Serotonin transporter polymorphism and potential response to SSRIs in bulimia nervosa.
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Bulimia↗
Biomedical subjects
A Favaro
Publications and source records attributed to A Favaro.
Gemfibrozil improves insulin sensitivity and flow-mediated vasodilatation in type 2 diabetic patients.
BACKGROUND: Endothelial dysfunction is an early feature of atherosclerosis. The relationship between insulin action and hypertriglyceridaemia on endothelial function is still debated. MATERIALS AND METHODS: This study was designed to determine the effect of a 3 month treatment with Gemfibrozil (GF) on flow-mediated vasodilatation and insulin sensitivity. Ten type 2 diabetic patients were randomised in crossover, double blind fashion, either to GF, 600 mg b.i.d. or placebo, for 12 weeks. Lipid profile, low-density lipoprotein (LDL) distribution and flotation properties, insulin action and flow-mediated vasodilatation (FMD) by brachial artery ultrasound, were assessed. RESULTS: GF decreased serum triglyceride (TG) concentration with an absolute difference of 1.79 +/- 1.28 mmol L-1 (P < 0.0016) between active treatment and placebo, and significantly increased serum high-density lipoprotein (HDL) cholesterol (P = 0.0233). No differences were observed in total, intermediate-density lipoproteins (IDL), LDL cholesterol concentration and LDL peak buoyancy between treatments. GF also improved SI, an index of insulin action (P = 0.005). The FMD was 7 +/- 3% in the baseline condition, 7 +/- 2% during placebo and 14 +/- 3% after GF (P < 0.006). CONCLUSIONS: GF treatment improves both insulin action and flow-mediated vasodilatation in type 2 diabetic patients. The reduction of TG concentration allows the simultaneous correction of two important components of the metabolic syndrome.
Aged↗
Insulin-like growth factor 1 (IGF-1), a nutritional marker in patients with eating disorders.
BACKGROUND AND AIMS: Though low levels of insulin-like growth factor-1 (IGF-1) have been repeatedly reported in patients with eating disorders, the nutritional significance of IGF-1 has not been evaluated. The study aimed to assess the utility of IGF-1 for screening malnutrition and for monitoring nutrition intervention in patients with eating disorders. METHODS: IGF-1 and nutritional status were evaluated in 82 patients, 59 with anorexia nervosa (AN), and 23 with bulimia nervosa (BN). Nutritional assessment included the evaluation of body mass index (BMI), body fat (FAT) and muscle mass (MM), assessed by skinfold anthropometry, serum albumin, transthyretin and retinol-binding protein, energy and protein intake. IGF-1 and nutritional parameters were reevaluated in the early phase of refeeding (2-4 weeks) in 20 AN patients who entered a refeeding program. RESULTS: Mean IGF-1 z-score was -1.74+/-0.74 in AN, and -0.74+/-0.91 in BN. Serum proteins were reduced in only a minority of patients. IGF-1 correlated with BMI (r=0.64), FAT (r=0.57), MAMC (mid-arm muscle circumference) (r=0.58) and MM (r=0.66) (P<0.001), while it did not correlate with serum proteins. In the early phase of nutritional repletion serum proteins and anthropometric parameters did not vary significantly, while a prompt and marked increase (73.9%) of IGF-1 was observed. CONCLUSIONS: IGF-1 represents a biochemical marker of malnutrition and a sensitive index of nutritional repletion in patients with eating disorders.
Adult↗
Sertraline in the treatment of restricting anorexia nervosa: an open controlled trial.
Few studies to date have examined the usefulness of selective serotonin reuptake inhibitors (SSRIs) in an outpatient multidisciplinary treatment of anoxrexia nervosa. The present study consists of an open, controlled trial of sertraline in a sample of 11 restricting-type anorexics, treated in an outpatient setting, compared with a control group of patients with similar characteristics. All subjects were assessed by means of a structured interview and self-reported questionnaires at baseline and after 14 weeks of treatment. Body weight and diagnostic status were evaluated again after a 64-week follow-up. At the 14-week follow-up, the sertraline group reported a significantly greater improvement of depressive symptoms, ineffectiveness, lack of interoceptive awareness, and perfectionism when compared to the control group. Both groups reported a significant improvement in body weight. At the 64-week follow-up, only one patient of the sertraline group and five patients of the control group still had a full diagnosis of an eating disorder. Further studies are necessary to define the role of sertraline and of other SSRIs in the treatment of anorexia nervosa.
