Gender differences in eating disorder psychopathology across DSM-5 severity categories of anorexia nervosa and bulimia nervosa.

OBJECTIVE: This study examined whether patterns of eating-disorder (ED) psychopathology differed by gender across DSM-5 severity specifiers in anorexia nervosa (AN) and bulimia nervosa (BN). METHOD: We tested whether ED psychopathology differed across DSM-5 severity specifiers among 532 adults (76% female) in a residential treatment center with AN or BN. We hypothesized that severity of ED psychopathology would increase in tandem with increasing severity classifications for both males and females with AN and BN. RESULTS: Among females with BN, DSM-5 severity categories were significantly associated with increasing ED psychopathology, including Eating Disorder Examination-Questionnaire dietary restraint, eating concern, shape concern, and weight concern; and Eating Disorder Inventory drive for thinness and bulimia. ED psychopathology did not differ across DSM-5 severity levels for males with BN. For both males and females with AN, there were no differences in ED psychopathology across severity levels. DISCUSSION: Results demonstrate that DSM-5 severity specifiers may function differently for males versus females with BN. Taken together, data suggest DSM-5 severity specifiers may not adequately capture severity, as intended, for males with BN and all with AN. Future research should evaluate additional clinical validators of DSM-5 severity categories (e.g., chronicity, treatment non-response), and consider alternate classification schemes.

Sex differences in the effects of residential treatment on the quality of life of eating disorder patients.

AIMS: This study compared the effects of residential treatment on improving health-related quality of life (HRQOL) between males and females diagnosed with eating disorders (EDs) from admission to discharge and at follow-up. This study also analyzed the association between changes in HRQOL and changes in the severity of ED pathology, depression, and trait anxiety. METHODS: 145 consecutive patients (34 males and 111 females) admitted to a residential ED unit completed a panel of surveys at admission and discharge. The survey panel included the Eating Disorders Quality of Life Survey (EDQLS), the Eating Disorder Examination Questionnaire, the Quick Inventory of Depressive Symptomatology and the State-Trait Anxiety Inventory. An online follow-up survey was also conducted for the EDQLS. Mixed-factorial ANOVA was used to examine sex differences and changes in HRQOL between admission, discharge and post-treatment follow-up. Multiple regression analysis was used to investigate the relationship between sex, change in HRQOL, and changes in all other variables studied. RESULTS: By the end of residential treatment, both males and females had made similar statistically significant improvements in HRQOL from admission to discharge, which persisted after treatment. Greater decreases in ED pathology and trait anxiety significantly predicted greater increases in HRQOL during residential treatment while sex and changes in depression did not. CONCLUSION: The data show that residential treatment is an effective approach to improving HRQOL in both males and females with EDs. Greater improvements in trait anxiety and ED pathology contributed to greater improvement in HRQOL in these patients.

Treatment issues and outcomes for males with eating disorders.

The aim of this article is to discuss critical issues in treating males with eating disorders, and to present assessment and treatment outcome data for 111 males who received residential treatment for moderate to severe eating disorders. Males with eating disorders are often not included in eating disorder research as the population of individuals with eating disorders has historically been predominantly female. Whether this is due to actual lower prevalence of this disorder among males or to fewer males seeking treatment is not clear. In any case, there is limited empirical research on the particular treatment issues of males, and in treatment environments males are frequently in the minority. We have found that an all-male treatment environment is helpful in allowing males to benefit from treatment with less stigma. Data are presented which characterize psychiatric co-morbidity, excessive exercise, body image, sexuality, and spirituality in males. Treatment outcomes for males in this environment are positive.

The reproducibility of the early detection of alcohol consumption test using split samples analyzed in different laboratories.

AIMS: This study analyzes the reproducibility of the Early Detection of Alcohol Consumption (EDAC) test by sending blood samples obtained from nine volunteers to four different laboratories. It also describes the reproducibility of the EDAC over time by analyzing the results of testing one subject whose blood sample was sent to seven different laboratories over a 10-year period. METHODS: The EDAC is a method of interpreting routine laboratory profiles to identify either binge drinking or heavy drinking; the components of the routine panel were chosen based on a best fit predictions model published previously. RESULTS: Overall, the results of the cross-sectional analysis showed that the coefficients of variations (CVs) of the routine tests in the panel were mostly below 16%. Only three analytes (total bilirubin, aspartate aminotransferase and monocytes) showed CVs between 20 and 38%. The differences in the EDAC predictions for these volunteers ranged from 0 to 24%. In the long-term analysis, the variation of the EDAC prediction ranged from 0 to 21% probability of heavy drinking for one subject over time. Thus, mild variations of the EDAC are to be expected when the blood samples are analyzed in different laboratories. However, based on this study, these variations in the prediction of heavy drinking should not exceed >24% when using the EDAC test. CONCLUSION: This study supports the standard practice established for similar contemporary alcohol biomarkers stipulating that indications of heavy drinking become evident only when subjects experience changes of >30% in the probability of heavy drinking over time.

