Person-specific and pooled prediction models for binge eating, alcohol use and binge drinking in bulimia nervosa and alcohol use disorder.

BACKGROUND: Machine learning could predict binge behavior and help develop treatments for bulimia nervosa (BN) and alcohol use disorder (AUD). Therefore, this study evaluates person-specific and pooled prediction models for binge eating (BE), alcohol use, and binge drinking (BD) in daily life, and identifies the most important predictors. METHODS: A total of 120 patients (BN: 50; AUD: 51; BN/AUD: 19) participated in an experience sampling study, where over a period of 12 months they reported on their eating and drinking behaviors as well as on several other emotional, behavioral, and contextual factors in daily life. The study had a burst-measurement design, where assessments occurred eight times a day on Thursdays, Fridays, and Saturdays in seven bursts of three weeks. Afterwards, person-specific and pooled models were fit with elastic net regularized regression and evaluated with cross-validation. From these models, the variables with the 10% highest estimates were identified. RESULTS: The person-specific models had a median AUC of 0.61, 0.80, and 0.85 for BE, alcohol use, and BD respectively, while the pooled models had a median AUC of 0.70, 0.90, and 0.93. The most important predictors across the behaviors were craving and time of day. However, predictors concerning social context and affect differed among BE, alcohol use, and BD. CONCLUSIONS: Pooled models outperformed person-specific models and the models for alcohol use and BD outperformed those for BE. Future studies should explore how the performance of these models can be improved and how they can be used to deliver interventions in daily life.

['Slimmer's paralysis': peroneal neuropathy in anorexia nervosa]. / 'Slimmer's paralysis'; nervus peroneusletsel bij anorexia nervosa.

We describe the development of slimmer’s paralysis or ‘foot drop’ in a patient with anorexia nervosa caused by a transient peroneal nerve injury. This was caused by extreme weight loss in combination with frequently crossing the legs in the context of anorexia nervosa with body image distortion. The most important interventions were weight recovery, physical therapy and avoiding precipitating factors. The relevance of this case lies in the fact that a physical complication of a predominantly mental illness is described. Moreover, this is a possibly lesser-known complication among psychiatrists. This case reminds clinical psychiatrists that mental illness can occur together with somatic complications. It is important to be aware of the possibility of this combination, in order to allow for early intervention and avoid additional injuries. This case also emphasizes the importance of multidisciplinary cooperation with respect to mental illness, in particular eating disorders.

[Lichaam en geest bij anorexia nervosa; een systematisch literatuuroverzicht]. / Lichaam en geest bij anorexia nervosa; een systematisch literatuuroverzicht.

BACKGROUND: Body image disturbance is a key component in anorexia nervosa (AN). In the treatment of AN this disturbed perception of the body poses a hindrance for clinical improvement and weight gain. Mindfulness and yoga are associated with a positive effect on the symptomatology of eating disorders. AIM: We examined the therapeutical effect of mindfulness and yoga in the treatment of body image disturbances in AN patients. METHOD: A systematic search in four medical databases using the concepts: ‘anorexia nervosa’, ‘consciousness-based therapy’ and ‘body image’. Results were included in a qualitative analysis. RESULTS: 10 studies were included in our analysis of which 3 dealt with mindfulness, 6 with yoga and 1 discussed a mixed program of both interventions. CONCLUSION: We revealed a favourable effect of mindfulness and yoga on the symptoms of eating disorders among which AN. We also saw both quantitative and qualitative improvements of body image disturbance through general and specific measuring instruments. After the interventions the preoccupation and dissatisfaction with the body diminished together with the urge to lose weight. The heightened bodily awareness gave patients the ability to challenge negative assumptions about their bodies and resulted in increased bodily acceptation.

The impact of COVID-19-related smell and taste disorders on a patient with bulimia nervosa: a case report.

