Regional decrease in gray matter volume is related to body dissatisfaction in anorexia nervosa.

Anorexia nervosa (AN) is a psychiatric disorder, in which the prognosis for some patients is poor. The etiology and effective treatments for AN have not been established. We examined morphometric changes in the brain of AN and clarified how the changes were associated with symptoms and pathophysiology. We enrolled 52 participants: 7 with the restrictive type of AN, 13 with the binge-eating/purging type, 3 with eating disorder not otherwise specified, and 29 healthy controls. Participants underwent T1-weighted MRI. Group differences between patients and controls in gray matter volume (GMV) were analyzed using voxel-based morphometry. Age and body mass index (BMI) were considered covariates. Correlations between regional GMVs and drive for thinness and body dissatisfaction were examined. Patients had decreased GMV in the superior/middle temporal gyrus (STG/MTG), pulvinar, and superior frontal gyrus after correction for age and BMI, and in the STG/MTG, middle frontal gyrus, and cingulate after correction for age. A correlational group difference was detected for body dissatisfaction and GMV in the STG. Our findings suggest that decreased GMV in the STG is related to body dissatisfaction that could come from impaired visuospatial perception, together with GMV decreases in several regions, which may be involved in development of AN.

Risk factors for elevated liver enzymes during refeeding of severely malnourished patients with eating disorders: a retrospective cohort study.

BACKGROUND: There are few previous reports regarding the cause and evolution of liver injury in patients with anorexia nervosa (AN) during the refeeding process, and its management remains controversial. This study aimed to determine the risk factors for elevated liver enzymes during refeeding and their effect on the therapeutic process in severely malnourished patients with eating disorders. METHODS: In a retrospective cohort study of 167 female inpatients in a single hospital from January 2004 to March 2015, 67 who had normal alanine aminotransferase (ALT) levels on admission were divided into two groups according to the presence or absence of elevated ALT levels during refeeding, and then compared. RESULTS: The median age and body mass index (BMI) of the patients on admission were 22 [interquartile range (IQR), 16-33] years and 12.2 (IQR, 11.1-13.0) kg/m2, respectively. Compared with their cohorts, significantly more patients in the early onset age group (<15 years old) had elevated ALT levels during refeeding (67% vs. 33%, p = 0.033), as did patients with longer median time to nadir BMI (3.0 vs. 0 days, p = 0.03). In addition, onset age [odds ratio (OR): 0.274; 95% confidence interval (CI): 0.077-0.981; p = 0.047] and time to nadir BMI (OR: 1.271; 95% CI: 1.035-1.56; p = 0.022) were significantly associated with the odds of elevated ALT levels during refeeding. CONCLUSIONS: The results of this study suggest that early age at onset may be a potential risk factor for elevated ALT levels during refeeding in severely malnourished patients with eating disorders. Furthermore, elevated ALT levels during refeeding were significantly associated with delay in the start of weight gain. No significant relationship was found between the amount of initial prescribed calories and elevated ALT levels during refeeding. The median time to maximum ALT was 27 (IQR, 21-38) days after the refeeding process started.

Dysfunction of response inhibition in eating disorders.

INTRODUCTION: Response inhibition in eating disorders (ED) has been studied using methods such as Go/No-go tasks and cognitive conflict tasks, but the results have been inconsistent with regard to the presence or absence of impaired response inhibition in ED. This may be due to variation across the studies in the characteristics of the tasks and in the degree of underweight of ED participants. METHOD: We investigated the presence or absence of impaired response inhibition in an ED patient group, including many severe cases (body mass index <15 kg/m(2)), by comparing the interference effect of ED patients and healthy participants with an arrow-space interference task as the cognitive conflict task. RESULTS: There was a significant interference effect on response time in healthy participants and ED patients, with no significant intergroup difference in response times. However, the interference effect on error rate was significantly greater in ED patients than healthy participants. There was no significant difference in this trend across different ED subtypes (restricting type anorexia nervosa, binge-eating/purging type anorexia nervosa, and eating disorder not otherwise specified). CONCLUSIONS: Attentional control such as focused attention and sustained attention are preserved in ED patients, but there appears to be dysfunction of response inhibition. This might be the basis of poor impulse control in the eating behavior of ED patients.