Improved recovery of repeat intoxicated drivers using fingernails and blood spots to monitor alcohol and other substance abuse.

OBJECTIVES: This study reports the results of a pilot program in Kenosha County that used a combination of direct biomarkers extracted from blood spots and nails to monitor repeat intoxicated drivers for their use of alcohol and drugs with a detection window spanning from 3 weeks to several months. The objectives were to test whether the direct biomarkers phosphatidylethanol (PEth), ethylglucuronide (EtG), and 5 drug metabolites would (1) help assessors obtain a more objective evaluation of repeat offenders during the assessment interview, (2) allow for timely identification of relapses and improve classification of drivers into risk categories, and (3) predict recidivism by identifying offenders most likely to obtain a subsequent operating while intoxicated (OWI) offense within 4 years of enrollment in the program. METHODS: All (N = 261) repeat offenders were tested using PEth obtained from blood spots and EtG obtained from fingernails; 159 participants were also tested for a 5 drugs of abuse nail panel. Drivers were tested immediately after the assessment interview (baseline) and at 3, 6, 9, and 12 months after baseline. Based on biomarker results and self-reports of abstinence, offenders were classified into different risk categories and required to follow specific testing timelines based on the program's decision tree. RESULTS: The baseline analysis shows that 60% of drivers tested positive for alcohol biomarkers (EtG, PEth, or both) at the assessment interview, with lower detection rates (0-11%) for the 5 drug metabolites. The comparison of biomarkers results to self-reports of abstinence identified 28% of all offenders as high risk and assigned them to more frequent testing and more intense monitoring. The longitudinal analysis shows that 56% (completers) of participants completed the program successfully and the remaining 44% (noncompliant) terminated prematurely. Two thirds (68%) of the completers were able to reduce or control their drinking and one third relapsed at least one time during their mandated monitoring periods. After a brief intervention by the assessors, 79% of relapsers tested negative for biomarkers in their repeat tests. The rearrest analysis showed that offenders classified in the noncompliant and relapsers groups were 7 times more likely to receive a new OWI 4 years after enrollment compared to drivers classified as abstainers or controllers. Refractory drivers were monitored the longest and reported no subsequent rearrests. CONCLUSION: These findings demonstrate the benefits of more individualized interventions with repeat OWI offenders and calls for further development of multimodal approaches in traffic medicine including those that use direct alcohol biomarkers as evidence-based practices to reduce recidivism.

An interactive voice response program to reduce drinking relapse: a feasibility study.

Substance-abusing patients often relapse soon after undergoing treatment, thus requiring intensive aftercare or re-treatment. More efficient monitoring and follow-up of patients could contribute to better treatment outcomes. This study evaluated the feasibility of a computer-automated interactive voice response (IVR) system to reduce relapse following discharge from residential treatment. Sixty participants completing a residential treatment program and meeting DSM-IV criteria for alcohol dependence were randomized to three groups: (1) daily IVR reporting with personal follow-up on noncompliant callers; (2) daily IVR reporting without follow-up; or (3) no IVR reporting (control group). At 30, 90, and 180 days after discharge, participants were interviewed to obtain timeline follow-back drinking data and completed the Work and Social Adjustment Scale, Obsessive-Compulsive Drinking Scale, SF-36, and Drinker Inventory of Consequences. This pilot study suggests that using automated IVR technology to monitor clients after discharge is feasible and warrants further research and development. IVR systems also provide the potential for delivering individualized feedback.

Using routine laboratory tests to detect heavy drinking in the general population.

This article describes a new biomarker known as the Early Detection of Alcohol Consumption (EDAC) test, which has been steadily penetrating the U.S. market. The EDAC uses routine laboratory tests to make a prediction of heavy drinking in any given person. When tested in mainstream insurance populations, the EDAC has shown twice the specificity of the traditional liver enzyme tests and is significantly more sensitive than the CDT test, which is expected because the EDAC uses a combination of laboratory tests. Maximum diagnostic accuracy is achieved when the CDT test is used to confirm a positive EDAC test. Since brief interventions have proven successful, the early identification of alcohol problems becomes a vital role for physicians. Improved awareness of alcohol misuse can certainly be accomplished through an increased use of biomarkers, with and without concomitant self-report. The ultimate goal is to facilitate early intervention and the successful management of patients diagnosed with heavy drinking.

