Anorexia nervosa in males: excess mortality and psychiatric co-morbidity in 609 Swedish in-patients

BackgroundAnorexia nervosa (AN) is a psychiatric disorder with high mortality.MethodA retrospective register study of 609 males who received hospitalized care for AN in Sweden between 1973 and 2010 was performed. The standardized mortality ratios (SMRs) and Cox regression-derived hazard ratios (HRs) were calculated as measures of mortality. The incidence rate ratios (IRRs) were calculated to compare the mortality rates in patients with AN and controls both with and without psychiatric diagnoses.ResultsThe SMR for all causes of death was 4.1 [95% confidence interval (CI) 3.1–5.3]. For those patients with psychiatric co-morbidities, the SMR for all causes of death was 9.1 (95% CI 6.6–12.2), and for those without psychiatric co-morbidity, the SMR was 1.6 (95% CI 0.9–2.7). For the group of patients with alcohol use disorder, the SMR for natural causes of death was 11.5 (95% CI 5.0–22.7), and that for unnatural causes was 35.5 (95% CI 17.7–63.5). The HRs confirmed the increased mortality for AN patients with psychiatric co-morbidities, even after adjusting for confounders. The IRRs revealed no significant difference in mortality patterns between the AN patients with psychiatric co-morbidity and the controls with psychiatric diagnoses, with the exceptions of alcohol use disorder and neurotic, stress-related and somatoform disorders, which seemed to confer a negative synergistic effect on mortality.ConclusionMortality in male AN patients was significantly elevated compared with the general population among only the patients with psychiatric co-morbidities. Specifically, the presence of alcohol and other substance use disorders was associated with more profound excess mortality.

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Faculty Opinions recommendation of Excess mortality, causes of death and prognostic factors in anorexia nervosa.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1147143.617820 ◽

2009 ◽

Author(s):

Guido Frank

Keyword(s):

Anorexia Nervosa ◽

Prognostic Factors ◽

Causes Of Death ◽

Excess Mortality ◽

Mortality Causes

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Sibling Alcohol Use Disorder Is Associated With Increased Risk for Suicide Attempt

Clinical Psychological Science ◽

10.1177/21677026211025041 ◽

2021 ◽

pp. 216770262110250

Author(s):

Mallory E. Stephenson ◽

Sara Larsson Lönn ◽

Jessica E. Salvatore ◽

Jan Sundquist ◽

Kenneth S. Kendler ◽

...

Keyword(s):

Alcohol Use ◽

Suicide Attempt ◽

Alcohol Use Disorder ◽

Cox Regression ◽

Population Based ◽

Swedish Population ◽

Sibling Pairs ◽

Increased Risk ◽

Using Data ◽

Shared Genetic

The association between having a sibling diagnosed with alcohol use disorder (AUD) and risk for suicide attempt may be attributable to shared genetic liability between AUD and suicidal behavior, effects of environmental exposure to a sibling’s AUD, or both. To distinguish between these alternatives, we conducted a series of Cox regression models using data derived from Swedish population-based registers with national coverage. Among full sibling pairs (656,807 males and 607,096 females), we found that, even after we accounted for the proband’s AUD status, the proband’s risk for suicide attempt was significantly elevated when the proband’s sibling was affected by AUD. Furthermore, the proband’s risk for suicide attempt was consistently higher when the sibling’s AUD registration had occurred more recently. Our findings provide evidence for exposure to sibling AUD as an environmental risk factor for suicide attempt and suggest that clinical outreach may be warranted following a sibling’s diagnosis with AUD.

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No significant difference by genotype in study of topiramate for alcohol use disorder

The Brown University Psychopharmacology Update ◽

10.1002/pu.30728 ◽

2021 ◽

Vol 32 (6) ◽

pp. 3-4

Keyword(s):

Alcohol Use ◽

Alcohol Use Disorder ◽

Significant Difference

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FMRI-based prediction of naltrexone response in alcohol use disorder: a replication study

European Archives of Psychiatry and Clinical Neuroscience ◽

10.1007/s00406-021-01259-7 ◽

2021 ◽

Author(s):

Patrick Bach ◽

Georg Weil ◽

Enrico Pompili ◽

Sabine Hoffmann ◽

Derik Hermann ◽

...

