The relationship between premorbid intelligence and symptoms of severe anorexia nervosa restricting type.

The purposes of this study were as follows: to compare premorbid IQ with present IQ in patients with more severe anorexia nervosa restricting type (AN-R) and to investigate the relationship between decreasing IQ and symptoms in patients with severe AN-R. Twenty-two participants were recruited (12 were AN-R patients; 10 were healthy controls). The average BMI in AN-R patients and healthy controls was 12.65 and 19.82, respectively. We assessed the outcomes using the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), the Japanese Adult Reading Test, The Eating Disorders Inventory-2 (EDI-2), Beck Depression Scale-2 (BDI-2) and State-Trait Anxiety Index. In two-way ANOVA, there were significant interactions for the FIQ and PIQ. Only in the AN-R group, a significant single main effect of time was evidenced for the FIQ and PIQ. In the AN-R group, a significantly high positive correlation was found between changes in the PIQ and the body dissatisfaction subscale of the EDI-2. These findings raise the possibility that in patients with severe AN-R, an excessive decrease in body weight induces decreased PIQ; as a result, they have worse dissatisfaction with their body shape.

Obestatin, acyl ghrelin, and des-acyl ghrelin responses to an oral glucose tolerance test in the restricting type of anorexia nervosa.

BACKGROUND: Obestatin is a recently identified peptide encoded by the same ghrelin gene. It has been reported that obestatin has anorexigenic and antigastroprokinetic activities as opposed to ghrelin. We investigated simultaneously obestatin, acyl ghrelin, and des-acyl ghrelin in the restricting type of anorexia nervosa (AN-R) patients. METHODS: Three hormonal responses to the oral glucose tolerance test (OGTT) were measured in 10 AN-R patients and 10 healthy women. RESULTS: Plasma obestatin, acyl ghrelin, and des-acyl ghrelin levels were significantly higher in AN-R patients than in control subjects throughout the OGTT. All of the three hormones decreased after the OGTT in both groups. CONCLUSIONS: We found that AN-R patients exhibited increased plasma levels of obestatin, acyl ghrelin, and des-acyl ghrelin throughout the OGTT compared with control subjects. The hormonal differences between groups are statistically most significant in obestatin, suggesting obestatin may serve as a marker reflecting both acute and chronic changes of the nutritional state in AN-R patients.

Effect of juggling therapy on anxiety disorders in female patients.

AIMS: The aim of this study was to investigate the effect of juggling therapy for anxiety disorder patients. DESIGN AND METHOD: Subjects were 17 female outpatients who met the DSM-IV diagnostic criteria for anxiety disorders. Subjects were treated with standard psychotherapy, medication and counseling for 6 months. For the last 3 months of treatment, subjects were randomized into either a non-juggling group (n = 9) or a juggling therapy group (juggling group: n = 8). The juggling group gradually acquired juggling skills by practicing juggling beanbags (otedama in Japan) with both hands. The therapeutic effect was evaluated using scores of psychological testing (STAI: State and Trate Anxiety Inventry, POMS: Profile of Mood Status) and of ADL (FAI: Franchay Activity Index) collected before treatment, 3 months after treatment (before juggling therapy), and at the end of both treatments. RESULTS: After 6 months, an analysis of variance revealed that scores on the state anxiety, trait anxiety subscales of STAI and tension-anxiety (T-A) score of POMS were significantly lower in the juggling group than in the non-juggling group (p < 0.01). Depression, anger-hostility scores of POMS were improved more than non-jugglers. In the juggling group, activity scores on the vigor subscale of POMS and FAI score were significantly higher than those in the non juggling group (p < 0.01). Other mood scores of POMS did not differ between the two groups. CONCLUSION: These findings suggest that juggling therapy may be effective for the treatment of anxiety disorders.

Incomplete restoration of the secretion of ghrelin and PYY compared to insulin after food ingestion following weight gain in anorexia nervosa.

BACKGROUND: In humans, ghrelin has been found to stimulate appetite while PYY3-36 to reduce it; these orexigenic and anorexigenic peptides play significant roles in appetite control. We investigated pre- and postprandial responses of ghrelin and PYY in anorexia nervosa (AN) and the influence of weight gain. METHODS: Plasma ghrelin, PYY3-36, glucose and insulin responses after ingestion of a 400 kcal standard meal were measured in 14 patients with restricting type of AN and 12 controls. The AN patients were evaluated before therapy and after inpatient therapy. Psychometry was performed by the use of Eating Disorders Inventory. RESULTS: Ghrelin was suppressed during the meal test, while PYY3-36 was increased in all of the groups. Before therapy, AN patients had significantly increased levels of ghrelin and PYY3-36 compared to the control (P<0.01). After therapeutic intervention, as the nutritional status of AN patients improved, the secretion of these hormones were increased (P<0.05), but not normalized as in psychological testing. In contrast, insulin and glucose responses were normalized after inpatient therapy. CONCLUSIONS: We found that both ghrelin and PYY3-36 increased in AN patients and these changes were not normalized in contrast to insulin after treatment. The increase in both orexigenic ghrelin and anorexigenic PYY3-36 may have a role in pathological eating behavior in AN.

Eating pattern and the effect of oral glucose on ghrelin and insulin secretion in patients with anorexia nervosa.

OBJECTIVE: Ghrelin is thought to be involved in the regulation of eating behaviour and energy metabolism in acute and chronic feeding states. Circulating plasma ghrelin levels in healthy humans have been found to decrease significantly after oral glucose administration. Because it is suggested that eating behaviour may influence the secretion of ghrelin and insulin in anorexia nervosa (AN), we examined the effect of oral glucose on ghrelin and insulin secretion in subtypes of AN patients. DESIGN AND PATIENTS: Twenty female AN patients and 10 age-matched female controls were subjects. The patients were subdivided into two subtypes based on eating behaviour as follows: 11 restricting type (AN-R), nine binge-eating and purging type (AN-BP). Subjects underwent an oral glucose tolerance test at 08.00 h. Blood was collected 0, 30, 60, 120 and 180 min after the glucose load. RESULTS: Both AN-R and AN-BP had a significant increased basal ghrelin level (P < 0.01) and a significantly decreased basal insulin level (P < 0.05) as compared to controls. The time of the nadir of mean ghrelin in AN-BP (120 min, 58.1% of basal level, 204.9 +/- 34.3 pmol/l, mean +/- SEM) was delayed compared to controls (60 min, 60.2%, 74.3 +/- 7.9 pmol/l), and in the AN-R group it kept decreasing for 180 min (80.0%, 182.4 +/- 31.5 pmol/l). The peaks insulin levels in AN-BP (120 min, 319.3 +/- 88.8 pmol/l) and AN-R (180 min, 418.9 +/- 68.4 pmol/l) were also delayed as compared to controls (60 min, 509.2 +/- 88.8 pmol/l). The glucose level at 180 min in AN-R was significantly (P < 0.05) higher than in controls. CONCLUSIONS: These findings suggest that differences in eating behaviour in AN may induce alterations in both ghrelin and insulin metabolism in the acute feeding state. Furthermore, metabolic changes in the restrictive eating pattern may be related to the pathophysiology of small quantitative meal intake in AN-R patients.