New drug targets for HIV.

A significant number of human immunodeficiency virus (HIV) infections have become resistant to antiretroviral treatment, which means that there is a paramount need for novel drug targets to defeat the virus. Until recently, all HIV drugs inhibited HIV replication by mechanisms operating inside infected cells. In contrast, new antiretroviral drugs operate outside infected cells. Their mechanism of action consists in inhibiting entry of the virus into cells, thereby halting the very first step of HIV replication. Examples of this new class of drugs include entry inhibitors, coreceptor antagonists, and fusion inhibitors. In addition to their novel mechanism of action, this new class of drugs also has potential action against drug-resistant HIV strains, causes minimal adverse effects, and may be administered in a simplified, once-daily dosing regimen. New classes of anti-HIV drugs--and new drugs in existing classes--represent the best hope for people infected with HIV, especially those who have exhausted current therapies.

Using the EDAC test to monitor abstinence and relapses during outpatient treatment.

The main objective of this study is to show the performance of the EDAC test in monitoring alcohol consumption during outpatient treatment. The EDAC is a new approach that uses routine laboratory tests to identify binge drinking as well as chronic drinking. The overall diagnostic performance of the EDAC fluctuates around 80 to 90% for both specificity and sensitivity. Close to two thousand subjects have been tested by the EDAC since the early eighties; 300 of these were patients undergoing treatment at different institutions across the U.S. This article selected five case studies to represent examples of classical drinking behaviors encountered in most outpatient clinics. The first four cases illustrate the use of the EDAC alone and the last case represents the use of the EDAC combined with CDT. These five case studies illustrate the use of the EDAC to detect relapse episodes, to monitor abstinence during outpatient treatment and to recognize a slip early enough to prevent more severe drinking. The use of biomarkers to monitor drinking behavior in alcohol dependent patients is gaining popularity because they provide objective information on a patient's drinking status when used as an adjunct to self-report.

Outcome variables for anorexic males and females one year after discharge from residential treatment.

The overall goal of this study was to evaluate the outcome of a residential program for eating disorders that uses a multidimensional approach to treatment. Patients were males and females admitted with a diagnosis of Anorexia Nervosa using DSM-IV criteria. A phone survey was developed by our staff and applied to patients 15-months post discharge. Responses were analyzed using paired t-test and multiple regression analysis. From discharge to follow-up, the females experienced an average weight gain of almost 7 lbs (P = 0.03) and the males experienced an average weight gain of 19 lbs (P = 0.025). Multiple regression analysis showed that a higher weight at contact date was associated with a higher weight at discharge, less fasting and the male gender. This kind of study helps us evaluate treatment outcome and identify key variables that predict changes in anorexics' body weight over time.

Alcohol biomarkers as tools to guide and support decisions about intoxicated driver risk.

OBJECTIVES: This article describes the results of a pilot study that used alcohol biomarkers to guide decisions about driving under the influence (DUI) driver risk in the United States, replicating a European best practices model. The pilot tested whether biomarkers (1) can help the assessor identify high-risk drivers who continue to drink heavily after their arrest and (2) detect relapses in drivers enrolled in their drivers' safety plans. METHODS: These questions were addressed using two biomarkers, carbohydrate-deficient transferrin (CDT), and the Early Detection of Alcohol Consumption (EDAC) test, to evaluate the drinking behavior in repeat offenders during the assessment interview (baseline) and at 3, 6, 9, and 12 months' follow-up. The cutoff used to determine heavy drinking at baseline was 2.2 percent CDT and 40 percent P-positive for EDAC. A 30 percentage point increase in biomarker value from an abstinent baseline signaled a relapse and a 30 percentage point decrease in biomarker value from a previous positive measure signaled reduced drinking/abstinence. RESULTS: The results show that the EDAC used alone identified 18 percent of drivers as heavy drinkers at baseline compared to 5 percent for CDT and 8 percent for GGT. The best detection rate was achieved with the EDAC-CDT combination, which captured heavy drinking in 20 percent of the repeat offenders at baseline, most of whom (68%) denied drinking at the assessment interview. During follow-up, 52 percent of drivers abstained/reduced their drinking, almost 20 percent experienced a relapse, and 30 percent remained noncompliant with testing. Drivers who relapsed were less likely to be employed full-time (67 versus 84%) or married (17 versus 30%) compared to those who abstained. Of the drivers who relapsed, 80 percent returned to abstinence or reduced their drinking after biomarker information was used as brief intervention by the counselors. CONCLUSION: Biomarker testing improved the assessment and monitoring of repeat offenders in this pilot because it provided an objective tool to identify high-risk drivers allowing for better treatment recommendations and helped identified drivers who relapsed during follow-up to facilitate a brief intervention by the counselor that resulted in reduced alcohol consumption. These results contribute to establish evidence based practices in highway safety and are setting up new guidelines in the United States to reduce drunk driving.