Association of Beck Depression Inventory score and Temperament and Character Inventory-125 in patients with eating disorders and severe malnutrition.

The authors investigated the association between personality and physical/mental status in malnourished patients with eating disorders. A total of 45 patients with anorexia nervosa, avoidant/restrictive food intake disorder, and other specified feeding or eating disorders were included and compared with 39 healthy controls. Personality characteristics and severity of depression were assessed using the Temperament and Character Inventory-125 and Beck's Depression Inventory. Depression correlated with harm avoidance and self-directedness in both cases and controls. Body mass index did not correlate with personality in either group. These findings should be verified by longitudinal studies with higher weight/weight recovered patients.

Social insecurity in relation to orbitofrontal activity in patients with eating disorders: a near-infrared spectroscopy study.

BACKGROUND: Functional neuroimaging techniques are widely used to elucidate changes in brain activity, and various questionnaires are used to investigate psychopathological features in patients with eating disorders (ED). It is well known that social skills and interpersonal difficulties are strongly associated with the psychopathology of patients with ED. However, few studies have examined the association between brain activity and social relationships in patients with ED, particularly in patients with extremely low body weight. METHODS: In this study, 22-channel near-infrared spectroscopy was used to quantify regional hemodynamic changes during a letter fluency task (LFT) in 20 female patients with ED with a mean body mass index of 14.0 kg/m(2) and 31 female controls (CTLs). Symptoms were assessed using the Eating Disorder Inventory-2 and Beck Depression Inventory. We hypothesized that frontal activity in patients with ED would be lower than in CTLs and would show different correlations with psychopathological features compared with CTLs. RESULTS: The LFT performance and score on the social insecurity subscale of the Eating Disorder Inventory-2 were significantly higher in the ED group than in the CTL group. The mean change in oxygenated hemoglobin (oxy-Hb) in bilateral frontal regions during the LFT was significantly smaller in the ED group than in the CTL group. Social insecurity score was positively correlated with the concentration of oxy-Hb in the bilateral orbitofrontal cortex in the ED group but not in the CTL group. CONCLUSIONS: These results suggest that activity of the orbitofrontal cortex is associated with social insecurity and disturbed in patients with ED. Therefore, disturbed orbitofrontal cortex activity may underlie the lack of insight and social isolation that is characteristic of patients with ED.

[Analysis of parent-child sleeping and living habits related to later bedtimes in children].

PURPOSE: To find the relationship between parents' sleeping and living behaviors and their children's sleeping habits, and to investigate factors specifically related to children staying up late in recent Japan. METHODS: During regular health check-ups of children at three local health centers in the city A, we recruited the parents of one-and-half-year-old and three-year-old children to participate in the Child Sleep Cohort Project (ChiSCoP). Parents of 184 children who consented to participation were mailed three questionnaires by placement method. These are "sleeping diary for 10 days," "sleeping and lifetime rhythm survey," and "emotional behavior assessment scale (CBCL : Child Behavior Checklist 2rd/3rd edition)," of which valid data on 178 children were collected over two years and analyzed. ANALYSIS: Participants' demographic data, perceived and actual sleeping and living habits, and bedtime patterns were compared among the groups classified by bedtime of children. Bedtimes were classified as early (before 21 : 00), normal (21 : 00 to 21 : 59), and late (after 22 : 00). Using one-way analysis of variance with two (early vs. late) and three bedtime categories, significant differences were found among the three bedtime categories about childcare environmental factors (meal, daytime activity, TV, nap, and bath). So we performed logistic regression analysis with "late bedtime" as the dependent variable and scores of environmental factors (upper or lower than median values) as independent variables in a stepwise manner to eliminate collinear variables and to obtain adjusted odds ratios. RESULTS: 1) Among the 178 children, 96 and 82 were recruited during the physical check-up for one-and-half-year-old and three-years-old, respectively. There were 49, 72, and 57 children in the early, normal, and late bedtime groups, respectively, and no significant difference in attribute factors was found. 2) In children of the early bedtime group, proportions of those with "efforts to establish good life rhythm" (P < 0.0001), "efforts to cultivate sleeping habits" (P < 0.0001), and "keeping a regular bedtime" (P < 0.05) were significantly higher, as well as for children who had more than 105 minutes of "daytime nap" compared to children who had less (P < 0.05). 3) Children's bedtimes were significantly correlated with "mother's wake-up time on weekdays" (r = 0.33) and "mother's bedtime on weekdays" (r = 0.33). Children's wake-up times were also correlated with "mother's wake-up time on weekdays and weekends" (r = 0.49) and "mother's bedtime on weekdays" (r = 0.34), which indicates that children's wake-up times had relationship with mother's sleeping and life habits. 4) Later "wake-up time on weekends" (odds ratio = 4.9) and "regular bedtime hour" (odds ratio = 3.53) were found to be the determinant of late bedtimes of children. CONCLUSIONS: To encourage earlier bedtimes in children, it is important to take he mother's sleeping and living habits into account and to maintain a regular wake-up and bedtime schedule across weekdays and weekends.

