Bryan Lask

The Neuropsychological Profile of Children, Adolescents, and Young Adults with Anorexia Nervosa

The neuropsychological profile of a sample of 155 patients with a clinical diagnosis of anorexia nervosa was assessed using a test battery specifically developed for such patients. The current findings suggest that the patients display a common neuropsychological profile including both strengths and weaknesses when compared with published norms. The patients displayed good verbal fluency skills, but performed poorly on tests of visuospatial memory, associated with relatively weak central coherence. They were within the average range on the assessment of executive functioning except for one measure of set-shifting. This study provides a valuable point of reference for clinicians when considering treatment options.

Motivating children and adolescents to improve adherence

Pediatricians and their colleagues often have considerable difficulty in understanding and managing poor adherence. It is hard to comprehend why children with life-threatening illnesses do not adhere to their treatment regimens and even more difficult to comprehend why their parents do not provide optimal care. Yet, clinical experience indicates that in chronic illness such as cystic fibrosis (CF), epilepsy, asthma, or diabetes, poor adherence is the norm. The general response of clinicians and parents to poor adherence is to coerce. This tends to have the opposite effect to that intended. The focus of this paper is on motivational enhancement therapy in children and adolescents with chronic illness to improve adherence to treatment.

Anorexia nervosa – A noradrenergic dysregulation hypothesis

Anorexia nervosa manifests a wide range of features which cannot fully be explained on the basis of socio-cultural pressures to be thin, nor by starvation, nor dehydration. Evidence is emerging of a significant neurobiological contribution to its aetiology. However there has to date been no explanation for its pathogenesis that integrates the previously identified genetic, neurobiological and socio-cultural contributing factors. In this paper we propose an empirically-based hypothesis that genetically determined noradrenergic dysregulation, interacting with epigenetic factors, leads to high levels of anxiety, impaired neuroplasticity and regional cerebral hypoperfusion. These, in combination, lead to insula dysfunction. The resulting impairment in insula homuncular representation explains the pathognomonic body image distortion. This distortion, combined with high levels of body-focused anxiety, gives rise to intense dieting, noradrenergic precursor depletion, and initial reduction in anxiety. The subsequent rebound exacerbation of anxiety leads to a vicious cycle of maintenance. Novel treatment implications based on this hypothesis are briefly considered.

Nibbling: frequency and relationship to BMI, pattern of eating, and shape, weight, and eating concerns among university women.

OBJECTIVEnNibbling has been defined by the Eating Disorder Examination (EDE 16.0) as eating in an unplanned and repetitious manner between meals and snacks without an accompanying sense of loss of control. We investigated the nature and frequency of nibbling in young women.nnnMETHODnFifty-eight university women aged 19-41 years with an average BMI of 22.8 (4.8) were administered the EDE-interview.nnnRESULTSnOnly 9% of women reported no nibbling during the preceding 28 days, 14% nibbled on 1-5 days; 40% on 6-12 days; 21% on 13-15 days and 17% nibbled on 16-28 days. Nibbling was not significantly related to BMI, frequency of meals, binge eating, dietary restraint, or shape, eating, or weight concerns. Significant inverse relationships were found between nibbling and food avoidance (-.27, p=.03) and sensitivity to weight gain (-.26; p=.04).nnnDISCUSSIONnNibbling occurred frequently among young women but did not appear to have significant consequences for BMI, the overall pattern or eating, shape or weight concerns, or for any measured pathological eating behaviors.

Convergent Validity of the Eating Disorder Examination and the Eating Disorder Examination-Questionnaire Among University Women in Norway

The present study compared the Eating Disorder Examination (EDE; 16.0) and the Eating Disorder Examination-Questionnaire (EDE-Q; 6.0) and investigated the psychometric properties of the Norwegian translation of the EDE. Fifty-eight university women aged 19-41 years (mean BMIu2009=u200923) were assessed with the EDE and EDE-Q. Satisfactory internal consistency and inter-rater reliability were demonstrated for the Norwegian translation of the EDE. Generally high convergent validity between the EDE and EDE-Q was found, with correlations ranging from 0.60 (Eating Concern) to 0.86 (Weight Concern). Agreement for OBEs and vomiting were excellent, while driven exercising generated lower levels of convergence. Consistent with prior studies, the EDE-Q generated significantly higher levels of psychopathology, although effect sizes were small. Owing to the significantly higher EDE-Q scores, it is ill advised to administer these two instruments interchangeably, as this may fail to produce meaningful data.

