Université catholique de Louvain

Faculté de Médecine
Santé Publique

Introduction à la recherche Scientifique dans le domaine médico-

social et hospitalier

Madame Sabine STORDEUR

Travail présenté par:

GADI MENGA

Année d’études : ESP 1 PM

Noma : 4421 – 05 - 00

Année académique 2006-2007

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 Thème de recherche: l’anorexie chez les adolescents.

Historique de la recherche

La première étape dans ce travail a consisté à trouver une thématique.

Une fois le sujet défini, je suis allée sur l’internet, en prenant Google comme moteur de
recherche, on tape  « pubmed ».

Dans pubmed, on introduit le mot –clé « anorexie », traduit au préalable en anglais en utilisant
le site de traduction « babel ».

Ce même site de traduction a été utilisé pour chaque mot –clé ainsi que la compréhension de
certains textes.

Sur pubmed , on sélectionne « abstrat » puis on va parcourir quelques résumés. Et puis

prendre l’abstrat le plus proche de mon sujet et faire copier-coller.
Pour le mot « anorxia » j’ai obtenu 932 résultats et pour « anorexia an teenagers » 264
résultats.

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J Clin Exp Neuropsychol. 2007 Feb;29(2):170-8.
 

Cognitive and executive functions in anorexia nervosa ten years after onset of eating
disorder.

Gillberg IC, Rastam M, Wentz E, Gillberg C.

Child and Adolescent Psychiatry, Goteborg University. Goteborg. Sweden.

In a longitudinal study, the authors explore the course of general cognition in anorexia
nervosa (AN) over time and compare general cognitive problems, executive function deficits,
attentional problems and visuomotor dysfunctions across AN individuals and healthy controls.
A community-based sample of adolescent onset AN cases (n = 40-47) was contrasted with an
age-, sex- and school matched comparison group (n = 47-51) on the Wechsler Adult
Intelligence Scale-Revised, the Wisconsin Card Sorting Test and Luria word recall test at a
mean age of 24 years. Only two of the cases tested were underweight at the time of the study.

The Wechsler scale had also been administered when the groups had a mean age of 21 years.
There were few differences across the two groups even though the comparison group
performed significantly better on the Object Assembly subtest of the WAIS-R. IQ increased
slightly but significantly over time in both groups. There was no relationship between level of
starvation and poor results on tests in the AN group.

A subgroup of the subjects had autism spectrum disorders. In this subgroup there were cases
with test profiles similar to those observed in autism and Asperger syndrome, just as there had
been on testing three years previously. Ten years after AN onset, the former AN cases showed
no major neuropsychological deficits. A subgroup with autistic features had test profiles
similar to those observed in autism spectrum disorders.

The AN group as a whole showed poor results on the object assembly subtest indicating weak
central coherence with a tendency to focus on details at the expense of configural information.
This cognitive style may account for their obsession with details, with implications for
psychoeducational approaches in treatment programmes/interventions.

Turk Psikiyatri Derg. 2007 Spring;18(1):87-91.

 
Case Report: Comorbid Anorexia Nervosa and Schizophrenia in a Male
Patient.

Cinemre B, Kulaksizoglu B.

Anorexia nervosa is a rare psychiatric disorder and epidemiological studies have shown a
female to male ratio of 10:1, suggesting it is a disorder predominantly seen among females.
The prevalence of anorexia nervosa comorbid with other psychiatric disorders has been
reported to be quite high.

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Whereas depression and anxiety disorders are the most common comorbid diagnoses in
anorexic patients, the dual-diagnosis of anorexia and schizophrenia is a relatively rare
condition. Based generally on the observations from single case reports or case series, several
explanations have been made about the co-occurrence of anorexia and schizophrenia.

Herein, we present a male patient who developed schizophrenia after an anorexic period of 4
years that began when he was 14 years old with the decision to lose weight, which then
progressed to a pattern of disordered eating and body image. This case is rare because the
patient is male and has a comorbid diagnosis of anorexia nervosa and schizophrenia.

