Economic costs for outpatient treatment of eating disorders in Japan.

BACKGROUND: Few studies have examined the economic costs of outpatient care for eating disorders in Japan. This study aimed to clarify the reimbursement for outpatient treatment of eating disorders and compare the costs between the departments of Psychosomatic Medicine and Psychiatry in Japan. METHOD: A multicenter, prospective, observational study of patients with an eating disorder was conducted in the Psychosomatic Medicine departments of three centers and the Psychiatry departments of another three centers in Japan. We analyzed medical reimbursement for an outpatient revisit, time of clinical interviews, and the treatment outcome measured by the Eating Disorder Examination Questionnaire (EDE-Q) global scores and body mass index (BMI) at 3 months. Multivariate linear regression models were performed to adjust for covariates. RESULTS: This study included 188 patients in the Psychosomatic Medicine departments and 68 in the Psychiatry departments. The average reimbursement cost for an outpatient revisit was 4670 yen. Even after controlling for covariates, the Psychosomatic Medicine departments had lower reimbursement points per minute of interviews than the Psychiatry departments (coefficient = - 23.86; 95% confidence interval = - 32.09 to - 15.63; P < 0.001). In contrast, EDE-Q global scores and BMI at 3 months were not significantly different between these departments. CONCLUSIONS: This study clarifies the economic costs of treating outpatients with eating disorders in Japan. The medical reimbursement points per interview minute were lower in Psychosomatic Medicine departments than in Psychiatry departments, while there were no apparent differences in the treatment outcomes. Addressing this issue is necessary to provide an adequate healthcare system for patients with eating disorders in Japan.

This study examined the cost of outpatient care for eating disorders in Japan, comparing treatment costs between the Psychosomatic Medicine and Psychiatry departments. The actual cost of outpatient care for eating disorders in Japan was clarified. The results indicate that Psychosomatic Medicine departments have lower reimbursement points per interview time compared to the Psychiatry departments, but there were no noticeable differences in treatment outcomes between the two. This highlights the need to address this cost difference to improve the healthcare system for patients with eating disorders in Japan.

Anorexia nervosa restricting type has increased in severity over three decades: Japanese clinical samples from 1988 to 2018.

OBJECTIVE: Although eating disorders (EDs) surged in the late 1900s and are now recognized worldwide, the time trend of ED characteristics remains unknown. This study aimed to clarify changes in characteristics of anorexia nervosa restricting type (AN-R) over 30 years. METHODS: We conducted a cross-sectional study and examined 996 female treatment-seeking patients with AN-R in Japan from 1988 to 2018. Demographics, body mass index (BMI), and Eating Disorder Inventory scores were compared among three groups in accordance with the time of initial consultation: Group 1 (1988-1998), Group 2 (1998-2008), Group 3 (2008-2018). RESULTS: The mean BMI at the initial consultation significantly decreased by 0.6 kg/m2 (from 14.0 kg/m2 in Group 1 to 13.4 kg/m2 in Group 3). Groups 2 and 3 scored significantly higher in drive for thinness, interpersonal distrust, and interoceptive awareness than those in Group 1. The range of onset age is wider and the number of late-onset AN-R with prolonged delay in treatment has increased over time. DISCUSSION: This study shows that AN-R has increased in physical and psychopathological severity over the past 30 years in Japan. Interdisciplinary research is needed to clarify the relationship between AN-R and time trend.

High prevalence of shoplifting in patients with eating disorders.

PURPOSE: Shoplifting, prevalent in patients diagnosed with bulimia nervosa (BN), is a serious behavioral problem in eating disorder (ED) patients. However, little is known about its overall presence, etiology, and consequences. This study aimed to determine whether shoplifting occurs before or after the onset of ED and to investigate the prevalence and correlates of shoplifting in ED patients. METHODS: This was a cross-sectional study of 284 treatment-seeking female patients aged 13-45 with EDs [171 anorexia nervosa (AN); 113 BN]. Shoplifting, impulsive behaviors (self-injury, suicide attempt, sexual promiscuity, alcohol, and illicit drug use), depression, self-esteem, and clinical features of EDs were assessed with an interview. RESULTS: Lifetime shoplifting prevalence was 28.5% (81/284) with 70.4% (57/81) occurring before ED onset. Multivariate logistic regression analysis revealed that depression [odds ratio (OR), 2.63; 95% confidence interval (CI), 1.24-5.60], alcohol abuse (OR, 3.91; 95% CI 1.34-11.38), illicit substance use (OR, 14.42; 95% CI, 1.65-125.86), and self-esteem (OR, 0.90; 95% CI; 0.82-0.99) were associated with lifetime shoplifting, while illness duration, BN, and ED symptom severity were not. CONCLUSIONS: Shoplifting is common in ED patients and precedes ED onset in most patients with a shoplifting history, although the causal relationship between shoplifting and EDs remains inconclusive. Shoplifting may be associated with impulsive behaviors (e.g., alcohol and illicit drug use), depression, and low self-esteem, but not with ED severity. Future research should focus on the unrecognized role of shoplifting as a marker to identify patients at risk of impulsive behaviors and consider treatment options. LEVEL OF EVIDENCE: Level V, observational cross-sectional descriptive study.

