Anorexia nervosa manifesting as massive ascites, hypercholesterolemia, and sequential binge eating in an 11-year-old girl: A case report.

RATIONALE: Anorexia nervosa (AN) is a serious eating disorder associated with a distorted body image. Hypercholesterolemia has been found in patients with AN but the mechanism of hyperlipidemia in AN remains little known. Ascites in patients with AN has been attributed to hypoalbuminemia and liver diseases, but massive ascites without the aforementioned etiologies has never been reported in AN. PATIENT CONCERNS: An 11-year-old girl was admitted for exclusion of organic underlying diseases due to severe body weight loss (18% within 3 weeks), poor appetite, and hypercholesterolemia (274 mg/dL). She complained of heartburn sensation, nausea, vomiting, constipation, and postprandial dull abdominal pain with fullness. DIAGNOSES: The patient's condition met with all 3 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for diagnosing AN. On admission, her total cholesterol level was 337 mg/dL and hypocomplementemia (C3 55.5 mg/dL) was also found. Abdominal sonography and computed tomography scans showed massive ascites. However, neither proteinuria nor hypoalbuminemia was found. Upper gastroduodenal endoscopy showed chronic superficial gastritis and colonoscopy revealed negative findings. Ascites obtained by paracentesis demonstrated a transudate without bacterial infection, tuberculosis, or pancreatitis. Exploratory laparoscopy showed nonpurulent ascites. However, biopsies from the small intestine, mesentery, and liver showed chronic inflammation and fibrosis. INTERVENTIONS: The intensive nutritional therapy by increasing total energy intake stepwise with a combination of high-energy formula and her favorite foods. OUTCOMES: Her hypercholesterolemia, hypocomplementemia, and massive ascites resolved after her weight was restored. She developed binge eating with continuous weight gain after discharge. Her weight significantly increased to an obese level (body mass index [BMI] 25.9 kg/m) after loss to follow-up for 4 years until she returned to our emergency room due to suicide attempt. CONCLUSION: Diagnostic crossover between subtypes in anorexia nervosa might be a potential risk factor for illness severity and poor prognosis. AN can manifest as massive ascites with normal albumin concentrations that could possibly be due to chronic inflammation of the intestinal serosa, mesentery, and peritoneal surface of the liver.

Does Bariatric Binge-Eating Size Matter? Conceptual Model and Empirical Support.

OBJECTIVE: Bariatric surgery affects the quantity of food individuals can eat, yet some individuals still experience loss of control (LOC) while eating. This cross-sectional study examined a new classification system for binge/LOC eating following bariatric surgery. METHODS: A total of 168 individuals who underwent bariatric surgery 6 months earlier and reported LOC eating were administered the Eating Disorder Examination-Bariatric Surgery Version interview and self-report measures of depressive symptoms, functional impairment, and physical and mental health-related quality of life. Three groups were created based on the largest LOC-eating episode determined by the Eating Disorder Examination-Bariatric Surgery Version interview as follows: (1) "traditional" objective binge-eating episodes, defined as eating unusually large quantities of food while having LOC; (2) "bariatric-objective binge eating," meaning unusually large quantities for postsurgical bariatric patients with LOC; and (3) "bariatric-subjective binge eating," meaning small quantities of food with LOC after surgery. RESULTS: In total, 75% (n = 126) met criteria for the bariatric-objective binge episodes group, 10% (n = 17) met criteria for the traditional objective binge-eating group, and 15% (n = 25) met criteria for the bariatric-subjective binge episodes group. The three groups differed significantly, with a graded pattern by binge size, in global eating-disorder psychopathology, depressive symptoms, and functional impairment but not quality of life. CONCLUSIONS: These findings provide empirical support for a new classification system for bariatric binge/LOC eating. Binge size was associated with distinct psychopathology. Longitudinal follow-up is needed to ascertain effects on clinical outcomes.

DEPRESSION, ANXIETY, AND BINGE EATING BEFORE AND AFTER BARIATRIC SURGERY: PROBLEMS THAT REMAIN.

