Biomarkers of Length of Stay On An Inpatient Eating Disorder Unit For Treatment of Anorexia Nervosa in Females

Abstract Background. Length of stay on an inpatient unit for treatment of anorexia nervosa (AN) is widely variable. Although previous research has used anthropometric and clinical variables and duration of illness to predict length of stay, there has been limited investigation of the predictive ability of biomarkers. Biomarkers, including those collected through a comprehensive metabolic panel (CMP) and appetite hormones, such as ghrelin and leptin, are impacted by disease presence and may play an etiological role in AN. Methods. Using a series of regression models, we retrospectively evaluated the associations of these putative biomarkers at admission with length of inpatient stay in 59 females receiving treatment on an inpatient eating disorder unit for anorexia nervosa. Results. Both lower levels of magnesium and higher active ghrelin levels at inpatient admission predicted length of stay. Conclusions. This research provides further evidence supporting both biological and psychological components of AN, identifying potential biomarkers that could aid in prospective prediction of treatment needs. Ghrelin monitoring throughout inpatient stays may aid clinicians in better predicting physical recovery and renourishment from AN and prepare for stepdown from an inpatient setting. Further research is necessary to replicate and extend these findings across treatment settings.

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Biomarkers of Length of Stay on an Inpatient Eating Disorder Unit

10.1101/2020.12.17.20248429 ◽

2020 ◽

Author(s):

Courtney E. Breiner ◽

Baiyu Qi ◽

Laura M. Thornton ◽

Kimberly A. Brownley ◽

Tonya Foreman ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Eating Disorder ◽

Length Of Stay ◽

Regression Models ◽

Predictive Ability ◽

Inpatient Stay ◽

Treatment Needs ◽

Duration Of Illness ◽

Comprehensive Metabolic Panel ◽

Potential Biomarkers

AbstractLength of stay on an inpatient unit for treatment of anorexia nervosa (AN) is widely variable. Although previous research has used anthropometric and clinical variables and duration of illness to predict length of stay, there has been limited investigation of the predictive ability of biomarkers. Biomarkers, including those collected through a comprehensive metabolic panel (CMP) and appetite hormones, such as ghrelin and leptin, are impacted by disease presence and may play an etiological role in AN. Using a series of regression models, we evaluated the associations of these putative biomarkers with length of inpatient stay in 46 females receiving treatment on an inpatient eating disorder unit. Active ghrelin levels at inpatient admission positively predicted length of stay and alkaline phosphatase at discharge was significantly positively correlated with length of stay. This research provides further evidence supporting both biological and psychological components of AN, identifying potential biomarkers that could aid in prospective prediction of treatment needs. Further research is necessary to replicate and extend these findings across treatment settings.

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Characterizing Treatment-Resistant Anorexia Nervosa

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.542206 ◽

2021 ◽

Vol 11 ◽

Author(s):

Sarah Smith ◽

D. Blake Woodside

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Depressive Symptoms ◽

Treatment Resistance ◽

Treatment Resistant ◽

Eating Disorder Treatment ◽

Duration Of Illness ◽

Eating Disorder Psychopathology ◽

Significant Difference ◽

Disorder Treatment

Background: The issue of treatment resistance in eating disorder care is controversial. Prior research has identified multiple failed treatment attempts as a common criterion for severe and enduring anorexia nervosa, but little is known about patients who have multiple failed treatment attempts. This study was designed to compare the clinical and demographic characteristics of eating disorder patients with multiple, incomplete inpatient admissions to those with good outcomes. Understanding if these patient populations differ at initial admissions has implications for the prediction and characterization of inpatient eating disorder treatment resistance.Methods: This study analyzed existing data from a specialist inpatient eating disorder program at a large Canadian teaching hospital collected between 2000 and 2016. Treatment resistance was defined as two or more incomplete admissions and no complete admissions in the study period. Data were available on 37 patients who met this criteria, and 38 patients who had completed their first admission and remained well (defined as a BMI > 18.5 with no binging or purging behavior) 1 year after discharge. Variables of interest included age, weight, diagnoses, duration of illness, eating disorder psychopathology, eating disorder behavioral frequencies and depressive symptoms at the time of index inpatient admissions. Statistical analyses consisted of Mann–Whitney U tests, Chi-square tests, and a logistic regression.Results: In our main bivariate analyses, patients with multiple incomplete admissions were characterized by more severe eating disorder psychopathology and depressive symptoms at admission as well as an increased prevalence of the binge purge subtype of anorexia nervosa. In our exploratory multivariate analyses controlling for diagnostic subtype and depressive symptoms, severity of eating disorder psychopathology did not remain significant. No statistically significant difference in body mass index (BMI) or frequencies of eating disorder behaviors were found. A trend toward a longer duration of illness did not meet statistical significance.Conclusions: This study found that patients considered resistant to inpatient eating disorder treatment differ from those with good outcomes at initial admission. These results suggest that while treatment-resistant anorexia nervosa may be related to severe and enduring anorexia nervosa, it may also be a different concept that warrants additional research.

