Florian Junne

Impulsivity in binge eating disorder: food cues elicit increased reward responses and disinhibition.

Background Binge eating disorder (BED) represents a distinct eating disorder diagnosis. Current approaches assume increased impulsivity to be one factor leading to binge eating and weight gain. We used eye tracking to investigate both components of impulsivity, namely reward sensitivity and rash-spontaneous behaviour towards food in BED for the first time. Methods Overweight and obese people with BED (BED+; n = 25), without BED (BED−; n = 26) and healthy normal-weight controls (NWC; n = 25) performed a free exploration paradigm measuring reward sensitivity (experiment 1) and a modified antisaccade paradigm measuring disinhibited, rash-spontaneous behaviour (experiment 2) using food and nonfood stimuli. Additionally, trait impulsivity was assessed. Results In experiment 1, all participants located their initial fixations more often on food stimuli and BED+ participants gazed longer on food stimuli in comparison with BED− and NWC participants. In experiment 2, BED+ participants had more difficulties inhibiting saccades towards food and nonfood stimuli compared with both other groups in first saccades, and especially towards food stimuli in second saccades and concerning sequences of first and second saccades. BED− participants did not differ significantly from NWC participants in both experiments. Additionally, eye tracking performance was associated with self-reported reward responsiveness and self-control. Conclusions According to these results, food-related reward sensitivity and rash-spontaneous behaviour, as the two components of impulsivity, are increased in BED in comparison with weight-matched and normal-weight controls. This indicates that BED represents a neurobehavioural phenotype of obesity that is characterised by increased impulsivity. Interventions for BED should target these special needs of affected patients.

Therapy options in irritable bowel syndrome.

Background Numerous meta-analyses have recently assessed the overall clinical benefit of single therapy options and groups of therapies in the irritable bowel syndrome (IBS). By large, this should enable physicians to select from a number of therapy options available. Methods We entered dichotomous outcome data from 121 IBS trials published over the last 35 years with different groups and subgroups of drugs (antispasmodics, motility-affecting agents, antidepressants, peppermint oil), dietary interventions (bran, probiotics), and psychotherapy (cognitive behavioral, psychodynamic, hypnotherapy, relaxation techniques) into meta-analytic tools and estimate the overall efficacy (odds ratio, number needed to treat). Results Highest efficacy is currently found for peppermint oil, followed by psychotherapeutic and psychopharmacological interventions and probiotics. Traditional antispasmodic therapy has a moderate efficacy, whereas the list of (partially failed or cancelled) motility affecting drugs yielded weak clinical results, and therapies by bran and fibers are of no value in IBS. Conclusion Evidence-based therapy in IBS provides a number of effective treatment options beyond the fact that many novel compounds under development have failed to reach the market. An algorithm for clinical therapy decision is proposed.

High Levels of Physical Activity in Anorexia Nervosa: A Systematic Review

High level physical activity is a frequent symptom in patients with anorexia nervosa (AN), influencing the development, maintenance, complications, treatment success, relapse rate and severity of the disease. Accelerometry is assumed to be an objective method to assess physical activity (PA) in AN. We aimed to review objectively measured levels of PA in AN and to give an overview for clinical practice and future research. Data were searched in PubMed and PsychINFO until April 2015 following the preferred reporting items for systematic reviews and meta-analyses statement. Twenty studies fulfilled the inclusion criteria. A notable heterogeneity of measurements, outcomes, participants and settings was found. Overall, HLPA is not adressed enough by current evidence. A common valid terminology of HLPA is not available, and accurate criteria of different levels of PA must be defined to create comparability of future studies. Further objective PA assessments are needed to improve treatment outcome and relapse rate.

A comparative analysis of anorexia nervosa groups on Facebook

PurposeTo analyze the content and culture of anorexia nervosa (AN)-related communication on the current major social network site (SNS) Facebook.MethodsWe searched for groups and sites related to AN on Facebook by means of a faux profile of a young female. Identified groups/sites were analyzed with respect to (1) category (education, self-help, professional help, pro-ana, anti pro-ana), (2) activity, (3) motivational aspects (prose, pictures), and (4) social support.ResultsNumerous relevant groups were found in all categories except that professional help was almost nonexistent. Pro-ana groups were found to be the most active, best organized, and offered the highest levels of social support. Prose motivation was distinctly offered in all categories. Motivation with pictures was particularly evident in pro-ana groups. The most functional motivation was found in self-help groups.ConclusionsSNS appears to be a relevant way for young females suffering from AN to communicate and exchange disease and health-related ideas. Caregivers, researchers, and institutions in the field of eating disorders should be aware of the existence, possibilities, dysfunctions, and influence of SNS. Whether SNS can help persons with AN to get therapeutic assistance as well as whether it can be integrated into psychotherapeutic strategies should be examined in future studies.

Food-Related Impulsivity in Obesity and Binge Eating Disorder—A Systematic Update of the Evidence

The specific eating pattern of Binge Eating Disorder (BED) patients has provoked the assumption that BED might represent a phenotype within the obesity spectrum that is characterized by increased impulsivity. Following the guidelines of the PRISMA statement (preferred reporting items for systematic reviews and meta-analyses), we here provide a systematic update on the evidence on food-related impulsivity in obese individuals, with and without BED, as well as normal-weight individuals. We separately analyzed potential group differences in the impulsivity components of reward sensitivity and rash-spontaneous behavior. Our search resulted in twenty experimental studies with high methodological quality. The synthesis of the latest evidence consolidates conclusions drawn in our initial systematic review that BED represents a distinct phenotype within the obesity spectrum that is characterized by increased impulsivity. Rash-spontaneous behavior in general, and specifically towards food, is increased in BED, while food-specific reward sensitivity is also increased in obese individuals without BED, but potentially to a lesser degree. A major next step for research entails the investigation of sub-domains and temporal components of inhibitory control in BED and obesity. Based on the evidence of impaired inhibitory control in BED, affected patients might profit from interventions that address impulsive behavior.

