Session 5: Biopsychosocial Factors for Anorexia Nervosa and Co-morbidity

Background. Since little is known about the long-term course and outcome of bulimia nervosa, the authors designed a 12-year prospective longitudinal study with five cross-sectional assessments based on a large sample of consecutively treated females with bulimia nervosa (purging type) (BN-P).Method. One hundred and ninety-six females with BN-P were assessed (1) at the beginning of treatment, (2) at the end of treatment, (3) at 2-year follow-up, (4) at 6-year follow-up, and (5) at 12-year follow-up. In self-ratings as well as expert ratings based on interviews we assessed specific eating-disorder and general psychopathology.Results. The general pattern of results over time showed substantial improvement during treatment, slight (in most cases non-significant) decline during the first two years after the end of treatment, and further improvement and stabilization until 12-year follow-up. At that point the majority of patients (70·1%) showed no major DSM-IV eating disorder, 13·2% had eating disorders not otherwise specified, 10·1% had BN-P and 2% had died. Very few had undergone transition to anorexia nervosa or binge-eating disorders. Logistic regression analyses showed that psychiatric co-morbidity was the best and most stable predictor for eating-disorder outcome at 2, 6 and 12 years.Conclusions. Course and outcome of BN-P was generally more favourable than for anorexia nervosa.

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Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance

European Psychiatry ◽

10.1016/s0924-9338(00)00212-1 ◽

2000 ◽

Vol 15 (1) ◽

pp. 38-45 ◽

Cited By ~ 224

Author(s):

N.T. Godart ◽

M.F. Flament ◽

Y. Lecrubier ◽

P. Jeammet

Keyword(s):

Anorexia Nervosa ◽

Anxiety Disorder ◽

Bulimia Nervosa ◽

Anxiety Disorders ◽

Separation Anxiety ◽

Age Of Onset ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Separation Anxiety Disorder ◽

Co Morbidity

SummaryThe objectives of the study were to assess lifetime prevalence of specific anxiety disorders, and their age of onset relative to that of eating disorders (ED), in a French sample of patients with anorexia nervosa (AN) or bulimia nervosa (BN). We assessed frequencies of seven anxiety disorders and childhood histories of separation anxiety disorder among 63 subjects with a current DSM-IV diagnosis of an ED, using the Composite International Diagnostic Interview (CIDI). Eighty-three percent of subjects with AN and 71% of those with BN had at least one lifetime diagnosis of an anxiety disorder. By far, the most frequent was social phobia (55% of the anorexics and 59% of the bulimics). When present, the co-morbid anxiety disorder had predated the onset of the ED in 75% of subjects with AN, and 88% of subjects with BN. Our results are consistent with those of studies conducted in other countries, and show that an anxiety disorder frequently exists before an ED. This has to be taken in consideration for successful treatment of patients with AN or BN.

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Medical findings and predictors of long-term physical outcome in anorexia nervosa: a prospective, 12-year follow-up study

Psychological Medicine ◽

10.1017/s0033291796004394 ◽

1997 ◽

Vol 27 (2) ◽

pp. 269-279 ◽

Cited By ~ 127

Author(s):

W. HERZOG ◽

H.-C. DETER ◽

W. FIEHN ◽

E. PETZOLD

Keyword(s):

Anorexia Nervosa ◽

Laboratory Data ◽

Chronically Ill ◽

Initial Examination ◽

Laboratory Findings ◽

Long Term Outcome ◽

Co Morbidity ◽

Chronic Course

Background. Patients with anorexia nervosa (AN) run a high risk of becoming chronically ill and of dying. In the acute phase of their illness they present with numerous physical and laboratory abnormalities. However, little is known about the long-term prognostic value of these findings or about the medical morbidity in large samples of consecutively treated patients in the long-term.Methods. We evaluated 84 consecutive female patients with AN who were studied again an average of 11·9 years later. The ability of some of the laboratory data obtained at the initial examination to predict a fatal or chronic course was analysed by discriminant and multiple regression analyses.Results. Abnormally low serum albumin levels ([les ] 36 g/l) and a low weight ([les ] 60% of average body weight) at the initial examination were variables best able to predict a lethal course. In addition, high serum creatinine and uric acid levels predicted a chronic course. Most of the initial abnormal laboratory findings were reversible with a normal food intake. At a 12-year follow-up 67% of the chronic anorexic patients and 27% of those in the good/intermediate outcome group (compared to 8% morbidity in normal controls) presented with medical co-morbidity, in particular osteoporosis and renal disease. The standardized mortality ratio was 9·6.Conclusions. Laboratory findings obtained at the initial examination may be helpful in predicting a fatal or chronic course of AN. An evaluation of the long-term outcome of eating disorders should include an assessment of the medical co-morbidity.

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

Psychological Medicine ◽

10.1017/s0033291717000034 ◽

2017 ◽

Vol 47 (8) ◽

pp. 1489-1499 ◽

Cited By ~ 6

Author(s):

J. Kask ◽

M. Ramklint ◽

N. Kolia ◽

D. Panagiotakos ◽

A. Ekbom ◽

...

Keyword(s):

Anorexia Nervosa ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Causes Of Death ◽

Excess Mortality ◽

Cox Regression ◽

Somatoform Disorders ◽

Psychiatric Diagnoses ◽

Co Morbidity ◽

Significant Difference

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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What predicts suicide attempts in women with eating disorders?

