[Gender Inequalities of the COVID-19 Pandemic: A Synthesis of Systematic Reviews with a Focus on Sexual and Gender Minorities]. / Geschlechtsspezifische Unterschiede und Ungleichheiten der COVID-19 Pandemie: Eine Synthese systematischer Reviews unter Einbeziehung sexueller und geschlechtlicher Minderheiten.

OBJECTIVE: From the very beginning of the COVID-19 pandemic, gender was shown to play a significant role in how people were affected by it, while aspects related to sexual and gender minorities (SGM) have been rather understudied. The aim of this review was to synthesize systematic reviews and meta-analyses that explicitly addressed the impact of gender within the context of the pandemic, with a focus on SGM. METHODS: We based the narrative synthesis of results on a literature search of PubMed. We included systematic reviews and meta-analyses as of 2019 with an identifiable gender comparison or SGM reference and a specified clinical outcome. RESULTS: The search yielded 2 658 hits; 29 systematic reviews were included for content synthesis. Of these, we identified 23 systematic reviews with gender comparisons and 8 related to SGM. Men showed higher prevalence, severity, and mortality of COVID-19 compared with women, but the psychological consequences of the COVID-19 pandemic affected women more compared with men. Evidence suggests that women are at higher risk for Long-COVID-19. SGM experienced increased mental health problems during the COVID-19 pandemic compared to the general population. DISCUSSION: It appears that biological and social risks led to differential susceptibility to infection and manifestation of COVID-19 disease and also accounted for differences in mortality between men and women. Insights on prevalence, disease burden, and mortality among SGM during the COVID-19 pandemic are lacking. This suggests an underrepresentation of SGM in COVID-19-related research. Despite the abundance of COVID-19 publications, gender effects have not often been explicitly and adequately studied. CONCLUSION: Future studies should examine gender differences and needs and concerns of SGM in mental disorders and further understudied entities like Long-COVID-19, to gain insights and help to provide preventive measures and adequate treatments for all, for potential future pandemics as well.

The impact of the COVID-19 pandemic on eating disorders: A systematic review.

OBJECTIVE: A growing body of evidence suggests that individuals with eating disorders (EDs) have experienced deteriorating symptoms, increased isolation, and an increase in hospital admissions as a result of the COVID-19 pandemic. Despite this, no systematic reviews have been conducted examining the COVID-19 and ED peer-reviewed literature. Therefore, this systematic review aimed to synthesize the impact of the COVID-19 pandemic on individuals with EDs. METHOD: Database searches of the peer-reviewed literature were completed in the subsequent databases: CINAHL, Embase, MEDLINE, and PsycINFO (from November 2019 to October 20, 2021). All research reporting on the relationship between the COVID-19 pandemic on individuals with EDs were included. RESULTS: Fifty-three studies met the inclusion criteria, including 36,485 individuals with EDs. The pooled hospital admissions across the studies demonstrated on average a 48% (pre = 591, post = 876, n = 10 studies) increase in admissions during the pandemic compared to previous pre-pandemic timepoints. In this review, 36% of studies (n = 19) documented increases in eating disorder symptoms during the pandemic, this increase in eating disorder symptoms were documented in AN, BED, BN, and OFSED patients. Studies also demonstrated increases in anxiety (n = 9) and depression (n = 8), however patterns of change appeared to be diagnostic and timing specific (e.g., lockdowns). DISCUSSION: We found a large increase in the number of hospitalizations and an increase in ED symptoms, anxiety, depression, and changes to BMI in ED patients during the pandemic. However, these changes appeared to be diagnostic and timing specific. Many qualitative studies described deterioration in ED symptomatology due to decreased access to care and treatment, changes to routine and loss of structure, negative influence of the media, and social isolation. Future studies are needed to focus on pediatric populations, new ED diagnoses, and severity of illness at presentation. PUBLIC SIGNIFICANCE: The scientific literature suggests that individuals with eating disorders have experienced deteriorating symptoms, increased isolation, and an increase in hospital admissions as a result of the COVID-19 pandemic. This study synthesized 53 articles and explored the impact of the COVID-19 pandemic on patients with eating disorders. We found increases in eating disorder symptoms during the pandemic; this increase in eating disorder symptoms was documented in patients with common eating disorders including anorexia nervosa, binge-eating disorder, bulimia nervosa, and other specified feeding and eating disorders. This review also demonstrated changes in body mass index (an index used to classify underweight, overweight, and obesity in adults) and increases in anxiety and depression during the pandemic compared to previous timepoints; patterns of change appeared to be related to timing of lockdowns. This review provides important information on the impact of COVID-19 on the physical and mental health of individuals with eating disorders.