Adolescent↗
Predictors of sertraline discontinuation syndrome in anorexia nervosa.
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Anorexia Nervosa↗
Repair of congenital mitral valve dysplasia in infants and children: is it always possible?
OBJECTIVES: Surgical management of congenital malformation of the mitral valve (MV) in the pediatric age group remains a therapeutic challenge for the wide spectrum of the morphological abnormalities and the high incidence of associated cardiac anomalies. We reviewed our experience so as to assess whether MV conservative surgery is always advisable and its results are superior to MV replacement. METHODS: Thirty-four consecutive children (20 male and 14 female) with a mean age of 5.9 years (range 45 days-18 years) treated surgically for congenital MV disease between January 1987 and June 1999. Four patients (11.7%) were under 12 months of age, while 21 patients (62%) were younger than 5 years. Twenty-two patients presented with MV incompetence (or prevalent incompetence), while 12 presented with stenosis (or prevalent stenosis). Associated cardiac lesions were present in 22 patients (62.8%). RESULTS: Mitral valve reconstruction was possible in all. There were no operative deaths. Three patients required reoperation for MV restenosis (a re-repair in one and MV replacement with mechanical prosthesis in two) 4 months, 27 months and 5.6 years after repair with no operative deaths. There was only one late death for prosthetic valve thrombosis. Follow-up data reveal that the 33 surviving patients are asymptomatic and well 4 months-12 years (mean 72 months) after surgery. At 12 years, actuarial survival and freedom from reoperation are 96.8 and 85.9%, respectively. Echocardiography performed in all of them shows no or mild incompetence or stenosis in 26 (78%), while residual moderate MV incompetence persists in six. CONCLUSIONS: Our experience indicates that MV reconstructive procedures in infants and children with congenital MV dysplasia may be effective and reliable with low mortality and low incidence of reoperation rate. Mitral valve repair should always be attempted, especially in infants, despite the frequent severity of MV dysplasia, to avoid the drawbacks of the currently available prostheses.
Adolescent↗
The effects of trauma among kidnap victims in Sardinia, Italy.
BACKGROUND: No study to date has investigated the effects of the trauma of being kidnapped for ransom. In the present study, we aimed to assess the general health status and the presence of post-traumatic stress disorder (PTSD) and major depression (MDD) in a sample of kidnap victims. We also focused attention on dissociative experiences and on the development of the Stockholm syndrome during captivity. METHODS: We investigated the traumatic experiences and reported general health status of 24 kidnap victims using a semistructured interview. The Structured Clinical Interview for DSM-IV was used to assess the presence of PTSD and MDD. The Dissociative Experiences Scale was also administered. RESULTS: The lifetime frequency of PTSD and MDD were 45.9% and 37.5% respectively. The Stockholm syndrome had been present in 50% of the sample during captivity. The presence of PTSD can be predicted by the number of violent experiences, whereas the number of humiliating or deprivation experiences predicts the development of the Stockholm syndrome. Subjects with both PTSD and the Stockholm syndrome reported a greater number of physical complaints at the interview. CONCLUSIONS: There is no significant connection between PTSD and the Stockholm syndrome. Both are indices of the severity of the trauma of being kidnapped, but they are associated with different aspects of the traumatic experience. The presence of both syndromes appears to have a detrimental effect on physical health.
Adult↗
Binge eating and eating attitudes among Nazi concentration camp survivors.
BACKGROUND: Prisoners in Nazi concentration camps lived through extreme situations that included starvation. We test our hypothesis that there is a greater lifetime presence of binge eating among survivors from concentration camps than in a control group. METHODS: The subjects were 51 political prisoners who survived Nazi concentration camps and 47 ex-partisans of similar age and sex. A clinical interview investigated the lifetime occurrence of binge eating. The Eating Attitudes Test was also administered. RESULTS: The mean reported loss of weight among survivors was 27-3 kg. Thirty-three per cent of them and 4% of the ex-partisans reported going on eating binges at some time in their lives (P < 0.0007). There was no significant difference in the Eating Attitudes Test scores of survivors and ex-partisans, but, among survivors, the Bulimia subscale significantly discriminated subjects who reported current binge eating. CONCLUSIONS: Our study confirms that subjects who have survived a period of extreme food deprivation are more likely to develop binge eating behaviour.
Aged↗
Self-injurious behavior in anorexia nervosa.
