Elina Sihvola

Incidence and outcomes of bulimia nervosa : a nationwide population-based study

BACKGROUND Little is known about the epidemiology of bulimia nervosa outside clinical settings. We report the incidence, prevalence and outcomes of bulimia nervosa using for the first time a nationwide study design. METHOD To assess the incidence and natural course and outcomes of DSM-IV bulimia nervosa among women from the general population, women (n=2881) from the 1975-79 birth cohorts of Finnish twins were screened for lifetime eating disorders using a two-stage procedure consisting of a questionnaire screen and the Structured Clinical Interview for DSM-IV (SCID). Clinical recovery was defined as 1-year abstinence from bingeing and purging combined with a body mass index (BMI) 19 kg/m2. RESULTS The lifetime prevalence of DSM-IV bulimia nervosa was 2.3%; 76% of the women suffered from its purging subtype and 24% from the non-purging subtype. The incidence rate of bulimia nervosa was 300/100000 person-years at the peak age of incidence, 16-20 years, and 150/100000 at 10-24 years. The 5-year clinical recovery rate was 55.0%. Less than a third of the cases had been detected by health-care professionals; detection did not influence outcome. After clinical recovery from bulimia nervosa, the mean levels of residual psychological symptoms gradually decreased over time but many women continued to experience significantly more body image problems and psychosomatic symptoms than never-ill women. CONCLUSIONS Few women with bulimia nervosa are recognized in health-care settings. Symptoms of bulimia are relatively long-standing, and recovery is gradual. Many clinically recovered women experience residual psychological symptoms after attaining abstinence from bingeing and purging.

Early‐onset depressive disorders predict the use of addictive substances in adolescence: a prospective study of adolescent Finnish twins

AIMS To explore the developmental relationships between early-onset depressive disorders and later use of addictive substances. DESIGN, SETTING AND PARTICIPANTS A sample of 1545 adolescent twins was drawn from a prospective, longitudinal study of Finnish adolescent twins with baseline assessments at age 14 years and follow-up at age 17.5 years. MEASUREMENTS At baseline, DSM-IV diagnoses were assessed with a professionally administered adolescent version of Semi-Structured Assessment for Genetics of Alcoholism (C-SSAGA-A). At follow-up, substance use outcomes were assessed via self-reported questionnaire. FINDINGS Early-onset depressive disorders predicted daily smoking [odds ratio (OR) 2.29, 95% confidence interval (CI) 1.49-3.50, P < 0.001], smokeless tobacco use (OR = 2.00, 95% CI 1.32-3.04, P = 0.001), frequent illicit drug use (OR = 4.71, 95% CI 1.95-11.37, P = 0.001), frequent alcohol use (OR = 2.02, 95% CI 1.04-3.92, P = 0.037) and recurrent intoxication (OR = 1.83, 95% CI 1.18-2.85, P = 0.007) 3 years later. ORs remained significant after adjustment for comorbidity and exclusion of baseline users. In within-family analysis of depression-discordant co-twins (analyses that control for shared genetic and familial background factors), early-onset depressive disorders at age 14 predicted significantly frequent use of smokeless tobacco and alcohol at age 17.5. CONCLUSIONS Our results suggest important predictive associations between early-onset depressive disorders and addictive substance use, and these associations appear to be independent of shared familial influences.

Chernobyl exposure as stressor during pregnancy and behaviour in adolescent offspring

Objective:  Research in animals has shown that exposure to stressors during pregnancy is associated with offspring behavioural disorders. We aimed to study the effect of in utero exposure to the Chernobyl disaster in 1986, and maternal anxiety presumably associated with that exposure, on behaviour disorder observed at age 14.

Anorexia and Bulimia Nervosa in Same-Sex and Opposite-Sex Twins: Lack of Association With Twin Type in a Nationwide Study of Finnish Twins

OBJECTIVE The authors tested the hypothesis that either prenatal feminization or masculinization hormone influences in utero or later socialization affects the risk for anorexia and bulimia nervosa and disordered eating in members of opposite-sex twin pairs. METHOD Finnish twins (N=2,426 women, N=1,962 men with known zygosity) from birth cohorts born 1974-1979 were assessed at age 22 to 28 years with a questionnaire for eating disorder symptoms. Based on the questionnaire screen, women (N=292), men (N=53), and their cotwins were interviewed to assess diagnoses of anorexia nervosa and bulimia nervosa (per DSM-IV and broad criteria). RESULTS In women from opposite-sex twin pairs, the prevalence of DSM-IV or broad anorexia nervosa was not significantly different than that of women from monozygotic pairs or same-sex dizygotic pairs. Of the five male anorexia nervosa probands, only one was from an opposite-sex twin pair. Bulimia nervosa in men was too rare to be assessed by zygosity; the prevalence of DSM-IV or broad bulimia nervosa did not differ in women from opposite- versus same-sex twin pairs. In both sexes, the overall profile of indicators on eating disorders was rather similar between individuals from opposite- and same-sex pairs. CONCLUSIONS The authors found little evidence that the risk for anorexia nervosa, bulimia nervosa, or disordered eating was associated with zygosity or sex composition of twin pairs, thus making it unlikely that in utero femininization or masculinization or socialization effects of growing up with an opposite-sex twin have a major influence on the later development of eating disorders.