OBJETIVO: Un creciente conjunto de evidencia sugiere que las personas con trastornos de la conducta alimentaria (TCA) han experimentado síntomas de deterioro, mayor aislamiento y un aumento en los ingresos hospitalarios como resultado de la pandemia de COVID-19. A pesar de esto, no se han realizado revisiones sistemáticas que examinen la literatura revisada por pares de COVID-19 y TCA. Por lo tanto, esta revisión sistemática tuvo como objetivo sintetizar el impacto de la pandemia de COVID-19 en las personas con TCA. MÉTODO: Las búsquedas en las bases de datos de la literatura revisada por pares se completaron en las bases de datos posteriores: CINAHL, Embase, MEDLINE y PsycINFO (de noviembre de 2019 al 20 de octubre de 2021). Se incluyeron todos los informes de investigación sobre la relación entre la pandemia de COVID-19 en individuos con TCA. RESULTADOS: Cincuenta y tres estudios cumplieron los criterios de inclusión, incluyendo 36,485 individuos con TCA. Los ingresos hospitalarios agrupados en los estudios demostraron en promedio un aumento del 48% (antes = 591, después = 876, n = 10 estudios) en los ingresos durante la pandemia en comparación con los puntos de tiempo previos a la pandemia. En esta revisión, el 36% de los estudios (n = 19) documentaron aumentos en los síntomas del trastorno alimentario durante la pandemia, este aumento en los síntomas del trastorno de la conducta alimentaria se documentó en pacientes con AN, TpA, BN y OSFED. Los estudios también demostraron aumentos en la ansiedad (n = 9) y la depresión (n = 8), sin embargo, los patrones de cambio parecían ser diagnósticos y específicos del momento (por ejemplo, encierros). DISCUSIÓN: Encontramos un gran aumento en el número de hospitalizaciones y un aumento en los síntomas de TCA, ansiedad, depresión y los cambios en el IMC en pacientes con TCA durante la pandemia. Sin embargo, estos cambios parecían ser diagnósticos y específicos del momento. Muchos estudios cualitativos describieron un deterioro en la sintomatología del trastorno de la conducta alimentaria (TCA) debido a la disminución del acceso a la atención y el tratamiento, los cambios en la rutina y la pérdida de estructura, la influencia negativa de los medios de comunicación y el aislamiento social. Se necesitan estudios futuros para centrarse en las poblaciones pediátricas, los nuevos diagnósticos de TCA y la gravedad de la enfermedad al momento de la presentación. PALABRAS CLAVE: trastornos de la conducta alimentaria, pandemia, COVID-19.

Gender differences in individuals with obesity and binge eating disorder: A retrospective comparison of phenotypical features and treatment outcomes.

OBJECTIVE: Phenotypical comparisons between individuals with obesity without binge eating disorder (OB) and individuals with obesity and comorbid binge eating disorder (OB + BED) are subject to ongoing investigations. At the same time, gender-related differences have rarely been explored, raising the question whether men and women with OB and OB + BED may require differently tailored treatments. METHOD: We retrospectively compared pre- versus post-treatment data in a matched sample of n = 180 men and n = 180 women with OB or OB + BED who received inpatient treatment. RESULTS: We found that men displayed higher weight loss than women independent of diagnostic group. In addition, men with OB + BED showed higher weight loss than men with OB after 7 weeks of treatment. CONCLUSIONS: The present findings add to an emerging yet overall still sparse body of studies comparing phenotypical features and treatment outcomes in men and women with OB and OB + BED; implications for further research are discussed. CLINICAL TRIAL REGISTRATION: The study was prospectively registered with the German Clinical Trial Register as part of application DRKS00028441.