The Early Detection of Alcohol Consumption (EDAC) test shows better performance than gamma-glutamyltransferase (GGT) to detect heavy drinking in a large population of males and females.

BACKGROUND: This study compared the effectiveness of using the Early Detection of Alcohol Consumption (EDAC) test versus gamma-glutamyltransferase (GGT) to screen for heavy drinking in the general population. Alcohol use was recorded by personal interview; heavy drinking was defined as males drinking 2.5 ounces of alcohol (5 drinks) per day and females drinking 2 ounces (4 drinks) of alcohol daily. MATERIAL/METHODS: The population analyzed consisted of 1,022 males (618 heavy drinkers and 404 light drinkers) and 583 females (203 heavy drinkers and 380 light drinkers). The EDAC used 27 routine laboratory tests; a P-positive value >50% was indicative of heavy drinking. The GGT test used a cutoff of 85 U/L for males and 65 U/L for females. RESULTS: The results showed that 30% of males reporting heavy drinking tested GGT positive compared to 65% who tested EDAC positive. Specificity was 92% for GGT and 89% for EDAC. Assuming 30% heavy drinking in this population, Positive Predictive Value (PPV) for GGT was 0.62 compared to 0.71 for EDAC. For females, the results showed that 23% of those reporting heavy drinking tested GGT positive compared to 34% who tested EDAC positive. Specificity was 94% for GGT and 98% for the EDAC. PPV for GGT was 0.62 compared to 0.88 for EDAC. CONCLUSIONS: The EDAC test identified twice as many males and 50% more female drinkers than GGT. With higher PPV, the EDAC is a better approach to screen for heavy drinking in both males and females.

The use of alternative medicine in the treatment of hepatitis C.

More than one-third of Americans use herbs for health purposes, yet patients and physicians usually lack accurate information about safety and efficacy of herbal remedies. In recent years, there has been a substantial increase in the use of so-called complementary and alternative therapies by patients with liver disease. Medical professionals and laboratorians need to be informed about popular alternative therapies and be open-minded to the possibility that some benefit may come from some therapies currently regarded as alternative. Silymarin extracted from the milk thistle is most widely subscribed to as a remedy for liver diseases. The beneficial effects of silymarin are most often seen in the patients who had cirrhosis as a result of alcohol abuse. An ongoing clinical trial will provide some insight as to whether milk thistle directly affects HCV. Silymarin has a good safety record and only rare case reports of gastrointestinal disturbances and allergic skin rashes have been published. The active component of licorice root, glycyrrhizin, has been shown to reduce alanine transaminase and aspartate transaminase values in the serum. This protective function has recently been explained as the inhibitory effects of glycyrrhizin on immune-mediated cytotoxicity against hepatocytes and on nuclear factor (NF)-kappa B, which activates genes encoding inflammatory cytokines in the liver. Finally, some patients with hepatitis C take St. John's Wort and ginger to treat the side effects caused by interferon therapy. An excellent review of this subject was recently published by the NCCAM.

Latest discoveries on the infection and coinfection with hepatitis D virus.

HDV is an incomplete virus that has HBV infection as a prerequisite. Superinfection by HDV leads to acute hepatitis and causes progression to liver cirrhosis in a significant proportion of HBsAg carriers. The traditional methods for the diagnosis of HDV infection, such as detection of serum anti-HD antibodies, are sufficient for the clinical diagnosis of delta infection. However, such techniques lack the sensitivity and specificity required to more accurately characterize the nature of HDV infection and to assess the efficacy of therapies. Recent improvements in molecular techniques, such as HDV RNA hybridization and RT-PCR, have provided increased diagnostic precision and a more thorough understanding of the natural course of HDV infection. These advances have enhanced the clinician's ability to accurately evaluate the stage of HDV infection, response to therapy, and occurrence of reinfection after orthotopic liver transplant.

