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Biomedical subjects

A E Andersen

Publications and source records attributed to A E Andersen.

At least 19 recordsLinked to original sources
PubMed2003

A critical examination of the amenorrhea and weight criteria for diagnosing anorexia nervosa.

BACKGROUND: Amenorrhea and weight loss to below 15% of 'healthy' weight are current diagnostic criteria for anorexia nervosa (AN). This study compares females who meet current International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for AN with females who meet the essential psychopathology and significant self-starvation, but lack either amenorrhea or weight loss below 85%. METHOD: This study retrospectively examined the medical charts of 588 consecutive admissions to an in-patient treatment program. All diagnoses conformed to ICD-10 and DSM-IV. RESULTS: Of 588 admissions, 297 females had some form of AN with 77.4% (230 of 297) meeting current criteria, while 22.6% (67 of 297) with core psychopathology and self-starvation were classified as eating disorders not otherwise specified or 'atypical' because of some menstrual function or final weight above 85%. The groups showed few statistically significant differences on demographics, illness history, and treatment response, psychopathology, or bone density. CONCLUSION: Amenorrhea may not be a useful diagnostic criterion. Also, requiring below 85% of healthy weight may need generalization.

Adult↗
PubMed2001

A slimming program for eating disorders not otherwise specified. Reconceptualizing a confusing, residual diagnostic category.

This study suggests that the category of EDNOS as currently defined is overly broad, representing many cases that could be more helpfully subsumed within AN or BN diagnostic criteria without changing the essential features of these categories but by rethinking the currently overly restrictive, perhaps research-derived criteria. The reconceptualizing of AN as a syndrome resulting from a decrement between setpoint versus illness-driven final weight avoids the inherent problems of imposing a category on a dimension. A rethinking of AN suggests that a specific female-only abnormality of reproductive hormone functioning, 3 months of amenorrhea, is too restrictive. Instead, a more encompassing criterion recognizing the multiple medical, social, and psychologic functional impairments that result from substantial starvation would be appropriate in its place. Clinicians who otherwise confidently treat AN and BN patients would welcome the clearer diagnostic categorization of the potentially confusing EDNOS category. Third party payers who currently, albeit wrongly, exclude EDNOS diagnoses from insurance payment, would have less difficulty with a smaller group of EDNOS. In summary, the currently overly broad category of EDNOS as currently used would benefit from a thoughtful dieting regimen.

Diagnosis, Differential↗
PubMed2001

Characteristics of an ideal psychotherapist for eating-disordered patients.

Psychotherapy is an essential component of the treatment of eating disorders. A fully competent ideal psychotherapist needs a body of knowledge; personality characteristics of nonpossessive warmth and perseverance; training in scientific, manual-based psychotherapy; and experience, including supervision. The formal discipline of the therapist is less important than are these qualifications. Ideal means fully competent, not perfect. An ideal therapist is a crucial component in the treatment of eating-disordered patients.

Clinical Competence↗
PubMed2000

[Congenital hip dysplasia in Ostfold 1990-96].

BACKGROUND: The focus in this paper is on the prevalence, risk factors and treatment of developmental dysplasia of the hip (DDH), before and after introduction of sonographic examination in 1993. MATERIAL AND METHODS: 1,469 (8.2%) infants were followed up because of clinical findings or risk factors (542 with X-ray and 927 with sonographic examination). RESULTS: The overall prevalence of DDH was 1.14%; 0.92% in neonates and 0.22% as late DDH. The prevalence of late DDH ranged from 0.07% to 0.52% (p < 0.01) with peaks in spring and autumn. The following changes occurred when sonography was introduced: Newborn DDH decreased from 1.06 to 0.77% (p < 0.05), late DDH decreased from 0.26 to 0.19% (not significant), and treatment duration decreased from 6.2 months (SD 1.4) to 4.2 months (SD 1.3)(p < 0.01). 56 of 198 infants with clinical findings (28%) were confirmed to have sonographic DDH (p < 0.01). Previous risk factors were confirmed. Mothers of infants with late DDH had higher pre-pregnancy weight, 63 kg (SD 11) vs 58.5 kg (SD 7.8), p < 0.02) and lower weight gain in the last trimester, (4.2 kg (SD 2.2) vs 6.6 kg (SD 2.7; p < 0.001), compared to a reference population. INTERPRETATION: Sonography has reduced treatment rate and duration of DDH.