Gesundheitliche Themen von LSBTIQ+Personen in der ärztlichen Ausbildung in Deutschland.

AIMS: Lesbian, gay, bisexual, trans, intersex and queer (LGBTIQ +) persons continue to experience discrimination and disadvantage in many areas of life, including healthcare. Studies indicate that LGBTIQ+persons show high rates of chronic physical and mental illness on the one hand, and report negative experiences with health care providers on the other hand. The aim of this work is to point towards barriers and the provision of inadequate health care for LGBTIQ+persons, and to draw attention to relevant gaps in medical education in Germany, needing to be followed by specific actions. METHODS: For these purposes, both scientific evidence for the disadvantage of LGBTIQ+persons within the health care system and important innovative interventions in the education of medical personnel are presented and discussed. RESULTS: A variety of different - in terms of scope, format, and content - training programs have already been tested and established, mainly in English-speaking regions of the world. In contrast, medical training in Germany lacks such programs. CONCLUSIONS: Raising awareness and expanding the training of medical students to include LGBTIQ+health topics is of great importance in Germany.

Exposure to the thin beauty ideal: Are there subliminal priming effects?

OBJECTIVE: Previous research suggested that exposure to the thin beauty ideal propagated by the media is associated with body dissatisfaction and the development of disordered eating. Given recent suggestions regarding the role of automatic processes, we aimed to enhance our understanding of automatic, unconscious responses to body pictures and the association with the internalization of the thin ideal and the severity of eating disorder symptoms. METHOD: An affective priming task with body pictures of different weight as primes and a normal-weight body picture as target, which had to be evaluated with regard to attractiveness and desirability, was administered to healthy women with either subliminal prime presentation (Experiment 1) or conscious presentation (Experiment 2). RESULTS: Subliminal presentation did not affect the evaluation of the normal-weight target, although strength of evaluative shifts was significantly associated with internalization of the thin ideal. In contrast, the conscious presentation of the ultra-thin prime decreased and of the obese prime increased desirability and attractiveness ratings of the target. DISCUSSION: Prevention strategies focusing on the critical evaluation of the thin ideal are important. Future studies are warranted to enhance our understanding of automatic, unconscious processes in women experiencing eating disorders.

Retrospective analysis of hypophosphatemia rates and other clinical parameters in patients with eating disorders.

OBJECTIVE: To retrospectively assess medical services of a specialist inpatient eating disorders (EDs) unit. METHOD: We retrospectively evaluated clinical parameters of 288 inpatients classified as 'moderately' or 'significantly' medically compromised between 1 January 2016 and 30 June 2019. RESULTS: We analysed 288 patients (mean age 32.5 [SD = 11.4] years, 96% women, 76% with anorexia nervosa). Average length of stay was 38.4 (SD = 28.4) days. Average admission body mass index (BMI) was 14.8 (SD = 1.8) kg/m2 , and 16.1 (SD = 1.9) kg/m2 at 4 weeks. At admission, 82% of patients were considered significantly medically compromised, while 6% were deemed moderately compromised. Only 5% of patients required transfer to intensive care unit. Prevalence of hypophosphatemia was 17.7%; rates did not increase significantly between years despite more assertive re-feeding processes. There was no association between risk classification at admission and change in BMI at 4 weeks (F(2,166) = 0.588, p = 0.557). BMI at admission was found to be significantly associated with clinical outcome (ß = 0.92, p < 0.001). DISCUSSION: Hypophosphatemia rates did not increase despite more assertive re-feeding over 3 years. Our results provide support for a model of treatment that simultaneously addresses the medical and psychiatric sequelae of patients with severe EDs.