Keyword(s):

Alcohol Use ◽

Pharmacological Treatment ◽

Alcohol Use Disorder ◽

Cox Regression ◽

Small Sample Size ◽

Cue Reactivity ◽

Small Sample ◽

Hazard Ratio ◽

Number Needed To Treat ◽

Significant Interaction Effect

AbstractPharmacological treatment in alcohol use disorder suffers from modest effect sizes. Efforts have been undertaken to identify patient characteristics that help to select individuals that benefit from pharmacological treatment. Previous studies indicated that neural alcohol cue-reactivity (CR) might provide a marker that identifies patients, which benefit from naltrexone treatment.We investigated the reproducibility of the association between ventral striatum (VS) activation and naltrexone (NTX) treatment response by analyzing data from a recent longitudinal clinical trial in N = 44 abstinent treatment-seeking alcohol-dependent patients. A follow-up was conducted over 3 months. We computed the percentage of significant voxels in VS and tested main effects and interactions with NTX treatment on relapse risk using Cox Regression models.We found a significant interaction effect between pre-treatment cue reactivity in the VS and NTX treatment on time to first heavy relapse (Hazard Ratio = 7.406, 95% CI 1.17–46.56, p = 0.033), such that the patient group with high VS activation (defined by a mean split) showed a significant medication effect (Hazard Ratio = 0.140, 95% CI 0.02–0.75, p = 0.022) with a number needed to treat of 3.4 [95% CI 2.413.5], while there was no significant effect in the group with low VS activation (Hazard Ratio = 0.726, p = 0.454).Thus, using an independent sample we replicated the previously described positive association between VS activation and NTX efficacy. Although our results should be considered cautiously in light of the small sample size, our results support the potential of neural alcohol CR as a tool for precision medicine approaches in alcohol dependence.

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Extrastriatal Dopamine D2/3 Receptor Availability in Alcohol Use Disorder and Individuals at High Risk

Neuropsychobiology ◽

10.1159/000521103 ◽

2022 ◽

pp. 1-10

Author(s):

Gianna Spitta ◽

Tobias Gleich ◽

Kristin Zacharias ◽

Oisin Butler ◽

Ralph Buchert ◽

...

Keyword(s):

High Risk ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Protective Factor ◽

Region Of Interest ◽

Anterior Cingulate ◽

Dopamine D2 ◽

Positron Emission ◽

Significant Difference ◽

Meta Analyses

Introduction: Reduced striatal dopamine D2/3 receptor availability in alcohol use disorder (AUD) has been demonstrated in recent clinical studies and meta-analyses. However, only a limited number of studies investigated extrastriatal D2/3 availability in AUD or in at-risk populations. In line with a dimensional understanding of addiction, extrastriatal dopaminergic neuroadaptations have been suggested to be relevant from a pathobiological perspective. Methods: We investigated D2/3 receptor availability via 18F-fallypride positron emission tomography applying a region of interest (ROI) approach. We selected ROIs for the prefrontal cortex (PFC) and the anterior cingulate cortex (ACC). Our sample included 19 healthy controls (low risk [LR]), 19 individuals at high risk (HR) to develop addiction, and 20 recently detoxified AUD patients. Results: We found significantly higher D2/3 receptor availability of HR compared to AUD in the left and right rostral ACC (rACC), as well as in the left ventrolateral PFC (vlPFC). We did not observe a significant difference between AUD and LR. After corrections for multiple comparisons none of the ROIs reached significance throughout the group comparison. The D2/3 receptor availability in the left rACC was inversely correlated with symptom severity assessed with the Alcohol Dependency Scale. Discussion: To our knowledge, the present work is the first study investigating extrastriatal D2/3 receptor availabilities in individuals at HR and patients with AUD. The observation that D2/3 receptor availabilities are highest in HR might suggest that their pathobiology differs from subjects with AUD. Future studies are necessary to clarify the intraindividual course of this biomarker over different disease stages and its possible role as a risk or protective factor.

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Occurrence of Alcohol Dependence, Pattern of Alcohol Use, and Psychiatric Comorbidity in a Tertiary Care Centre in Upper Assam, India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/316 ◽

2021 ◽

Vol 8 (21) ◽

pp. 1674-1678

Author(s):

Kamala Deka ◽

Manju Partha Baruah ◽

Dipjyoti Bora

Keyword(s):