To the best of our knowledge, there is only one previous case report in the literature
describing a male anorexic patient with comorbid schizophrenia. In this case presentation, the
diagnosis of anorexia nervosa in males is addressed, the definition and significance of sub-
threshold cases are discussed, and the comorbidity of anorexia nervosa and schizophrenia are
reviewed in light of the literature.

Parasitology. 2007 Mars 16;

 
A model to account for the consequences of host nutrition on the outcome of
gastrointestinal parasitism in sheep: logic and concepts.

Vagenas D, Bishop SC, Kyriazakis I.

Animal Nutrition and Health Department, SAC, West Mains Road, Edinburgh EH9 3JG, UK.

A deterministic, dynamic simulation model is developed to account for the interactions

between gastrointestinal parasitism and host nutrition, and predict their consequences on
performance and level of parasitism of sheep.

Larval intake and established adult worms are assumed to result in nutrient loss for the host.
In order to reduce this loss the host will mount an immune response, which will affect the
establishment rate of incoming larvae, mortality rate of adult worms, and fecundity of female
worms, as well as nutrient loss caused by larval intake per se. Host anorexia is modelled as a
function of worm mass.

Parasitism is also assumed to affect the allocation of ingested nutrients to the host's bodily
functions, with maintenance getting absolute priority, and protein allocated to immunity and
production proportionally to their requirements. Inputs to the model include the expected
growth attributes of the animal, feed quality, various parasitological parameters and daily
larval intake.

Outputs include feed intake, growth rate and body composition, as well as worm burden and
faecal egg counts. The model allows exploration of the consequences of gastrointestinal
parasitism on sheep of different growth characteristics, kept under environments that vary in
the provision of nutrients and exposure to parasites.

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Z Gastroenterol. 2007 Mars

 
Digestive and predigestive functions in patients with eating disorders.

Rapps N, Enck P, Martens U, Sammet I, Teufel M, Otto B, Zipfel S.

Medizinische Universitatsklinik, Abteilung fur Psychosomatische Medizin und

Psychotherapie, Universitatsklinikum Tubingen.

Patients with eating disorders (anorexia nervosa, AN; bulimia nervosa, BN) frequently exhibit
gastrointestinal symptoms and altered gastrointestinal functions, especially delayed gastric
emptying. These symptoms are regarded as secondary to the disordered eating behaviour,
vomiting or laxative misuse. They often improve during successful therapy.

There are, however, studies showing that in addition predigestive functions (smell, taste,
cephalic phase of digestion) and the hormonal regulation of digestion may be changed in
eating disorders. This underlines the possibility that, in a subpopulation of patients with AN
and BN, the disturbed digestive and predigestive functions may be involved in the
pathogenesis of the eating disorders. The current literature is analysed and summarised in this
context.

Psychother Psychosom Med Psychol. 2007 Mar 14;

The Barbie-Matrix: Effectiveness of a School Based German Program for the

Primary Prevention of Anorexia Nervosa Developed for Girls up to the Age of
12.

Berger U, Joseph A, Sowa M, Strauss B.

Institut fur Psychosoziale Medizin und Psychotherapie, Klinikum der Friedrich-Schiller-

Universitat Jena.

More than 25 % of the 12-year-old girls in Thuringia (Germany) show problematic eating
behaviour as measured with the Eating-Attitudes-Test (EAT-26D), which corresponds to an
increased risk for the development of anorexia nervosa or bulimia nervosa.

This was the starting position of a controlled study using a pre-post-design to check the
effectiveness of a newly developed German program for the prevention of anorexia nervosa in
girls ("PriMa"). 42 Thuringian schools (20 as treatment group) with 1006 girls participated in
the pilot study, which lasted from September 2004 to July 2005.

Program effectiveness was analysed with mostly standardized questionnaires at three times of
measurement (before, after the intervention and at 3 months follow-up) referring to body

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related self esteem (FBeK), satisfaction with body shape (KEDS), eating behaviour (EAT-
26D) and body related attitudes.

The program was established in 9 x 90-minute lessons including interactive exercises and
discussing especially developed posters that show scenes of a Barbie-doll's life including the
reports of a patient suffering from anorexia. Significant improvements on all variables could
be reached for the higher risk group (EAT-26D >/= 10 points; = 26,7 %). Mean values in the
EAT-26D decreased 5 points at the average which is equivalent with 6.6 % of the EAT-26D
range, reflecting a practically significant change effect.