Adult↗
PubMed2000

Osteoporosis and osteopenia in men with eating disorders.

The occurrence of eating disorders and related deficiencies in bone mineral density are well established in women. However, we provide evidence that eating disorders are as common in men as in women, and are perhaps more severe.

Adult↗
PubMed2000

Effects of acute food deprivation on eating behavior in eating disorders.

OBJECTIVE: Effects of acute food deprivation on eating behavior in bulimic patients and controls were investigated. It was predicted that food deprivation would increase overall food intake and result in overeating in bulimics. METHOD: Following 19 hr of food deprivation (in which breakfast and lunch were skipped), or no deprivation, food intake was measured in 9 inpatients with anorexia nervosa (binge eating/purging subtype, ANB), 10 inpatient (BN/in) and 9 outpatient (BN/out) normal-weight bulimics, and 11 unrestrained and 10 restrained controls. RESULTS: A general trend for increased food intake following deprivation was found. However, only BN/in patients consumed significantly more and selected higher energy foods following deprivation. ANB patients demonstrated the greatest degree of variability in intake and the least magnitude of change in ratings as a function of eating. DISCUSSION: A period of acute food deprivation did not trigger marked eating pathology as evidenced by overconsumption. Chronic dietary restraint may be a more potent precipitating factor in overeating than absolute number of hours of food restriction.

Adult↗
PubMed2000

Involuntary treatment of eating disorders.

OBJECTIVE: Involuntary treatment of any psychiatric disorder has always been controversial, especially for eating disorders. Patients with an eating disorder of life-threatening severity frequently refuse hospitalization. In this study, the authors compared individual characteristics and treatment outcomes of patients admitted to an inpatient program for voluntary or involuntary treatment of their eating disorder. METHOD: This study examined 397 patients admitted to an inpatient treatment program over 7 years. Demographic measures, length of illness, weight history, and treatment response of patients admitted for voluntary treatment and those legally committed for involuntary treatment were compared. RESULTS: The two groups were similar in age, gender ratio, and marital status, but those legally committed for involuntary treatment had a longer illness duration and significantly more previous hospitalizations. At admission, the patients legally committed for involuntary treatment were lower in weight and required a significantly longer hospitalization to attain a healthy discharge weight. However, there was no statistically significant difference between involuntary and voluntary patients in rate of weight restoration (2.6 versus 2.2 lb/week, respectively). The groups did not differ in history of comorbid substance abuse or clinical depression but did differ significantly on all admission IQ measures. Eating disorder severity, as assessed by the Eating Attitudes Test-26, Eating Disorder Inventory, and MMPI-II, was similar for both patient groups. CONCLUSIONS: This study suggests that a substantial minority of patients with severe eating disorders will not seek treatment unless legally committed to an inpatient program. Despite the involuntary initiation of treatment, the short-term response of the legally committed patients was just as good as the response of the patients admitted for voluntary treatment. Further, the majority of those involuntarily treated later affirmed the necessity of their treatment and showed goodwill toward the treatment process. Only a long-term follow-up study will indicate whether these two populations differ in the enduring nature of their treatment response.

Adult↗
PubMed1999

Predictors of success or failure of transition to day hospital treatment for inpatients with anorexia nervosa.

