Cognitive impairment and its association with homocysteine plasma levels in females with eating disorders - findings from the HEaD-study.

Higher plasma homocysteine levels have been found in females with anorexia nervosa. Furthermore, elevated homocysteine levels are associated with cognitive decline in dementia and healthy elderly people. Aim of this prospective study was to investigate a possible association between homocysteine serum levels and Clinically well known cognitive deficits in females with eating disorders. We found that moderately elevated plasma homocysteine levels were associated with normal short- and long-term verbal memory while normal plasma homocysteine levels were associated with poorer memory performance in 14 females with anorexia nervosa and 12 females with bulimia nervosa (logistic forward regression Wald chi(2)=8.566, OR=24.75, CI 2.89 - 212.23, P=0.003). These results indicate that under the special circumstances of eating disorders elevated homocysteine levels improve memory signaling possibly by facilitating long-term potentiation.

Homocysteine plasma levels are elevated in females with anorexia nervosa.

In the present pilot study significantly (T = 2.46, P = 0.018) higher levels of homocysteine were found in female anorectic patients (14.07, SD 7.3 micromol/l; n = 18) when compared with bulimic patients (10.25, SD 2.82; n = 27) or healthy controls (8.10, SD 1.79; n = 25). Since homocysteine can induce neuronal cell death leading to brain atrophy in different diseases and since it has been linked to depressive disorders these findings may have important implications for understanding common symptoms in patients suffering from anorexia.

Lipoprotein metabolism in patients with anorexia nervosa: a case-control study investigating the mechanisms leading to hypercholesterolaemia.

Hypercholesterolaemia is a common finding in patients with anorexia nervosa (AN). To investigate the type, frequency and pathophysiological mechanisms of changes in lipoprotein metabolism in AN we performed a cross-sectional study in fifty-eight female patients (mean age 24.2 years, BMI 15.3 (sd 1.5) kg/m(2)) and fifty-eight healthy age-matched controls (CO; BMI 22.2 (sd 1.7) kg/m(2)). Total cholesterol and LDL-cholesterol were higher in AN (5.5 (sd 1.3) v. 5.0 (sd 0.8) mmol/l, P=0.023; 3.6 (sd 1.1) v. 3.2 (sd 0.7) mmol/l, P=0.025 respectively). LDL particles were significantly more enriched in cholesterol and triacylglycerol in AN. In multiple regression analysis with LDL-cholesterol as the dependent and BMI, total body fat ( %), lathosterol:cholesterol ratio (endogenous cholesterol synthesis), 7alpha-hydroxy-4-cholesten-3-one (bile acid synthesis), non-esterified glycerol, free triiodothyronine and free thyroxine as independent variables, BMI was the only significant predictor in CO (R(2) 0.36, overall P=0.001). In AN the variability of LDL-cholesterol was significantly predicted by total body fat, free thyroxine, BMI, free triiodothyronine and non-esterified glycerol (R(2) 0.55, overall P<0.001). Subgroup analysis between restricting (AN-R) and binge-eating-purging patients (AN-B) indicated that in AN-R changes in lipoproteins, BMI and total body fat were more pronounced. AN-R patients had lower bile acid synthesis than AN-B (P=0.02). We conclude that elevated cholesterol concentrations in AN are generally due to an increase in LDL-cholesterol, which is mostly determined by the severe loss of body fat and the resulting changes in thyroid hormones, increased lipolysis and decreased endogenous cholesterol synthesis with resulting decrease in LDL removal. The clinical subtype of AN plays a major role in the mechanisms leading to hypercholesterolaemia.

Dexamethasone suppression test using saliva cortisol measurement in bulimia nervosa.

The assessment of cortisol in saliva has been proven a valid and reliable reflection of the respective unbound hormone in blood. In the present study, a standard dexamethasone suppression test (DST) with measures of salivary cortisol levels was performed in bulimic women without depression (DSM-IV; N=48) and healthy controls (N=24) matched for age. Feedback sensitivity was assessed using the standard DST with pre- and post-measures of salivary cortisol. Subjects were divided into suppressors and nonsuppressors according to their post-DST levels. Bulimic suppressors and nonsuppressors were compared for their basal cortisol levels, body weight (body mass index, BMI), previous episodes of anorexia nervosa, and their results in psychometric tests. A total of 16 (33.3%) out of 48 women with bulimia nervosa (BN) failed to suppress in the DST. Basal salivary cortisol levels were elevated in bulimic nonsuppressors. Significant differences between suppressors and nonsuppressors were found for body weight and previous episodes of anorexia nervosa. The results are in accordance with recent findings. They support the hypothesized association between low body weight and DST nonsuppression. Using saliva cortisol in the standard DST could be advantageous for studying bulimic patients. Furthermore, the results show the importance of determining HPA reagibility when measuring cortisol in bulimic patients.

Thirty-month outcome in patients with anorexia or bulimia nervosa and concomitant obsessive-compulsive disorder.

