Holmer Graap

Association between Obesity and Adult Attention-Deficit/Hyperactivity Disorder in a German Community-Based Sample

Objective: The goal of the present study was to examine the association between attention-deficit/hyperactivity disorder (ADHD) and obesity in a representative community based sample of the German population. Method: Participants were 1,633 German residents (53.6% female) aged 18–64 years. A retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD were administered for diagnosis of adult ADHD. In addition, binge eating and purging behaviors as well as depression and anxiety were assessed using selfrating instruments. Results: The estimated prevalence of ADHD in obese participants was 9.7% compared to 3.8% in overweight and 4.3% in under-/normal-weight participants. The prevalence of obesity was 22.1% among adults with ADHD and 10.2% among persons without ADHD. Adult ADHD was significantly associated with a greater likelihood of being obese but not overweight even after adjusting for sociodemographic characteristics. Results were similar when adjusting for depression and anxiety symptoms and for purging behaviors. Odds ratios decreased after adjusting for binge eating; however, the results were still significant which shows that the relationship between obesity and ADHD in adulthood is not fully explained by binge eating. Conclusion: Overall, the results indicate that adult ADHD is associated with obesity in a community-based sample of the adult German population.

Internet use among patients with psychosomatic disorders: What are the health-related demands and needs?

While Internet-based health-related offers for various disorders are increasing, little is known about the way patients with psychosomatic disorders use the Internet. We conducted a questionnaire survey in outpatient clinics at two university hospitals’ Departments of Psychosomatic Medicine. Seventy-four percent of N = 274 patients had Internet home access and 60 percent of those patients reported health-related Internet use. Patients expressed the wish for more professional, evidence-based online information and expert-guided treatment. The survey results support the Internet’s high potential in future treatment strategies for patients with psychosomatic disorders.

The effect of dronabinol in a male patient with anorexia nervosa suffering from severe acute urge to be physically active

OBJECTIVE A 27-year-old male suffering from chronic anorexia nervosa was admitted for inpatient psychotherapy suffering from severe urge to be physically active. METHODS An off-label treatment with dronabinol was initiated, to reduce his symptoms related to that urge. Several attempts to reduce symptoms including intensive psychotherapy and several psychopharmacological agents had failed in the past. RESULTS Following treatment with 7.5 mg dronabinol twice a day, the patient reported a significant reduction in his acute urge to be physically active. Also eating disorder-specific cognitions and compulsive behaviors remitted. DISCUSSION Previous studies have applied much lower doses and showed no effect of dronabinol upon the urge to be physically active. Up to date, the patient reported no side effects, especially no psychotropic effects. Implications of this case report are discussed.

Media exposure and posttraumatic stress disorder: review and implications for psychotherapy

The posttraumatic stress disorder (PTSD) is conceptualised as a psychological reaction upon traumatic events of distinct threat. Especially after the terrorists´ attacks of September 11th 2001, the scientific evaluation of the impact of media coverage of war and terrorism on mental functions of healthy individuals and the question whether the exposure of previously traumatised individuals to media coverage of war and disasters may act as a trigger for a trauma re-activation has begun in the US. There are positive associations between media exposure and the presence of PTSD symptoms. The amount (length) of media consumption appears to be a crucial variable to consider. Psychotherapists are asked to broach the issue of a careful and self-protecting handling of media coverage during therapy.

Neural processing of food and emotional stimuli in adolescent and adult anorexia nervosa patients

Background A constant preoccupation with food and restrictive eating are main symptoms of anorexia nervosa (AN). Imaging studies revealed aberrant neural activation patterns in brain regions processing hedonic and reward reactions as well as–potentially aversive–emotions. An imbalance between so called “bottom-up” and “top-down” control areas is discussed. The present study is focusing on neural processing of disease-specific food stimuli and emotional stimuli and its developmental course in adolescent and adult AN patients and could offer new insight into differential mechanisms underlying shorter or more chronic disease. Methods 33 adolescents aged 12–18 years (15 AN patients, 18 control participants) and 32 adult women (16 AN patients, 16 control participants) underwent functional magnetic resonance imaging (fMRI, 3T high-field scanner) while watching pictures of high and low-calorie food and affective stimuli. Afterwards, they rated subjective valence of each picture. FMRI data analysis was performed using a region of interest based approach. Results Pictures of high-calorie food items were rated more negatively by AN patients. Differences in activation between patients and controls were found in “bottom up” and “top down” control areas for food stimuli and in several emotion processing regions for affective stimuli which were more pronounced in adolescents than in adults. Conclusion A differential pattern was seen for food stimuli compared to generally emotion eliciting stimuli. Adolescents with AN show reduced processing of affective stimuli and enhanced activation of regions involved in “bottom up” reward processing and “top down” control as well as the insula with regard to food stimuli with a focus on brain regions which underlie changes during adolescent development. In adults less clear and less specific activation differences were present, pointing towards a high impact that regions undergoing maturation might have on AN symptoms.