The impact of duration of illness on treatment nonresponse and drop-out: Exploring the relevance of enduring eating disorder concept.

OBJECTIVE: There are no generally accepted definitions or markers of treatment nonresponse in eating disorders (EDs). The aim of this paper was to examine how the duration of illness and other potential prognostic markers impacted on nonresponse and drop-out from treatment across different EDs subtypes. METHODS: A total sample of 1199 consecutively treated patients with EDs, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, participated in this study. Kaplan-Meier curves were calculated for each ED diagnosis in which the probability of recovery was plotted against the duration of illness. RESULTS: Full remission was more likely for people with binge eating disorder (BED; 47.4%) and anorexia nervosa (AN; 43.9%) compared to bulimia nervosa (BN; 25.2%) and other specified feeding and EDs (OSFED; 23.2%). The cut-off points for the duration of the illness related with high likelihoods of poor response was 6-8 years among OSFED, 12-14 years among AN and BN and 20-21 years among BED. Other variables predicting nonresponse included dysfunctional personality traits. CONCLUSIONS: Nonresponse to treatment is associated with duration of illness which is in turn associated with poor response to previous treatment. However, there was no evidence for staging the illness using specific duration of illness criteria. Nevertheless, the shorter temporal trajectory for OSFED suggests that early interventions may be of importance for this group.

Implicit bias to food and body cues in eating disorders: a systematic review.

BACKGROUND: Rigid, restrictive eating patterns, fear of gaining weight, body image concerns, but also binge eating episodes with loss of control leading to overweight, at times followed by compensatory measures to control weight, are typical symptoms in eating disorders (EDs). The regulation of food intake in EDs may underlie explicit processes that require cognitive insight and conscious control or be steered by implicit mechanisms that are mostly automatic, rapid, and associated with affective-rather than cognitive-processing. While introspection is not capable of assessing implicit responses, so-called indirect experimental tasks can assess implicit responses underlying a specific behavior by-passing the participant's consciousness. Here, we aimed to present the current evidence regarding studies on implicit biases to food and body cues in patients with EDs. METHODS: We performed a systematic review (PRISMA guidelines). We included controlled studies performed in clinical ED cohorts (vs. healthy control subjects or another control condition, e.g., restrictive vs. binge/purge AN) and using at least one indirect assessment method of interest. RESULTS: Out of 115 screened publications, we identified 29 studies fulfilling the eligibility criteria, and present a synthesis of the essential findings and future directions. CONCLUSION: In this emerging field of research, the present work provides cornerstones of evidence highlighting aspects of implicit regulation in eating disorders. Applying both direct (e.g., self-reports) and indirect measures for the assessment of both explicit and implicit responses is necessary for a comprehensive investigation of the interplay between these different regulatory mechanisms and eating behavior. Targeted training of implicit reactions is already in use and represents a useful future tool as an add-on to standard psychotherapeutic treatments in the battle against eating disorders. EVIDENCE LEVEL: 1 (systematic review).

Pavlovian-to-instrumental transfer in Anorexia Nervosa: A pilot study on conditioned learning and instrumental responding to low- and high-calorie food stimuli.