OBJECTIVE: Clinicians are under increasing pressure to transfer inpatients with anorexia nervosa to less intensive treatment early in their hospital course. This study identifies prognostic factors clinicians can use in determining the earliest time to transfer an inpatient with anorexia to a day hospital program. METHOD: The authors reviewed the charts of 59 female patients with anorexia nervosa who were transferred from 24-hour inpatient care to an eating disorder day hospital program. They evaluated the prognostic significance of a variety of anthropometric, demographic, illness history, and psychometric measures in this retrospective chart review. RESULTS: Greater risk of day hospital program treatment failure and inpatient readmission was associated with longer duration of illness (for patients who had been ill for more than 6 years, risk ratio = 2.7), amenorrhea (for patients who had this symptom for more than 2.5 years, risk ratio = 5.7), or lower body mass index at the time of inpatient admission (for patients with a body mass index of 16.5 or less, risk ratio = 9.6; for those with a body mass index 75% or less than normal, risk ratio = 7.2) or at the time of transition to the day hospital program (for patients with a body mass index of 19 or less, risk ratio = 3.9; for those with a body mass index 90% or less than normal, risk ratio = 11.7). CONCLUSIONS: Inpatients with anorexia nervosa who have the poor prognostic indicators found in this study are in need of continued inpatient care to avoid immediate relapse and higher cost and longer duration of treatment.

Adult↗
PubMed1998

Videotape assessment of changes in aberrant meal-time behaviors in anorexia nervosa after treatment.

This study compared meal-time behaviors in patients with anorexia nervosa to normal-weight controls and the effects of hospital treatment on these behaviors. Ten restricting-anorexics and six normal-weight controls were given a standard lunch and asked to eat the entire meal. Their behaviors were recorded via hidden camera. All participants were tested twice--anorexics before and after in-patient treatment, and controls at similar intervals. Videotapes of these sessions were analysed for occurrence and duration of eight categories of non-ingestive behaviors: food manipulation, food preparation, food moving, non-food manipulation, concealment, vigilance, passivity and physical activity. Food-ingestion patterns, including number of bites of food and switches between different kinds of food, were also recorded. Results indicated that anorexics spent significantly more time than controls in behaviors that were directly food-related, and exhibited more vigilance behavior. Pre-treatment anorexics spent significantly more time in these behaviors than did post-treatment anorexics. Few group differences or treatment effects were found in food-ingestion patterns, although there was an indication that both pre- and post-treatment anorexics avoided high-fat foods more than controls did. These results suggest that videotaping provides a useful technique for characterizing the behavior associated with eating disorders. Further studies should explore whether normalization of these behaviors is associated with a positive clinical outcome.

Adolescent↗
PubMed1997

Effects of preloads of differing energy and macronutrient content on eating behavior in bulimia nervosa.

Evidence suggests that bulimics demonstrate blunted satiety possibly due to repeated episodes of overeating. This suggestion was tested further by comparing responses to yogurt preloads differing in carbohydrate and fat relative to a lower energy control yogurt in 12 bulimics and 12 age- and weight-matched controls. Participants were tested on three occasions at lunchtime. On each occasion, appetite and mood were rated before and after receiving a lunch of raspberry yogurt (350 g). Covert manipulation of energy and nutrient content was achieved by matching the yogurts on sensory properties and formulating a control yogurt (161 kcal), a high-fat version (357 kcal: 65% calories from fat), and a high-carbohydrate version (357 kcal: 81% calories from carbohydrate). Although there were no differential effects of the preloads on intake of an ad libitum test meal given 5 hr later in either the control or bulimic groups, there were significant differences in test meal energy intake between groups. On average and with all conditions combined, bulimics ate significantly fewer calories (775 +/- 167 kcal) than controls (1182 +/- 94 kcal) and consumed a greater percentage of calories from carbohydrate than controls. Bulimics restricted their intake relative to controls, and chose foods low in fat. This study provides further evidence of restricted eating in bulimia nervosa when the opportunity to purge is not available. Furthermore, the present study suggests that intake by bulimics is not influenced by nutrient content per se but by consideration of the caloric value of foods and the consequences of eating certain foods for weight control.

Adult↗
PubMed1997

Males with eating disorders: challenges for treatment and research.