Vertex. 2007 Jan-Feb;

Endocannabinoids: the inside plant.

Adler E.

Instituto de Investigaciones Farmacologicas, CONICET, Buenos Aires, Argentina.

eadler@ffyb.uba.ar.

An endogenous compound that binds to the same receptor sites activated by the main
psychoactive constituent of marihuana, delta 9 tetrahydrocannabinol (THC), is synthetised in
the brain and in several peripheral tissues.The endogenous cannabinoid was named
anandamide on the basis of the sanscrit word ananda, that means bringer of inner bliss.

Anandamide reproduces marihuana effects,is synthetised in response to physical activity, and

is involved in neurobiologic mechanisms common to drug addiction. Cannabinoid CB1
receptors, and their endogenous ligands, are present in brain areas linked to reward circuits.

The blockade of CB1 receptors causes anorexia and is being employed to treat obesity. On the
contrary, activation of CB1 receptors has appetite stimulant, antiemetic and analgesic
properties, that deserve to be studied for putative therapeutical uses.

J Clin Endocrinol Metab. 2007 Mar 13;

 
Relationships between Serum Adipokines, Insulin Levels and Bone Density in
Girls with Anorexia Nervosa.

Misra M, Miller KK, Cord J, Prabhakaran R, Herzog DB, Goldstein M, Katzman DK,
Klibanski A.

Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston,
MA, Harris Center, Massachusetts General Hospital, Boston, MA, Division of Adolescent
Medicine, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA,
Division of Adolescent Medicine, Department of Paediatrics, Hospital for Sick Kids, Toronto,
Canada.

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Background: Adolescents with anorexia nervosa (AN) have low bone mineral density (BMD).
Adipokines and insulin play an important role in bone metabolism in healthy individuals.
However, their association with bone metabolism in AN is unknown.

Objective: To determine whether adipokines and insulin are independently associated with
measures of BMD in adolescents with AN and controls.

Design/Methods: Levels of adiponectin and insulin, fasting and after oral glucose, were
evaluated in 17 AN and 19 controls 12-18 yo, in whom hormonal parameters (growth
hormone, IGF-I, cortisol, estradiol, leptin, ghrelin and peptide YY) had been previously
determined. Body composition, bone mineral content (BMC) and BMD at the lumbar spine
(LS), hip, femoral neck (FN) and total body (TB) were assessed by DXA. Two bone
formation and bone resorption markers were examined. Setting: General Clinical Research
Center.

Results: Adiponectin differed between AN and controls after controlling for fat mass, and
decreased in both following oral glucose (P = 0.02 and 0.07). On regression modeling,
independent associations were observed of (i) BMI and adiponectin with LS bone mineral
apparent density (BMAD) Z- scores (r(2) = 0.45), (ii) lean mass, peptide YY and ghrelin with
hip Z-scores (r(2) = 0.55), (iii) adiponectin and lean mass with FN-BMAD Z-scores (r(2) =
0.34), and (iv) lean mass, PYY, GH and ghrelin with TB-BMC/height Z-scores (r(2) = 0.64),
for the combined group. Adiponectin was also independently associated with BMD, and
insulin with bone turnover markers in the groups considered separately.

Conclusions: Adiponectin contributes significantly to the variability of bone density, and

insulin to bone turnover markers in adolescent girls.

Peptides. 2007 Feb;

Recent progress in PYY research--an update report for 8th NPY meeting.
Ashby D, Bloom SR.

Department of Metabolic Medicine, Hammersmith Hospital, Imperial College London, 6th

Floor Commonwealth Building, Du Cane Road, London W12 ONN, UK.

PYY(3-36) is a gut regulatory peptide which has recently been found to reduce appetite.
Variability of this effect across different experimental conditions has led to confusion and
polarization of opinion on its potential as an anti-obesity treatment. This review summarizes
recent progress in this area.

