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PubMedDate not supplied

[Selected issues of biological aspects of eating disorders].

This paper reviews the recent progress in the understanding of the neurobiology of the eating disorders. The analysis of the biochemical abnormalities present in the patients with bulimia nervosa indicates the decrease of central serotonin and noradrenalin activity, elevation of the levels of cerebrospinal fluid peptide YY, alterations of the endogenous opioids and also reduction of peripheral cholecystokinin levels. As these studies were performed on patients who were actively binging and purging it is conceivable that the above abnormalities can results from a pathological feeding pattern. It is also suggested that the reduction of central serotoninergic activity is the stable, trait-related dysregulation of neurotransmitter system activity. In patients with anorexia nervosa the endocrine disturbances of the hypothalamic-pituitary-ovarian and hypothalamic-pituitary-adrenal axes were thoroughly studied. Underweight anorectic patients have been found to have elevations of cerebrospinal fluid level of neuropeptide Y, corticotropin releasing hormone and vasopressin as well as reductions of beta-endorphin and oxytocin level. However, most of the neuropeptide alterations normalize following weight recovery. The only exception is a persistent increase of central serotonin activity postulated to be responsible for the obsessive-compulsive personality traits and disturbed eating behaviors found in these patients.

Anorexia Nervosa↗
PubMedDate not supplied

Hypochondriasis: conceptualization, treatment, and relationship to obsessive compulsive disorder.

BACKGROUND: Hypochondriasis (HC) involves preoccupation with fears of having a serious illness. The preoccupation is persistent and based on misinterpretation of benign bodily sensations. In response, patients often resort to frequent checks with doctors, of their own body, and of medical references, to reassure themselves of their health status. Some authors have likened HC to obsessive-compulsive disorder (OCD) on the basis of similarities between obsessions and illness preoccupation and the ritualistic checking behavior observed in each condition. METHODS: In this article, the phenomenology of HC is discussed in terms of factors that account for the development and persistence of this disorder. Treatment that is derived from this conceptual model is also described. RESULTS: HC is best considered as an anxiety problem in which pathological fear is focused on innocuous bodily sensations and other health-relevant cues. CONCLUSIONS: Many of the psychological mechanisms of HC are similar to those present in OCD.

Antidepressive Agents, Tricyclic↗
PubMed2002

Helpseeking and access to mental health treatment for obsessive-compulsive disorder.

OBJECTIVE: To identify predictors of helpseeking and use of mental health treatment for obsessive-compulsive disorder (OCD) using the behavioral model of health service use. METHOD: Data were drawn from the 1996 National Anxiety Disorders Screening Day. Participants (n=14 860) completed screening measures providing information about demographics, mental disorders, helpseeking, and treatment experiences for OCD. RESULTS: Previous use of mental health treatment was associated with comorbid panic disorder [odds ratio (OR)=1.6 (1.3-1.98)], while minority racial status [OR=0.7 (0.5-0.9)] emerged as a barrier to receiving care among individuals with OCD. Among those who had never received mental health care, comorbid panic disorder [OR=2.0 (1.5-2.8)], post-traumatic stress disorder [OR=1.7 (1.3-2.4)], and suicidal ideation [OR=1.7 (1.2-2.3)] increased readiness to seek treatment while being employed [OR=0.7 (0.5-0.9)], and feeling one could handle the problem on his/her own [OR=0.5 (0.3-0.7)] decreased readiness to seek help for the first time. CONCLUSION: These data suggest that access to treatment for OCD may not be equally accessible to all in need by revealing non-disease related factors (e.g. race, health beliefs) that have a significant impact on decisions to seek and use mental health treatment.

Adult↗
PubMed1996

The role of avoidance and obsessiveness in matching patients to cognitive and interpersonal psychotherapy: empirical findings from the treatment for depression collaborative research program.

This article examines the hypothesis that cognitive therapy (CT) is more effective than interpersonal therapy (IPT) for treatment of depressed patients with an elevated level of avoidant personality, whereas the reverse holds for depressed patients with elevated level of obsessive personality. This hypothesis was derived in part from the preliminary results of previous unpublished pilot work, which examined the course of dynamic and cognitive therapies for avoidant and obsessive-compulsive personality disorders. With the "completer" data set available from the Treatment for Depression Collaborative Research Program (I. Elkin et al., 1989), the expected significant interactions between treatment (CT vs. IPT) and avoidance and between treatment and obsessiveness were found. A significant interaction was also found between marital status and treatment, indicating that married patients did better after CT, whereas single and noncohabiting patients improved more after IPT. Similar patterns of results were found using the Hamilton Rating Scale for Depression and the Beck Depression Inventory. A matching factor formula of patients to CT vs. IPT is presented.