Clinical Features of Japanese Males with Anorexia Nervosa.

BACKGROUND: Anorexia nervosa (AN) is a mental disease with a high mortality rate, and progresses to a serious state, even in males; however the characteristics of male AN patients, including the sex ratio in Japan and the consultation behavior, have not yet been clarified. Therefore, the objective of the present study was to investigate the clinical characteristics of Japanese male AN patients, with the aim of achieving early interventions. METHODS: A total of 2015 AN patients, 60 males and 1955 females, were extracted from 4606 eating disorder patients who consulted Osaka City University Hospital for 34.5 years. The sex ratio was examined, and clinical features, mainly those related to consultation behavior, were compared between males and females. The rate of early drop-outs from outpatient treatments was also determined in male AN patients. RESULTS: The male ration in AN patients was 3.0%, which was markedly lower than generally considered. No significant sex difference was noted in the mean age at the time of consultation or delays in treatment. The rate of weight loss from the premorbid to lowest body weight was similar between males and females. Regarding social backgrounds, the employment rate was higher in males than in females. Male AN patients were more likely to initially consult the psychiatry department. Furthermore, the rate of early drop-outs from outpatient treatments appeared to be higher among males than females. CONCLUSIONS: The male ratio in Japanese clinical AN patients was low. Consultation between may be restricted in males more than in other countries because eating disorders are considered to be female diseases. Male AN is physically severe, similar to female AN; therefore, early interventions were considered important. Educational programs for eating disorders not only in the general public, but also in school and companies may promote early interventions. Treatments that considered sex differences need to be developed in order to prevent early drop-outs.

Relationships between occupational stress and depressive symptoms among prison officers in Japan.

BACKGROUND: The relationships between occupational stress and depressive symptoms in prison officers have rarely been studied in Japan. Thus, we analyzed the associations between occupational stress factors and depressive symptoms among Japanese prison officers. METHODS: This was a cross-sectional study involving 426 male prison officers (20-60-year-old). Depressive symptoms were assessed using the Zung Self-Rating Depression Scale. Using this scale and a cut-off point of 50, the subjects were divided into the "depressive group" and "non-depressive group". Occupational stress was evaluated using the Generic Job Stress Questionnaire. Comparisons among the groups were performed with multiple logistic regression analysis. RESULTS: Of the 426 subjects, 107 were included in the depressive group. After adjusting for demographic and occupational variables, higher scores for the physical environment, role ambiguity, and quantitative workload and a lower score for social support from co-workers were found to be associated with an increased odds ratio of depressive symptoms. CONCLUSIONS: The physical environment, role ambiguity, quantitative workload, and social support from coworkers are associated with depressive symptoms in Japanese prison officers. We hope that educating prison officers about the results of this study and organizational/individual-based improvement strategies will reduce their risk of depression.

[Eating disorders in the workplace].

The prevalence of eating disorders (ED) has increased and these are intractable disorders that require prolonged treatment. The workplace is an important life scene for the patients, but there are few reports available about the current status and correspondence to ED in workplace. Based on a survey of 1248 enterprises, we discuss the cognition of each form of ED. In addition, the background, eating behaviors, and job stress of 2004 workers were also surveyed. Based on these responses, workers who were supposed to demonstrate anorexia nervosa (AN), bulimia nervosa (BN), or night eating syndrome (NES) were identified. The same survey was conducted among outpatients with ED, and the findings were compared with those of a healthy control group. The terms ED, AN, and BN were highly acknowledged in the workplace, but recognition of NES was low. In addition, the prevalence of workers suspected of AN, BN, or NES were 0.27%, 0.21%, and 12.9%, respectively. Based on comparisons of job stress in working ED patients with job stress in workers without ED, and comparisons of job stress in NES workers with job stress in workers without eating problems, specific job stressors were supposed to be associated with ED. These findings indicate the importance of learning appropriate techniques for coping with job stress and the necessity of recognizing abnormal eating behaviors in the workplace.