Anorexia Nervosa is characterized by persistent restraint eating despite severe negative consequences and often a chronic course of the disease. Recent theoretical models suggest that abnormalities in reward processing and incentive salience of disorder-compatible stimuli as observed in addictive behaviours contribute to the development and maintenance of Anorexia Nervosa. The aim of the present study was to investigate the process of the acquisition of food-related conditioned responses and the influence of conditioned low-calorie and high-calorie food stimuli on instrumental responding for different foods. A Pavlovian-to-instrumental transfer paradigm and questionnaires on eating disorder psychopathology (EDE-Q, EDI-2) were administered to patients with Anorexia Nervosa (n = 39) and healthy controls (n = 41). Results indicated that patients with Anorexia Nervosa showed deficits of the acquisition of knowledge of the experimental contingencies. Nevertheless, in patients with Anorexia Nervosa and healthy controls instrumental responding for low- and high-calorie food rewards was affected by stimuli conditioned to these rewards; no group differences were observed. Importantly, in Anorexia Nervosa, instrumental responding for low-calorie food increased with increasing severity of eating disorder psychopathology suggesting weight-loss directed behaviour. Future studies are warranted to enhance our understanding of deficits of reward-associated learning and to replicate and extend findings with regard to the impact of conditioned stimuli on instrumental responding. At present, our findings suggest that cognitive treatment interventions might be warranted that challenge dysfunctional beliefs about weight loss.

Assessment of Use and Preferences Regarding Internet-Based Health Care Delivery: Cross-Sectional Questionnaire Study.

BACKGROUND: There has been an incremental increase in the use of technology in health care delivery. Feasibility, acceptability, and efficacy of interventions based on internet technologies are supported by a growing body of evidence. OBJECTIVE: The aim of this study was to investigate use and preferences in the general adult population in Germany for remote, internet-based interaction (eg, email, videoconferencing, electronic medical records, apps). METHODS: A nationwide cross-sectional questionnaire survey in adults that was representative in terms of age, sex and educational level was carried out. RESULTS: A total of 22.16% (538/2428) of survey participants reported not using the internet for work or private use. The nonuser phenotype can be described as being older, having lower educational and income status, and living in less populated areas. The majority of participants within the cohort of internet users reported that they would not consider using electronic medical records (973/1849, 52.62%), apps (988/1854, 53.29%), or emails to report symptoms (1040/1838, 56.58%); teleconference with one (1185/1852, 63.98%) or more experts (1239/1853, 66.86%); or participate in video psychotherapy (1476/1853, 79.65%) for the purpose of medical consultation or treatment. Older age and lower educational level were the most robust predictors of assumed future denial of use. CONCLUSIONS: Our results point toward low use and preference rates among the general population for the use of telemedicine. It also seems that those who might benefit from telemedical interventions the most, are, in fact, those who are most hesitating. These low use and preference rates of eHealth should be considered prior to designing and providing future telemedical care, supporting the need for easy-to-use, data secure solutions.

Protective factors of depressive symptoms in adult cancer patients: The role of sense of coherence and posttraumatic growth in different time spans since diagnosis.

Purpose: The purpose of this study was to investigate the impact of posttraumatic growth (PTG) and sense of coherence (SOC) as protective factors on depressive symptoms at different time spans after cancer diagnosis. Design: In a cross-sectional study, adult cancer patients were recruited from the tumor clinics of the University Hospital in Erlangen (Germany) and from peer-support groups for cancer survivors. Sample: Participants included 157 adult patients with primary cancer or in remission (53.5% female; mean age: 58.0 ± 14.1 years; mean time since diagnosis: 46.7 ± 72.8 months) with various forms of cancer. Methods: Multiple linear regression analyses were conducted. The patients were divided into two groups (≤1 year and >1 year since diagnosis) to test the impact of PTG and SOC on depressive symptoms at different time intervals after diagnosis. The Posttraumatic Growth Inventory (PTGI), Sense of Coherence Scale (SOC-13), and Hospital Anxiety and Depression Scale (HADS) were applied. Findings: After controlling for major demographic and clinical variables, SOC (ß = -.489, p < .001) was found to be the only significant predictor for depressive symptoms ≤ 1 year after diagnosis; >1 year after diagnosis, SOC (ß = -.571, p < .001), PTG (ß = -.318, p = .002), and metastatic cancer (ß = .231, p = .023) were significant predictors of depressive symptoms (high levels of SOC as well as PTG, and having no metastatic cancer were associated with low manifestations of depressive symptoms). Conclusions: These findings suggest that SOC may be a protective factor against depressive symptoms in both the short as well as in the long term after cancer diagnosis, but PTG only in the long term. Implications for psychosocial providers or policy: To prevent the development of depressive symptoms in cancer patients, individuals with a low SOC should be detected and should receive psychological assistance.