The basic anorexigenic effect leading to weight loss in rodents has now been confirmed by
several groups. Anorexia has also been confirmed in human studies although optimal route
and dosing remain to be defined. Gastric bypass causes PYY levels to rise, which may in part
mediate the weight loss occurring after this surgery, and levels have been found to be normal
or low in obese people. The straightforward ARC model of mechanism, involving inhibition
and activation, respectively, of NPY and POMC neurons, is giving way to a more complicated
system involving vagal afferent signals. Conclusion: It works, but not how we thought it did.

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Psychol Med. 2007 Mar 12;:1-12

 
Two-phase survey of eating disorders in gifted dance and non-dance high-
school students in Taiwan.

Tseng MM, Fang D, Lee MB, Chie WC, Liu JP, Chen WJ.

Department of Psychiatry, National Taiwan University Hospital and College of Medicine,

National Taiwan University, Taipei, TaiwanInstitute of Preventive Medicine, College of
Public Health, National Taiwan University, Taipei, Taiwan Institute of Occupational
Medicine and Industrial Hygiene, College of Public Health, National Taiwan University,
Taipei, Taiwan.

Background: Despite a growing body of literature reporting eating disorders (EDs) in non-
Western countries in recent years, most of these studies are limited to questionnaire-based
surveys or case-series studies. This study aimed to investigate the prevalence and correlates of
EDs in Taiwanese high-school students.

Methods: The study subjects consisted of all the female high-school students enrolled in the
gifted dance class in 2003 in Taiwan (n=655) and non-dance female students randomly
chosen from the same school (n=1251). All the participants were asked to complete self-
report questionnaires, including the 26-item Eating Attitudes Test (EAT-26) and the Bulimic
Investigatory Test Edinburgh (BITE). All the screen positives and an approximate 10%
random sample of the screen negatives were then interviewed using the Structured Clinical
Interview for DSM-IV-TR Axis I Disorders Patient Version (SCID-I/P).

Results: The prevalence of individual EDs was much higher in the dance [0.7% for anorexia
nervosa (AN), 2.5% for bulimia nervosa (BN) and 4.8% for EDs, not otherwise specified
(EDNOS)] than in the non-dance (0.1, 1.0 and 0.7% respectively) students. Multivariate
logistic regression analyses revealed that being in the dance class, higher concern about body
shape and lower family support were correlates of EDs for all students, whereas lower
parental education level was associated with EDs only for non-dance students.

Conclusion: EDs were more prevalent in the weight-concerned subpopulation. Although AN

is still rare, BN has emerged as a comparable prevalent disorder in Taiwan, as in Western
countries.

Am J Clin Nutr. 2007 Mar;85(3):695-701.

 
Comparison of nutritional and inflammatory markers in dialysis patients with
reduced appetite.

Carrero JJ, Qureshi AR, Axelsson J, Avesani CM, Suliman ME, Kato S, Barany P, Snaedal-

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Jonsdottir S, Alvestrand A, Heimburger O, Lindholm B, Stenvinkel P.

Divisions of Renal Medicine and the Baxter Novum Clinical Research Laboratory,
Department of Clinical Science, Intervention and Technology, Karolinska Institute,
Karolinska University Hospital at Huddinge, Stockholm, Sweden.

BACKGROUND: Anorexia is common in chronic kidney disease and worsens as the disease
progresses. Sex hormones and inflammatory cytokines may be related to feeding behavior.

OBJECTIVE: We hypothesized that appetite would be related to inflammation and outcome

in hemodialysis patients but that sex may account for differences in the symptoms associated
with poor appetite.

DESIGN: A cross-sectional study was conducted in patients undergoing prevalent

hemodialysis (n = 223; 127 M; x +/- SD age: 66 +/- 14 y). Anthropometric markers of body
composition, handgrip strength, and nutritional and inflammatory status were measured, and 3
groups according to their self-reported appetite were established. Overall mortality was
assessed after 19 mo (range: 2-29 mo) of follow-up.

RESULTS: Poor appetite was associated with a longer vintage time, increased inflammation
(higher serum concentrations of interleukin 6 and C-reactive protein), and a worse nutritional
status (lower serum concentrations of insulin-like growth factor I, albumin, urea, and
creatinine). However, across worsening appetite scale, handgrip strength was incrementally
lower in men but not in women (multivariate analysis of variance).

