Medical findings in 1,026 consecutive adult inpatient-residential eating disordered patients.

OBJECTIVE: Eating disorders are associated with multiple medical complications. We report contemporary medical data, for newly admitted adult inpatient and residential level of care patients. METHOD: Medical records of a transdiagnostic sample of 1,026 patients, with eating disorders, were retrospectively reviewed for the presence of a broad array of medical complications at time of admission. The prevalence of physiologically relevant medical complications was assessed across major eating disorder categories. RESULTS: Of the patients, 93.6% were female, and they had an average age of 28.1 (SD = 10.1, range 17-69). The average admission body mass index was 16.1 (SD = 2.3). The prevalence of abnormal laboratory values varied by eating disorder subtype. In patients with anorexia nervosa-restricting subtype, 51.4% had low prealbumin, 36.1% were leukopenic, 34.3% had osteoporosis, 30.0% vitamin D deficiency, 16.8% metabolic alkalosis, 16.0% had hyponatremia, 14.2% hypokalemia, and 7.1% hypoglycemia. These patients had normal average QTc intervals. In patients with anorexia nervosa-binge purging subtype, 42.4% had hypokalemia, 33.3% metabolic alkalosis, osteoporosis in 21.1%, and they had longer QTc intervals (433.9 ms, p < .001). Only 6.0% of patients with anorexia nervosa had hypophosphatemia. Patients with bulimia nervosa demonstrated hypokalemia in 26.2%, and metabolic alkalosis in 23.4%; the QTc interval was longer than in AN-R patients (437.9 ms, p < .001), but still in the normal range. DISCUSSION: Numerous medical complications are associated with severe eating disorders. As the severity increases, the number of complications increase and are related to the presence or absence of purging behaviors.

Acceptance and psychological change at the higher levels of care: A naturalistic outcome study.

This naturalistic outcome study reports on psychological change among a large (N = 617), transdiagnostic sample of eating disordered adults treated at higher levels of care at a private facility. Patients were assessed at admission and discharge for eating disorder psychopathology, depression, personality, and acceptance. Effect sizes ranged from d = .29 to d = 1.29, and the majority of participants (58.2%) were treatment responders, with BN patients showing a higher response rate than AN-R patients. Increased acceptance over the course of treatment was strongly associated with decreased eating disorder risk and may be an important factor in recovery.

Elevated outcome-anticipation and outcome-evaluation ERPs associated with a greater preference for larger-but-delayed rewards.

Although waiting for a reward reduces or discounts its value, some people have a stronger tendency to wait for larger rewards and forgo smaller-but-immediate rewards. This ability to delay gratification is captured by individual differences in so-called intertemporal choices in which individuals are asked to choose between larger-but-delayed versus smaller-but-immediate rewards. The current study used event-related potentials (ERPs) to examine whether enhancement in two neurocognitive processes, outcome anticipation and outcome evaluation, modulate individual variability in intertemporal responses. After completing a behavioral intertemporal choice task, 34 participants performed an ERP gambling task. From this ERP task, we separately examined individual differences in outcome anticipation (stimulus-preceding negativity; SPN), early outcome valuation (feedback-related negativity; FRN), and late outcome evaluation (P3). We observed that both elevated outcome-anticipation (SPN) and late outcome-evaluation (P3) neural processes predicted a stronger preference toward larger-but-delayed rewards. No relationship was observed between intertemporal responses and early outcome evaluation (FRN), indicating that the relationship between outcome evaluation and intertemporal responses was specific to the late outcome-evaluation processing stream. Moreover, multiple regression analyses indicated that the SPN and P3 independently modulate individual differences in intertemporal responses, suggesting separate mechanisms underlie the relationship between these two neurocognitive processes and intertemporal responses. Accordingly, we identify two potential neurocognitive modulators of individual variability in intertemporal responses. We discuss the mechanisms underlying these modulators in terms of anticipation-related processing (SPN) and a saliency bias toward gain (compared to loss) outcomes (P3).

Asymmetrical frontal cortical activity associated with differential risk for mood and anxiety disorder symptoms: An RDoC perspective.

The recently launched NIMH Research Domain Criteria (RDoC) initiative aims to examine the relationship between core biobehavioral dimensions and symptom profiles that either cut across traditional disorder categories or that are unique to specific clinical phenomenon. A biobehavioral construct that has received considerable attention and that is directly relevant to the Positive Valence Systems domain of the RDoC initiative is approach motivation. One way approach motivation is frequently operationalized is left versus right frontal electroencephalographic (EEG) activity, with greater relative left frontal EEG activity reflecting increased approach motivation and decreased relative left frontal EEG activity reflecting decreased approach motivation or increased withdrawal tendencies. The objective of the present review paper is to examine the relationship between relative left frontal EEG activity and mood and anxiety related symptoms from an RDoC perspective. We first provide an overview of the approach-withdrawal motivational model of frontal EEG asymmetry. Second, we review evidence that relative left frontal EEG activity is associated with a differential risk for unipolar depression versus bipolar disorder. Third, and in line with the mission statement of the RDoC, we move beyond considering mood and anxiety disorders as unitary constructs or homogenous disorders and instead propose that individual differences in relative left frontal EEG activity may be uniquely associated with specific symptom clusters of depression (i.e., anhedonia), hypomania/mania (i.e., symptoms characterized by excessive approach motivation), and anxiety (i.e., anxious apprehension versus anxious arousal). Identifying the relationship between relative left frontal EEG activity and specific mood and anxiety-related symptom clusters has important implications for clinical science, assessment, and treatment.