours) after a temperature gradient reversal between Tt, Tr and ICT. Fisher’s exact test showed that there was a significant difference in the incidence of temperature gradient reversal between Tt, Tr and ICT in survivors and non-survivors (p < 0.001). We conclude that a significant temperature difference exists between Tt, Tr and ICT when maintaining brain normothermia. The daily practice of non-invasive Tt measurement may cause doctors to underestimate ICT; reversal of the ICT and Tt and/or Tr temperatures could be an early marker of a poor prognosis for patients with severe TBI.     

Direct esterification of p-nitrobenzoic acid with n-butanol using diethyl chlorophosphate in pyridine: A DFT study

Direct esterification reaction mechanism of the p-nitrobenzoic acid with n-butanol have been studied using density functional theory (DFT) by B3LYP and M06 with a 6-311++G(d,p) basis set, with the polarized continuum model (PCM) to simulate the solvent effects of pyridine. This project sheds light on the detailed processes of the title reaction proceeding along two channels: with the diethyl chlorophosphate (DECP) absence (channel a) and presence (channel b). The calculated results have demonstrated that channel b smoothes the reaction by reducing the energy barrier, which is in good agreement with the experimental observations. Especially, in channel b, for yield of the important intermediate of carboxylate-phosphate anhydride (CPA), two possible mechanisms have been proposed: channel b1 suggests the carboxylic acid R1 reacts with DECP via a four-membered ring transition state, while channel b2 advises that R1 will dissociate to its relative carboxylate radical anion R1′ before reacting with DECP by the S_N2 mechanism. The calculated results indicated that channel b2 shows the more energy-favorable mechanism. The natural bond orbital (NBO) charge analysis has been implemented to gain more information about the electronic properties and to prove the feasibility of each reaction step. Moreover, the reasons for how and why the introduction of DECP could make the reaction easier to occur have also been clarified.     

Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome

Objective

The study was aimed at assessing the prevalence of compulsive exercising to control shape and weight in eating disorders (EDs) and its relationship with treatment outcome.

Method

Compulsive exercising to control shape and weight, defined according to a modified version of the Intense Exercising to Control Shape or Weight section of the Eating Disorder Examination (EDE), was assessed in 165 consecutive ED inpatients entering a protocol based on the transdiagnostic cognitive behavior theory and treatment of EDs. Baseline assessment also included anthropometry, the global EDE interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory (STAI), the Eating Disorders Inventory-Perfectionism Scale, and the Temperament and Character Inventory.

Results

Of the patients, 45.5% were classified as compulsive exercisers, the prevalence being highest (80%) in restricting-type anorexia nervosa (AN), lowest in EDs not otherwise specified (31.9%), and intermediate in binge/purging AN (43.3%) and in purging-type bulimia nervosa (39.3%). Compulsive exercising to control shape and weight was independently predicted by the EDE restraint score (odds ratio, 1.32; 95% confidence interval, 1.06-1.64; P = .014) after adjustment for ED; the total amount of exercise was associated with EDE restraint, as well as with the Temperament and Character Inventory reward dependence. At follow-up, an improved EDE global score was predicted by lower baseline values, higher baseline STAI and STAI improvement, and lower amount of exercise in the last 4 weeks. Voluntary treatment discontinuation was not predicted by baseline exercise.

Discussion

Compulsive exercising to control shape and weight is a behavioral feature of restricting-type AN, associated with restraint and temperament dimensions, with influence on treatment outcome.     

What does remission tell us about women with eating disorders? Investigating applications of various remission definitions and their associations with quality of life

Objective

To compare remission rates, determine level of agreement and identify quality of life (QoL) distinctions across a broad spectrum of remission definitions among patients with eating disorders (ED).

Methods

Women (N = 195; 94 AN, 24 BN, and 77 EDNOS) from inpatient and partial hospital ED programs participated in a study of treatment outcomes. Remission rates were evaluated with percentages, kappa coefficients identified level of agreement and Mann–Whitney–Wilcoxon tests with Bonferroni corrections determined differences in quality of life between remitted and not remitted patients by remission definition.

Results

Depending on remission definition used, the percent of remitted patients varied from 13.2% to 40.5% for AN, 15.0% to 47.6% for BN and 24.2% to 53.1% for EDNOS. Several definitions demonstrated “very good” agreement across diagnoses. Remission was associated with higher quality of life in psychological, physical/cognitive, financial and work/school domains on a disease-specific measure, and in mental but not physical functioning on a generic measure.

Conclusions

Remission rates vary widely depending on the definition used; several definitions show strong agreement. Remission is associated with quality of life, and often approximates scores for women who do not have an eating disorder. The ED field would benefit from adopting uniform criteria, which would allow for more accurate comparison of remission rates across therapeutic interventions, treatment modalities and facilities. We recommend using the Bardone-Cone criteria because it includes assessment of psychological functioning, was found to be applicable across diagnoses, demonstrated good agreement, and was able to distinguish quality of life differences between remitted and not remitted patients.     

An Association Study of the A218C Polymorphism of the Tryptophan Hydroxylase 1 Gene with Eating Disorders in a Korean Population: A Pilot Study

Objective

We examined the association between the tryptophan hydroxylase 1 (TPH1) gene and eating disorders focusing on obsessionality.

Methods

The sample included 62 women with a lifetime diagnosis of anorexia nervosa (AN) as well as 50 women with a lifetime diagnosis of bulimia nervosa (BN) recruited from specialist clinics for eating disorders and 131 healthy women in Korea. Blood samples were collected from all participants for the TPH1 genotyping. The patients were ad ministered the Korean version of the Eating Disorders Examination and obsessionality was conceptualized using measures of persistence, harm avoidance, and obsessive-compulsive symptoms.

Results

In the case-control comparisons, the frequency of the A/A genotype was increased in the patients with BN, but this difference was not significant after correcting for multiple testing. We found no effect of the TPH A218C polymorphism on obsessionality in the patients with AN or BN.

Conclusion

Although the present findings should be regarded as preliminary because of the small size of our sample, they suggest that the TPH1 gene may contribute to the genetic susceptibility to BN and be associated with the other unexplored traits of bulimic case status.