Adult↗
PubMed1999

Obsessive-compulsive disorder and anorexia nervosa in a high school athlete: a case report.

OBJECTIVE: To describe the case of a basketball and track athlete who presented with both anorexia nervosa and obsessive- compulsive disorder (OCD). BACKGROUND: OCD is a psychiatric condition known to appear with significant frequency among those with anorexia. Although treatable with drug and behavioral therapy, it must be specifically sought because some of its symptoms are similar to those of anorexia nervosa. DIFFERENTIAL DIAGNOSIS: Obsessive-compulsive disorder, anxiety disorder. TREATMENT: Behavioral therapy involves exposure to the obsessive fears without allowing the patient to ritualize. This is best used in combination with drugs that selectively block the reuptake of serotonin in the brain. UNIQUENESS: Anorexia nervosa is notoriously difficult to treat. In our patient, anorexic symptoms all but disappeared along with the OCD in a matter of weeks, once treatment of the OCD began. Lengthy treatment for anorexia alone had been unsuccessful. CONCLUSIONS: OCD occurs frequently in patients with anorexia, and successful treatment requires that both conditions be specifically identified and managed. Athletic trainers may be the first to recognize key signs and symptoms of this illness; by referring the individual for psychiatric evaluation, they can be instrumental in helping the patient to obtain appropriate treatment.

Journal Article↗
PubMed1994

Refractory obsessive compulsive disorder and ECT.

The authors review their experience with electroconvulsive therapy (ECT) in 32 patients meeting DSM-IIIR criteria for obsessive compulsive disorder. All patients had received extensive behavioral and cognitive therapy and pharmacotherapy prior to the initiation of ECT without apparent benefit. Following ECT, most subjects showed considerable improvement in obsessive compulsive symptoms and remained improved up to 1 year after therapy. Some patients also showed short-term improvements on several measures of depression. The change in obsessive compulsive symptoms, however, appeared to be independent of changes in measures of depression.

Depressive Disorder↗
PubMedDate not supplied

Diagnosis of rapid eye movement sleep disorder with electroencephalography and treatment with tricyclic antidepressants in a dog.

A 9-month-old, female Labrador retriever mix was presented for two types of seizure-like episodes, one of which occurred only during sleep. The two types of episodes were morphologically distinct. An electroencephalogram (EEG) demonstrated that the sleep-associated episodes occurred during rapid eye movement (REM) sleep, supporting a diagnosis of a REM behavior disorder. Based on their morphology and response to antiseizure medications, the waking episodes were diagnosed as seizures. The animal was also diagnosed with an obsessive-compulsive and generalized anxiety disorder. The REM behavior disorder and anxiety-related behaviors improved with tricyclic antidepressant therapy.

Animals↗
PubMed1998

SCL 90-R interpretation and brain tumour: a correction factor?

OBJECTIVE: Determine whether spurious SCL 90-R profiles resulting from endorsement of neurologic treatment items can be corrected and still retain ecological validity. DESIGN: The proportion of subjects' item endorsement was compared with the adult non-patient norm group. Items with discriminative power (chi 2 > 25, p < 0.001 and endorsement by at least 25% of subjects) underwent principal-components analysis with somatic treatment and psychiatric factors identified. Items in the somatic treatment factor were extracted as the corrective factor. The resultant corrected T scores were plotted against original SCL 90-R profiles. SETTING: University medical centre. PATIENTS: Thirty community dwelling adults with biopsy confirmed malignant brain tumours referred by their treating physician for evaluation prior to aggressive treatment. INTERVENTIONS: The SCL 90-R was part of a neuropsychological test battery. MAIN OUTCOME MEASURE: The SCL 90-R was selected prior to data collection because it is the second most frequently used psychosocial instrument in medical settings, yet has demonstrated attenuated validity with neurologic patients. RESULTS: Extraction of 10 somatic treatment items resulted in lower profiles on Somatization, OBSESSIVE: Compulsive, Depression, and Anxiety dimensions and the global indicators. However, clinical caseness for individuals remained greater than indicated by clinical interview. CONCLUSION: Correction for SCL 90-R neurologic treatment items resulted in reduced sensitivity and poorer ecological validity.

Adult↗
PubMed1998

Personality disorders in patients with eating disorders in Japan.