Recent reports have postulated the existence of two different types of self-injurious behavior: impulsive and compulsive. The aim of the present study is to analyze the dimensionality of self-injurious behavior and to study the link between self-injurious behavior and clinical features in anorexia nervosa. The study involved 236 consecutive patients with anorexia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-reported questionnaires, such as the Eating Disorders Inventory and Hopkins Symptom Checklist. A principal component analysis was used to study the dimensionality of different types of self-injurious behavior, including purging. Our findings confirm the distinction between impulsive and compulsive self-injurious behavior. The dimensions appear to be represented as a continuum in both the anorexia nervosa diagnostic subgroups. A third distinct dimension emerged that included self-induced vomiting and laxative/diuretics abuse. Childhood sexual abuse and anxiety significantly predict the presence of impulsive self-injury, whereas obsessionality and age predict compulsive self-injury. The coexistence of a positive score on both dimensions of self-injurious behavior was the strongest predictor of treatment dropout. The present study highlights the importance of self-injurious behavior; it should be given due consideration in future outcome studies on anorexia nervosa
Adolescent↗
Differences between binge eating disorder and nonpurging bulimia nervosa.
OBJECTIVE: To compare the pathway to binge eating and clinical characteristics of binge eating disorder patients (BED) and nonpurging bulimics. METHODS: The subjects were 45 nonpurging bulimics and 45 BED patients who consecutively sought treatment in an outpatient eating disorders unit. The subjects underwent a clinical interview and replied to the Eating Disorders Inventory and the Hopkins Symptom Checklist. RESULTS: In most of the nonpurging bulimics (89%), binge eating is preceded by dieting and weight loss, whereas among BED patients the pathway to binge eating is more variable. Previous episodes of anorexia nervosa are significantly more frequent among nonpurging bulimics than among BED patients. The two groups did not differ in other clinical and psychological characteristics, such as psychiatric symptoms, frequency of binging, and impulsivity traits. However, on many of the variables, the BED group shows a significantly greater variance. DISCUSSION: Unlike nonpurging bulimics, BED patients appear to form a more heterogeneous group.
Adolescent↗
Post-traumatic stress disorder and major depression among Italian Nazi concentration camp survivors: a controlled study 50 years later.
BACKGROUND: The study aimed to assess the current and lifetime rates of post-traumatic stress disorder (PTSD) and major depression (MDD) among Nazi concentration camps survivors. METHODS: We investigated 51 Italian political deportees and 47 Resistance Movement veterans who reported traumatic experiences during active service. The Structured Clinical Interview for DSM-IV was used to assess the presence of PTSD and MDD. The Dissociative Experiences Scale and the shorter version of the Hopkins Symptoms Checklist were also administered. RESULTS: The lifetime rates of PTSD and MDD were 35.3% and 45.1% respectively among deportees and 4.3% and 6.4% among former partisans. The current rates for PTSD and MDD were 25.5% and 33.3% among deportees and 4.3% and 4.3% among former partisans. Dissociative symptoms were more severe among deportees than among Resistance movement veterans. CONCLUSIONS: Concentration camp internment, even for political reasons, appears to have severe long-term psychiatric consequences.
Aged↗
Traumatic experiences, posttraumatic stress disorder, and dissociative symptoms in a group of refugees from former Yugoslavia.
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Adolescent↗
A preventive intervention program in adolescent schoolgirls: a longitudinal study.
BACKGROUND: To explore the impact of a prevention program on the eating and body attitudes of a sample of adolescent schoolgirls. METHODS: The program involved lessons and group discussions of general adolescent problems and eating disorders. A total of 254 16-year-old schoolgirls were evaluated, of whom 154 participated in the program and a further 154 subjects formed the control group. Variations in weight, Eating Attitudes Test and Eating Disorders Inventory at a 1-year follow-up were compared for the two groups. RESULTS: Among high-risk subjects, no significant differences were found between the prevention and the control group. The preventive program appeared to reduce significantly body dissatisfaction and to decrease the risk of bulimic attitudes in low-risk subjects. CONCLUSIONS: Providing schoolgirls with the correct information about eating disorders did not encourage unhealthy attitudes to eating and weight regulation practices. However, for high-risk subjects more intensive and specific intervention may be required, for which further research is needed.
Adolescent↗
Water intoxication in anorexia nervosa: a case report.