Males represent only 10 percent of eating disorder cases. This gender discrepancy is among the most extreme in psychiatry and medicine. Determining what differences in etiology and mechanism best explain the discrepancy presents an intellectual challenge. Beginning at about the third grade, boys and girls diverge in social development. Boys show significantly less desire to lose weight, express dissatisfaction with the upper rather than the lower body, and use dieting to achieve specific external goals rather than as a cultural norm. Males reach a significantly higher body mass index (BMI) than females do before they beginning dieting. (27.2 versus 24.3, p < .01). While overall treatment principles are similar, males in treatment require attainment of a different hormonal milieu (testosterone), attention to past and future sexual role, amelioration of perception of stigma, and preparation for return to male social roles. Males and females suffer comparable degrees of osteopenia and brain shrinkage during anorexia nervosa. The effectiveness of antidepressants in males with eating disorders (compared with that in females) has not been well studied. Male gender is not an adverse factor in short-term or long-term treatment outcome. Understanding the lower frequency of these illnesses in males may lead to more effective means of protecting girls from eating disorders and from the culturally induced distress about normal body size and shape that burdens adolescent development and adult life.

Antidepressive Agents↗
PubMed1996

Food preferences and desire to eat in anorexia and bulimia nervosa.

OBJECTIVE: To determine whether eating disordered patients and controls differ in visual analog scale (VAS) ratings of liking and desire to eat various foods and whether ratings differ according to caloric or macronutrient content of the foods. METHOD: Fifty-five female inpatients with eating disorders and 15 controls rated their liking of and desire to eat 50 common foods at admission and discharge using 100-mm VAS. RESULTS: All patient groups rated their desire to eat high-calorie foods significantly lower than their desire to eat low-calorie foods whereas controls rated their desire to eat high- and low-calorie foods equally. Patients also differed from controls more in ratings of desire to eat than in liking when foods were classified according to macronutrient content. In restricting anorexics (N = 25), ratings of liking and desire to eat for high-fat/low-carbohydrate (CHO) and high-fat/high-CHO foods were not significantly correlated at admission. Disparity in correlations between restrictors, bulimics (N = 18), and controls was attenuated with treatment while anorexics with bulimic features (N = 12) became less like controls from admission to discharge. DISCUSSION: Differences in the way patients and controls perceive foods should be borne in mind during the treatment process. Furthermore, since patients had not completely normalized by discharge, treatment strategies should emphasize acceptance of foods varying in macronutrient and caloric content, as intake of a varied diet is of key importance in regaining and maintaining good health.

Adult↗
PubMed1996

Improved eating behavior in eating-disordered inpatients after treatment: documentation in a naturalistic setting.

OBJECTIVE: Abnormalities of eating behavior are definitional components of eating disorders (ED), but are seldom observed directly. This study assessed abnormalities of eating behavior in ED patients before treatment and documented changes after multidisciplinary treatment. METHOD: Thirty-three ED patients (13 ANR, 10 ANB, 10 BN) and 10 controls selected a lunch meal in a cafeteria before and after treatment with energy intake (kilocalories) and macronutrients covertly observed. Visual analog scales (VAS) measured hunger and satiety. RESULTS: Before treatment, all ED patient groups experienced low hunger and high fullness, compared to controls. After treatment, hunger increased and satiety decreased. ANR patients, after treatment, increased energy intake from 366 to 916.5 kcal (p < .001), while BN patients increased from 409.9 to 663 kcal (p = .03). ANB nonsignificantly increased. ANR chose significantly more fats (22.7% to 36.2%, p = .05). DISCUSSION: Treatment partially normalizes pre-meal hunger and satiety in ED patients and significantly improves eating behavior (total energy intake and fat content) in ANR and BN patients. Reasons for nonsignificant changes in ANB are not obvious. We recommend documentation of eating behavior by simple, inexpensive, observational methods in a naturalistic setting before and after treatment of ED patients.

Adolescent↗
PubMed1996

Eating disorders. Guide to medical evaluation and complications.