Clinical management of females seeking fertility treatment and of pregnant females with eating disorders.

The presence of eating disorders (EDs) might have a significant impact upon pregnancy, birth, and the offspring's well-being. Thus, several specific aspects are to be considered by medical professionals when females with EDs either become pregnant or intend to undergo fertility treatment. Clinical management algorithms for gynaecologists and fertility specialists are missing. Here, based on currently available evidence on the topic, specific clinical recommendations are presented. Treatment by a mental health professional may be necessary for pregnant females suffering from acute EDs or prior to fertility treatment. Because the regulation of the menstrual cycle is known to be induced in the course of ED-specific treatment due to weight gain and eating behaviour stabilization, the necessity and drawbacks of fertility treatments in females with EDs are discussed.

[Implicit Self-Regulation of Food-Intake: Consequences for Psychotherapy]. / Die implizite Selbstregulation am Beispiel des Essverhaltens: Konsequenzen für die Psychotherapie.

Explicit processes of self-regulation require insight and control during implementation and are therefore often experienced as being strenuous, while implicit processes of steering behavior are automatic, rapid and effortless. However, self-regulation is not always either explicit or implicit; all variants ranging from those that are entirely automatic to those being entirely under control are present. As individuals are not aware of their underlying implicit modes of self-regulation, it is necessary to create an approach that is proximal to affective processing, by-passing the cognitive, verbal level. Promising approaches of this kind are such including embodied experiences or such shifting the body to a state, in which the apperception of implicit mechanisms is facilitated. Given that therapeutic work of self-regulation is in many cases carried out on an explicit level of processing, the need for novel, neurobiologically founded strategies intervening on the implicit (pre-verbal) level are called for. Correspondent paradigms, e. g. the approach-avoidance task (AAT) for the assessment of implicit processes are presented here with regard to food-intake regulation. This work is a narrative (qualitative) review aiming at illustrating the field of implicit bias research as well as the development of new implicit bias training paradigms to be used as add-on in future psychotherapeutic treatments. Therefore, a selection of relevant studies based on subjective criteria was made. Thus, this work is not a systematic review and does not claim to be an exhaustive description of studies of this kind.

[Development and validation of a questionnaire for patient competence in coping with cancer (PCQ)]. / Entwicklung und Validierung eines Fragebogens zur Patientenkompetenz im Umgang mit einer Krebserkrankung (PUK).

Development and validation of a questionnaire for patient competence in coping with cancer (PCQ) Objectives: The aim of the study was the development and evaluation of the psychometric properties of a self-assessment questionnaire for resource-orientated coping with cancer (Patient Competence Questionnaire, PCQ). Methods: In 420 patients and members of cancer support-groups item selection and evaluation of item properties, reliability (Cronbach's Alpha), validity (convergent and divergent) and factorial structure were performed in two studies. Results: The final version of the PCQ (18 items) demonstrated a Cronbach's Alpha between 0.71 and 0.91 for five subscales identified with exploratory factor analysis (religious/spiritual coping, coping competence, healthy lifestyle, information seeking, adaptability) and 0.85 for the total score. The PCQ shows a high convergent validity (r = 0.46) with the Freiburg Questionnaire on Coping with Illness (FKV) and significant correlations with depression (r = -0.23), posttraumatic growth (r = 0.65) and religiosity (r = 0.59). Conclusions: First analyses underline that the PCQ can be regarded as a valid and reliable instrument for assessing patients' resources in dealing with cancer.

The effect of dronabinol in a male patient with anorexia nervosa suffering from severe acute urge to be physically active.

