Jean Chambry

Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality.

OBJECTIVE To compare clinical characteristics of men and women with severe AN and to analyze mortality in men. METHOD One thousand and nine patients including 23 anorectic males were hospitalized in St. Anne Hospital in Paris between 1988 and 2004. Data were collected during hospitalization. Fatal outcome was assessed in 2008. RESULTS Men presented significantly later age of onset, were more likely to have a history of premorbid overweight than women and less likely to have attempted suicide. Mortality in men was high (standardized mortality ratio: 8.08; 95% CI: 1.62-23.62). Several predictive factors for mortality in men were identified: lower admission body mass index (BMI), later age at admission, and AN-R subtype. All the three deceased patients had dropped out from the inpatient unit. The 10-year survival did not differ between men and women, but men died sooner after hospitalization. DISCUSSION Male inpatients should receive close follow-up after their discharge, especially if they have a restrictive form of AN, present low BMI, or are older at admission.

Involvement of cytokines in eating disorders: a critical review of the human literature

A number of findings from clinical and animal studies indicate that pro-inflammatory cytokines may play roles in eating disorders. The measurement of pro-inflammatory cytokines (IL-1, IL-6, TNFalpha), which are known to decrease food intake, provides highly variable data from which firm conclusions cannot be drawn. In most of the longitudinal studies where pro-inflammatory cytokines have been shown to be impaired in anorexia or bulimia nervosa, a return to normal values was observed after renutrition. However these findings do not exclude the possibility that pro-inflammatory cytokines might be overproduced in specific brain areas and act locally without concomitantly increased serum or immune production. It was also pointed out that the production of the major type-1 cytokines (especially IL-2) was depressed in anorexia nervosa. It remains unclear whether this is due to undernutrition or to a specific underlying cause common to eating disorders. The impaired cytokine profile observed in eating disorders could be related to several factors including impaired nutrition, psychopathological and neuroendocrine factors. More particular attention should be devoted to the deregulation of the anti/pro-inflammatory balance. Deregulation of the cytokine network may be responsible for medical complications in eating disorder patients who are afflicted with chronic underweight.

Correlation between serum levels of interleukin-4 and alexithymia scores in healthy female subjects: preliminary findings

Some studies suggest that inaccuracy in recognizing and describing emotional states, combined with a highly descriptive mode of expression, as in alexithymia, may influence the immune response. We therefore investigated in healthy women the relationship between alexithymia and circulating levels of IL-1, IL-2 and IL-4. Seventeen mentally and physically healthy women aged between 20 and 25 years completed psychological questionnaires to assess alexithymia (Toronto Alexithymia Scale: TAS) and depressed mood (Hospital Anxiety and Depression Scale: HAD). Serum concentrations of IL-1, IL-2 and IL-4 were measured by ELISA. We found a significant positive correlation between serum levels of IL-4 and TAS score (r=0.55; p=0.021) and between factor 1 of the TAS (difficulty in identifying feelings) and IL-4 (r=0.57; p=0.017) while serum IL-1 and IL-2 were not detected in ten and six patients, respectively. Although there was a significant correlation between age and IL-4 levels, a linear regression with BMI, age, depressed mood and TAS as independent variables showed that only alexithymia could predict significantly increased levels of IL-4. Alexithymia and difficulty in identifying feelings could be associated with increased levels of IL-4 which may result in chronic impairment of pro/anti-inflammatory cytokine balance with psychological and somatic consequences. Nevertheless, these intriguing findings would deserve replication and extension in a larger sample of subjects.

Cytokines and Anorexia Nervosa

Objective Recent studies have indicated that the inflammatory cytokines could be implicated in anorexia nervosa and in its complications. To determinate the potential role of interleukins (IL-1, IL-2, IL-4, IL-6, IL-10), interferon (IFN &ggr;), tumor necrosis factor (TNF-&agr;), and transforming growth factor (TGF-&bgr;2) in anorexia nervosa, serum concentrations of these cytokines were measured in patients suffering from anorexia nervosa in comparison to healthy subjects. Method Twenty-nine anorexic women according to DSM-IV criteria participated in the study. The control group consisted of 20 healthy women without eating disorders, mood disorders, and immunological disorders. Results We find that serum IL-2 and TGF-&bgr;2 concentrations were both significantly decreased in anorexic patients, although the other cytokines did not differ significantly between the two groups. Conclusion Our results show that in patients with anorexia nervosa, there are lower levels of specific cytokines (especially IL-2 and TGF-&bgr;2). These levels may reflect the combination of impaired nutrition and weight loss, therefore, the dysregulation of these cytokines may contribute in anorexia’s complications. Follow-up studies should examine the effects of parameters such as starvation, psychopathologic factors, and psychoneuroendocrinological perturbation which could affect interplay between cytokines, neuropeptides, and neurotransmitters.

Alexithymia in infertile women.

Objective. Alexithymia was compared in women with fertility disorders and fertile women who have never been confronted with fertility problems. Method. Self-report instruments (TAS-20 and BVAQ) were used to measure alexithymia in a group of 73 infertile women and in a comparison group of 32 fertile women. Semi-structured interviews were used to assess medical history, current and lifetime diagnosis of psychiatric disorders. Results. Infertile women showed significantly higher rates of alexithymia than fertile women. The degree of alexithymia does not constitute a discriminating variable between unexplained infertile women and women with an organic aetiology of infertility. The prevalence of psychiatric diagnosis did not differ between the two groups of patients. Lifetime prevalence of depression, obsessive-compulsive disorders, post-traumatic stress disorder were statistically comparable. Conclusion. This result raises the question of secondary alexithymia as a coping strategy in women with fertility troubles. Given the lack of published data on alexithymia in infertile women, there is a need to replicate our results and evaluate other aspects of affect regulation in infertile patients.