OBJECTIVE: The present study examines whether concomitant obsessive-compulsive disorder (OCD) indicates a poorer prognosis for patients with anorexia or bulimia nervosa. METHOD: Seventy-five female inpatients who met DSM-IV criteria for anorexia or bulimia nervosa took part in the follow-up study; 29 of these patients met criteria for concomitant OCD. All patients were investigated twice: during inpatient treatment and at follow-up 30 months after discharge. A semistructured diagnostic interview was used as well as the Eating Disorder Inventory and the Hamburg Obsession-Compulsion Inventory--Short Form. RESULTS: At follow-up, 51% (N = 38) of the patients no longer fulfilled DSM-IV criteria for anorexia or bulimia nervosa, but this improvement was not significantly correlated with the earlier presence of concomitant OCD. Analysis of variance for repeated measures revealed significant improvement over time on six of the eight Eating Disorder Inventory subscales for all patients regardless of OCD presence. Furthermore, no significant group effects or group-by-time interactions were identified. Clinically significant change, as reflected by improvement in scores on the Eating Disorder Inventory, was seen somewhat more often in patients without concomitant OCD, but this trend was not statistically significant. The patients whose eating disorders were most improved at follow-up also showed the highest reduction of obsessions and compulsions. CONCLUSIONS: The results suggest that concomitant OCD does not indicate a significantly poorer prognosis for patients with anorexia or bulimia nervosa.

[Effects of sexual abuse experiences on therapeutic outcome: study of eating disordered patients 2 years after inpatient psychotherapy]. / Auswirkungen sexueller Missbrauchserlebnisse auf das Therapieergebnis: Untersuchung essgestörter Patientinnen zwei Jahre nach einer stationären Psychotherapie.

The incidence of CSA in the general female population is supposed to range between 10 and 40 percent. There has not yet been done much research on how CSA victims differ in comparison to non-CSA patients in regard to psychotherapy outcome. This paper presents the results of a study concerning this problem. 670 female patients suffering from anorexia or bulimia nervosa, who had undergone an inpatient treatment were asked to fill out a questionnaire on their body image two years later. Moreover the patients were asked if their symptomatology persisted, if they had been satisfied with the therapy, how often they were ill (and unable to work) before and after the therapy and if they attempted suicide before or after the therapy. The questionnaires of 393 patients could be evaluated. 21.1% (n = 83) of them had a history of CSA. There were only few statistically significant differences: 1. CSA patients more often improved their attitude towards their head and their genitals in comparison to non-CSA patients. 2. They more often attempted suicide before therapy. 3. After the therapy only among the anorexic CSA patients suicidal attempts happened more often than among anorexics without CSA. These results suggest that CSA patients benefit from an inpatient therapy at least as well as non-CSA patients do. On the other hand further qualitative research is needed to understand more about the individual coping strategies of CSA victims.

[Compulsive symptoms in anorexia and bulimia nervosa]. / Zwangssymptome bei Anorexia und Bulimia nervosa.

The present study reports findings concerning the prevalence of obsessive-compulsive symptoms in eating disorders. Ninety-three women meeting DSM-III-R criteria for anorexia nervosa (AN) or bulimia nervosa (BN) were investigated using the Hamburg Obsession Compulsion Inventory HZI-K (Klepsch et al. 1993). Forty-six patients (49.5%) met the criteria for obsessive-compulsive disorder (OCD). This subgroup showed significant pathologically elevated scores on several scales of the Eating Disorder Inventory (Garner et al. 1983), and two different personality questionnaires (Freiburger Persönlichkeitsinventar, Fahrenberg et al. 1984; Giessen-Tests, Beckmann et al. 1983). The results demonstrate a high rate of OCD in AN and BN. The relationship between eating disorders and OCD and the question of clinical relevance is discussed.

Obsessive-compulsive disorder among patients with anorexia nervosa and bulimia nervosa.

OBJECTIVE: The present study sought to determine the prevalence of obsessive-compulsive disorder among patients with eating disorders. METHOD: Ninety-three women who met DSM-III-R criteria for anorexia nervosa or bulimia nervosa were investigated by using a semistructured diagnostic interview, the Yale-Brown Obsessive Compulsive Scale, and the Eating Disorder Inventory. RESULTS: Thirty-four patients (37%) met the DSM-III-R criteria for obsessive-compulsive disorder and also had a clinically significant score of 16 or higher on the Yale-Brown scale. These patients also had significantly higher, and hence pathological, mean scores on five of eight Eating Disorder Inventory scales than patients with eating disorders without concomitant obsessive-compulsive disorder. CONCLUSIONS: These results suggest that there is a high prevalence of obsessive-compulsive disorder among patients with anorexia and bulimia nervosa and that this prevalence may be correlated with the severity of the eating disorder.

[Eating disorder and confession. Is there a correlation between the type of eating disorder and specific religious affiliation?]. / Essstörung und Konfession. Gibt es einen Zusammenhang zwischen dem Typ der Essstörung und einer bestimmten Religionszugehörigkeit?

At the Klinik am Korso in Bad Oeynhausen, a special center for eating disorders, 789 patients from the years 1989 and 1990 were subdivided according to their diagnosis and religious affiliation and analyzed. The most striking result was a higher incidence of anorectic abstainers among Protestants and of bulimia with vomiting among Roman Catholics. This was linked up with the more internalized drive control of the Protestants. Further investigations are encouraged to analyze the essence of this connection.