Einar Vedul-Kjelsås

Time trends in obesity and eating disorders

OBJECTIVE Obesity is a well-known risk factor for eating disorders, and has been increasing in the normal population over the last decades. This study examines whether the increase in obesity is followed by an increase in prevalence of eating disorders in the general female population. METHOD We compared the prevalence of eating disorders and obesity in two nationally representative surveys in Norway in 1991 (n = 1,537) and 2004 (n = 1,467). Eating disorder diagnoses were obtained using the self-report questionnaire survey for eating disorders (SEDs) at both time points. RESULTS The prevalence of overweight and obesity has doubled from 1991 to 2004, whereas the prevalence of eating disorders has been stable. Obesity was strongly associated with eating disorders both in 1991 and 2004. CONCLUSION Despite the strong association between obesity and eating disorders, the increase in obesity is not followed by an increase in eating disorders.

Prevalence of all relevant eating disorders in patients waiting for bariatric surgery: a comparison between patients with and without eating disorders.

OBJECTIVE: To study the prevalence of all relevant eating disorders in 157 obese patients waiting for bariatric surgery. Another aim was to explore for possible differences between gender, and those with and without ED. The dependent variables were: socio-demographic characteristics, BMI, obesity onset, and obesity-related somatic diseases. METHODS: ED was assessed using the self-report questionnaire, “Eating Disorders in Obesity” (EDO). The patients answered a questionnaire that targeted socio-demographic and health information. RESULTS: Subgroups were based on the patients responses to items on the EDO: 1 patient (0.6%) with Bulimia Nervosa (BN), 6 (3.8%) with Eating Disorder Not Otherwise Specified (EDNOS), 21 (13.4%) with Binge Eating Disorder (BED), and 23 (14.6%) with Binge Eating (BE). The patients in the EDNOS group were those who lacked one criterion of the BN diagnosis. The patients in the BE group lacked one criterion of the BED diagnosis. Twenty-eight (17.8%) fulfilled the DSM-IV-TR criteria for ED. When patients with BE were added, 51 patients (32.5%) were identified with ED or sub-threshold ED. In the explorative part of the study, no gender differences in socio-demographic variables, BMI, obesity onset, and obesity-related somatic diseases emerged. With the exception of age, no differences were found in these variables between those with and without ED. CONCLUSION: Employing all relevant eating disorders and binge eating symptoms (BE) for this population identified patients with pathological eating behaviors, which are not detected in previous studies measuring only BED and BE.

The role of the primary auditory cortex in the neural mechanism of auditory verbal hallucinations

Auditory verbal hallucinations (AVHs) are a subjective experience of “hearing voices” in the absence of corresponding physical stimulation in the environment. The most remarkable feature of AVHs is their perceptual quality, that is, the experience is subjectively often as vivid as hearing an actual voice, as opposed to mental imagery or auditory memories. This has lead to propositions that dysregulation of the primary auditory cortex (PAC) is a crucial component of the neural mechanism of AVHs. One possible mechanism by which the PAC could give rise to the experience of hallucinations is aberrant patterns of neuronal activity whereby the PAC is overly sensitive to activation arising from internal processing, while being less responsive to external stimulation. In this paper, we review recent research relevant to the role of the PAC in the generation of AVHs. We present new data from a functional magnetic resonance imaging (fMRI) study, examining the responsivity of the left and right PAC to parametrical modulation of the intensity of auditory verbal stimulation, and corresponding attentional top-down control in non-clinical participants with AVHs, and non-clinical participants with no AVHs. Non-clinical hallucinators showed reduced activation to speech sounds but intact attentional modulation in the right PAC. Additionally, we present data from a group of schizophrenia patients with AVHs, who do not show attentional modulation of left or right PAC. The context-appropriate modulation of the PAC may be a protective factor in non-clinical hallucinations.

