Attention-deficit/hyperactivity disorder symptoms and psychological comorbidity in eating disorder patients.

PURPOSE: There is some evidence that eating disorders (ED) and Attention-deficit/hyperactivity disorder (ADHD) share common clinical features and that ADHD might contribute to the severity of eating disorders. A greater understanding of how the presence of comorbid ADHD may affect the psychopathological framework of eating disorder seems of primary importance. The aim of our study was to evaluate rates of ADHD in three ED subgroups of inpatients: anorexia nervosa restricting type (AN-R), anorexia nervosa binge-eating/purging type (AN-BP) and bulimia nervosa (BN). The secondary aim was the evaluation of the associated psychological characteristics. METHOD: The sample consisted of 73 females inpatients (mean age 28.07 ± 7.30), all with longstanding histories of eating disorder (ED). The presence of a diagnosis of ADHD was evaluated in a clinical interview based on DSM-IV-TR criteria. The following psychometric instruments were used: the eating attitude test (EAT-40), the Bulimic Investigatory Test, Edinburgh (BITE), the Eating Disorder Inventory (EDI-2), the Wender Utah Rating Scale (WURS), the Brown Attention Deficit Disorder Scale (BADDS), the Hamilton scales for Anxiety (HAM-A) and Depression (HAM-D), and the Barrat Impulsivity Scale (BIS-10). RESULTS: Among the three ED subgroups, 13 patients reported comorbidity with ADHD; three in the AN-R subtype, nine in the AN-BP and one in the BN. The remaining 60 patients (n = 34 AN-R; n = 19 AN-BP; n = 7 BN) presented only a diagnosis of ED. The EAT (p = 0.04) and HAM-A (p = 0.02) mean scores were significantly higher in patients with comorbid ADHD. CONCLUSIONS: In our study the comorbidity between ADHD and ED appeared to be frequent, particularly among patients with AN-BP. ED inpatients with higher level of anxiety and more abnormal eating attitudes and bulimic symptoms should be assessed for potentially associated ADHD.

Borderline personality disorder and mental healthcare service use among adolescents.

Borderline personality disorder (BPD) is believed to be frequent among adolescents. While several prospective studies have assessed the use of mental health services among adults who suffer from BPD, few studies have provided adolescent data. This paper presents findings from the first assessment point of the European Research Network on Borderline Personality Disorder (EURNET BPD) study. In this study, we describe lifetime treatment utilization for 85 adolescents with BPD (Mean age: 16.3 years old). In line with adult findings, adolescents with BPD reported greater mental healthcare service use (outpatient: 98%; inpatient: 79%) compared to controls. Phenothiazine, a sedative neuroleptic, was the most frequently prescribed treatment. 47% of patients had received psychotherapy; in one our of three cases this was psychodynamic therapy. Patients who had received psychotherapy did not differ on any psychopathological variables from those who did not receive psychotherapy; however, psychotherapy was more frequent among females.

Body dissatisfaction is improved but the ideal silhouette is unchanged during weight recovery in anorexia nervosa female inpatients.

OBJECTIVE: Few studies have examined the impact of weight gain on body image disturbance (BID) in patients suffering from anorexia nervosa (AN). This study aims to explore the evolution of body distortion and body dissatisfaction following inpatient treatment. METHOD: Sixty-four women suffering from AN enrolled in our inpatient Cognitive and Behavioural Therapy programme and undertook a body image perception test and completed the Eating Disorder Inventory (EDI). Thirty-four participants completed a total of four evaluations over a three-month period. RESULTS: Patients' weight gain following treatment was significant. Weight regain was accompanied by significant reductions in both body distortion and body dissatisfaction. These reductions were complemented by improved scores for both EDI Drive for Thinness and Body Dissatisfaction. Perceived body image differed significantly between the onset and the completion of inpatient treatment whereas ideal body image did not. DISCUSSION: The high severity of the included patients and the significant attrition rate should limit our conclusions for a subgroup of patients. New approaches are needed to facilitate changes in the way patients assess their ideal body image.

Factors predictive of ten-year mortality in severe anorexia nervosa patients.