[Analysis of late bedtime and influencing factors for it with respect to infants' development age and sleep behavior of parents and children].

PURPOSE: To understand influencing factors for late bedtime of infants having nocturnal life, with respect to each development age and sleep behavior of parents and children. We researched on sleep-awake behaviors and ten-day sleep logs of 277 subjects, who registered for a three-year cohort survey. The cohort is recruited at the time of routine examinations for 4 month, 1.5 years, and 3 years, held at three Health and Welfare centers in Fukuoka city in September and October, 2007. We conducted two-way analysis of variance and post-hoc test of Turkey's multiple comparative tests. The independent variables are three age groups (infants, 1.5 years, and 3 years) and three bedtime categories (late: after 22 o'clock, normal: between 21 and 22 o'clock, and early: before 21 o'clock), and the dependent variables are background date, sleep parameter of parents and children, and factors of sleep behavior and so on. The qualitative data including physical conditions, growth status, frequencies of each life activity are analyzed by tabulation, and fulfillment in child raring is analyzed by stepwise multiple linear regression analysis with 15 objective variables, to bring out factors to induce nocturnal life. RESULTS: Children's bedtime had significant effect for bedtime variables. The bedtime difference was about 40 minutes between the early bedtime group and the late bedtime group. The early bedtime group had the earliest wake-up time among the all age groups, followed by the normal, and then the late bedtime group. Efforts to keep regular sleep and wake-up times were made greatly in the early bedtime group, and the normal and then the late bedtime group followed after. The mothers in the late bedtime group considened an ideal bedtime was around 21h although they were not able to realize it. The lengths of TV viewing and daytime nap had also significant effects for children's bedtimes. As a result of multiple comparisons, there were significant differences between the early and the late bedtime groups and between the normal and the late bedtime groups. For the bedtime of children, only mothers' total sleep hours on weekdays had a significant negative correlation, while all the other parameters were significantly and positively correlated. DISCUSSION: The study showed influencing factors for bedtime of children were mothers' routine duties in daily life, especially wake-up time, total sleep hours, daytime napping hours of children, and the length of TV viewing. This suggests that further effort on education for sleep environment management is needed.

[Early detection and initial treatment of depression].

Clinical interaction between primary care physicians and psychiatrists is important in the treatment of depression. Most depressive patients first visit to primary care physicians. In this paper, we explain early detection and initial treatment of depression to primary care physicians. They first should have a question about insomnia to their patients to detect depression. And we show seven principles in the initial treatment of depression to primary care physicians.

[Study of relationships between state of mental health and indicators of medical expenses].