OBJECTIVE AND METHOD: A case of water intoxication in a patient with anorexia nervosa is reported. RESULTS: Differently from the other cases previously reported, the patient had a long duration of illness (13 years). A compulsory treatment was necessary since the patient refused any cooperation and her weight had dropped to 19.5 kg (body mass index = 8.3). After a slow weight recovery and a multidisciplinary inpatient treatment of 15 months, the patient started an outpatient treatment. One month later she complained of headache, vomiting, and grand-mal seizures with hyponatremia, hypokalemia, hypochloremia, and low urine osmolarity. Later, we were able to learn from her that some weeks before she had begun to drink large amounts of water before the weight control visits to maintain the target weight. After this episode, she carried on the abnormal drinking habit, although she knew the risks related to excessive drinking. DISCUSSION: Studies on larger samples are needed to understand the risk factors for abnormal drinking habits in anorexia nervosa.
Adult↗
Impulsive and compulsive self-injurious behavior in bulimia nervosa: prevalence and psychological correlates.
A specific link between self-injurious behavior and bulimia nervosa has been observed. In affective spectrum disorders, some authors propose a distinction between impulsive and compulsive self-injurious behavior. One of the aims of the present study is to examine how different kinds of self-injurious behavior, including purging behavior, may be classified in bulimia nervosa. The clinical impact of the different types of self-injury will be studied. The subjects of the study were 125 consecutive patients with bulimia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-report questionnaires (Eating Disorders Inventory and Hopkins Symptom Checklist). In our sample, the distinction between compulsive and impulsive self-injurious behavior appeared to be confirmed by a principal component analysis. Self-induced vomiting loaded on the compulsive dimension and laxative abuse on the impulsive dimension. To study the clinical impact of the two kinds of behavior, bulimic subjects were divided according to their position in the two dimensions. The presence of impulsive self-injurious behavior is associated with a history of sexual abuse and with higher scores on the Symptom Checklist. The presence of both impulsive and compulsive behavior is associated with greater depression, whereas the presence of impulsive features in the absence of compulsive ones seems to be linked to a longer duration of illness and to a higher dropout rate. Both compulsive and impulsive self-injurious behaviors are associated with a greater lack of interoceptive awareness.
Adolescent↗
Impact of a history of physical and sexual abuse in eating disordered and asymptomatic subjects.
The present study aimed to explore the impact of sexual and/or physical abuse among eating disordered patients (ED) and asymptomatic subjects. A total of 86 patients with anorexia nervosa, 69 patients with bulimia nervosa and 81 asymptomatic subjects were assessed. Among ED, we did not find a significant association between abuse experiences and the severity of the eating disorder, or between abuse and dissociative symptoms. Among ED, self-destructive behaviour appears to be the most important predictor of a history of sexual and/or physical abuse. In contrast, in the asymptomatic group, the score on the Dissociation Questionnaire is the only significant predictor of reported abuse experiences.
Adolescent↗
Burden and psychiatric symptoms on key relatives of patients with eating disorders: a preliminary study.
Although eating disorders are serious illnesses that affect adolescents and strongly involve their families, no study to date investigated the burden of these families. Forty relatives of 24 patients with eating disorders were assessed on subjective and objective burden, overinvolvement, hypercriticism and psychiatric symptoms. The subjective burden reported by the key relatives of patients with Anorexia Nervosa was significantly greater than that of the key relatives of patients with Bulimia Nervosa. Moreover, the relatives of anorexic patients scored higher for overinvolvement and psychiatric symptoms than the relatives of bulimic patients. The findings of the present study suggest the usefulness of treatment programs that include family counselling.
Adult↗
Suicidality in eating disorders: clinical and psychological correlates.
Although many authors have described eating disorders as often being associated with suicidal feelings and behavior, few studies to date have evaluated the prevalence and characteristics of suicidal behaviour in eating disordered patients. In the present study, in which a consecutive series of 495 out-patients was studied, 13% of the patients reported at least one suicide attempt and 29% reported current suicidal ideation; 26% of attempters reported multiple attempts. A history of suicide attempt was more prevalent among binge-eating/purging anorexics and among purging bulimics than in the other subgroups. In cases with anorexia nervosa, suicide attempters were older, had a longer illness duration, weighed less, had more often used drugs and/or alcohol and tended to be more obsessive than non-attempters. In cases with bulimia nervosa, attempters presented with more psychiatric symptoms and had more frequently been sexually abused.
Adolescent↗