BACKGROUND: As the number of surgeries increases and the elapsed time of the realization increases as well, the postoperative evaluations would become increasingly necessary. AIM: To assess the psychological profile before and after surgery. METHODS: Were evaluated 281 patients from the public service of bariatric surgery. In this study, 109 patients completed the evaluations before surgery (T0) and up to 23 months after surgery (T1); 128 completed the evaluations in T0 and between 24 months and 59 months after surgery (T2); and 44 completed the evaluations in T0 and 60 months after surgery (T3). A semi-structured interview, the Beck Depression Inventory (BDI), Beck Anxiety (BAI), and the Binge Eating Scale (BES) were used. RESULTS: There was a higher prevalence of female (83%), patients with less than 12 years of education (83%), and patients who have a partner (64%). Analyzing all times of evaluation, regarding anxiety, depression, and binge eating, there was a reduction in all symptoms in T1, pointing to significant improvements in the first 23 months after surgery. Already, in T2 and T3, there was an increase in all indicators of anxiety, depression, and binge eating pointing to the transient impact of weight loss or bariatric surgery on these symptoms. CONCLUSIONS: This study shows the importance of the continuous psychological evaluation and needs for the appropriate interventions for these patients who have undergone bariatric surgery, even after weight loss.

The Overlap Between Binge Eating Behaviors and Polycystic Ovarian Syndrome: An Etiological Integrative Model.

Studies indicate that Polycystic Ovarian Syndrome (PCOS) features (e.g. insulin instability, food cravings, overproduction of androgens and menstrual irregularities) are associated with increased appetite, impaired impulse control and feelings of body dissatisfaction. Counter intuitively, binge eating behaviors have been shown to reinforce PCOS symptomatology, precipitating concurrently body dissatisfaction, weight gain, insulin instability and overproduction of androgens. The present systematic literature review aspires to investigate the relationship between binge eating, in the broader context of eating disorder behaviors, and Polycystic Ovarian Syndrome (PCOS), taking into account shared characteristics between EDs (Eating Disorders) and PCOS. To address this aim, the PRISMA guidelines are adopted. A total of 21 studies, which investigated the presence of binge eating in PCOS population and the presence of PCOS in EDs population, were synthesized. Findings suggested that an increased prevalence of binge eating has been reported in women with Polycystic Ovarian Syndrome (PCOS); and that women suffering from BN (Bulimia Nervosa) and BED (Binge Eating Disorder) are more likely to display polycystic ovaries. Further research on their shared liability is required in order to inform more efficient prevention and treatment initiatives for populations presenting with comorbid features.

Depression, anxiety, and binge eating before and after bariatric surgery: problems that remain / Depressão, ansiedade e compulsão alimentar antes e após cirurgia bariátrica: problemas que persistem

ABSTRACT Background: As the number of surgeries increases and the elapsed time of the realization increases as well, the postoperative evaluations would become increasingly necessary. Aim: To assess the psychological profile before and after surgery. Methods: Were evaluated 281 patients from the public service of bariatric surgery. In this study, 109 patients completed the evaluations before surgery (T0) and up to 23 months after surgery (T1); 128 completed the evaluations in T0 and between 24 months and 59 months after surgery (T2); and 44 completed the evaluations in T0 and 60 months after surgery (T3). A semi-structured interview, the Beck Depression Inventory (BDI), Beck Anxiety (BAI), and the Binge Eating Scale (BES) were used. Results: There was a higher prevalence of female (83%), patients with less than 12 years of education (83%), and patients who have a partner (64%). Analyzing all times of evaluation, regarding anxiety, depression, and binge eating, there was a reduction in all symptoms in T1, pointing to significant improvements in the first 23 months after surgery. Already, in T2 and T3, there was an increase in all indicators of anxiety, depression, and binge eating pointing to the transient impact of weight loss or bariatric surgery on these symptoms. Conclusions: This study shows the importance of the continuous psychological evaluation and needs for the appropriate interventions for these patients who have undergone bariatric surgery, even after weight loss.

RESUMO Racional: Avaliações pós-operatórias têm se tornado necessárias em ciruriga bariátrica considerando o grande número de operações e o tempo decorrido de sua realização. Objetivo: Avaliar o perfil psicológico de pacientes de um serviço público de cirurgia bariátrica antes e após o procedimento. Métodos: Foram avaliados no total 281 pacientes. Destes, 109 completaram as avaliações antes (T0) e até 23 meses após a operação (T1); 128 completaram as avaliações em T0 e entre 24 meses e 59 meses após a operação (T2); e 44 completaram as avaliações em T0 e 60 meses após a operação (T3). Foram utilizados entrevista semi-estruturada, Inventário Beck de Depressão (BDI), Inventário Beck de Ansiedade (BAI) e Escala de Compulsção Alimentar Periódica (ECAP). Resultados: Observou-se maior prevalência de mulheres (83%), pacientes com menos de 12 anos de escolaridade (83%) e pacientes que tinham um companheiro(a) (64%). Ao analisar todos os tempos de avaliação, observou-se que, com relação à ansiedade, depressão e compulsão alimentar, houve redução de todos os sintomas em T1, apontando para melhorias significativas nos primeiros 23 meses após a operação. Já em T2 e T3 observou-se aumento de todos os indicadores de ansiedade, depressão e compulsão alimentar, apontando para o impacto transitório da perda de peso alcançada pela cirurgia bariátrica nesses sintomas. Conclusões: Este estudo mostra a importância de avaliações psicológicas contínuas e a necessidade de intervenções multiprofissionais apropriadas para pacientes submetidos à cirurgia bariátrica, mesmo após a perda de peso.