In a multivariate logistic regression analysis (pseudo r(2) = 0.19), appetite loss was associated
with sex [odds ratio (OR): 0.41; 95% CI: 0.24, 0.72], insulin-like growth factor I (3.58; 2.10,
6.32), and C-reactive protein > 10 mg/L (2.39; 1.34, 4.11). Finally, appetite loss was
associated with worse clinical outcome even after adjustment for age, sex, inflammation,
dialysis vintage, and comorbidity (likelihood ratio = 44.3; P < 0.0001).

CONCLUSIONS: These results show a close association among appetite, malnutrition,

inflammation, and outcome in patients undergoing prevalent hemodialysis. Moreover, our
data suggest that uremic men may be more susceptible than are women to inflammation-
induced anorexia.

Orv Hetil. 2007 Mar 4;148(9):405-12.

 
[Medical complications in children and adolescents with anorexia nervosa.]

Paszthy B.

Semmelweis Egyetem, Altalanos Orvostudomanyi Kar I. Gyermekgyogyaszati Klinika

Budapest Bokay u 53. 1083.

Anorexia nervosa in children and adolescents is still a serious cause of morbidity and
mortality which may result in premature death or life-long medical and psychosocial

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morbidity. This condition can cause significant medical complications in every organ system
of the growing and developing body. Although many of these medical complications improve
with nutritional rehabilitation and recovery from the disorder some are potentially
irreversible.

This article summarizes the evidence based literature on medical complications that has been
specially studied in child and adolescent population with anorexia nervosa over the past two
decades. This review of the literature focuses on the acute symptoms of anorexia nervosa with
special emphasis on the fluid and electrolyte levels and refeeding sydrome, and detailes the
cardiovascular complications.

Summarizes the special alterations in childhood and adolescent anorexia nervosa such as
impaired bone mineral accretion and the possible therapeutic interventions of osteopenia and
alterations in linear growth. The reviewed literature suggests that the medical complications in
adolescents with anorexia nervosa are different from those reported in the adult population.

The unique clinical presentation, the early onset and the unknown impact of these
complications underline the need for early identification and early efficient treatment of
anorexia nervosa in adolescents. There is an increasing number of evidence that highlight the
importance of interdisciplinary teams of healthcare providers in the identification and in the
therapy of adolescent anorexia nervosa as well.

J Clin Psychiatry. 2007 Feb;

 
Efficacy of a novel biphasic controlled-release methylphenidate formula in
adults with attention-deficit/hyperactivity disorder: results of a double-blind,
placebo-controlled crossover study.

Jain U, Hechtman L, Weiss M, Ahmed TS, Reiz JL, Donnelly GA, Harsanyi Z, Darke AC.

Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

OBJECTIVE: To evaluate the efficacy and safety of a new biphasic multilayer-release (MLR)
methylphenidate formulation in a double-blind, placebo-controlled crossover study of adults
with attention-deficit/hyperactivity disorder (ADHD).

METHOD: Adults 18 to 60 years of age with a DSM-IV diagnosis of ADHD entered a no-
medication baseline week and were then randomly assigned to once-daily MLR
methylphenidate or matching placebo. Patients were titrated to optimal effect over 1 to 3
weeks followed by 2 weeks of treatment on a stable dose. The same titration protocol was
repeated with the alternate treatment. Clinical Global Impressions scale (CGI) and Conners'
Adult ADHD Rating Scales (Self-rated, CAARS-S, and Observer-rated, CAARS-O) were
collected at weekly clinic visits. The study was conducted between October 2003 and April
2004.

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RESULTS: Fifty patients were randomly assigned to treatment, and 39 were analyzed in a
per-protocol population (23 men, 16 women; mean age = 37.9 years). CGI-Improvement
scores of subjects taking MLR methylphenidate were significantly improved compared with
placebo (Global Improvement: 2.6 vs. 3.7; p = .0015). MLR methylphenidate produced
improvements over placebo on the ADHD Index T scores of the CAARS-S (12.2 vs. 5.4
[change from baseline score]; p = .0083) and the CAARS-O (10.9 vs. 6.6 [change from
baseline score]; p = .1404). The most frequent adverse events for MLR methylphenidate and
placebo were headache (26% and 24%, respectively), anorexia (22% and 6%), insomnia (22%
and 8%), nervousness (20% and 4%), and nausea (16% and 8%). There were no serious
adverse events.