OBJECTIVE: The purpose of this study is to determine the relationships between the state of mental health and indicators of medical expenses for inpatient, outpatient and dental services. METHODS: This study was conducted using data from 140 people (54 males and 86 females) who participated in a lifestyle intervention program. The result of General Health Questionnaire (GHQ)-30 survey performed in August 2003 was used as the indicator of mental health, whereas diagnoses based on International Classification of Diseases (ICD) 10 from medical expense claims in the 2003 fiscal year were used for disease classification by the Proportional Disease Magnitude (PDM) method. The subjects were classified into two groups by GHQ-30 score: low-score group (n=96) and high-score group (n=44). The differences between the two groups were compared by an unpaired t-test. RESULTS: For outpatient service in the high-score group, the medical expenses and the numbers of consulting days, medical expense claims and consultation cases at least two per month were significantly higher (p < 0.05) than those in the low-score group. However, there were no significant differences in the same indicators between inpatient and dental services. In the high-score group, the medical expenses of the XVIII group (symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified) of ICD10 were also significantly higher (p < 0.05) than those of the low-score group. CONCLUSIONS: The state of mental health is significantly associated with indicators of medical expenses for outpatient service. The medical expenses of a problematic non-mentally healthy group are significantly higher than those of a mentally healthy group.

[Relationship between the change of mental health and the improvement of lifestyle and physical health].

OBJECTIVES: The purpose of this study was to clarify the relationship between the change of mental health and the improvement of lifestyle and physical health in the lifestyle intervention program. METHODS: The study was conducted using data from 126 persons (50 males and 76 females) who participated in the 6-month lifestyle intervention program. We used the result of the General Health Questionnaire (GHQ)-30 as the indicator of mental health, the number of steps, surveys concerning caloric intake, and sleeping hours as the indicator of lifestyle, and body weight, BMI, blood pressure, triglycerides, total cholesterol, LDL cholesterol, HDL cholesterol and HBA1c. The subjects were classified into four groups based on the change of mental health: Group-GG, change from good to good (n = 80); Group-PG, change from poor to good (n = 25); Group-PP, change from poor to poor (n = 13); and Group-GP, change from good to poor (n = 8). The changes between pre-intervention and post-intervention were compared for each group by the paired t-test, and among the 4 groups by ANCOVA. RESULTS: In Group-GG, the number of steps (p < 0.01), calorie intake (p < 0.05) and sleeping hours (p < 0.01) were significantly improved, triglyceride was significantly decreased (p < 0.01), and total and HDL cholesterol were significantly increased (p < 0.01). However there were no significant changes in Group-GP. CONCLUSION: The state and change of mental health were found to be significantly associated with the improvement of lifestyle and physical health.

Weight reduction decreases soluble cellular adhesion molecules in obese women.

1. Obesity is known to increase the risk for atherosclerotic diseases. Serum levels of cellular adhesion molecules are reported to be indices of atherosclerosis. The aim of the present study was to assess the effect of weight reduction on soluble intercellular adhesion molecule-1 (sICAM-1) and soluble E-selectin (sE-selectin). 2. Eighteen non-diabetic normotensive obese women participated in a 3 month lifestyle-modification programme (intervention group). The programme consisted of lectures on diet, exercise sessions and behavioural modification by weight charting. Fourteen women who did not enter the programme served as controls. Body fat mass (FM) was measured by dual-energy X-ray absorptiometry. Soluble ICAM-1 and sE-selectin were measured by ELISA. 3. After 3 months, sICAM-1 and sE-selectin, as well as body FM, decreased in the intervention group (P < 0.001), while no changes were observed in the control group. The baseline sE-selectin was positively correlated with total body FM, trunk FM and percentage body fat (r = 0.50-0.57; P < 0.01), but not with leg FM. The change in sE-selectin was also correlated with changes in total body FM and trunk FM (both r = 0.46; P < 0.01). Baseline sICAM-1 was not significantly correlated with these variables. The associations between changes in sICAM-1 and changes in total body FM or trunk FM were of borderline significance (both r = 0.34; P = 0.06). Linear regression analysis indicated that the change in sE-selectin was explained by the change in trunk FM (R2 = 0.18; P < 0.01). 4. Soluble ICAM-1 and sE-selectin were positively correlated with obesity, especially with central obesity. Weight reduction resulted in decreases in soluble adhesion molecules, which may suggest a downregulation of endothelial activation.