We assessed the prevalence of personality disorders (PD) using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) in 36 patients with restricting anorexia nervosa, 30 patients with anorexia nervosa and bulimia nervosa, and 42 patients with bulimia nervosa. Of the 108 patients, 51% met the criteria for at least one PD. The patients with PD had more severe clinical features in terms of bulimic behaviors, concurrent depressive, anxious, and obsessive-compulsive symptoms, and psychopathology related to eating disorders compared to the patients without any PD. The patients with PD, especially borderline PD, also had more severe global functioning and greater numbers of suicidal attempts and hospital admissions. We compare these results with those reported in the Western world and discuss them cross-culturally.

Adolescent↗
PubMed2001

Altered response to meta-chlorophenylpiperazine in anorexia nervosa: support for a persistent alteration of serotonin activity after short-term weight restoration.

OBJECTIVE: Patients with anorexia nervosa (AN) have disturbances of appetite and behaviors, such as dysphoria, inhibition, and obsessions, that could be related to altered serotonin activity. To investigate such relationships, we administered meta-chlorophenylpiperazine (m-CPP), a relatively serotonin-specific drug. METHODS: To avoid the confounding effects of malnutrition or weight loss, we studied 12 patients with restricting-type AN between 5 and 17 days after a return to a normal weight and while on a stable dietary intake. We compared them to 12 healthy control women (CW). m-CPP was administered double blind and placebo controlled. RESULTS: Although weight restored, AN women had lower body weight and increased ratings for depression and obsessionality compared with CW. After m-CPP, AN women had an elevation in mood and a reduction in body image distortion when compared with placebo. After m-CPP, groups had similar cortisol, adrenocorticotropin (ACTH), and growth hormone responses whereas AN women had an uncertain reduction in prolactin response. DISCUSSION: These data support other studies that suggest that altered serotonin activity persists after weight restoration in AN patients. The finding that m-CPP temporarily improved mood and reduced body image distortions supports the hypothesis that altered serotonin activity may contribute to the pathophysiology of AN.

Adolescent↗
PubMed2006

Habit learning and anorexia nervosa: a cognitive neuroscience hypothesis.

OBJECTIVE: Anorexia nervosa (AN) is characterized by abnormal behaviors involving eating and weight that are impressively resistant to change. The persistence of these behaviors likely plays an important role in the high relapse rate after initial treatment. Persistent, stereotyped behaviors are also characteristic of obsessive-compulsive disorder (OCD). This article presents a neurocognitive model of AN, based on comparisons with OCD. METHOD: This article reviews clinical, neuropsychological, and neuroimaging findings in both OCD and AN relevant to a neurobiological understanding of a potential mechanism of the perpetuation of AN. RESULTS: The identification of specific neurocognitive disturbances in individuals with OCD has led to a compelling hypothesis of the neural mechanisms mediating this disorder. Evidence suggests that similar disturbances, involving neural circuits between the cortex and the basal ganglia, may be present in individuals with AN. CONCLUSION: Research on such neurocognitive disturbances has the potential both to inform understanding of neural mechanisms underlying AN and to lead to advances in treatment.

Anorexia Nervosa↗
PubMed2006

[Dysmorphophobia].

In the ICD-10 classification, the body dysmorphophobic (dysmorphic) disorder is subsumed under the code for somatoform or hypochondriacal disorders (F45.2). To the fore is an excessive preoccupation with an imagined, but not objectifiable, bodily defect, usually affecting a part of the body that is either exposed or considered to be of importance for the patient's attractiveness. In many cases, the patient insistently demands surgical correction. During the further course of the condition, depression, social phobia, obsessive-compulsive and self-destructive behavior may develop. The condition usually begins early in the patient's life, and the lifetime prevalence is estimated to be 5%. Since an involvement of the serotonergic system is assumed, selective serotonin reuptake inhibitors are considered to be the medication of first choice. Surgical interventions do not lead to remission but simply to a transference of symptoms. Referral to a psychiatric specialist with the aim of clarifying the diagnosis is indicated.

Adolescent↗
PubMed1989

Animal models of compulsive behavior.

A convergence of clinical and pathological evidence points to the basal ganglia as the site of disturbance in compulsive disorders. However, the limbic system may be implicated as well. This article draws upon various lines of animal research in an attempt to explain how disturbances in one or another of these systems may produce compulsive behavior. Possible models include stimulation of the reinforcement mechanism, manipulation of the striatal "comparator" function, production and blockade of displacement behavior, and interference with the hippocampus' modulation of the stereotypy-inducing effect of reward. The common denominator of these models is a relative excess of dopaminergic activity in the basal ganglia. However, this does not necessarily implicate a primary dopaminergic disturbance in all human compulsive behavior.

Animals↗