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Interesting genome study identifying gene links to Anorexia Nervosa looking closely at single-nucleotide (SNPs) and parallel correlations of copy number variations (CNVs). This is the first and largest genome-wide association study on Anorexia Nervosa, which can only help in furthering the improvement of valid research and quality of care– like it! Merci Dr Hakon and co, keep up the great work.

The Am Journal of Psych

… where are we?

Objective: The present review addresses the outcome of bulimia nervosa, effect variables, and prognostic factors. Method: A total of 79 study series covering 5,653 patients suffering from bulimia nervosa were analyzed with regard to recovery, improvement, chronicity, crossover to another eating disorder, mortality, and comorbid psychiatric disorders at outcome. Forty-nine studies dealt with prognosis only. Final analyses on prognostic factors were based on 4,639 patients. Results: Joint analyses of data were hampered by a lack of standardized outcome criteria. There were large variations in the outcome parameters across studies. Based on 27 studies with three outcome criteria (recovery, improvement, chronicity), close to 45% of the patients on average showed full recovery of bulimia nervosa, whereas 27% on average improved considerably and nearly 23% on average had a chronic protracted course. Crossover to another eating disorder at the follow-up evaluation in 23 studies amounted to a mean of 22.5%. The crude mortality rate was 0.32%, and other psychiatric disorders at outcome were very common. Among various variables of effect, duration of follow-up had the largest effect size. The data suggest a curvilinear course, with highest recovery rates between 4 and 9 years of follow-up evaluation and reverse peaks for both improvement and chronicity, including rates of crossover to another eating disorder, before 4 years and after 10 years of follow-up evaluation. For most prognostic factors, there was only conflicting evidence. Conclusions: One-quarter of a century of specific research in bulimia nervosa shows that the disorder still has an unsatisfactory outcome in many patients. More refined interventions may contribute to more favorable outcomes in the future.

http://ajp.psychiatryonline.org/cgi/content/short/appi.ajp.2009.09040582v1?rss=1

An interesting study… 

This study shows that serum brain-derived neurotophic factor (BDNF) is significantly lower in women with anorexia nervosa (AN) compared with women without an eating disorder and women recovered from AN. While recovery from AN is difficult to define, BDNF may emerge as a useful biomarker of AN and of recovery from AN.

Finding biomarkers for AN and recovery from AN can help improve diagnostic accuracy and help better identify individuals who have recovered from AN. BDNF polymorphisms have not only previously been associated with AN {1}, but the BDNF-specific receptor neurotrophic tyrosine kinase receptor type 2 has also been associated with temperament characteristics and low BMI in individuals with eating disorders {2}. The current study evaluated serum BDNF levels in women with AN (n=29), women without an eating disorder (n=28) and women recovered from AN for 1 or more years (n=18). In addition, set-shifting ability was also evaluated in all 3 groups using the Wisconsin Card Sorting Task (WCST). Age was similar among all three groups, and women with AN and recovered women did not differ in lowest lifetime BMI. Women with AN had lower serum BDNF than controls and recovered women. Overall, there was a positive association between BDNF and BMI. BDNF was inversely correlated with the eating concerns, shape concerns, weight concerns, and global scale on the Eating Disorder Examination Questionnaire and on the depression and anxiety sections of the Hospital Anxiety and Depression Scale. Women with AN made more mistakes on the WCST than control women, but BDNF level was not associated with performance on the WCST. Set-shifting was not impaired in individuals recovered from AN. The current study excluded healthy control women with a BMI below 19 or over 26 thereby excluding constitutionally thin and obese women. It is plausible that BDNF is related more to BMI or the starvation state than to AN per se. However, the relationship between BDNF and BMI is unclear as the results from one study indicate lower levels of BDNF in morbidly obese individuals compared with obese individuals {3}. Including constitutionally lean and obese women in future studies may help clarify the relationship among BDNF, BMI, and AN. BDNF may be a useful biomarker in the underweight AN state and in indexing recovery from AN. However, it is important to first ensure that BDNF is in fact associated with AN and not strictly BMI or other indices of starvation.

References: {1} Ribases et al. Mol Psychiatry 2003, 8:745-51 ]. {2} Ribases et al. Mol Psychiatry 2005, 10:851-60 ]. {3} Bullo et al. Eur J Endocrinol 2007, 157:303-10 ].

EOEDs

 

… it’s not “just a phase”.

 

Potentially life threatening medical complications are ‘common’ in children affected by early onset eating disorders (EOEDs), a study reported in the Medical Journal of Australia has found.