Prevalence of auditory verbal hallucinations in a general population: A group comparison study

The present study was specifically designed to investigate the prevalence of auditory verbal hallucinations (AVH) in the general population, and sought to compare similarities and differences regarding socio‐demographics, mental health and severe life events between individuals who have never experienced AVH with those who had. The study also aimed to compare those who sought professional help for their experience of AVH with those who had not sought help. Through a postal questionnaire, 2,533 participants ages 18 and over from a national survey completed the Launay‐Slade Hallucinations Scale and other measures examining AVH characteristics and other areas related to AVH. In total, 7.3% of the sample reported a life‐time prevalence of AVH. Those with AVH were more likely to be single and unemployed, reported higher levels of depression and anxiety, and experienced a higher number of severe life events compared with those without AVH. Only 16% of those who experienced AVH in the general population sought professional help for these experiences. Compared to those who did not seek professional help, participants that had were more likely to experience AVH with a negative content, experience them on a daily basis, undergo negative reactions when experiencing AVH, and resist AVH. In conclusion, the prevalence of AVH was found to be relatively high. The results also revealed higher levels of reduced mental health for individuals who sought professional help, followed by those who did not, compared with those who had never experienced AVH.

Health-Related Quality of Life in Obese Presurgery Patients with and without Binge Eating Disorder, and Subdiagnostic Binge Eating Disorders

Objective. To study health-related quality of life (HRQoL) in obese presurgery patients with binge eating disorder (BED) and with subdiagnostic binge eating disorder (SBED) compared to patients without eating disorders or SBED. Method. Participants were patients referred to St. Olavs University Hospital, Norway, for bariatric surgery. Eating Disorders in Obesity (EDO) questionnaire was used to diagnose BED and SBED. Short-Form Health Survey (SF-12) assessed health-related quality of life. Questionnaires were returned by 160 of 209 patients. The present study sample consisted of 143 patients (103 women and 40 men) as 17 patients did not complete the SF-12. Results. Patients with BED and patients with SBED both had significantly lower mental HRQoL, but not physical HRQoL, compared to patients without eating disorders. Discussion. The findings indicate that obese presurgery patients with BED, and also SBED, may have special treatment needs in regard to their mental health.

High Aerobic Intensity Training and Psychological States in Patients with Depression or Schizophrenia

Aim: To explore changes in psychological states in response to a bout of high aerobic intensity training (HIT) in patients with depression or schizophrenia compared to healthy individuals. Methods: After familiarization training of HIT, 20 patients with schizophrenia, 13 patients with depression, and 20 healthy individuals performed a no-training day followed by a training day. HIT was 4 × 4 min intervals at 85–95% of peak heart rate, intermitted by 3 min active rest periods at 70% of peak heart rate. Self-evaluation questionnaires of positive affect, negative affect, state anxiety, well-being, distress, and fatigue were completed before training, 15 min after, and 3 h after training. The two latter measures were also completed the no-training day. Results: All three groups improved in positive affect and well-being 15 min after HIT (p < 0.01), but only patients with depression had maintained the effect after 3 h (p = 0.007, p = 0.012). The duration of the improved positive affect was longer in depression (p = 0.002) and schizophrenia (p = 0.025) than in healthy individuals (F2.50 = 5.83, p < 0.01). Patients with depression or schizophrenia had reduced distress and state anxiety 15 min after HIT and 3 h after HIT (p < 0.05). The improvement in distress 15 min after HIT was larger in patients with depression (p = 0.028) compared to healthy individuals (F2.50 = 5.05, p < 0.01). No changes were found during the no-training day (p > 0.05). Conclusion: High aerobic intensity training used as an acute intervention improved positive affect and well-being and reduced distress and state anxiety in patients with depression and schizophrenia. ClinicalTrials.gov identifier: NCT01310998.

Depression, anxiety, and neuroticism in obese patients waiting for bariatric surgery: Differences between patients with and without eating disorders and subthreshold binge eating disorders

SUMMARY OBJECTIVE This study investigated self-reported levels of depression, anxiety and neuroticism in obese patients waiting for bariatric surgery. The patients who indicated that they might have eating disorders (ED) or subthreshold binge eating disorders (SBED) were compared with those without. METHOD The design was cross sectional. Obese patients (n = 160, 117 women, 43 men) returned self-report questionnaires: Eating Disorders in Obesity (EDO) indicated eating disorder status; Hospital Anxiety and Depression Scale (HADS) assessed symptoms and caseness of depression and anxiety; and the Eysenck Personality Questionnaire (EPQ-12) captured neuroticism. Age, BMI and gender were also recorded. RESULTS Patients with ED (n = 28) presented significantly higher levels of depression, anxiety and neuroticism as well as more HADS-cases for depression and anxiety than those without ED (n = 109). Patients with sub-diagnostic binge eating disorders (SBED, n = 23) also reported significantly more depression symptom levels, and number of HADS-cases of depression, than those without ED. In addition, the SBED group showed significantly more neuroticism than patients without ED. No significant differences were found between men and women, for high/low age, or for high/low BMI. CONCLUSION The data displayed that obese pre-surgery patients with eating disorders have more psychological problems than those without. Patients with SBED were more similar to those with full scale eating disorders in their level of depression and neuroticism than those without ED. Clinically, obese patients with SBED should probably be regarded as those who have full scale ED.

