Purging disorder: psychopathology and treatment outcomes.

OBJECTIVE: To characterize a tertiary care treatment-seeking sample and assess post-treatment remission and completion rates for purging disorder (PD). METHOD: Consecutively admitted women with PD (n = 122), anorexia nervosa (AN) restricting subtype (AN-R; n = 146), AN binge-purge subtype (AN-B; n = 154), and bulimia nervosa-purging subtype (BN-P; n = 415) were compared on general and eating disorder specific psychopathology. A subsample (n = 256) attended a day treatment program and were assessed for post-treatment remission and completion rates. RESULTS: PD occurred in 17.3% of eating disorders not otherwise specified and 6.7% of total eating disorder referrals. PD patients were similar to AN-B and BN-P, but had higher levels than AN-R, on general and eating disorder psychopathology. PD individuals did not have different post-treatment remission or completion rates compared to other eating disorders. DISCUSSION: The results add to a growing literature on the utility of PD as a diagnosis.

Predictors of treatment acceptance and of participation in a randomized controlled trial among women with anorexia nervosa.

OBJECTIVE: This study aimed to identify predictors of acceptance of intensive treatment and of participation in a randomized controlled trial (RCT) among women with anorexia nervosa (AN). METHOD: Participant data were drawn from a tertiary care intensive treatment programme including a previously published RCT. Women with AN (N = 106) were offered intensive treatment, and 69 were approached to participate in an RCT of olanzapine's efficacy as an adjunctive treatment for AN. AN subtype and pretreatment psychological variables were used to predict acceptance of intensive treatment and RCT participation. RESULTS: AN binge purge subtype and higher depression and body dissatisfaction predicted intensive treatment acceptance. No variable predicted RCT participation among treatment acceptors. DISCUSSION: Clinicians may focus on enhancing motivation or use a stepped care approach to increase intensive treatment acceptance especially among women with AN-restricting type and among all those with AN who have lower levels of distress.

Testing a maintenance model for eating disorders in a sample seeking treatment at a tertiary care center: a structural equation modeling approach.

Fairburn et al (Fairburn, CG, Cooper, Z, Shafran, R. Behav Res Ther 2003;41:509-528) proposed additional maintenance mechanisms (ie, interpersonal difficulties, mood intolerance, low self-esteem, and perfectionism) for some individuals with eating disorders in addition to core eating disorder psychopathology (ie, overevaluation of eating, weight, and shape and their control). This is the first study to both elaborate and test this maintenance model as a structural model. Adults seeking treatment of an eating disorder (N = 1451) at a specialized tertiary care center were included in this cross-sectional study. In the first part of the study, diagnostically heterogeneous participants (n = 406) were randomly selected to test a structural model based on the maintenance model. In the second part of the study, remaining participants (n = 1045) were grouped according to eating disorder diagnosis to test for invariance of the structural paths of the final model across diagnoses. Overall, the structural model with core and additional mechanisms fit the data well and, with 1 exception, represented maintenance processes for each of the diagnostic groups. Treatment models based on both core and additional maintenance factors for those seeking therapy at a specialized tertiary care center may result in improved treatment outcomes for these patients with eating disorders.

Recall of Pharmaceutical Pictograms by Older Adults.

BACKGROUND: Low health literacy and high medication burden in the older adult population are contributing factors to the misunderstanding of medication instructions, leading to an increased risk of poor adherence and adverse events in this group of patients. OBJECTIVE: To evaluate the ability of older adults to recall the meaning of 13 pharmaceutical pictograms 4 weeks after receipt of feedback on pictogram meaning. METHODS: Older adults (aged 65 or older) were recruited from one community pharmacy in Canada. One-on-one structured interviews were conducted to assess the comprehensibility of 13 pharmaceutical pictograms from the International Pharmaceutical Federation's database of pictograms. Each participant was then told the meaning of each pictogram. Recall was assessed 4 weeks later. RESULTS: A total of 58 participants met the inclusion criteria and agreed to participate. The number of pictograms meeting the ISO threshold for comprehensibility of symbols increased from 10 at the initial comprehensibility assessment to 13 at the recall assessment. Analysis of demographic data showed no associations between initial comprehensibility of the pictograms and age, sex, education level, or number of medications taken. CONCLUSIONS: The results of this study indicate that after being informed of the meaning of pharmaceutical pictograms, older adults were able to recall the pictogram meanings for at least 4 weeks.