Psychological Medicine ◽

10.1017/s0033291703001545 ◽

2004 ◽

Vol 34 (5) ◽

pp. 843-853 ◽

Cited By ~ 71

Author(s):

D. L. FRANKO ◽

P. K. KEEL ◽

D. J. DORER ◽

M. A. BLAIS ◽

S. S. DELINSKY ◽

...

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Longitudinal Study ◽

Drug Use ◽

Suicide Attempt ◽

Bulimia Nervosa ◽

Suicide Attempts ◽

Prospective Longitudinal Study ◽

Co Morbidity ◽

Prospective Longitudinal

Background. Suicide is a common cause of death in anorexia nervosa and suicide attempts occur often in both anorexia nervosa and bulimia nervosa. No studies have examined predictors of suicide attempts in a longitudinal study of eating disorders with frequent follow-up intervals. The objective of this study was to determine predictors of serious suicide attempts in women with eating disorders.Method. In a prospective longitudinal study, women diagnosed with either DSM-IV anorexia nervosa (n=136) or bulimia nervosa (n=110) were interviewed and assessed for suicide attempts and suicidal intent every 6–12 months over 8·6 years.Results. Fifteen percent of subjects reported at least one prospective suicide attempt over the course of the study. Significantly more anorexic (22·1%) than bulimic subjects (10·9%) made a suicide attempt. Multivariate analyses indicated that the unique predictors of suicide attempts for anorexia nervosa included the severity of both depressive symptoms and drug use over the course of the study. For bulimia nervosa, a history of drug use disorder at intake and the use of laxatives during the study significantly predicted suicide attempts.Conclusions. Women with anorexia nervosa or bulimia nervosa are at considerable risk to attempt suicide. Clinicians should be aware of this risk, particularly in anorexic patients with substantial co-morbidity.

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Trends of hospitalization for anorexia nervosa in USA: A nationwide analysis

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.326 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S164-S164

Author(s):

Z. Mansuri ◽

M. Rathod ◽

P. Bansal ◽

U. Mansuri ◽

S. Shambhu

Keyword(s):

Anorexia Nervosa ◽

Hospital Mortality ◽

Secondary Outcome ◽

Chi Square ◽

Co Morbidity ◽

Chi Square Test ◽

Competing Interest ◽

Morbidity Index ◽

The Cost ◽

Mean Cost

ObjectivesAnorexia Nervosa (AN) is an important cause of morbidity and mortality in hospitalized patients. While AN has been extensively studied in the past, the contemporary data for impact of AN on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998-2011 using the ICD-9 codes for AN. Severity of co-morbid conditions was defined by Deyo modification of Charlson co-morbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, chi-square test, t-test and Cochran-Armitage test were used to test significance.Results28,150 patients were analyzed. 93.94% were female and 6.06% were male (P < 0.0001). 88.67% were white, 2.93% were black and 8.4% were of other race (P < 0.0001). Rate of hospitalization decreased from 1530/million to 1349.5/million from 1998-2011. Overall mortality was 0.78% and mean cost of hospitalization was 25,829.82$. The in-hospital mortality reduced from 0.95% to 0.44% (P < 0.0001) and mean cost of hospitalization increased from 11,956.55$ to 39,831.51$. Total yearly spending on AN related admissions increased from $145.33 million/year to $420.61 million/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $145.33 million/year to $420.61 million/year, which leads to an estimated $275.28 million additional burden to the US health care system. In the era of cost conscious care, preventing AN related Hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for AN related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Dissection of the Genetic Association between Anorexia Nervosa and Obsessive–Compulsive Disorder at the Network and Cellular Levels

Genes ◽

10.3390/genes12040491 ◽

2021 ◽

Vol 12 (4) ◽

pp. 491

Author(s):

Weichen Song ◽

Weidi Wang ◽

Shunying Yu ◽

Guan Ning Lin

Keyword(s):

Anorexia Nervosa ◽

Obsessive Compulsive Disorder ◽

Neuronal Cell ◽

Cell Types ◽

Morbidity Rate ◽

Obsessive Compulsive ◽

Risk Genes ◽

Compulsive Disorder ◽

Co Morbidity ◽

Underlying Mechanisms

Anorexia nervosa (AN) and obsessive–compulsive disorder (OCD) exhibit a high co-morbidity rate, similar symptoms, and a shared genetic basis. However, an understanding of the specific underlying mechanisms of these commonalities is currently limited. Here, we collected Genome-Wide Association Analysis results for AN and OCD, and obtained genes hit by the top SNPs as the risk genes. We then carried out an integrative coexpression network analysis to explore the convergence and divergence of AN and OCD risk genes. At first, we observed that the AN risk genes were enriched in coexpression modules that involved extracellular matrix functions and highly are expressed in the postnatal brain, limbic system, and non-neuronal cell types, while the OCD risk genes were enriched in modules of synapse function, the prenatal brain, cortex layers, and neurons. Next, by comparing the expressions from the eating disorder and OCD postmortem patient brain tissues, we observed both disorders have similar prefrontal cortex expression alterations influencing the synapse transmission, suggesting that the two diseases could have similar functional pathways. We found that the AN and OCD risk genes had distinct functional and spatiotemporal enrichment patterns but carried similar expression alterations as a disease mechanism, which may be one of the key reasons they had similar but not identical clinical phenotypes.

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