Differences in aerobic fitness between inpatients and outpatients with severe mental disorders

Background: Patients with severe mental disorders have increased mortality, and cardiovascular disease (CVD) accounts for a large part. Physical inactivity and low aerobic fitness have been recognized as significant risk factors for CVD. In this study, we investigated the differences in aerobic fitness and physical activity between in- and outpatients with severe mental disorders. Method and Subjects: Fifty in- and outpatients from a regional psychiatric department were included. The patients filled in a questionnaire on physical activity and completed a clinical examination. An estimation of aerobic fitness was calculated for each patient, using gender, age, waist circumference, resting heart rate, and physical activity level as variables. Results: Inpatients had lower estimated aerobic fitness than outpatients (VO2peak 42 vs. 50 mL kg−1 min−1, p < 0.001). Compared to population data matched for age and gender, inpatients had lower aerobic fitness, while outpatients were not different from the population average. Conclusion: Inpatients at a psychiatric department had lower estimated aerobic fitness than outpatients, and a lower aerobic fitness compared to the general population. Our findings suggest that inpatients with severe mental disorders should be considered a high risk group for CVD.

T2. DO ADVERSE LIFE EVENTS AT FIRST ONSET OF AUDITORY VERBAL HALLUCINATIONS INFLUENCE SUBSEQUENT VOICE-CHARACTERISTICS? RESULTS FROM AN EPIDEMIOLOGICAL STUDY

Abstract Background Understanding what happens at first onset of auditory verbal hallucinations (AVHs) is important at both a clinical and theoretical level. Previous studies have focused on age with regard to first onset of AVHs. In the current epidemiological study, we investigated the role of adverse life events (e.g. accidents, divorce, bullying, unemployment) at the time of first onset of AVHs regarding symptom severity and general mental health later in life. Methods Using data from the Launay-Slade Hallucination Scale (LSHS), we compared participants who reported having experienced at least one adverse life events at first onset of AHVs (Trigger group; N = 76) to those who did not report any specific events at first onset of AVHs (No-trigger group; N = 59) on a large array of variables using Fisher’s exact test. Results Results revealed that the Trigger group experienced the AVHs as more emotional and they were also more troubled by the AVHs compared to the No-trigger group (all p < 0.01). Also, the Trigger group more often reported hallucinations in other (non-auditory) sensory modalities (e.g. visual, p = 0.012) compared to the No-trigger group. Furthermore, the Trigger group reported poorer mental health in general, and having had more frequent contact with mental health professionals, and also reported more frequently taking medication for mental problems in general (all p < 0.01). Discussion Adverse life events at first onset of AVHs appear to have a negative influence on subsequent voice-characteristics and general mental health, suggesting their presence to be an important factor to take into account when determining the risk for psychosis or other mental disorders. However, future longitudinal studies are needed in order to corroborate these findings.

Do adverse life events at first onset of auditory verbal hallucinations influence subsequent voice characteristics? Results from an epidemiological study

Understanding what happens at first onset of auditory verbal hallucinations (AVHs) is extremely important on a clinical and theoretical level. Previous studies have only focused on age with regard to first onset of AVHs. In the current epidemiological study, we examined a number of aspects relating to first onset of AVHs, such as the role of adverse life events at first onset of AVHs on symptom severity and general mental health. For this purpose, we compared participants who reported adverse life events at first onset of AHVs (adverse-trigger group; N = 76) to those that did not report any specific events at first onset of AVHs (no-adverse-trigger group; N = 59) on a large array of variables. Results showed that AVHs in the adverse-trigger group were experienced as more emotional compared to the no-adverse-trigger group. In addition, the adverse-trigger group more often reported hallucinations in other (non-auditory) sensory modalities (e.g. visual) compared to the no-adverse-trigger group. Furthermore, the adverse-trigger group reported poorer general mental health, reported having contact with mental health professionals more often, and also reported more frequently taking medication for psychological problems in general. The implications of these findings are discussed.