CONCLUSIONS: Once-daily MLR methylphenidate produces significant improvements in

ADHD symptoms and situational behavior in adult patients with ADHD, with a prolonged
duration of effect and minimal side effects, thus having the potential to improve compliance
and, therefore, treatment outcomes in routine clinical use.

Clin Nutr. 2007 Feb 16

 
Bone mineral density in adolescent girls with early onset of anorexia nervosa.

Diamanti A, Bizzarri C, Gambarara M, Calce A, Montecchi F, Cappa M, Bianco G, Castro M.

Gastroenterology and Nutrition Unit, Pediatric Hospital "Bambino Gesu", Piazza S. Onofrio,
4-00165 Rome, Italy.

BACKGROUND & AIMS: To assess prevalence of bone mineral density (BMD) reduction
and relationship between bone mineral status and anthropometric assessment, nutritional
intake and physical activity in adolescents with early anorexia nervosa (AN).

METHODS: Fifty-seven consecutive AN patients and 57 healthy controls underwent

anthropometric status, bone density, body composition and physical activity evaluations. In
AN patients clinical features and nutritional intake were also assessed.

RESULTS: Thirty-five patients with AN (62%) and 44 healthy subjects (77%) (pNS) showed
normal BMD. Mean value of BMD Z-score was -0.6+/-0.9 in AN patients and -0.2+/-1.4 in
controls (pNS). Weight at diagnosis and lean mass resulted the main predictor of bone loss
but also height, best weight before diagnosis and BMI resulted correlated with bone mineral
status in AN patients. Additionally, AN patients maintained good levels of protein intake and
sport activity

CONCLUSIONS: Early diagnosis may prevent bone loss in AN patients. Protein intake and
moderate physical activity seem to be useful to maintain an adequate bone mineral status.

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J Consult Clin Psychol. 2007 Feb

 
Testing mediators of intervention effects in randomized controlled trials: An
evaluation of two eating disorder prevention programs.

Stice E, Presnell K, Gau J, Shaw H.

Department of Psychology, University of Texas at Austin, Austin, TX, USA. estice@ori.org

The authors investigated mediators hypothesized to account for the effects of 2 eating disorder
prevention programs using data from 355 adolescent girls who were randomized to a
dissonance or a healthy weight intervention or an active control condition.

The dissonance intervention produced significant reductions in outcomes (body

dissatisfaction, dieting, negative affect, bulimic symptoms) and the mediator (thin-ideal
internalization), change in the mediator correlated with change in outcomes and usually
occurred before change in outcomes, and intervention effects became significantly weaker
when change in the mediator was partialed, providing support for the hypothesized mediators
and this new approach to testing mediation in randomized trials. Findings provide somewhat
less support for the hypothesis that change in healthy eating and exercise would mediate the
healthy weight intervention effects. Copyright 2007 APA, all rights reserved.

Clin Chim Acta. 2007 Apr;

 
High prevalence of increased trisialotransferrin concentrations in patients
with anorexia nervosa: Implications for determination of carbohydrate-
deficient transferrin.

Arndt T, Erkens M, Holtkamp K, Keller T, Gressner AM.

Bioscientia Institut fuer Medizinische Diagnostik GmbH, D-55218 Ingelheim, Germany.

BACKGROUND: Carbohydrate-deficient transferrin (asialo-+monosialo-+disialotransferrin,

CDT) is currently the most specific laboratory marker of chronic alcohol abuse. We tested
whether previous findings of false-positive CDT results for anorexia nervosa patients have
been due to invalid CDT analysis methods or anorexia nervosa by itself.