Alcohol Use ◽

Alcohol Use Disorder ◽

Psychiatric Comorbidity ◽

Tertiary Care ◽

Occupancy Rate ◽

Care Centre ◽

Bed Occupancy ◽

Tertiary Care Centre ◽

Co Morbidity ◽

Alcohol Dependent

BACKGROUND There has been an increased rate of diagnosis of alcohol dependent syndrome (ADS) observed in our psychiatry clinic constituting a major portion of them into inpatients care. Evaluation of psychiatric complaints in patients with alcohol dependant syndrome is challenging at times. Depression has been found to be a common psychological association seen in them. Suicidality and other selfharming behaviour as a co morbidity are also not uncommon. There is dearth of information available on occurrence of alcohol dependent syndrome in psychiatry attendees and pattern of alcohol use especially from this part of north-eastern region of Assam. We wanted to assess the occurrence and pattern of alcohol use disorder amongst patients attending psychiatry unit of a tertiary care centre in upper Assam, estimate its bed occupancy rate, and determine psychiatric comorbidity among them. METHODS A hospital based cross sectional study was conducted among 104 consecutive subjects attending Psychiatry department of Jorhat Medical College, Assam. After thorough examination and informed written consent subjects were administered with alcohol use disorder identification test (AUDIT) and MINI plus. Semi structured socio demographic Proforma was used to collect information on demographic data and different variables. As it was a descriptive study, data collected were organized in frequency tables and analysed using percentage. RESULTS In present study, prevalence of alcohol dependent syndrome in psychiatry set up was 12.68 % and bed occupancy rate of ADS was 13 %. Majority were between the age 28 and 47 years, males, Hindus, married, belonged to nuclear family and hailed from upper lower social class followed by lower middle class. Approximately 18 % of cases had psychiatric co morbidity and majority of them had depression and suicidality. CONCLUSIONS A major number of alcohol dependant patients attended psychiatry OPD and occupied almost half of the beds as inpatients of a tertiary care hospital. Mood disorder was the commonest comorbid condition in these patients. Though the results cannot be generalized, it may definitely reflect the magnitude of alcohol use in this region. Hence forth a psychiatry unit like ours warrant a full-fledged department for treatment of ADS and alcohol related problems and some policy to work for its prevention. KEYWORDS ADS, Occurrence, Bed Occupancy, Psychiatric Co-Morbidity

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Physical exercise in the treatment of alcohol use disorder (AUD) patients affects their drinking habits: A randomized controlled trial

Scandinavian Journal of Public Health ◽

10.1177/1403494818759842 ◽

2018 ◽

Vol 47 (4) ◽

pp. 462-468 ◽

Cited By ~ 5

Author(s):

Kurt Jensen ◽

Charlotte Nielsen ◽

Claus Thorn Ekstrøm ◽

Kirsten K. Roessler

Keyword(s):

Alcohol Use ◽

Alcohol Use Disorder ◽

Training Stimulus ◽

Controlled Trial ◽

Control Group ◽

Treatment As Usual ◽

Drinking Habits ◽

Training Frequency ◽

Significant Difference ◽

Group A

Aim: The aim of this study is to compare the effect of exercise training on physical capacity and alcohol consumption in alcohol use disorder (AUD) patients. Methods: One hundred and five AUD patients were randomly assigned to treatment as usual combined with running and brisk walking for 30–45 min twice a week, either in small supervised groups (GR) or individually (IND), or to a control group with no running (C). Assessments were made after 6 and 12 months of training. Results: Training volume was estimated as 36 min per training bout at an intensity of 78% of HRmax with no differences between GR and IND ( p>.05). A highly significant reduction in training frequency was seen in both training groups after the first month ( p<.0001). Only IND increased VO2max, by 5.7% ( p<.05), while no differences were seen between GR, IND and C. Alcohol intake decreased from 219 to 41 units per 30 days as the average for the entire sample with no significant difference of drinking outcomes between groups ( p<.0001). Conclusions: We saw an effect on drinking habits after running in both groups. However, no additional effect was seen when compared with the control group. A drop in the training frequency during the intervention might have resulted in an insignificant training stimulus.

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Adolescent psychiatric in-patients

The British Journal of Psychiatry ◽

10.1192/bjp.176.2.121 ◽

2000 ◽

Vol 176 (2) ◽

pp. 121-125 ◽

Cited By ~ 14

Author(s):

Ellen Kjelsberg

Keyword(s):

Anxiety Disorder ◽

Mental Disorder ◽

Record Linkage ◽

Causes Of Death ◽

Excess Mortality ◽

Mortality Rates ◽

Psychiatric Diagnoses ◽

Organic Mental Disorder ◽

Standardised Mortality Ratios ◽

Almost All

BackgroundResearch has demonstrated increased mortality rates in adolescent psychiatric in-patients.AimsTo investigate this excess mortality by calculating standardised mortality ratios (SMRs) relative to cause of death, diagnosis, cohort and age.MethodA nationwide Norwegian sample of 1095 former adolescent psychiatric in-patients were followed up 15–33 years after first hospitalisation by record linkage to the National Death Cause Registry.ResultsThe SMR was significantly increased for almost all causes of death investigated. In males, all psychiatric diagnoses had significantly increased SMRs, whereas in females, organic mental disorder, anxiety disorder and affective disorder had non-significantly increased SMRs. The SMR was significantly elevated for all age-spans and cohorts investigated.ConclusionsA broad prevention strategy is needed to combat the increased mortality rates found in adolescent psychiatric in-patients.