A large number of patients with COVID-19 will suffer from long-term smell and taste disorders (STD). These STD symptoms could have a significant impact on patients with an eating disorder (ED). To highlight this issue, a case is presented of a patient with bulimia nervosa who experienced COVID-19-relate STD symptoms. Clinicians should reassess patients with an ED who suffer from COVID-19 with STD symptomatology and potentially redirect treatment. More research is needed on STD symptoms in patients with an ED to improve our knowledge on the role of smell and taste in disordered eating behaviors and improve treatment guidelines.

[Diabetes mellitus and eating disorders: modified treatment is necessary]. / Diabetes mellitus en eetstoornissen: aangepaste behandeling nodig.

The combination of an eating disorder and diabetes mellitus type 1 is a serious double diagnosis. Compensation behavior is often present in the form of insulin restriction which can have debilitating health consequences. Studies on prevalence, diagnosis and mortality are well documented but literature regarding evidence-based treatments is limited. In this article we describe a case study of a patient with diabetes who was admitted to our treatment unit for eating disorders due to manipulation of her diabetes medication. On the basis of this case and a literature study, we conclude that the standard treatment for eating disorders is insufficient for this double diagnosis. An adapted treatment, aimed at both the eating disorder and the diabetes is necessary to increase the chance of recovery.

[Conversion and dissociation: together or separated?] / Conversie en dissociatie: samen of apart in de DSM?

BACKGROUND: Conversion and dissociation in their relationship have made a lot of pendulum movements over time between moving together and away from each other. In the run-up to the introduction of DSM-5, it was argued that conversion should be classified as a dissociative disorder, but this didn't happen. AIM: In this article, the clinical scientific evidence is examined for the relationship between conversion and dissociation. We provide an overview of the recent clinical studies that examine both syndromes together. We also investigate the main overlapping predisposing characteristics and psychopathological explanatory models of both syndromes. METHOD: Literature review in PubMed and PsycArticles. RESULTS: Our findings confirm that there is a large comorbidity between conversive and dissociative symptoms in clinical reality. Both syndromes have a high prevalence of reported trauma and emotion dysregulation. However, evidence for present biomarkers is still llimited. The underlying explanation models are applicable for both conversion and dissociation. CONCLUSION: We want to draw attention to the plea to bring conversion disorders back together with dissociative disorders. Moreover, the possible presence of trauma, the influential role of psychosocial stressors, the present psychiatric co-morbidity and the style of emotion regulation seem to justify the approach to conversion problems from a biopsychosocial perspective rather than from a purely biomedical perspective.

[Electroconvulsive therapy in the treatment of depression in anorexia nervosa]. / Elektroconvulsietherapie in de behandeling van depressie bij anorexia nervosa.

BACKGROUND: Often anorexia nervosa occurs with other psychiatric comorbidities of which mood disorders are the most frequent. Depressive feelings hamper the chance of a favourable outcome of this persistent disorder. In addition, the underweight makes antidepressants work suboptimal. Electroconvulsive therapy (ECT) offers an important therapeutic value in the treatment of mood disorders. We are investigating whether ECT can be an effective treatment method for patients with anorexia nervosa and major depressive disorder. AIM: Analysis of the literature on the possible effectiveness of electroconvulsive therapy (ECT) in the treatment of major depressive disorder and anorexia nervosa supplemented with a case report. METHOD: Literature study in PubMed, Web of Science and Embase and a case report. RESULTS: 262 published articles were found between 1955 and 2020, 16 were found to be relevant. CONCLUSION: From the literature, clinical recommendations cannot be made binding. No randomized controlled trials have been published on this subject. However, we saw in our case study and in the literature found that clearing the depressive symptoms through electroconvulsive therapy led to an improvement in food and fluid intake. ECT has no effect on their deranged thought pattern.

[Clinical zoanthropy: a woman with the rare delusion of being an animal]. / Klinische zoantropie; een vrouw met de zeldzame waan een dier te zijn.