A Pilot Study on Telephone Cognitive Behavioral Therapy for Patients Six-Months Post-Bariatric Surgery.

OBJECTIVE: This study aimed to determine the feasibility and preliminary efficacy of a post-operative telephone-based cognitive behavioral therapy intervention (Tele-CBT) in improving eating pathology and psychosocial functioning. METHODS: Six-month post-operative bariatric surgery patients (n = 19) received six sessions of Tele-CBT. Study outcome variables included binge eating (BES), emotional eating (EES), depressive symptoms (PHQ-9), and anxiety symptoms (GAD-7). RESULTS: Retention was 73.7 % post-intervention. Tele-CBT resulted in significant reductions in mean difference scores on BES, EES-Total, EES-Anxiety, EES-Anger, PHQ9, and GAD7. Tele-CBT patients experienced a mean weight loss of 8.62 ± 15.02 kg between 6-months post-surgery (pre-Tele-CBT) and 12-months post-surgery. CONCLUSIONS: These preliminary results suggest that post-surgery Tele-CBT is feasible and can improve post-surgery symptoms of psychopathology in this uncontrolled study, supporting the need for a randomized controlled trial.

Loss-of-control eating following sleeve gastrectomy surgery.

BACKGROUND: Postoperative loss-of-control (LOC) eating is related to poorer weight loss outcomes after bariatric surgery, but little is known about LOC eating after sleeve gastrectomy surgery. OBJECTIVES: To examine LOC eating severity and weight loss after sleeve gastrectomy SETTING: University School of Medicine, United States METHODS: Participants were 71 individuals (84.5% female; n = 60) who underwent sleeve gastrectomy surgery within the previous 4 to 9 months and reported LOC eating at least once weekly during the previous 28 days. LOC eating was assessed using the Eating Disorder Examination (EDE) Bariatric Surgery Version. Current mean age and body mass index were 47.3 (SD = 10.1) years and 37.9 (SD = 8.2) kg/m2. Two groups, bariatric binge-eating disorder (Bar-BED) and loss-of-control eating only (LOC-only), were created based on modified binge-eating disorder (BED) criteria, which excluded the "unusually large quantity of food" criterion due to limited gastric capacity postsurgery. Bar-BED criteria mirrored BED criteria and consisted of the following: at least 12 LOC eating episodes over the prior 3 months (once weekly), 3 of 5 associated symptoms, marked distress over LOC eating, and lack of regular compensatory behaviors. RESULTS: Based on these revised criteria, 49.3% (n = 35) were classified as the Bar-BED group and 50.7% (n = 36) as the LOC-only group. Compared with the LOC-only group, the Bar-BED group had significantly greater EDE global and subscale scores and lower percent weight loss by 6 months postsurgery. CONCLUSION: Findings suggest LOC eating that parallels BED postsurgery is associated with poorer outcomes after sleeve gastrectomy including poorer weight loss and greater severity of eating-disorder psychopathology.

Binge-eating disorder and the outcome of bariatric surgery in a prospective, observational study: Two-year results.