OBJECTIVE: A 27-year-old male suffering from chronic anorexia nervosa was admitted for inpatient psychotherapy suffering from severe urge to be physically active. METHODS: An off-label treatment with dronabinol was initiated, to reduce his symptoms related to that urge. Several attempts to reduce symptoms including intensive psychotherapy and several psychopharmacological agents had failed in the past. RESULTS: Following treatment with 7.5 mg dronabinol twice a day, the patient reported a significant reduction in his acute urge to be physically active. Also eating disorder-specific cognitions and compulsive behaviors remitted. DISCUSSION: Previous studies have applied much lower doses and showed no effect of dronabinol upon the urge to be physically active. Up to date, the patient reported no side effects, especially no psychotropic effects. Implications of this case report are discussed.

Prospective, randomized, double-blind, placebo-controlled phase IIa clinical trial on the effects of an estrogen-progestin combination as add-on to inpatient psychotherapy in adult female patients suffering from anorexia nervosa.

BACKGROUND: There is a need for novel treatment approaches in anorexia nervosa (AN). While there is broad knowledge with regard to altered appetite regulation and neuropsychological deficits in AN patients on the one hand, and the effects of estrogen replacement upon neuropsychological performance in healthy subjects on the other, up to now, no study has implemented estrogen replacement in AN patients, in order to examine its effects upon AN-associated and general psychopathology, neuropsychological performance and concentrations of peptide components of the hypothalamus-pituitary-adrenal (HPA) axis and within appetite-regulating circuits. METHODS: This is a randomized placebo-controlled clinical trial on the effects of a 10-week oral estrogen replacement (combination of ethinyl estradiol 0.03 mg and dienogest 2 mg) in adult female AN patients. The primary target is the assessment of the impact of sex hormone replacement upon neuropsychological performance by means of a neuropsychological test battery consisting of a test for verbal intelligence, the Trail making test A and B, a Go/No-go paradigm with food cues and the Wisconsin Card Sorting Test. Secondary targets include a) the examination of safety and tolerability (as mirrored by the number of adverse events), b) assessments of the impact upon eating disorder-specific psychopathology by means of the Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Disorder Inventory-2 (EDI-2), c) the influence upon anxiety using the State-Trait-Anxiety Inventory (STAI), d) assessments of plasma cortisol levels during a dexamethasone-suppression test and appetite-regulating plasma peptides (ghrelin, leptin, insulin, glucose) during an oral glucose tolerance test and, e) a possible impact upon the prescription of antidepressants. DISCUSSION: This is the first study of its kind. There are no evidence-based psychopharmacological options for the treatment of AN. Thus, the results of this clinical trial may have a relevant impact on future treatment regimens. Novel approaches are necessary to improve rates of AN symptom remission and increase the rapidity of treatment response. Identifying the underlying biological (e.g. neuroendocrinological) factors that maintain AN or may predict patient treatment response represent critical future research directions. Continued efforts to incorporate novel pharmacological aspects into treatments will increase access to evidence-based care and help reduce the burden of AN. TRIAL REGISTRATION: European Clinical Trials Database, EudraCT number 2015-004184-36, registered November 2015; ClinicalTrials.gov Identifier: NCT03172533 , retrospectively registered May 2017.

Posttraumatic Stress Disorder, Quality of Life, and the Subjective Experience in Liver Transplant Recipients.

OBJECTIVE: A high prevalence of posttraumatic stress disorder (PTSD) symptoms among transplant recipients has been associated with a low adherence to treatment and poor survival. It is crucial to detect and prevent the development of posttraumatic stress in transplant settings. METHODS: We examined the prevalence of posttraumatic stress symptoms in 3 liver transplant recipients by means of the Essen Trauma Inventory (ETI), a self-report questionnaire. The Short Form-36 was used to assess the perceived health-related quality of life. Patients were asked to indicate the most traumatic events within the context of the liver transplantation procedure. RESULTS: Five patients (4.9%) fulfilled the criteria for PTSD related to liver disease or transplantation (ETI score greater than 27). In these patients, diagnosis was confirmed by a structured clinical interview. Fourteen (13.6%) patients had a partial PTSD with the ETI score less than 27 and greater than 16. Posttraumatic stress symptoms were significantly associated with perceived poor physical and mental health-related quality of life. Patients reported that the physicians' disclosure of diagnosis was experienced as traumatic, followed by treatment in an intensive care unit and the liver transplantation itself. CONCLUSIONS: The ETI resulted in prevalence rates for PTSD comparable to previous studies in liver transplantation settings. Medical professionals requested additional training in how to deliver severe diagnoses to patients.