METHODS: Serum CDT from 49 anorexia nervosa patients, 14 bulimia nervosa patients and
22 healthy controls (all adolescent, female and age-matched) was determined in a
retrospective study by HPLC (Clin-Rep(R)-CDT-in-serum-online, cut-off >/=1.8%, Recipe),
by capillary electrophoresis (Capillarys-CDT, cut-off >/=1.3%, Sebia) and (due to limited
surplus serum volume for a subset of 18 anorexia nervosa patients with increased
trisialotransferrin detected by HPLC) by immunoassay based on anion-exchange CDT and
non-CDT fractionation (%CDT-TIA, cut-off >/=2.6% CDT, Bio-Rad).

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RESULTS: HPLC and capillary electrophoresis: No false-positive CDT results were obtained.
Asialo- and monosialotransferrin were not detected and disialotransferrin (CDT) was in each
case clearly below the test-specific cut-offs. Trisialotransferrin (a non-CDT isoform) was
increased (cut-off >/=5.0% for HPLC) in 33 anorexia patients, 2 bulimia patients and 2
controls. %CDT-TIA: 8 false-positive CDT results of >/=2.6% out of the 18 samples tested
(CDT-range/mean/median 2.6-4.6/3.2/2.8%).

CONCLUSIONS: Anorexia nervosa does not cause by itself increased CDT results. False-
positive CDT values from the past are most likely due to an incomplete separation of
trisialotransferrin from CDT and thus overdetermination of CDT. Immunological CDT testing
without confirmatory analysis by HPLC or CE is no longer acceptable.

Orthop Nurs. 2007 Jan-Feb.

 
Scoliosis, superior mesenteric artery syndrome, and adolescents.

Schwartz A.

The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Adolescent idiopathic scoliosis is defined as a lateral curvature of the spine that can occur in
any region of the spinal column. For curves that require surgical correction, spinal fusion is
the surgical treatment, and superior mesenteric artery syndrome is a possible complication.
Risk factors for superior mesenteric artery syndrome include a small aorta-superior
mesenteric artery angle, spinal lengthening, and an asthenic habitus. Asthenic habitus may be
due to natural build, peptic ulcer disease, or anorexia, especially among adolescent females.

Research regarding adolescent idiopathic scoliosis and superior mesenteric artery syndrome is
warranted to identify if some adolescents are more likely to develop superior mesenteric
artery syndrome. The advanced practice nurse can identify which adolescents may develop
superior mesenteric artery syndrome and provide safe care to avoid this complication.

Eat Weight Disord. 2006 Dec;

 
Resolving a disagreement in a clinical team: overcoming conflicting views
about the role of family therapy in an outpatient treatment programme for
anorexia nervosa.

Godart N, Perdereau F, Rein Z, Curt F, Kaganski I, Lucet R, Corcos M, Fermanian J, Flament

M, Jeammet P.

Department of Psychiatry, Universite Paris-Descartes, Faculte de Medecine, Site Institut

Mutualiste Montsouris, Paris, France. nathalie.godart@imm.fr

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In the Adolescent Psychiatry Department at the Institut Mutualiste Montsouris, Paris, as is
also observed in the literature, the outcome for anorexic patients can sometimes be
catastrophic, regardless of treatments proposed. This disturbing finding led us to reassess our
therapeutic treatment strategies, in an effort to improve patient outcome.

The multidimensional treatment program implemented in the Department includes parent

counselling, but not the whole family in a family therapy procedure. It has been demonstrated
better outcome for patients who underwent family therapy in comparison to patients who
underwent individual therapy. This raised the question of whether family therapy could
improve our outpatient programme. This paper describes here how a research programme was
developed to resolve a disagreement in our clinical team as to whether family therapy should
be added to the existing care programme. The paper describes the difficulties encountered by
our team, and the experimental design chosen to resolve the debate. Data will not be set out
here.

Eat Weight Disord. 2006 Dec;

 
Attachment in anorexia nervosa: an exploration of associations with eating
disorder psychopathology and psychiatric symptoms.

Zachrisson HD, Kulbotten GR.

Eating Disorder Center, University Hospital of Aarhus, Psychiatric Hospital for Children and
Adolescents, Risskov, Denmark. heza@fhi.no

Previous research on attachment and eating disorder has to a great extent presupposed direct
links between states of mind with respect to attachment and eating disorder diagnoses. The
authors provide a brief review stating that no such association can be found in current
literature.