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Hematopoietic Cell Transplant Co-Morbidity Index (HCTCI) and Multiple Myeloma (MM) Survival After Autologous Hematopoietic Cell Transplantation (AHCT)

Blood ◽

10.1182/blood.v120.21.4217.4217 ◽

2012 ◽

Vol 120 (21) ◽

pp. 4217-4217

Author(s):

Anuj Mahindra ◽

Ayman A Saad ◽

Mei-Jie Zhang ◽

Xiaobo Zhong ◽

Angela Dispenzieri ◽

...

Keyword(s):

Dose Reduction ◽

Cox Regression ◽

Conflicts Of Interest ◽

Risk Groups ◽

Hematopoietic Cell ◽

High Dose ◽

Cell Transplant ◽

Co Morbidity ◽

Significant Difference ◽

The Impact

Abstract Abstract 4217 Background: AHCT improves survival (OS) in newly diagnosed MM patients (pts) in large randomized trials. These trials have limited eligibility to younger, healthier pts. Selection of older pts and those with co-morbid illness for AHCT is problematic. HCT-CI, originally developed as predictor of post-allogeneic transplant outcomes, maybe valuable in stratifying risk of transplant related mortality (TRM) risk and OS in the AHCT setting. We investigated the relative impact of HCT CI along with other patient and MM related variables on outcomes after AHCT in a large cohort of transplant recipients. Methods: Outcomes of 1156 MM pts receiving AHCT after high dose Melphalan (MEL) between 2007 and 2010 reported to the CIBMTR (Center for International Blood and Marrow Transplant Research) were analyzed. HCTCI scores and individual comorbidities were prospectively reported at time of AHCT. Median follow up of survivors was 26 month. The impact of HCTCI and other potential prognostic factors including Karnofsky performance status (KPS) on OS were studied in multivariate Cox regression models. Results: HCTCI score was 0, 1, 2, 3, >3 in 42%, 18%, 13%, 13% and 14% respectively. Most common co-morbidities included pulmonary, diabetes, obesity, psychiatric, cardiac, renal and prior solid tumor. Using consolidated HCTCI scores, patients were stratified initially into 3 risk groups – HCTCI 0 (42%) vs. HCTCI 1–2 (32%) vs. HCTCI >2 (26%). Males and Caucasians were more likely to have greater HCTCI score. Higher HCTCI was associated with lower KPS <90 (33% in HCTCI 0 cohort vs. 50% in HCTCI >2). HCTCI score >2 was associated with MEL dose reduction to 140 mg/m2 (22% vs. 10% in score 0 cohort). Cytogenetic risk and MM related factors were not correlated with HCTCI. TRM at 12 month was 2%, 2%, and 3% for 3 risk groups. With extremely few TRM events, multivariate analysis did not suggest an impact of HCTCI. OS was 95%, 92%, 92% at 1 year and 87%, 81%, 80% at 2 year, respectively. OS was inferior for HCTCI >2 cohort (RR of death 1.48, p=0.02) and HCTCI cohort 1–2 (RR 1.37, p=0.04) compared with HCTCI 0 cohort. There was no significant difference in OS between HCTCI >2 vs. HCTCI 1–2 (p=0.64). Therefore the latter 2 groups were combined as the HCTCI >0 cohort [N=667] and compared with HCTCI=0 [N=489] in multivariate models. HCTCI >0 predicted inferior OS (RR of death= 1.41, p=0.01). Other significant predictors of inferior survival were KPS <90 (RR of death 1.61, p<0.01), IgA subtype (RR 1.64, p<0.01), >1 pretransplant regimen (RR 1.47, p<0.01), resistant MM at AHCT (RR 1.78, p<0.01). Major cause of death in both groups was progressive MM. Conclusion: In clinical practice, higher HCTCI score was associated with MEL dose reduction. Mortality after AHCT is predominantly related to MM progression/relapse with low incidence of TRM. Higher HCTCI scores were independently associated with inferior OS. KPS remains an important tool for risk stratification. Disclosures: No relevant conflicts of interest to declare.

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