Clinical zoanthropy, or the conviction of having turned into an animal, is a rare delusion. There are different views about its pathogenesis. This delusion can occur with an underlying psychiatric disorder, but it can also be secondary to structural or functional disorders of the brain. Additional investigations with brain imaging and electroencephalogram are therefore advised. Treatment for the underlying disorder is recommended. In this case report we describe a 54-year-old woman who was briefly convinced she was a chicken, followed by a generalized seizure. We discuss the epidemiology, theories about pathogenesis and treatment advice for clinical zoanthropy. We also discuss the possible relevance of epilepsy to this matter. With this case report, we hope to contribute to documenting this rare, but possibly underreported phenomenon.

Prednisolone induces osteoporosis-like phenotype in regenerating zebrafish scales.

UNLABELLED: We demonstrate that glucocorticoids induce an osteoporotic phenotype in regenerating scales of zebrafish. Exposure to prednisolone results in altered mineral content, enhanced matrix breakdown, and an osteoporotic gene-expression profile in osteoblasts and osteoclasts. This highlights that the zebrafish scale provides a powerful tool for preclinical osteoporosis research. INTRODUCTION: This study aims to evaluate whether glucocorticoid (prednisolone) treatment of zebrafish induces an osteoporotic phenotype in regenerating scales. Scales, a readily accessible dermal bone tissue, may provide a tool to study direct osteogenesis and its disturbance by glucocorticoids. METHODS: In adult zebrafish, treated with 25 µM prednisolone phosphate via the water, scales were removed and allowed to regenerate. During regeneration scale morphology and the molar calcium/phosphorus ratio in scales were assessed and osteoblast and osteoclast activities were monitored by time profiling of cell-specific genes; mineralization was visualized by Von Kossa staining, osteoclast activity by tartrate-resistant acid phosphatase histochemistry. RESULTS: Prednisolone (compared to controls) enhances osteoclast activity and matrix resorption and slows down the build up of the calcium/phosphorus molar ratio indicative of altered crystal maturation. Prednisolone treatment further impedes regeneration through a shift in the time profiles of osteoblast and osteoclast genes that commensurates with an osteoporosis-like imbalance in bone formation. CONCLUSIONS: A glucocorticoid-induced osteoporosis phenotype as seen in mammals was induced in regenerating scalar bone of zebrafish treated with prednisolone. An unsurpassed convenience and low cost then make the zebrafish scale a superior model for preclinical studies in osteoporosis research.

[Sexuality in eating-disorder patients]. / Seksualiteit bij vrouwelijke patiënten met een eetstoornis.

BACKGROUND: A link is suspected between eating disorders and dysfunctional sexuality. The grounds for this link are thought to be clinical, biological and psychological. AIM: To find out from the literature what is known about sexuality in patients with eating disorders, to identify differences related to subtypes of the disorders and to ascertain whether sexuality can play a role in the diagnosis and treatment of various types of eating disorders. METHOD: We studied the research literature with the help of PubMed. RESULTS: Patients with eating disorders are more likely to have sexual problems; these include reduced libido, reduced sexual activity and sexual dissatisfaction. The distorted body image leads to the avoidance of sexual activity. Anorexia patients are more negative about sexuality and have a greater loss of libido than do bulimia patients, who experiment more with sex. CONCLUSION: Patients with eating disorders experience sexual dysfunction, but there are clear differences between the various eating-disorder subtypes. It is advisable that, in the future, sexuality should be included in the outcome of research in eating disorders. This step will help researchers to evaluate the effect that treatment can have on the outcome of the eating disorder.

Affinity purification of in vivo assembled whirlin-associated protein complexes from the zebrafish retina.

