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Trent S.A.,Denver Health Medical Center | Moreira M.E.,Denver Health Medical Center | Colwell C.B.,Denver Health Medical Center | Mehler P.S.,Center for Eating Disorders
American Journal of Emergency Medicine | Year: 2013

Background Eating disorders are one of the "great masqueraders" of the twenty-first century. Seemingly healthy young men and women with underlying eating disorders present to emergency departments with a myriad of complaints that are not unique to patients with eating disorders. The challenge for the Emergency Medicine physician is in recognizing that these complaints result from an eating disorder and then understanding the unique pathophysiologic changes inherent to these disorders that should shape management in the emergency department. Objective In this article, we will review, from the perspective of the Emergency Medicine physician, how to recognize patients with anorexia and bulimia nervosa, the medical complications and psychiatric comorbidities, and their appropriate management. Conclusions Anorexia and bulimia nervosa are complex psychiatric disorders with significant medical complications. Recognizing patients with eating disorders in the ED is difficult, but failure to recognize these disorders, or failure to manage their symptoms with an understanding of their unique underlying pathophysiology and psychopathology, can be detrimental to the patient. Screening tools, such as the SCOFF questionnaire, are available for use by the EM physician. Once identified, the medical complications described in this article can help the EM physician tailor management of the patient to their underlying pathophysiology and effectuate a successful therapeutic intervention. © 2013 Elsevier Inc.

Jonker N.C.,University of Groningen | Ostafin B.D.,University of Groningen | Glashouwer K.A.,University of Groningen | Glashouwer K.A.,Center for Eating Disorders | And 2 more authors.
Addictive Behaviors | Year: 2014

Reward sensitivity and to a lesser extent punishment sensitivity have been found to explain individual differences in alcohol use. Furthermore, many studies showed that addictive behaviors are characterized by impaired self-regulatory processes, and that individual differences related to alcohol use are moderated by executive control. This is the first study that explores the potential moderating role of executive control in the relation between reward and punishment sensitivity and alcohol use. Participants were 76 university students, selected on earlier given information about their alcohol use. Half of the participants indicated to drink little alcohol and half indicated to drink substantial amounts of alcohol. As expected, correlational analyses showed a positive relationship between reward sensitivity and alcohol use and a negative relation between punishment sensitivity and alcohol use. Regression analysis confirmed that reward sensitivity was a significant independent predictor of alcohol use. Executive control moderated the relation between punishment sensitivity and alcohol use, but not the relation between reward sensitivity and alcohol use. Only in individuals with weak executive control punishment sensitivity and alcohol use were negatively related. The results suggest that for individuals with weak executive control, punishment sensitivity might be a protective factor working against substantial alcohol use. © 2013 Elsevier Ltd.

Neimeijer R.A.M.,University of Groningen | Neimeijer R.A.M.,Center for Eating Disorders | de Jong P.J.,University of Groningen | Roefs A.,Maastricht University
Appetite | Year: 2015

Objective: The aim of the present study was to investigate the role of automatic approach/avoidance tendencies for food in Anorexia Nervosa (AN). We used a longitudinal approach and tested whether a reduction in eating disorder symptoms is associated with enhanced approach tendencies towards food and whether approach tendencies towards food at baseline are predictive for treatment outcome after one year follow up. Method: The Affective Simon Task-manikin version (AST-manikin) was administered to measure automatic approach/avoidance tendencies towards high-caloric and low-caloric food in young AN patients. Percentage underweight and eating disorder symptoms as indexed by the EDE-Q were determined both during baseline and at one year follow up. Results: At baseline anorexia patients showed an approach tendency for low caloric food, but not for high caloric food, whereas at 1 year follow up, they have an approach tendency for both high and low caloric food. Change in approach bias was neither associated with change in underweight nor with change in eating disorder symptoms. Strength of approach/avoidance tendencies was not predictive for percentage underweight. Discussion: Although approach tendencies increased after one year, approach tendencies were neither associated with concurrent change in eating disorder symptoms nor predictive for treatment success as indexed by EDE-Q. This implicates that, so far, there is no reason to add a method designed to directly target approach/avoidance tendencies to the conventional approach to treat patients with a method designed to influence the more deliberate processes in AN. © 2015 Elsevier Ltd.

Isomaa R.,Center for Eating Disorders | Isomaa R.,University of Tampere
Nordic Journal of Psychiatry | Year: 2014

Background: Eating disorders (EDs) show a varying course and outcome. Within 10 years, between half and three-quarters of patients recover from their disorder. There is, however, a lack of consensus in how to define recovery. Aims: The aim of the present naturalistic study was to assess clinical and full recovery in ED patients 5 years after initiated treatment at a specialized outpatient unit for EDs. Methods: Data was collected at three time points: After the investigation period (T1), at the end of treatment (T2) and 5 years after the beginning of treatment (T3). Data at T1 and T2 were collected from patient records, and at T3 using a questionnaire. The number of participants was 71 and response rate 78%. Results: At T3, the proportion in clinical recovery was 83.1%, with no significant differences between diagnostic groups. The proportion in full recovery, i.e. in addition to a subjective account of being fully recovered, presenting no physical, behavioural or psychological ED symptoms, was 40.8%. Conclusions: For most ED patients, outpatient treatment is sufficient to enable recovery. How to define and measure recovery still warrants discussion. © 2014 Informa Healthcare.

Brambilla F.,Center for Eating Disorders | Dalle Grave R.,Villa Garda Hospital | Calugi S.,Villa Garda Hospital | Marchesini G.,University of Bologna | And 2 more authors.
Psychoneuroendocrinology | Year: 2010

The effects of cognitive-behavioral therapy (CBT) on central dopamine (DA), noradrenaline (NE) and serotonin (5-HT) secretion were studied in a group of 50 female inpatients, of which 14 suffered from anorexia nervosa restricted type (AN-R), 14 from anorexia nervosa bingeing-purging type (AN-BP), and 22 from bulimia nervosa (BN). The aim of the study was to see whether or not CBT modifies the secretion of central DA (blood homovanillic acid=HVA), NE (blood 3-methoxy-4-hydroxy-phenylglycol=MHPG) and the 5-HT transporter (as evaluated by the platelet paroxetine binding=[3H]-Par-binding), if the physical and psychological effects of CBT correlate with changes of the neurotransmitter secretion; and if the biological effects of CBT are linked to specific psychopathological aspect of the disorders. The treatment lasted 20 weeks. Body-mass Index, bingeing and purging, specific AN-BN psychopathological (EDE 12-OD), depression (Beck Inventory), anxiety (STAY Form-Y-1), impulsiveness (Barratt Impulsiveness Scale), self-esteem (Rosenberg Self-Biochemical Scale) and temperament (Temperament and Character Inventory, Cloninger Scale) were assessed at baseline and at the end of the treatment. CBT significantly improved the psychophysical aspects of the diseases. HVA and MHPG concentrations did not change. The [3H]-Par-binding parameters, the maximum binding capacity (Bmax) and dissociation constant (Kd) values did not change in either AN-R or AN-BP patients, while the [3H]-Par Bmax (and not the Kd) increased significantly in BN patients. Correlations emerged between basal and final [3H]-Par Bmax values and psychopathological scores, but not between CBT-induced differences between basal and final values. Our data suggest that only in BN CBT may act through changes in 5-HT system function. © 2009 Elsevier Ltd.

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