Differential Diagnoses of Food-Related Gastrointestinal Symptoms in Patients with Anorexia Nervosa and Bulimia Nervosa: A Review of Literature.

OBJECTIVES: The present review investigates the prevalence and medical causes of food-related gastrointestinal symptoms in eating disorder (ED) patients and recommends a diagnostic algorithm based on the current literature. METHODS: A literature search was conducted, which included publications from January 2000 until January 2017 Results: Over 90% of ED patients suffer from food-related symptoms. There is no evidence for a higher prevalence of immunological or structural gastrointestinal disorders in ED patients compared to the healthy population. Most food-related symptoms in ED patients are likely to be functional. CONCLUSIONS: Diagnostic work-up of food-related symptoms in ED patients needs to be based on clinical history. Only if timing and quality of symptoms point towards a disorder independent from the ED is a comprehensive diagnostic work-up necessary.

Virtual reality jogging as a novel exposure paradigm for the acute urge to be physically active in patients with eating disorders: Implications for treatment.

The acute urge to be physically active is a relevant clinical phenomenon in patients suffering from eating disorders. In this study with n = 20 female patients with anorexia nervosa and n = 10 female patients with bulimia nervosa, a virtual reality (VR) jogging paradigm was applied as a novel highly immersive 3D exposure paradigm. Patients were asked to rate their acute urge to be physically active during the exposure procedure. A 10-item self-report questionnaire (smQ) was developed to capture the cognitive, emotional, and behavioral aspects of the acute urge to move. We hypothesized that exposure would lead to habituation of the urge to be physically active. We also hypothesized that leptin levels would be associated with the degree of the subjective urge to be physically active, while habituation would be associated with a decrease in stress hormones (α-amylase, cortisol, and cortisone in saliva). A statistically significant change in subjective scores in the smQ from baseline to postexposure was seen. Our novel VR paradigm may serve as a therapeutic tool for exposure and habituation of the urge of acutely engaging in physical activity in patients with eating disorders.

Up to a Third of Renal Transplant Recipients Have Deficiencies in Cognitive Functioning.

INTRODUCTION: Kidney transplantation is beneficial in improving cognitive abilities in patients with chronic kidney disease; however, there is still uncertainty concerning which cognitive domains benefit and to what extent. AIM: In the present study, cognitive functioning of renal transplant recipients was compared to normative data. Sociodemographic and clinical parameters that were associated with low cognitive performance were identified. DESIGN: A total of 109 renal transplant recipients (63% men) participated in the study, with a mean age of 51.8 (standard deviation [SD] = 14.2) years. The cognitive test battery consisted of measurements assessing memory, attention, executive function, reproductive, and deductive ability. RESULTS: In all tests, participants showed mean scores ranging within 1 SD of the population means. However, except for tests measuring memory, the percentage of participants scoring more than 1 SD below normed means was higher than expected in a normal distribution of performance. In certain tests, up to a third of the participants scored below average. Participants with continuous low performance (11%) showed higher age, poorer education, a longer time since transplantation, higher serum levels of urea and creatinine, and were more likely to have a deceased donor allograft. DISCUSSION: Altough cognitive performance in renal transplant recipients matches normative data and confirms former findings, the amount of patients scoring more than 1 SD below average suggests that there are a considerable number of patients whose cognitive performance in certain domains lies below those of the general population. The identified sociodemographic and biochemical factors might be helpful to identify renal transplant recipients at risk.