Eating disorders lead to numerous physical complaints with signs and symptoms affecting nearly every organ system of the body. We review the presentation of a patient with eating disorder to the primary care giver or general psychiatrist, focusing on the physical manifestations of the underlying illness. Specific complications related to laboratory findings, the gastrointestinal tract, and the endocrine system are reviewed. Algorithms for medical evaluation of these patients are also presented.

Blood Cell Count↗
PubMed1995

Olfactory dysfunction in anorexia and bulimia nervosa.

Fifty-five eating-disordered women and 16 normal controls participated in this study to determine whether olfactory function is altered in patients with food-restricting anorexia, anorexia with bulimic features, and bulimia nervosa. Olfactory function was assessed using the University of Pennsylvania Smell Identification Test and by determining phenyl ethyl alcohol odor detection thresholds. Only the very low-weight anorexics showed impairments in their identification and detection of odors. This group's olfactory function did not improve from admission to discharge despite significant weight gain. Although, overall, smoking had only a minor influence on olfactory function, the very low-weight anorexic smokers had the lowest scores of all subjects. Since higher-weight anorexics did not show such impairments, the results suggest that the severe and prolonged starvation experienced by the very low-weight anorexics caused or contributed to intractable deficits in the olfactory system and that these deficits are compounded by smoking.

Adolescent↗
PubMed1995

Bone mineral density of eating disorder subgroups.

OBJECTIVE: We tested nine hypotheses among eating disorder subgroups and a control group on spinal bone density and investigated the relationship of their spinal bone density with a critical fracture threshold and five clinical variables--age of onset, years ill, percentage of ideal body weight (IBW), months of amenorrhea, and hours per week of exercise. METHOD: Dual photon absorptiometry measured spinal bone density. RESULTS: Anorectic patients had significantly less spinal bone mass than bulimic patients with no history of anorexia nervosa or control patients. Eating disordered patients with past or present anorexia nervosa had significantly more spinal bone density values below a critical fracture threshold. Duration of amenorrhea and exercise significantly predicted spinal bone density. DISCUSSION: Anorectic women were unlikely to reach their peak bone density, thus possibly developing osteoporosis later in life, and were likely to be at risk for nontraumatic spinal fractures. Predicting spinal bone density of anorectic women could be done by knowing their duration of amenorrhea and exercise.

Adolescent↗
PubMed1995

Gastrointestinal symptoms in bulimia nervosa: effects of treatment.

OBJECTIVES: The aim of this study was to characterize the frequency and severity of gastrointestinal symptoms in bulimic patients and to determine their response to treatment of the eating disorder. METHODS: Forty-three consecutive bulimic patients admitted to the inpatient Eating Disorders Unit of the Psychiatry Service were asked to fill out a gastrointestinal symptoms questionnaire, an Eating Disorders Inventory, and a Zung Depression Inventory on admission and discharge. Thirty-two age- and sex-matched healthy volunteers completed the same questionnaire. RESULTS: In bulimic patients, the most commonly reported gastrointestinal symptoms were bloating (74.4%), flatulence (74.4%), constipation (62.8%), decreased appetite (51.2%), abdominal pain (48.8%), borborygmi (48.8%), and nausea (46.5%). The average symptom score (sum of severity ratings) on the gastrointestinal symptoms questionnaire decreased from 20.6 +/- 10.8 (mean +/- SD) on admission to 13.46 +/- 10.5 (t(27) = 3.31, p < 0.01) on discharge but remained significantly higher than that of the control group (4.4 +/- 6.2, t(43) = 4.02, p < 0.001). However, the severity of reported gastrointestinal symptoms was correlated with the severity of depression (r = 0.43, p < 0.05), and when the possible mediating effects of depression on gastrointestinal symptoms were controlled statistically (analysis of covariance), the effects of treatment on gastrointestinal symptoms were not statistically significant. CONCLUSION: Gastrointestinal symptoms in bulimics are common, multiple, and often severe and they improve with treatment. However, the most important determinant of gastrointestinal symptoms appears to be depression.

Abdominal Pain↗