Intracerebroventricular administration of leptin increases anxiety-like behavior in female rats after semi-starvation--implications for anxiety in eating disorders.

BACKGROUND: Patients with eating disorders often exhibit abnormal eating conditions like food restriction, adipocyte and body weight reduction, and pathologic anxiety-like behavior. The role of leptin, which is recognized as an adipocyte-derived hormone, on anxiety-like behavior in eating disorders is still unclear. METHODS: We investigated the role of leptin on anxiety-like behavior with or without semi-starvation using the elevated plus-maze test in adolescent female rats. In our first experiment, anxiety-like behavior was evaluated with the elevated plus-maze test 30 min after intracerebroventricular administration of 3 microg of leptin or vehicle. In our second experiment, the rats were allowed access to food for only 2 hr each day for 7 days. Then, leptin or vehicle was administered to the rats after the last 2 hr feeding period, and anxiety-like behaviors were evaluated in the same way as in the first experiment. RESULTS: In the first experiment, there was no difference between the anxiety-like behaviors observed after leptin administration and those seen after vehicle administration. Under the conditions of semi-starvation, however, the percentage of time spent in the open arms in the rats given leptin was lower than that in rats given vehicle. CONCLUSIONS: These results suggest that leptin administration causes anxiety-like behavior only after semistarvation. Leptin might play an important role in pathologic anxiety-like behavior in eating disorders.

Corticotropin-releasing factor receptor type 1, but not type 2, in the ventromedial hypothalamus modulates dopamine release in female rats.

Corticotropin-releasing factor (CRF) plays an important role in stress responses and is mediated through two subtypes of receptors, CRF receptor type 1 (CRFR1) and CRF receptor type 2 (CRFR2). Each CRF receptor might have a different function through several neurotransmitter systems; however, the mechanism remains unclear. To clarify the role of each receptor in dopamine (DA) metabolism, we measured the change of extracellular concentrations of DA and the metabolites in the ventromedial hypothalamus (VMH) that played important roles in the stress response of freely moving female rats in response to the direct administration of comparative CRFR1 selective agonist, CRF, or CRFR2 selective agonist, Urocortin II (Ucn II), into the brain region. Administration of 10 microg CRF increased extracellular concentrations of DA compared with 2 microg CRF immediately after injection, and this effect was not observed after 60 min of 10 microg CRF injection. On the other hand, this change did not always occur after Ucn II administration. These results suggest that the activation of CRFR1, but not CRFR2, modulates the release of DA in VMH.

[Animal model of eating disorders].

Patients with eating disorders are increasing in number. Some neurocircuits concerned with feeding behavior might be dysfunctional in these patients with repeated expression of disorganized eating behavior like long-lasting dieting. These neuronal, or endocrinological dysfunctions might even be enhanced by psychological stress. To understand the biological bases of eating disorders is necessary to establish effective treatment. According to the clinical features of the patients, we have conducted some rat studies. We have found that space restriction stress enhances rebound hyperphagia induced by time-restricted scheduled feeding, and propose the phenomenon as a possible rat model of binge eating. We can speculate some part of the biological bases of human eating disorders, and effective prevention and treatment through such animal models.

Acute effects of ozone exposure on lung function in mice sensitized to ovalbumin.

Pulmonary responses to ozone exposure (1.0 ppm) were investigated in mice sensitized to ovalbumin compared with control mice receiving saline. Pulmonary function parameters were measured by pneumotachography. Arterial blood gases and the concentrations of soluble intercellular adhesion molecule-1 (sICAM-1) and tumor necrosis factor-alpha (TNF-alpha) in bronchoalveolar lavage fluid were analyzed. Ozone exposure, when compared with filtered air exposure, caused significantly larger decreases in dynamic compliance (P<0.05) and minute ventilation (P<0.05) in ovalbumin-sensitized mice but not in control mice. Moreover, the decrease in minute ventilation in response to ozone exposure was significantly greater (P<0.01) in ovalbumin-sensitized mice than in control mice. Ozone exposure caused a significant decrease in PaO2 in ovalbumin-sensitized mice but not in control mice. PaO2 after ozone exposure tended to be smaller in ovalbumin-sensitized mice than in control mice. The concentration of sICAM-1 in bronchoalveolar lavage fluid increased in ovalbumin-sensitized mice, but effects of ozone exposure were not observed. These results indicated that sensitization of the immune system to ovalbumin might be a risk factor which aggravates the effects of ozone exposure on the respiratory system.