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Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa

Journal of Eating Disorders ◽

10.1186/s40337-020-00348-7 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Deborah R. Glasofer ◽

Alexandra F. Muratore ◽

Evelyn Attia ◽

Peng Wu ◽

Yuanjia Wang ◽

...

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Inpatient Treatment ◽

Weight Status ◽

Self Report ◽

Healthy Weight ◽

Health Maintenance ◽

Duration Of Illness ◽

Clinical Impairment

Abstract Background Anorexia nervosa (AN) is a life-threatening psychiatric disorder associated with significant medical and psychosocial impairment. Hospital-based behavioral treatment is an effective intervention in the short-term. However, relapse rates following discharge are high and thus, there is a need to identify predictors of longitudinal outcome. The current study provides information regarding illness course and health maintenance among patients with AN over 5 years following discharge from an eating disorder inpatient unit. Methods Participants were individuals with AN who were discharged from a specialized, inpatient behaviorally-based unit. Prior to discharge, height and weight were measured and participants completed self-report measures of eating disorder severity and general psychopathology (depression, anxiety, harm avoidance). Participants were contacted annually for self-report measures of weight, eating disorder severity and clinical impairment. Outcome was defined by illness course (body mass index (BMI) and clinical impairment during the 5 years) and health maintenance (categories of weight and eating disorder symptom severity) across follow-up, using all available data. Linear mixed models were used to examine whether demographic and clinical parameters at discharge predicted BMI and clinical impairment over time. Additional analyses examined whether these variables significantly influenced an individual’s likelihood of maintaining inpatient treatment gains. Results One-hundred and sixty-eight individuals contributed data. Higher trait anxiety at discharge was associated with a lower BMI during follow-up (p = 0.012). There was a significant interaction between duration of illness and time, whereby duration of illness was associated with a faster rate of weight loss (p = 0.003) during follow-up. As duration of illness increased, there was a greater increase in self-reported clinical impairment (p = 0.011). Increased eating disorder severity at discharge was also associated with greater clinical impairment at follow-up (p = 0.004). Higher BMI at discharge was significantly associated with maintaining healthy weight across a priori BMI-based definitions of health maintenance. Conclusions Weight status (higher BMI) and duration of illness are key factors in the prognosis of AN. Higher weight targets in intensive treatments may be of value in improving outcomes.

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Faculty Opinions recommendation of Eating disorder symptoms and quality of life: where should clinicians place their focus in severe and enduring anorexia nervosa?

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

10.3410/f.718502443.793516520 ◽

2016 ◽

Author(s):

Glenn Waller

Keyword(s):

Quality Of Life ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Eating Disorder Symptoms

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Pharmacotherapy for Eating Disorders

10.1093/oxfordhb/9780190620998.013.20 ◽

2017 ◽

Cited By ~ 1

Author(s):

Susan McElroy ◽

Anna I. Guerdjikova ◽

Nicole Mori ◽

Paul E. Keck

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Mental Disorders ◽

Bulimia Nervosa ◽

Binge Eating ◽

Binge Eating Disorder ◽

Night Eating Syndrome ◽

Night Eating

This chapter addresses the pharmacotherapy of the eating disorders (EDs). Many persons with EDs receive pharmacotherapy, but pharmacotherapy research for EDs has lagged behind that for other major mental disorders. This chapter first provides a brief rationale for using medications in the treatment of EDs. It then reviews the data supporting the effectiveness of specific medications or medication classes in treating patients with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other potentially important EDs, such as night eating syndrome (NES). It concludes by summarizing these data and suggesting future areas for research in the pharmacotherapy of EDs.

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Epidemiology and Course of Eating Disorders

The Oxford Handbook of Eating Disorders ◽

10.1093/oxfordhb/9780195373622.013.0003 ◽

2010 ◽

pp. 24-32 ◽

Cited By ~ 2

Author(s):

Pamela Keel

Keyword(s):

Public Health ◽

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Bulimia Nervosa ◽

The Public ◽

Purging Disorder ◽

Not Otherwise Specified ◽

Public Health Significance ◽

Health Significance

The epidemiology of eating disorders holds important clues for understanding factors that may contribute to their etiology. In addition, epidemiological findings speak to the public health significance of these deleterious syndromes. Information on course and outcome are important for clinicians to understand the prognosis associated with different disorders of eating and for treatment planning. This chapter reviews information on the epidemiology and course of anorexia nervosa, bulimia nervosa, and two forms of eating disorder not otherwise specified, binge eating disorder and purging disorder.