OBJECTIVE: A previous study reported that preoperative binge-eating disorder (BED) did not attenuate weight loss at 12 months after bariatric surgery. This report extends the authors' prior study by examining weight loss at 24 months. METHODS: A modified intention-to-treat population was used to compare 24-month changes in weight among 59 participants treated with bariatric surgery, determined preoperatively to be free of a current eating disorder, with changes in 33 surgically treated participants with BED. Changes were also compared with 49 individuals with obesity and BED who sought lifestyle modification for weight loss. Analyses included all available data points and were adjusted for covariates. RESULTS: At month 24, surgically treated patients with BED preoperatively lost 18.6% of initial weight, compared with 23.9% for those without BED (P = 0.049). (Mean losses at month 12 had been 21.5% and 24.2%, respectively; P = 0.23.) Participants with BED who received lifestyle modification lost 5.6% at 24 months, significantly less than both groups of surgically treated patients (P < 0.001). CONCLUSIONS: These results suggest that preoperative BED attenuates long-term weight loss after bariatric surgery. We recommend that patients with this condition, as well as other eating disturbances, receive adjunctive behavioral support, the timing of which remains to be determined.

Eating Behavior, Low-Frequency Functional Mutations in the Melanocortin-4 Receptor (MC4R) Gene, and Outcomes of Bariatric Operations: A 6-Year Prospective Study.

OBJECTIVE: Data on the effects of eating behavior and genetics on outcomes of gastrointestinal surgery for diabesity have been sparse, often flawed, and controversial. We aimed to assess long-term outcomes of bariatric operations in patients characterized for eating behavior and rare mutations in the melanocortin-4 receptor (MC4R) gene, which is strongly implicated in energy balance. RESEARCH DESIGN AND METHODS: Between 1996 and 2005, 1,264 severely obese Swiss patients underwent current laparoscopic adjustable gastric banding, gastroduodenal bypass, or a hybrid operation. Of these, 872 patients were followed for a minimum of 6 years and were screened for MC4R mutations. Using regression models, we studied relationships between eating behavior and MC4R mutations and postoperative weight loss, complications, and reoperations after 6 years. RESULTS: At baseline, rare functional MC4R mutation carriers exhibited a significantly higher prevalence of binge eating disorder (BED) or loss-of-control eating independent of age, sex, and BMI. Six years after bariatric surgery, the mutation carriers had more major complications than wild-type subjects independent of age, baseline BMI, sex, operation type, and weight loss. Furthermore, high baseline BMI, male sex, BED, and functional MC4R mutations were independent predictors of higher reoperation rates. CONCLUSIONS: Sequencing of MC4R and eating typology, combined with stratification for sex and baseline BMI, might significantly improve patient allocation to banding or bypass operations for diabesity as well as reduce both complication and reoperation rates.

Food addiction associations with psychological distress among people with type 2 diabetes.

AIMS: To assess the relationship between a food addiction (FA) model and psychological distress among a type 2 diabetes (t2d) sample. METHODS: A cross-sectional study of 334 participants with t2d diagnoses were invited to complete a web-based questionnaire. We measured variables of psychological distress implementing the Depression Anxiety and Stress Scale (DASS-21), the Yale Food Addiction Scale (YFAS), and other factors associated with t2d. RESULTS: In our study a novel finding highlighted people with t2d meeting the FA criterion had significantly higher depression, anxiety, and stress scores as compared to participants who did not meet the FA criterion. Moreover, FA symptomology explained 35% of the unique variance in depression scores, 34% of the unique variance in anxiety scores, and 34% of the unique variance in stress scores, while surprisingly, BMI explained less than 1% of the unique variance in scores. CONCLUSION: We identified that psychological distress among people with t2d was associated with the FA model, apparently more so than BMI, thereby indicating further research being necessary lending support for future research in this realm. Moreover the FA model may be beneficial when addressing treatment approaches for psychological distress among people with t2d.

The influence of negative urgency, attentional bias, and emotional dimensions on palatable food consumption.

We tested a theoretical model concerning the role of attentional bias and negative affect in food consumption that offers important advances. We hypothesized that the effects of negative affect manipulations on food consumption vary as a function of trait levels of negative urgency (NU; tendency to act impulsively when distressed), and attentional bias and that the roles of emotional arousal and negative emotional valence differ and should be studied separately. 190 undergraduate women were randomly assigned to either an anger or neutral mood condition. Women in both conditions completed the Food Stroop, in which the presentation of food and neutral words were counterbalanced. After the task, participants were given the opportunity to eat mandarin oranges and/or chocolate candy while the experimenter was out of the room. The type and quantity of food consumed was counted after the participant departed. As hypothesized, the roles of emotional arousal and valence differed and the effect of the induced emotion was moderated by NU. Women high in NU who experienced emotional arousal were more likely to eat candy and consumed more candy than other women. Emotional valence had no effect on candy consumption. Neither increases in emotional arousal or emotional valence influenced attentional bias to food cues. Attentional bias was also unrelated to food consumption. The impact of negative mood inductions on palatable food consumption appears to operate through emotional arousal and not negative emotional valence, and it may operate primarily for women high in NU.

