Anja Spindler

Cortical and trabecular bone density and structure in anorexia nervosa

The aim of the study was to examine bone density and architecture with three different measurement methods in a sample of young women with anorexia nervosa (AN) and in an age-matched control group of women. Three-dimensional periphery quantitative computer tomography (3D-pQCT) at the ultradistal radius, a new technology providing measures of cortical and trabecular bone density and architecture, was performed, as well as quantitative ultrasound (QUS) at the heel, and dual energy X-ray absorptiometry (DXA) at the spine and hip. Thirty-six women with AN aged 18–30 years (mean duration of AN: 5.8 years) and 30 age-matched women were assessed. Bone mineral density measured by DXA at the spine and hip, and broadband ultrasound attenuation measured by QUS at the heel were significantly lower in patients than controls. 3D-pQCT demonstrated a highly significant deficit in the absolute number of bone trabecules and a significant reduction of cortical thickness. Severity of underweight was significantly associated with bone deficits at the hip measured by DXA. 3D-pQCT revealed mostly deficits of cortical bone related with age of onset of eating disorder. Using three different methods to measure bone density and bone structure at the hip, spine, heel and ultradistal radius, significant deficits in bone mineral density both in trabecular and cortical bone, as well in trabecular structure could be demonstrated in the AN patients.

Psychosocial Profiles After Transplantation : A 24-Month Follow-Up of Heart, Lung, Liver, Kidney and Allogeneic Bone-Marrow Patients

Objectives. Quality of life and psychosocial well-being usually improve after an organ transplant and remain stable for a minimum of several years. These findings, however, mainly apply to the “average” trend for transplant patients. This study aims to investigate whether transplant patients fall into different groups in good or poor psychosocial outcome after organ transplantation. Methods. One hundred thirty-one patients were assessed before and 6, 12, and 24 months after a heart, lung, liver, kidney, or bone-marrow transplant. Cluster analysis was applied to identify typical outcome profiles of the patients’ mental health (SF-36); differences between the clusters were investigated with regard to further psychosocial parameters (sense of coherence, optimism, psychosocial functioning, anxiety, depression, life/health satisfaction, medication experience). Results. The analysis revealed two clusters of transplant patients. Cluster A (n=78, 59.5%) showed a fairly good psychosocial outcome, improving over the posttransplant period of 2 years. Cluster B (n=53, 40.5%) included patients who reported a limited or poor outcome, deteriorating after the transplant. Furthermore, there are significant differences between clusters A and B in psychosocial parameters and physical functioning. Conclusions. These findings indicate that the experience of the transplant process may vary greatly from patient to patient, and that a considerable number of transplant recipients require psychosocial support, despite the majority of patients showing an unquestionable posttransplant improvement in psychosocial well-being.

Axes I and II Comorbidity and Treatment Experiences in Eating Disorder Subjects

Background: The present study determined the psychiatric comorbidity of Axes I and II in a sample of subjects with eating disorders (EDs). The objective was to investigate associations between comorbidity and current and past treatment. Methods: In a sample of 248 women (77 anorexia nervosa, 137 bulimia nervosa, 34 eating disorders not otherwise specified), psychiatric comorbidity of Axes I and II was determined with the Structured Clinical Interview of DSM-IV. Current and past treatment since ED onset were also assessed. Results: High levels of psychiatric comorbidity were found in the total sample (71% Axis I and 68% Axis II). Only 17% of cases had no psychiatric comorbidity. Anxiety (52%) and affective disorders (50%) were the most common Axis I diagnoses. Personality disorders of Clusters C (52%) and B (23%) were most common for Axis II. Twenty-one percent of participants who were not in treatment at the time had a history of inpatient treatment, and an additional 59% had a history of outpatient treatment. Thirty-eight percent of participants currently in outpatient treatment had a history of inpatient treatment. Participants with multiple comorbidity (Axes I and II) had the highest proportion of cases who had been treated by health professionals. Higher levels of comorbidity were associated with experiences in more intense treatment settings (ranging from no treatment to inpatient treatment). Conclusions: ED subjects with greater comorbidity require more treatment encounters and more intense treatment settings. The association between comorbidity and treatment experiences may represent a bias in the assessment of comorbidity when samples with heterogeneous treatment history are recruited.

Psychiatric Comorbidity and Eating Disorder Inventory (EDI) Profiles in Eating Disorder Patients

Objective: This study examines potential overlaps between psychiatric comorbidity (Axis I and II) and scores on the subscales of the Eating Disorder Inventory (EDI) in women with eating disorders (EDs). Method: In a sample of 248 women (72 with anorexia nervosa, 140 with bulimia nervosa, and 36 with eating disorders not otherwise specified), we determined psychiatric comorbidity using the Structured Clinical Interview for DSM-IV. Behavioural and psychological characteristics of EDs were quantified with the EDI. Results: Psychiatric comorbidity was high in both axes (74% for Axis I and 68% for Axis II). While most EDI subscales pertaining to psychological traits showed significant associations with Axis I and II disorders, the subscales concerning eating and perception of weight and shape were much less associated with psychiatric comorbidity. Affective and anxiety disorders, as well as personality disorders of clusters A and C, showed a similar pattern with links to most psychological subscales. The profile for substance-related disorders was different, showing associations with the Ineffectiveness and Interoceptive Awareness scales. Personality disorders of cluster B were related only to the Bulimia subscale and not to any of the psychological subscales. Conclusions: The EDI appears to primarily reflect Axis I and II disorders related to affective and anxiety problems. Clinicians and researchers employing the EDI should be aware that it is not sensitive for all forms of comorbidity prevalent in ED patients.

The severity of ADHD and eating disorder symptoms: a correlational study.

BackgroundAttention deficit/hyperactivity disorders (ADHD) and eating disorders (ED) share several clinical features. Research on the association between ADHD and ED is still quite sparse and findings are ambiguous.MethodsCorrelations between the severity of ADHD key features (Barratt Impulsiveness Scale, and Attention Deficit/Hyperactivity Disorder-Self-Rating questionnaire) and the severity of specific ED symptoms (Structured Interview for Anorexia and Bulimia Nervosa) were examined in 32 female patients diagnosed with ED.ResultsMost correlations between the severity of ADHD features and the severity of ED symptoms were low (r<0.30) and did not reach statistical significance. The only exception was a statistically significant, but counterintuitive association between impulsivity and the avoidance of fattening food.ConclusionsThe findings in this small sample suggest a weak link between the severity of ADHD key features and the severity of single ED symptoms in female patients with ED. The role of ADHD features for the development, maintenance, and treatment of EDs seems to be intricate and requires further study.

Lung function, sociodemographic characteristics, and psychological reaction to transplant associated with chronic stress among lung recipients

Abstract Chronic stress is a well-known consequence of somatic diseases. In this study, we investigated whether physical, sociodemographic, or transplant-related psychological factors were associated with the patients chronic stress level. A cross-sectional study enrolling 76 patients measured chronic stress (Screening Scale, Screening Subscale of Chronic Stress of the Trier Inventory for the Assessment of Chronic Stress) and the emotional effects of the transplant (Transplant Effects Questionnaire), as well as physical and sociodemographic conditions (lung function, bronchiolitis obliterans syndrome, working status, and parenting). Chronic stress after a lung transplant was significantly lower than in a normal community sample. In the multiple regression analysis, worries concerning the transplant were significantly associated with the patients chronic stress, but not with physical or sociodemographic parameters, nor with interactions between physical and psychological parameters. These results underscore the importance of transplant-related worries, regardless of the patients current state of health.