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Pharmacotherapy of the Eating Disorders

The Oxford Handbook of Eating Disorders ◽

10.1093/oxfordhb/9780195373622.013.0024 ◽

2010 ◽

pp. 416-451 ◽

Cited By ~ 2

Author(s):

Susan L. McElroy ◽

Anna I. Guerdjikova ◽

Anne M. O’Melia ◽

Nicole Mori ◽

Paul E. Keck

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Mental Disorders ◽

Bulimia Nervosa ◽

Binge Eating ◽

Binge Eating Disorder ◽

Night Eating Syndrome ◽

Night Eating

Many persons with eating disorders (EDs) receive pharmacotherapy, but pharmacotherapy research for EDs has lagged behind that for other major mental disorders. In this chapter, we first provide a brief rationale for using medications in the treatment of EDs. We then review the data supporting the effectiveness of specific medications or medication classes in treating patients with anorexia nervosa (AN), bulimia nervosa, binge eating disorder (BED), and other potentially important EDs, such as night eating syndrome (NES) and sleep-related eating disorder (SRED). We conclude by summarizing these data and suggesting future areas for research in the pharmacotherapy of EDs.

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Healthcare Utilization Due to Suicide Attempts among Homeless Youth in New York State

American Journal of Epidemiology ◽

10.1093/aje/kwab037 ◽

2021 ◽

Author(s):

Rie Sakai-Bizmark ◽

Hiraku Kumamaru ◽

Dennys Estevez ◽

Emily H Marr ◽

Edith Haghnazarian ◽

...

Keyword(s):

Emergency Department ◽

New York ◽

Length Of Stay ◽

Suicide Attempt ◽

Healthcare Utilization ◽

Regression Models ◽

Homeless Youth ◽

Suicide Attempts ◽

New York State ◽

Individual Characteristics

Abstract Suicide remains the leading cause of death among homeless youth. We assessed differences in healthcare utilization between homeless and non-homeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009–2014) were used to identify homeless and non-homeless youth ages 10 to 17 who utilized healthcare services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for mortality, use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models were adjusted by individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with healthcare utilization rates of 347.2 (95% Confidence Interval [CI]: 317.5, 377.0) and 67.3 (95%CI: 66.3, 68.3) per 100,000 person-years for homeless and non-homeless youth, respectively. Length of stay for homeless youth was statistically longer than non-homeless youth (Incidence Rate Ratio 1.53; 95%CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with non-homeless youth. Interventions tailored to homeless youth should be developed.

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Adapting a neuroscience-informed intervention to alter reward mechanisms of anorexia nervosa: a novel direction for future research

Journal of Eating Disorders ◽

10.1186/s40337-021-00417-5 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Ann F. Haynos ◽

Lisa M. Anderson ◽

Autumn J. Askew ◽

Michelle G. Craske ◽

Carol B. Peterson

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Anxiety Disorders ◽

Reward Processing ◽

Future Research ◽

Restrictive Eating ◽

Eating Disorder Symptoms ◽

Mood And Anxiety Disorders ◽

Reward Responsivity ◽

Eating Disorder Behaviors

AbstractAccumulating psychobiological data implicate reward disturbances in the persistence of anorexia nervosa (AN). Evidence suggests that individuals with AN demonstrate decision-making deficits similar to those with mood and anxiety disorders that cause them to under-respond to many conventionally rewarding experiences (e.g., eating, interacting socially). In contrast, unlike individuals with other psychiatric disorders, individuals with AN simultaneously over-respond to rewards associated with eating-disorder behaviors (e.g., restrictive eating, exercising). This pattern of reward processing likely perpetuates eating-disorder symptoms, as the rewards derived from eating-disorder behaviors provide temporary relief from the anhedonia associated with limited responsivity to other rewards. Positive Affect Treatment (PAT) is a cognitive-behavioral intervention designed to target reward deficits that contribute to anhedonia in mood and anxiety disorders, including problems with reward anticipation, experiencing, and learning. PAT has been found to promote reward responsivity and clinical improvement in mood and anxiety disorders. This manuscript will: (1) present empirical evidence supporting the promise of PAT as an intervention for AN; (2) highlight nuances in the maintaining processes of AN that necessitate adaptations of PAT for this population; and (3) suggest future directions in research on PAT and other reward-based treatments that aim to enhance clinical outcomes for AN.

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