Paved with good intentions: Paradoxical eating responses to weight stigma.

Because body weight is largely seen as controllable, weight stigma-the social devaluation of those who are overweight-is not subject to the social norms that condemn open expression of racism and sexism. Indeed, rejection of peers based on perceptions of excess weight is normative. Since weight stigma is internalized, popular views (and often the views of physicians) have suggested that increasing the salience of weight stigma might produce a reduction in overeating and/or an increase in physical activity. However, that perspective is not rooted in scientific evidence. Recent randomized controlled designs demonstrate that stigma may promote overeating. Correlational evidence suggests that self-reported stigma experience is associated with risk for binge eating and decreased interest in physical exercise and dieting, for children and adults. In addition to reviewing these research studies, this paper examines the potential for intersectionality of stigma across multiple social identities and considers alternatives to stigmatizing weight loss interventions.

Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment.

Despite decades of research documenting consistent stigma and discrimination against individuals with obesity, weight stigma is rarely considered in obesity prevention and treatment efforts. In recent years, evidence has examined weight stigmatization as a unique contributor to negative health outcomes and behaviors that can promote and exacerbate obesity. This review summarizes findings from published studies within the past 4 years examining the relationship between weight stigma and maladaptive eating behaviors (binge eating and increased food consumption), physical activity, weight status (weight gain and loss and development of obesity), and physiological stress responses. Research evaluating the effects of weight stigma present in obesity-related public health campaigns is also highlighted. Evidence collectively demonstrates negative implications of stigmatization for weight-related health correlates and behaviors and suggests that addressing weight stigma in obesity prevention and treatment is warranted. Key questions for future research to further delineate the health effects of weight stigmatization are summarized.

Eating disorders and body image dissatisfaction among college students / Transtornos alimentares e insatisfação com a imagem corporal em estudantes universitários

Introduction: Body image dissatisfaction and disordered eating behavior increase during college. Objectives: To identify symptoms of eating disorders and body image dissatisfaction in college students and to verify the relationship between eating disorders and body image dissatisfaction. Methods: A cross-sectional study was conducted with 408 college students (283 females), aged 18-23y, enrolled in the first semester of health science in public universities from Recife-PE. Symptoms of eating disorders and body image dissatisfaction were assessed by self-report questionnaires (EAT-26, BITE, BES, BSQ). Results: Body image dissatisfaction was independently associated with a 22-fold increased risk for anorexia nervosa, 18-fold for bulimia nervosa and 25-fold for binge eating. Female college students (32.5%; CI95%=27.2-38.1%) have higher symptoms of eating disorders than males (18.4%; CI95%=12.3-25.9%). Specifically for bulimia, both females (26.1%; CI95%=21.3-31.5%) and males (21.6%; CI95%=15.1-29.5%) are at greater risk of developing this illness. Conclusion: The current findings provide preliminary evidence about risks of college health sciences students with body image dissatisfaction to develop eating disorders.

Introdução: Insatisfação com a imagem corporal e comportamentos alimentares inadequados aumentam durante a faculdade. Objetivo: Identificar sintomas de transtornos alimentares e insatisfação com a imagem corporal em universitários e verificar a correlação entre sintomas de transtornos alimentares e insatisfação com a imagem corporal. Métodos: Estudo transversal conduzido com 408 estudantes universitários (283 mulheres), idade 18 a 23 anos, matriculados no primeiro semestre de cursos de graduação da área da saúde. Sintomas de transtornos alimentares e insatisfação com a imagem corporal foram avaliados por questionários autoaplicáveis (EAT-26, BITE, BES, BSQ). Resultados: A imagem corporal foi associada com o aumento do risco em 22 vezes para anorexia nervosa, 18 vezes para bulimia nervosa e 25 vezes para compulsão alimentar. Mulheres (32,5%; IC95%=27,2-38,1%) apresentaram maior prevalência de sintomas quando compradas com homens (18,4%; CI95%=12,3-25,9%). Para bulimia, tanto mulheres (26,1%; CI95%=21,3-31,5%) quanto homens (21,6%; CI95%=15,1-29,5%) demonstraram elevado risco para o desenvolvimento da doença. Conclusão: Os resultados apresentam evidências preliminares sobre o risco de estudantes universitários da área da saúde com insatisfação da imagem corporal em desenvolver transtornos alimentes.