Prospective associations of early-onset Axis I disorders with developing eating disorders.

OBJECTIVE The purpose of this study is to analyze the developmental relationships of adolescent-onset Axis I mental disorders and eating disorders (EDs). METHOD One thousand three hundred eighteen adolescent twins born from 1983 to 1987 completed a professionally administered semistructured psychiatric interview at the age of 14 years and a questionnaire follow-up at the age of 17.5 years. RESULTS Eating disorders at the age of 17.5 years were significantly predicted by major depressive disorder (odds ratio, 5.9; 95% confidence interval, 2.6-15.3) and generalized anxiety disorder (GAD) (odds ratio, 4.7; 95% confidence interval, 1.8-15.6) at the age of 14 years, when baseline EDs were excluded. Early-onset major depressive disorder in combination with GAD increased the likelihood of developing EDs compared with either mood or anxiety disorders alone. Similar risks and trends were evident in within-family analyses of twin pairs discordant for baseline predictors and ED outcome. CONCLUSIONS Depressive disorder and GAD that manifest at that age of 14 years predict future EDs. Analysis of discordant twins suggested that early-onset depressive disorder and GAD prospectively relate to EDs in adolescence, even after familial factors are taken into account.

Lifetime anorexia nervosa in young men in the community: Five cases and their co-twins

OBJECTIVE To describe patterns, comorbidity, and outcomes from a case series of anorexia nervosa (AN) among young men from the general population and their co-twins. METHOD Men (N = 2,122) born between 1975 and 1979 from Finnish twin cohorts were screened for lifetime eating disorders by questionnaire. The administration of the short version of the Structured Clinical Interview for DSM-IV for screen positives led to a lifetime AN diagnosis in five participants, described here with their co-twins. RESULTS In males, overweight commonly predated AN, and symptoms of body dysmorphic disorder, particularly of muscle dysmorphia, were common among the anorexia-discordant co-twins. Affective and anxiety disorders were present in both the probands and their co-twins. CONCLUSION We found a strong familial clustering of AN, affective and anxiety disorders, and symptoms of muscle dysmorphia among men in the general population. In men, muscle dysmorphia may represent an alternative phenotype of AN.

Brain serotonin transporter binding of [123I]ADAM: within-subject variation between summer and winter data.

The neurotransmitter serotonin (5‐HT) controls several physiological functions, and a disturbance of the 5‐HT system is implicated in many psychiatric conditions. Seasonal variation has been suggested in the 5‐HT system. We investigated within‐subject seasonal variation in brain serotonin transporter (SERT) binding with the SERT‐ligand [123I]ADAM and single photon emission computed tomography (SPECT) in 12 healthy individuals. No systematic variation was found in the midbrain or thalamus areas between scans done in summer and winter. Our results suggest that factors other than season are more important in causing within‐subject variation of brain SERT binding between summer and winter. (Author correspondence: anu.koskela@helsinki.fi)

Constraining antimatter domains in the early universe with big bang nucleosynthesis.

We consider the effect of a small-scale matter-antimatter domain structure on big bang nucleosynthesis and place upper limits on the amount of antimatter in the early universe. For small domains, which annihilate before nucleosynthesis, this limit comes from underproduction of 4He. For larger domains, the limit comes from 3He overproduction. Since most of the 3He from &pmacr; 4He annihilation are themselves annihilated, the main source of primordial 3He is the photodisintegration of 4He by the electromagnetic cascades initiated by the annihilation.

Inhomogeneous big bang nucleosynthesis and the high baryon density suggested by Boomerang and MAXIMA

The recent Boomerang and MAXIMA data on the cosmic microwave background suggest a large value for the baryonic matter density of the universe,

Determination of Omega(b) from big bang nucleosynthesis in the presence of regions of antimatter

{\ensuremath{\omega}}_{b}\ensuremath{\sim}0.03.