Role of HIV phenotypic assays in the management of HIV infection.

Contemporary phenotypic assays such as the PhenoSense HIV assay are more straightforward to interpret than genotyping results because they do not require the expert interpretation of complex mutation patterns. The drug susceptibility data provides information for the clinician to select a treatment regimen effective against the predominant viral population circulating in the patient's blood. Compared to traditional phenotypic assays, the PhenoSense HIV assay uses a virus vector and a luciferase reporter gene to provide a quick and sensitive measure of viral replication. The main use of phenotypic assays at present is to identify those antiretroviral drugs that still retain activity against the patient's virus. Phenotypic assays are useful to provide guidance after treatment failure and to select a proper combination of drugs prior to initiation of therapy. They are also useful to detect transmission of resistance virus and to monitor HIV patients during early viral rebound. In essence, phenotypic testing provides information to target antiretroviral therapy against the predominant HIV variant in the patient for a prolonged suppression of viral replication, decreased mortality, and lower health-care costs.

Detection of alcohol misuse using a routine test panel: the early detection of alcohol consumption (EDAC) test.

AIMS: This study describes the derivation and validation of the early detection of alcohol consumption (EDAC) test, which uses linear discriminant function (LDF) analysis for the identification of alcohol misuse. This form of LDF aims to predict a categorical dependent variable (alcohol misuse) on the basis of several independent, predictor variables (routine laboratory tests). METHODS: EDAC was developed to classify individuals as heavy or light drinkers using a database of 1599 subjects recruited from 25 sites in the USA. The predictor variables for the LDF were 36 routine chemistry and haematology analytes. RESULTS: The EDAC model produced 80.7% sensitivity and 84.4% specificity, with an overall correct classification rate of 82.5%. Using a stepwise method, 20 of the 36 routine tests used in the LDF were selected as the optimal predictor variables. The top three variables with the highest contribution in the stepwise EDAC model were: bilirubin ratio (direct to total), aspartate aminotransferase and albumin. CONCLUSIONS: This study shows that LDF analysis in conjunction with new, user-friendly computer packages is a practical and cost-effective laboratory tool for detecting excessive drinking using blood constituents ordered routinely in a variety of clinical settings. Diagnostic performance can be adjusted to achieve higher specificity rates.

Use of contemporary biomarkers in the detection of chronic alcohol use.

Alcohol is the most commonly abused substance yet alcoholism is frequently undiagnosed. The misuse of alcohol is common and frequently an occult problem. More than 10% of current drinkers meet diagnostic criteria for alcohol abuse or dependence while the lifetime prevalence for these conditions in outpatient settings ranges from 16 to 36 percent. Long-term, heavy drinking is associated with significant morbidity, mortality, and economic costs. Clues to alcohol use can be discovered from a patient's history and physical stigmata. Validated screening instruments such as the Alcohol Use Disorders Identification Test (AUDIT), CAGE Questionnaire, and Brief Michigan Alcoholism Screening Tests help confirm the clinical suspicion of alcohol dependence. Laboratory abnormalities of mean corpuscular volume, gamma-glutamyl transferase, alkaline phosphatase, or alanine amino transferase levels are non-specific indicators of possible alcohol-induced liver impairment. Newer, less well-known FDA-approved biochemical markers such as the Carbohydrate Deficient Transferrin and the Early Detection of Alcohol Consumption test may also be used to detect heavy alcohol abuse and to monitor relapse episodes. Brief interventions are successful, making identification and diagnosis a vital role for the family physician. Improved awareness of alcohol misuse, increased use of screening tools, and the appropriate use of biochemical markers will facilitate early intervention and successful management of patients with alcohol use disorders.

Streamlining microarray technology in a prototype core laboratory.

The overall scheme of a microarray experiment is summarized in Figure 3. The real benefit of using microarrays in research is gaining knowledge from the abundant data provided from the series of related microarray experiments. The core laboratory has produced three cDNA arrays, a mouse 15K array, a human 13K array, and a human apoptosis array with 350 plus apoptotic elements. Recently, the 15K array is being used in building a database for gene expression in several areas of the mouse brain and for studying transgenic and knockout mice. The apoptosis array has been used by cancer researchers to further elucidate changes and interactions between genes leading to cell death and cancer. The UCHSC Gene Expression Array Core is supported by the National Institute on Aging and the National Cancer Institute (Bethesda, MD) to serve all academic users and has a special interest in providing a solid technological base for genomic researchers interested in alcohol and cancer research.