Resurgence of anorexic symptoms during smoking cessation in patients with a history of anorexia nervosa: An unseen problem?--Report of two cases.

This report describes a resurgence of anorexic symptoms during a smoking cessation program in two patients with a history of anorexia nervosa. These two events were identified among patients lost to follow-up by using a strategy implemented to limit early drop out. In both cases, the resurgence of anorexic symptoms occurred rapidly after having reached abstinence from tobacco and was described as a response to the weight gain they had experienced just after the start of smoking cessation. The smoking cessation process itself was considered as the most plausible explanation for these two events. Given the potential serious consequences, further research is needed to determine whether such events are frequent during smoking cessation but being unseen because of being hidden in the loss to follow-up. This report also suggests that systematic screening for both binge eating and anorexic behaviors during smoking cessation is warranted.

Psychiatric comorbidity in women with polycystic ovary syndrome.

AIM: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder that women experience during their reproductive years and is associated with many psychiatric disorders. This study sought to determine the existence of psychiatric disorders in women with untreated PCOS. Another objective of the study was to examine whether an association exists between psychiatric disorders, insulin resistance, and body mass index. MATERIAL AND METHODS: Women who met the Rotterdam criteria for PCOS (n = 88) were included. Structured Clinical Interviews for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edn were conducted. After the psychiatric evaluations, blood samples were obtained from the participants. RESULTS: Prevalence for all comorbid psychiatric disorders was 50% (n = 44). The most common psychiatric disorder was major depression (33%), followed by generalized anxiety disorder (13.6%) and binge-eating disorder (6.8%). No significant difference in body mass index and insulin resistance index scores was found between women with and without psychiatric disorders (P > 0.05 for both comparisons). CONCLUSION: A considerable number of women with PCOS experience a psychiatric disorder during their lifetime. Clinicians should be aware that women with PCOS are at a high risk for major depression, generalized anxiety disorder, and binge-eating disorder.

A case of hyperemesis in bulimia nervosa.

Bulimia nervosa is an eating disorder defined by recurrent episodes of binge eating followed by compensatory behaviors, primarily self-induced vomiting. Most common complications are due to purge behaviors and are frequently responsible for hospitalization. These include electrolyte disturbances, dehydration, hypovolemia, stomatitis, esophageal diseases, and functional impairment of the colon. However, an obstruction-like syndrome has never been reported. We report the case of a middle-age woman suffering from bulimia nervosa and referring at the emergency department with a 7-day story of hyperemesis responsible for an acute renal failure. During hospitalization, after the most important and common medical causes of hyperemesis were excluded, an upper gastrointestinal endoscopy was performed. The endoscopist reported the presence of an impressive bezoar, which underwent to mechanical fragmentation and biopsy sampling, revealing it was made up exclusively of liquorice wheels. An endoscopy performed few days after showed the complete dissolution of the bezoar, and the patient was discharged without any further gastrointestinal complaint.

Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease.

BACKGROUND: Behavioural disorders associated with compulsive use of dopaminergic drugs for Parkinson's disease (PD) such as dopamine dysregulation syndrome (DDS) and impulse control disorders (ICDs) may have devastating consequences and are challenging to manage. Whether or not such patients should undergo subthalamic nucleus (STN) deep brain stimulation (DBS) is controversial. A few case reports and small series have reported contrasting effects of STN DBS on dopamine misuse and ICDs, while a recent prospective study found clear beneficial effects of STN DBS on these disorders. METHODS: We conducted an observational study on 110 consecutive parkinsonian patients scheduled for STN DBS surgery. Patients were assessed preoperatively through extensive behavioural and psychiatric evaluations and divided into two groups: with or without compulsive dopaminergic medication use. Evaluations were repeated 1 year after surgery in both groups. RESULTS: Before surgery 18 patients (16.3%) were compulsive dopamine users of whom 12 (10.9%) fulfilled all criteria for DDS. 90% of these patients also had at least one ICD compared to 20% in the group without compulsive dopamine use. One year after surgery, one patient had persistent compulsive dopamine use, while no new occurrences were reported in the group without the condition before surgery. STN DBS did not provoke any major psychiatric complications and ICDs were reduced in all patients. CONCLUSIONS: Our results suggest that STN DBS may reduce compulsive use of dopaminergic medication and its behavioural consequences. Whether this improvement is the result of STN DBS or the consequence of better treatment management remains to be established.