 The first prospective national study of EOEDs also revealed major limitations in current diagnostic criteria, possible missed diagnoses and a need for better education of health professionals. The study examined data from 101 cases of EOEDs in children aged five to 13 years, and found that 78% were hospitalised with an average length of stay of almost 25 days.

Study co-author and leading child psychologist Dr Sloane Madden, from Westmead Children’s Hospital, said the results show younger children with EOEDs are presenting with severe disease. “Only 37% of inpatients in the study met the current diagnostic criteria for anorexia nervosa, yet 61% had potentially life threatening complications of malnutrition and only 51 % met the weight criteria,” Dr Madden said. “This suggests the current criteria for diagnosing anorexia nervosa in young children are limited.”

An editorial on the study in the same edition of the MJA highlighted that about a quarter of cases in the study were boys. Editorial author, Foundation Chair of Mental Health at the University of Western Sydney’s School of Medicine, Professor Phillipa Hay, said “The relatively high proportion of younger boys with EOEDs contrasts with men accounting for about one in ten adult cases of anorexia nervosa and bulimia nervosa,” Professor Hay said. “More research is needed, but the work by Madden and colleagues supports the hypothesis that EOEDs may differ in important ways, including sex distribution and course, from eating disorders with onset in adolescence and adulthood. “It is imperative that research attention is now directed towards understanding why such young children are developing severe eating disorders and how effective identification and treatment can be targeted earlier.”

-SourceMedical Journal of Australia

UCAN

 

I often, as many other parents of children suffering from an eating disorder, find myself envisioning what the future may hold for our daughter when she is older, well beyond the preparatory stages of ED recovery-maintenance, living a full, healthy and ED-free adult life will be like; especially when there may come a time when she decides upon a life-long partnership, marriage and/or family of her own.

Wouldn’t it be comforting and assuring to know that the care your son or daughter is receiving now will also be available for him/her and their partner-spouse when and if the time comes?

Thankfully some forward-thinking clinicians from the UNC Eating Disorders Program are working to provide just such a program, which is at this time addressing Anorexia Nervosa, and can continue to implement these necessary and supportive elements towards long-term health and maintenance for those who have loved ones suffering.

The UCAN Program

UCAN is a research program funded by the National Institute of Mental Health and is part of the UNC Eating Disorders Program. UCAN aims to help couples work together in the treatment of anorexia nervosa. Couples participate in UCAN over a period of six months and return for follow-up treatment three months after the end of the original six-month period. Your participation in UCAN can help you gain new confidence in facing anorexia as a team and can help us understand how best to involve partners in the treatment of eating disorders.
What Couples Can Expect
Treatment Team
Couples can expect that their treatment will be conducted by trained, licensed professionals from the UNC Eating Disorders Program who are experienced in the treatment of eating disorders.
Comprehensive Assessment
All participating couples have four assessments during which they complete questionnaires and interviews with a clinician, and are videotaped having a discussion with their partner about an anorexia nervosa-related topic.
Comprehensive Treatment
During their participation in UCAN, couples will be randomly assigned (like a coin flip) to receive 20 sessions of either:
• Couples Therapy
• Family Supportive Therapy
In addition, the patient also receives comprehensive treatment for anorexia nervosa from the UNC Eating Disorders Program at no additional cost, including:
• Individual Psychotherapy
• Psychiatry Consultations
• Nutritional Counseling

 

*For further information about registering for the program contact at: UCAN@unc.edu or phone: (919)966.3065


 

 
I previously wrote a tidbit about this study back in January: The Horse In The Barn but here is an additional interview-vid with Dr Lock himself to further elaborate.
shanti

Eating Disorder Support

 

The National Eating Disorders Association-NEDA has issued a Call for Proposals for the September ’09 Conference sagaciously titled: Reshaping Our Future: A Vision for Recovery, Research, Attitudes and Action!

The goals of this conference are:

 

– Help family members, treatment professionals, health educators and activists to connect and share useful and supportive information that can be transformed into action.
 

– Familiarize attendees with the latest developments in the field of eating disorders and the implications of this new knowledge for prevention and treatment.

– Reduce the associated stigma of eating disorders and generate awareness about the realities of the illnesses by educating conference attendees, the media and, in turn, the general public, policymakers and opinion leaders.

– Provide a national convening to promote inclusiveness, enthusiasm, energy, optimism and a vision of hope for all conference attendees.

 

 Workshop presenters can have a focus within the areas of family, treatment, special issues, outreach and education. The conference will be held in Minneapolis, Minnesota September 10-12th, and the deadline for conference committee consideration on submissions is Wednesday, March 25th.

For further information contact Director of Programs-Laurie Vanderbloom info@nationaleatingdisorders.org – (206)382.3587.