The relationship of body image with symptoms of depression and anxiety in patients with anorexia nervosa during outpatient psychotherapy: results of the ANTOP study

Body image disturbance represents a central characteristic of anorexia nervosa (AN). Depression and anxiety are the most common mental comorbidities in patients with AN. This study aims to investigate the relationship of body image with symptoms of depression and anxiety during outpatient psychotherapy in AN. Analyses were conducted using the data set of the Anorexia Nervosa Treatment Outpatient Study (ANTOP) randomized controlled trial. The ANTOP study included N = 242 females with AN between 18 and 56 years of age. The trial was designed to compare enhanced cognitive behavioral therapy (CBT-E) and focal psychodynamic therapy (FPT) with optimized treatment as usual (TAU-O) for patients with AN. The analyses on body image dimensions were conducted using measures of correlations and multiple linear regression analyses to assess the relationship and longitudinal prediction of symptoms of depression and anxiety by body image dimensions. Results showed that body image perceptions were significantly associated with symptoms of depression and anxiety in patients with AN at all treatment stages. In addition, body image dimensions at early treatment stages predict depression and anxiety in follow-up measurements. The correlation of symptoms of depression and anxiety by body image perceptions increased along treatment course. The persistence of body image disturbance, while body mass index increases under treatment (persistency effect), may constitute a relevant factor contributing to the course of the most common affective comorbidities of depression and anxiety in patients with AN. Body image disturbances in patients with AN should therefore be explicitly targeted within the specialized psychotherapy of affected patients. (PsycINFO Database Record

Cost-effectiveness of focal psychodynamic therapy and enhanced cognitive–behavioural therapy in out-patients with anorexia nervosa

BACKGROUND Anorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive-behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN. METHOD The analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost-utility and assumptions underlying the base case were investigated in exploratory analyses. RESULTS Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends. CONCLUSIONS Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.

Peer-assisted learning (PAL) in undergraduate medical education: An overview

Peer-assisted learning (PAL) has a long tradition and is nowadays implemented in the curricula of most medical faculties. Besides traditional areas of application like problem-based learning, anatomy, or CPR, more and more departments and institutes have established PAL as part of their everyday teaching. This narrative review provides some background information and basic definitions of PAL. It offers an overview on features and determinants as well as underlying learning theories and developments in PAL. In addition, motives for implementation are highlighted followed by a comparison of advantages and disadvantages. After outlining aspects of quality management including the training of tutors and the evaluation and acceptance of PAL formats, this review concludes with an outlook on how PAL can proceed into the future and where further research is necessary.

Professional burnout among medical students: Systematic literature review and meta-analysis

Abstract Background: This systematic review and meta-analysis aim to summarize the available evidence on the prevalence of professional burnout among medical students. Methods: The review was performed according to the PRISMA guidelines. Databases were systematically searched for peer-reviewed articles, reporting burnout among medical students published between 2000 and 2017. The meta-analysis was conducted on the available data on burnout rates in medical students measured with the Maslach Burnout Inventory (MBI-HSS). Results: Fifty-eight out of 3006 studies were found eligible for inclusion. Twelve of these studies met the criteria for meta-analysis. Weighted mean values for the three sub-dimensions of the MBI–HSS were M = 22.93 (SD = 10.25) for Emotional Exhaustion, M = 8.88 (SD = 5.64) for Depersonalization, and M = 35.11 (SD = 8.03) for Personal Accomplishment. Prevalence rates for professional burnout ranged from 7.0% to 75.2%, depending on country-specific factors, applied instruments, cutoff-criteria for burnout symptomatology. Conclusion: This review underlines the burden of burnout among medical students. Future research should explicitly focus on specific context factors and student group under investigation. Such efforts are necessary to control for context-dependent confounders in research on medical students’ mental health impairment to enable more meaningful comparisons and adequate prevention strategies.

Validation of the German Version of the Commitment to Exercise Scale

Pathological forms of exercising are a topic of debate in terms of classification, etiology, and treatment. Validated instruments are a precondition for research in this field. The aim of this study was to validate the German version of the Commitment to Exercise Scale (CES-de). A confirmatory factor analysis was conducted using data from a large community sample (n = 571). In a second study, 100 eating disordered patients, 107 elite athletes and 100 individuals engaged in leisure time sporting activities were compared to assess discriminant validity and psychological correlates. A 1-factor solution showed the best fit to the data. The CES-de differentiated between the eating disordered group and individuals engaged in leisure time sporting activities, but not between those with an eating disorder and competitive athletes. The total score was significantly correlated with drive for thinness, perfectionism, and overall psychopathology. The CES-de can be considered a valid instrument for measuring problematic behavioral and attitudinal aspects of the commitment to exercise. The use of the CES-de total score is recommended. However, a more specific instrument should be used for athletes. A limitation of the study is that the samples were not stratified by age and gender.