CONTEXTE: Les faibles connaissances en matière de santé des personnes âgées et le lourd fardeau des médicaments qui pèse sur elles sont des facteurs qui contribuent à l'incompréhension des instructions relatives à l'administration des médicaments, ce qui entraîne un risque plus élevé de mauvaise adhésion au traitement et d'événements indésirables dans ce groupe de patients. OBJECTIF: Évaluer la capacité des adultes plus âgés à se souvenir du sens des 13 pictogrammes pharmaceutiques, quatre semaines après avoir été informés de leur sens. MÉTHODES: Les adultes plus âgés (65 ans et au-delà) ont été recrutés dans une pharmacie communautaire du Canada. Des entrevues structurées en tête-à-tête ont été menées pour évaluer l'intelligibilité de 13 pictogrammes pharmaceutiques extraits de la base de données de la Fédération internationale pharmaceutique. Le sens de chaque pictogramme a ensuite été communiqué à chaque participant et, quatre semaines plus tard, leur capacité à s'en souvenir a été évaluée. RÉSULTATS: Cinquante-huit participants répondaient au critère d'inclusion et ont accepté de participer à l'étude. Le nombre de pictogrammes répondant au seuil ISO d'intelligibilité des symboles est passé de 10 (au moment de l'évaluation d'intelligibilité initiale) à 13 (au moment de l'évaluation du rappel). L'analyse des données démographiques n'a indiqué aucune association entre l'intelligibilité initiale des pictogrammes et l'âge, le sexe, le niveau de formation ou le nombre de médicaments que prenaient ces personnes. CONCLUSIONS: Les résultats de cette étude indiquent qu'après avoir été informés du sens des pictogrammes pharmaceutiques, les aînés étaient en mesure de s'en souvenir pendant au moins quatre semaines.

Attachment insecurity mediates the relationship between childhood trauma and eating disorder psychopathology in a clinical sample: a structural equation model.

OBJECTIVES: Childhood maltreatment occurs often among those with an eating disorder and is considered a nonspecific risk factor. However, the mechanisms by which childhood maltreatment may lead to an eating disorder are not well understood. The current study tests a model in which attachment insecurity is hypothesized to mediate the relationship between childhood maltreatment and eating disorder psychopathology. METHOD: Treatment seeking adults with eating disorders (N=308) completed questionnaires about childhood maltreatment, eating disorder psychopathology, and adult attachment. RESULTS: Structural equation models indicated that childhood trauma had a direct effect on eating disorder symptoms. Also, attachment anxiety and avoidance each equally mediated the childhood maltreatment to eating disorder psychopathology relationship. CONCLUSIONS: Attachment insecurity, characterized by affect dysregulation and interpersonal sensitivities may help to explain why eating disorder symptoms may be one consequence of childhood maltreatment in a clinical sample. Clinicians treating primarily those with trauma might assess for disordered eating as a potential manifestation of the sequelae of trauma and attachment insecurity.

Characterization of IGF-II isoforms in binge eating disorder and its group psychological treatment.

INTRO: Binge eating disorder (BED) affects 3.5% of the population and is characterized by binge eating for at least 2 days a week for 6 months. Treatment options include cognitive behavioral therapy, interpersonal psychotherapy, and pharmacotherapy which are associated with varied success. Little is known about the biology of BED. Since there is evidence that the insulin like growth factor system is implicated in regulation of body weight, insulin sensitivity and feeding behavior, we speculated it may be involved in BED. METHODS: A cross-sectional comparison was made between three groups of women: overweight with BED, overweight without BED and normal weight without BED. Women were assigned to Group Psychodynamic Interpersonal Psychotherapy. Blood was collected before therapy, at completion and at 6 months follow up for evaluation of IGF-II using Western blot. RESULTS: 97 overweight women with BED contributed to the cross-sectional comparison. The two control groups comprised 53 overweight women without BED, and 50 age matched normal weight women without BED. Obese women had significantly lower Big IGF-II than normal weight women, p = .028; Overweight women with BED had higher Mature IGF-II than normal weight women, p<.05. Big IGF-II showed a significant decreasing slope from pre- to post- to six months post-group psychological treatment, unrelated to changes in BMI (p = .008). CONCLUSION: Levels of IGF-II isoforms differed significantly between overweight and normal weight women. Overweight women with BED display abnormal levels of circulating IGF-II isoforms. BED is characterized by elevated mature IGF-II, an isoform shown to carry significant bioactivity. This finding is not related to BMI or to changes in body weight. The results also provide preliminary evidence that BIG IGF-II is sensitive to change due to group psychological treatment. We suggest that abnormalities in IGF-II processing may be involved in the neurobiology of BED.

Temperament, life events, and psychopathology among the offspring of bipolar parents.

OBJECTIVES: The present study examines the relationship between temperament, recent and remote life events, and psychopathology among the offspring of parents with bipolar disorder and well comparisons. METHODS: Offspring of bipolar and well parents were clinically assessed using KSADS-PL format interviews. Lifetime psychiatric diagnoses were made on a blind consensus basis in accordance with DSM-IV criteria. Depending on offspring age, either the child or their parent on their behalf, completed a semi-structured interview quantifying the number and impact of recent life events and remote permanent losses, as well as a measure of temperament. RESULTS: In this study, there was an association between psychopathology and the number of recent negative life events, but no association between psychopathology and the number of early losses. Emotionality was positively correlated with recent life events. However, in stepwise regression analyses, only emotionality significantly contributed to lifetime psychopathology in general and emotionality and age contributed to the risk of mood disorder in particular. CONCLUSIONS: These findings, replicate in a sample of offspring at high risk for bipolar disorder, previously reported associations between high emotionality and unipolar depression. In this population, any effect of undesirable life events would appear to be mediated through the association with emotionality.