Do abnormalities in regional cerebral blood flow in anorexia nervosa resolve after weight restoration

OBJECTIVEnPrevious studies have demonstrated localised abnormalities of cerebral blood flow in anorexia nervosa, suggesting reduction of cerebral activity and function in specific regions. There is debate as to whether such findings are secondary to starvation or indicative of a primary abnormality predating the illness, representing an underlying biological substrate. This small study, the first in early onset anorexia nervosa, reports findings of regional cerebral blood flow (rCBF) at both baseline and follow up.nnnMETHODnNine participants who had previously undergone rCBF studies at the start of treatment, had a repeat scan at an average of 4.2 years later.nnnRESULTSnSeven out of the nine had persisting reduced cerebral blood flow in one area of the brain, predominantly the medial temporal region.nnnDISCUSSIONnThese data suggest that in the majority of cases rCBF does not return to normal following weight restoration. The implications for future research are explored.

Neurobiological Status at Initial Presentation Predicts Neuropsychological Functioning in Early Onset Anorexia Nervosa at Four-Year Follow Up

This study explores whether neurobiological status (indexed by regional cerebral blood flow) at initial presentation predicts neuropsychological status at four-year follow up in a sample of children with early onset anorexia nervosa. Neuropsychological assessment was conducted on 15 females four years after their initial treatment, and matched controls. At follow up there were significant differences between subgroups (based on neurobiological status at initial presentation) and matched controls in long-term visual memory and cognitive inhibition. This study offers preliminary evidence that neurobiological abnormalities at initial presentation predict neuropsychological status at follow up, suggesting a distinct neurodevelopmental subtype of early onset anorexia nervosa.

Predicting the weight gain required for recovery from anorexia nervosa with pelvic ultrasonography: An evidence‐based approach

Target weights are an arbitrary means of determining return to physical health in patients with anorexia nervosa (AN) and lack reliability and validity. Transabdominal pelvic ultrasound scanning (U/S) offers a more objective method of ascertaining physical well being by the ability to determine reproductive maturity. This study aimed to explore the correlations between the maturity grading on pelvic U/S and weight for height (WfH) ratios and body mass index (BMI) percentiles. Ultrasound studies were performed in 72 female adolescents (aged 11-17 years at intake) with AN. Scans were graded for maturity using published parameters of pelvic maturity and compared with the patients WfH ratio and BMI percentile. In our sample was a wide variation of WfH ratios and BMI percentiles at each grade of maturity. This supports the view that arbitrary targets for weight, WfH ratio or BMI percentile are likely to be unnecessarily high for some patients and too low for others. We recommend that targets be based upon baseline pelvic U/S grading and follow-up scanning.

Memory Versus Perception of Body Size in Patients with Anorexia Nervosa and Healthy Controls

The objective of this study was to compare body size estimation based on memory versus perception, in patients with anorexia nervosa (AN) and healthy controls, adjusting for possible confounders. Seventy-one women (AN: 37, controls: 35), aged 14-29u2009years, were assessed with a computerized body size estimation morphing program. Information was gathered on depression, anxiety, time since last meal, weight and height. Results showed that patients overestimated their body size significantly more than controls, both in the memory and perception condition. Further, patients overestimated their body size significantly more when estimation was based on perception than memory. When controlling for anxiety, the difference between patients and controls no longer reached significance. None of the other confounders contributed significantly to the model. The results suggest that anxiety plays a role in overestimation of body size in AN. This finding might inform treatment, suggesting that more focus should be aimed at the underlying anxiety.

Patient-clinician conflict: causes and compromises.

Conflict is an everyday phenomenon, a part of everyday life. It is hardly surprising that it also occurs in a clinical setting, not only between clinicians and within teams, but also between patients, their families and clinicians. This is all the more the likely in a setting that deals with a chronic disease such as CF. The physical, emotional, social and practical burdens of the illness are such that coping mechanisms are stretched to their limits. Disagreements, misunderstandings, impaired trust and different expectations may all challenge the patient-clinician relationship. In a context in which children and adolescents form at least half the clientele, the potential for conflict is intensified because of the involvement of parents. This paper emphasises the normality of such conflicts, and using case illustrations, explains the reasons for conflicts and explores how best to resolve them. The basic principles of conflict-resolution are outlined, and useful techniques, readily applicable in everyday practice, are described.