NEDA 2009

 

Is this year’s theme during NEDA’s Awareness Week 2009- February 22-28 and there are so many ways to get involved within your community– let’s all work towards the continuation of creating greater access to quality ED care-treatment, prevention and awareness!

FAQ for potential NEDAwareness Week participants.Find events & Coordinators in your area. Research into eating disorders focuses on causes, prevention and cures.
Source: National Eating Disorders Association

Eating Disorders are illnesses, not choices! NEDA’s mission is to support those affected by eating disorders and be a catalyst for prevention, education and access to quality care.
NEDAwareness Week – February 22 – 28, 2009 – “Until Eating Disorders Are History” – throughout the US, Canada and other countries

Bulimia Study

 

When caring for an adolescent suffering with an eating disorder for any length of time, you soon realize how invaluable earlier diagnosis and treatment become in making purposeful and healthy strides forward, as well as any necessary changes and re-strategizing needed to better support a loved ones recovery process.

And while there is a better knowledge base available regarding eating disorders today, studies and research of “what works” and “what doesn’t” in the real day to day of those living with this illness, and how to better train, educate and provide for those treatment services are still slowly surfacing.

Dr James Lock, whom many a parent are familiar with from his work and book: Help Your Teenager Beat an Eating Disorder is spearheading one of the Largest-Ever Bulimia Study  involving adolescents suffering from bulimia through Stanford University:

…psychiatrists at the Stanford University School of Medicine and the University of Chicago are seeking volunteers for the largest-ever randomized controlled trial of bulimia treatments for adolescents.

Only two small randomized trials have previously been done in this age group. “We desperately need more information,” said James Lock, MD, PhD, professor of psychiatry and behavioral sciences at Stanford and the study’s senior investigator. Lock is also director of psychiatric services at the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital.

Prior bulimia-treatment trials focused on adult patients, Lock said, which is why the National Institute of Mental Health awarded his team a five-year, $2 million grant to compare bulimia treatments for young people. Full-blown bulimia affects 1 to 2 percent of adolescents, and another 2 to 3 percent display significant bulimic behaviors, Lock noted. Female patients outnumber males by five to one, he said.

The team will study three treatments that may help adolescent bulimics. Study subjects will be randomly assigned to receive 20 outpatient consultations using cognitive behavioral therapy, family therapy or individual psychotherapy. Cognitive behavioral therapy is widely recognized as the preferred bulimia treatment for adults, whereas family therapy is used in teens with anorexia nervosa. Individual psychotherapy has succeeded as an alternate treatment for bulimic adults and adolescents.

Interested individuals should contact research assistant Brittany Alvy at (650) 723-9182.

The pathology Lock hopes to heal stems from poor body image and an unhealthy focus on rigid dieting. Strict dieting sets up patients for lapses of control—binge-eating episodes. After binge eating on thousands of calories, patients purge with vomiting, laxatives or excessive exercise. They then feel guilty over their loss of control, fueling further negative thoughts and deepening the downward spiral.

Cognitive behavioral therapy works on changing patients’ behaviors and thinking patterns related to food and to body image. The therapist aims to help the patient stop thoughts that overemphasize the importance of weight and shape and end severe, destructive dieting. Family therapy focuses solely on eating behaviors.

The patient’s parents are involved in every therapy session, and the underlying goal is to change the home environment so that it reinforces healthy eating and discourages dieting. “In this treatment, we see parents as a resource to facilitate behavioral change,” Lock said. Individualized psychotherapy, rather than targeting eating, examines underlying life problems that contribute to negative self-image. 

“We hope early intervention will become a chronic, long-lasting strategy,” Lock said. Instead of treating bulimia in adulthood, “after the horse is out of the barn,” early treatment has a better shot at causing a lasting cure, he added.

About Stanford University Medical Center Stanford University Medical Center integrates research, medical education and patient care at its three institutions — Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children’s Hospital at Stanford. For more information, please visit the Web site of the medical center’s Office of Communication & Public Affairs at http://mednews.stanford.edu/.

About Lucile Packard Children’s Hospital Ranked as one of the best pediatric hospitals in the nation by U.S.News & World Report and Child magazine, Lucile Packard Children’s Hospital at Stanford is a 272-bed hospital devoted to the care of children and expectant mothers. Providing pediatric and obstetric medical and surgical services and associated with the Stanford University School of Medicine, Packard Children’s offers patients locally, regionally and nationally the full range of health care programs and services — from preventive and routine care to the diagnosis and treatment of serious illness and injury. For more information, visit http://www.lpch.org/.

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