The authors suggest that the association might exist on the level of eating disorder pathology
and psychiatric symptoms, rather than diagnostic level. Based on 20 Adult Attachment
Interviews coded with the Dynamic-Maturational method from patients diagnosed with
anorexia, the authors explore the associations between attachment and diagnostic subgroups,
eating disorder psychopathology (Eating Disorder Inventory--2nd edition), and psychiatric
symptoms.

All patients were coded within the range of insecure attachment. State of mind with respect to
attachment did not differentiate between diagnostic subgroup and eating disorder pathology.
Individuals classified as dismissing reported higher levels of anxiety-related distress than
those classified as preoccupied or mixed dismissing/preoccupied. A high frequency of
unresolved traumas and losses was found.

The findings support previous reports of high frequencies of insecure attachment and
unresolved traumas in anorexic patients. The high level of anxiety-related stress in the
dismissing group lead the author to suggest that attachment plays a role in the patient's
handling of distress following the eating disorder, rather than in the disorder itself.

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Am J Psychiatry. 2007 Jan

Perceived coercion and change in perceived need for admission in patients

hospitalized for eating disorders.

Guarda AS, Pinto AM, Coughlin JW, Hussain S, Haug NA, Heinberg LJ.

Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins

University Hospital, Meyer 101, 600 N. Wolfe St., Baltimore, MD 21287, USA.
aguarda@jhmi.edu

OBJECTIVE: Ambivalence toward treatment is characteristic of eating disorders, and patients

are often admitted to inpatient programs under pressure from clinicians, family, friends,
educators, or employers. This study evaluated patient perceptions of the admissions process
and perceived need for hospitalization and assessed whether these perceptions remain stable
in the short term.

METHOD: A total of 139 patients with eating disorders completed a 13-item self-report scale
on the admission experience when they were admitted to a behavioral inpatient specialty
program and again 2 weeks into their hospitalization.

RESULTS: Patients with anorexia nervosa reported higher levels of perceived coercion and
pressure and a lower sense of procedural justice than did those with bulimia. Patients under 18
(N=35) reported more perceived coercion than did adult patients (N=104), and a trend was
noted for them to disagree that they needed hospitalization. Perceptions of coercion, of
pressure by others toward hospitalization, and of procedural justice were stable in the short
term. However, of the 46 patients (30 of them adults) who initially did not endorse needing
admission, 20 patients (17 of them adults) changed their minds by 2 weeks into
hospitalization and agreed that they needed hospital admission.

CONCLUSIONS: Nearly half of patients with eating disorders who denied a need for
treatment on admission converted to acknowledging that they needed to be admitted within 2
weeks of hospitalization. Since treatment avoidance is associated with poor outcome, these
findings suggest a need for studies assessing the long-term outcome and ethics of pressuring
patients with eating disorders into treatment.

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Brain Dev. 2006 Dec 26;

 
Hyperkalemia and hyperdopaminemia induced by an obsessive eating of
banana in an anorexia nervosa adolescent.

Tazoe M, Narita M, Sakuta R, Nagai T, Narita N.

Department of Pediatrics, Koshigaya Hospital, Dokkyo University School of Medicine,

Saitama, Japan.

Banana is known as a dopamine-rich and potassium-rich food, however no previous data

regarding biochemical or psychological alteration induced by excess intake of banana has
been reported. We have experienced an adolescent female case of Anorexia nervosa (AN)
who denied eating anything but maximum 20 bananas and less than 500ml mineral water per
day for more than two years. During the period of massive banana eating habit, she showed
increase of serum potassium (from 4.7mEq/l to 6.1mEq/l) and whole blood dopamine (from
11ng/ml to 210ng/ml; normal range 0.5-6.2ng/ml), and obvious dysthymia that is inexplicable
only by the pathology of AN.

When the patient resumed other food ingestion after 26 months of obsessive and restricted
eating of banana, the abnormalities in her blood data and her psychological state were all
corrected toward normal. We conclude that in this case, the obsessive and restricted habit of
banana ingestion resulted in hyperkalemia, hyperdopaminemia, and psychological change.

16
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