Mutations in WHRN lead to Usher syndrome type 2d or to non-syndromic hearing impairment. The WHRN-encoded gene product whirlin directly interacts with the intracellular regions of the other two Usher syndrome type 2-associated proteins, usherin and ADGRV1. In photoreceptor cells, this protein complex constitutes fibrous links between the periciliary membrane and the connecting cilium. However, the molecular mechanism(s) of retinal degeneration due to compromised formation and function of the USH2-associated protein complex remains elusive. To unravel this pathogenic mechanism, we isolated and characterized whirlin-associated protein complexes from zebrafish photoreceptor cells. We generated transgenic zebrafish that express Strep/FLAG-tagged Whrna, a zebrafish ortholog of human whirlin, under the control of a photoreceptor-specific promoter. Affinity purification of Strep/FLAG-tagged Whrna and associated proteins from adult transgenic zebrafish retinas followed by mass spectrometry identified 19 novel candidate associated proteins. Pull down experiments and dedicated yeast two-hybrid assays confirmed the association of Whrna with 7 of the co-purified proteins. Several of the co-purified proteins are part of the synaptic proteome, which indicates a role for whirlin in the photoreceptor synapse. Future studies will elucidate which of the newly identified protein-protein interactions contribute to the development of the retinal phenotype observed in USH2d patients. SIGNIFICANCE: Since protein-protein interactions identified using targeted in vitro studies do not always recapitulate interactions that are functionally relevant in vivo, we established a transgenic zebrafish line that stably expresses a Strep/FLAG-tagged ortholog of human whirlin (SF-Whrna) in photoreceptor cells. Affinity purification of in vivo-assembled SF-Whrna-associated protein complexes from retinal lysates followed by mass spectrometry, identified 19 novel candidate interaction partners, many of which are enriched in the synaptic proteome. Two human orthologs of the identified candidate interaction partners, FRMPD4 and Kir2.3, were validated as direct interaction partners of human whirlin using a yeast two-hybrid assay. The strong connection of whirlin with postsynaptic density proteins was not identified in previous in vitro protein-protein interaction assays, presumably due to the absence of a biologically relevant context. Isolation and identification of in vivo-assembled whirlin-associated protein complexes from the tissue of interest is therefore a powerful methodology to obtain novel insight into tissue specific protein-protein interactions and has the potential to improve significantly our understanding of the function of whirlin and the molecular pathogenesis underlying Usher syndrome type 2.

Interplay of Val66Met and BDNF methylation: effect on reward learning and cognitive performance in major depression.

BACKGROUND: There is a growing interest in the role of brain-derived neurotrophic factor (BDNF) in major depressive disorder (MDD). BDNF potentially exhibits opposite effects in the pathways linked to anhedonia and reward learning on the one hand and cognitive performance, on the other hand. However, the epigenetic mechanisms behind this remain unknown. In the present study, we aimed to investigate the interplay of DNA methylation of different BDNF exons and the common Val66Met polymorphism on anhedonia, reward learning and cognitive performance in MDD. METHODS: We recruited 80 depressed patients and 58 age- and gender-matched healthy controls. Participants underwent clinical assessment including neuropsychological testing and a probabilistic reward task to assess reward learning. Val66Met polymorphism and DNA methylation of BDNF promoters I, IV and exon IX were assessed from whole blood derived DNA, using pyrosequencing. RESULTS: BDNF promoter I methylation was lower in MDD patients (p = 0.042) and was negatively associated with self-reported anhedonia. In depressed patients, both Val66Met polymorphism and DNA methylation of promoter I were significantly associated with reward bias (p < 0.050 and p = 0.040, respectively), without an interaction effect. On the other hand, methylation of exon IX had a negative impact on executive functioning (p = 0.002) and mediated the effect of Val66Met on this outcome in patients with MDD. CONCLUSIONS: Our results provide the first evidence of Val66Met susceptibility to differential epigenetic regulation of BDNF exons in reward learning and executive functioning in MDD, which needs to be further explored.

[De Clérambault syndrome. A case report and a review of the literature on the difference between primary and secondary erotomania]. / Het syndroom van De Clérambault. Een gevalsbeschrijving en literatuuronderzoek naar het onderscheid tussen primaire en secundaire erotomanie.

This case report is about a female patient with an erotomanic delusion, who is convinced that a man is deeply in love with her. Because the specific course of primary erotomania and its response to treatment have been documented, the literature was studied to find out whether it distinguishes between primary and secondary erotomania. The search, however, showed that erotomania occurs so rarely and is defined in such ambiguous terms that it is impossible to divide these subtypes into two separate entities.