OBJECTIVE: Little is known concerning mortality and predictive factors for anorexia nervosa in-patients. This study aimed to establish mortality rates and identify predictors in a large sample of adults through a 10-year post in-patient treatment follow-up. METHOD: Vital status was established for 601 anorexia nervosa (DSM-IV) consecutive in-patients with initial evaluation at admission. Standardized mortality ratio (SMR) was calculated. Cox analyses for hypothesized predictors of mortality were performed. RESULTS: Forty deaths were recorded. SMR was 10.6 [CI 95% (7.6-14.4)]. Six factors at admission were associated with death: older age, longer eating disorder duration, history of suicide attempt, diuretic use, intensity of eating disorder symptoms, and desired body mass index at admission. CONCLUSION: Anorexia nervosa in-patients are at high risk of death. This risk can be predicted by both chronicity and seriousness of illness at hospitalization. These elements should be considered as warnings to adapt care provision and could be targeted by treatment.

The level of associated depression and anxiety traits improves during weight regain in eating disorder patients.

We assessed whether re-nutrition and weight gain have an influence on comorbid depression and anxiety in patients hospitalised for chronic eating disorders (ED). Seventy-five inpatients agreed to participate by completing the Eating Attitudes Test (EAT-40), the Beck Depression Inventory (BDI-13), and the State-Trait Anxiety Inventory (STAI-Y) before, during and after three months of treatment. Patients suffering from either anorexia nervosa or bulimia nervosa successfully regained weight during treatment. This weight gain was accompanied by statistically significant reductions in ED symptoms. Anxiety and, to a lesser extent, depressive symptoms diminished, but remained at pathological levels, with between diagnostic subtype differences. Improvement of depressive (r=0.77) and anxiety (r=0.64) levels were significantly (p<0.001) and positively correlated with the reduction of eating attitudes (EAT). These results are discussed in the context of re-orienting the therapeutic strategies aimed at reducing emotional suffering in patients with ED.

Motor threshold in transcranial magnetic stimulation: comparison of three estimation methods.

AIMS: Motor threshold (MT) is an important parameter for the practice of transcranial magnetic stimulation. Our goal was to compare three methods to estimate MT in a clinical setting. METHODS: Comparison of three MT estimation algorithms: 1) the Rossini-Rothwell method consists in lowering stimulus intensity until only five positive responses out of 10 trials are recorded, defining MT; 2) the Mills-Nithi method considers the MT as the mean of an upper threshold (10 positive out of 10 trials) and a lower threshold (0 out of 10 trials); 3) the supervised parametric method estimates the MT by fitting (mathematically and graphically) a sigmoid function on raw data obtained by stimulation at variable intensities. Six MT estimations (two per method) were recorded in a single session in 10 healthy subjects. RESULTS: The within-subject variation of MT (expressed as % of the mean MT+/-standard deviation) during a single session was of 8.5+/-7.2% for the Rossini-Rothwell method, 8.7+/-5.7% for the Mills-Nithi method and 9.5+/-4.0% for the supervised parametric method. No significant differences in variability of MT estimation were found between the methods, but the Rossini-Rothwell method was significantly shorter (half the number of stimuli compared to the two other methods). CONCLUSION: In our setting, Rossini-Rothwell method was superior to the two other methods. The variability of MT estimation measured in our study is important, yet acceptable for clinical applications. However, this variability can be a source of considerable errors in excitability studies and should be a focus of future research.

[Choice of an antidepressive agent]. / Le choix d'un traitement antidépresseur.

UNLABELLED: A WIDE SELECTION: New drugs have recently been added to the list of antidepressor agents which includes more than 20 compounds in 1998. The mechanisms of action are quite different. MECHANISM OF ACTION: Better knowledge of each compound and its mechanism of action on the different monoamines functioning in the brain has not been sufficient to determine a pharmacoclinical classification of depression. Likewise, alone mechanism of action is insufficient for choosing the right drug for a given individual. CLINICAL SIGNS: Therapeutic decisions must also take into account the clinical and functional features expressed by the patient, focusing on the importance of the patient-physician relationship in treating patients with states of depression.