Kristin Stedal

The Neuropsychological Profile of Children, Adolescents, and Young Adults with Anorexia Nervosa

The neuropsychological profile of a sample of 155 patients with a clinical diagnosis of anorexia nervosa was assessed using a test battery specifically developed for such patients. The current findings suggest that the patients display a common neuropsychological profile including both strengths and weaknesses when compared with published norms. The patients displayed good verbal fluency skills, but performed poorly on tests of visuospatial memory, associated with relatively weak central coherence. They were within the average range on the assessment of executive functioning except for one measure of set-shifting. This study provides a valuable point of reference for clinicians when considering treatment options.

An examination of the ravello profile--a neuropsychological test battery for anorexia nervosa.

The Ravello Profile test battery was developed to ensure a consistent methodology when researching neuropsychological functioning in anorexia nervosa (AN). To date, 157 patients with AN have been assessed with the full Ravello Profile. The present review is the first study to systematically investigate the tests included in the battery. Fifteen experimental studies, comparing AN patients with healthy control participants on at least one of the Ravello Profile tests, were identified, and effect sizes were calculated. Three of the tests, Verbal Fluency Test (VFT), Rey Complex Figure Test (RCFT) and Trail Making Test (TMT), were meta-analysed, and the pooled standardized effect size was significant for all three tests (0.25, -0.68 and 0.49, respectively). Patients with AN performed significantly better than healthy control participants on assessment of verbal fluency (VFT) and worse on tests of visual memory (RCFT) and set-shifting (TMT). The Ravello Profile test battery appears to consist of tests that are appropriate for assessing characteristic neuropsychological profiles specific in AN.

Eating Disorder Examination Questionnaire (EDE-Q) in Norwegian Adults: Discrimination between Female Controls and Eating Disorder Patients

OBJECTIVE To determine the optimal Eating Disorder Examination-Questionnaire (EDE-Q) global score to discriminate between female controls and patients by eating disorder (ED) diagnosis, body mass index (BMI) and age. METHOD A sample of 1845 control participants and 620 patients from specialty ED treatment centres. RESULTS Mean global EDE-Q was 4.00 [standard deviation (SD) = 1.32] for patients and 1.25 (SD = 1.10) for controls. Receiver operating characteristic analyses demonstrated an area under the curve of 0.93 (95% CI: 0.91-0.94), with an optimal cut-off score of 2.50 (sensitivity = 0.86; specificity = 0.86), ranging from 2.09 for anorexia nervosa, 2.62 for bulimia nervosa and 2.63 for ED otherwise not specified. Optimal cut-off scores also varied according to BMI, ranging from 1.62 (BMI ≤ 18.0 kg/m(2) ) to 3.26 (BMI ≥ 30 kg/m(2) ), with less variability for age, ranging inversely from 2.16 (>40 years) to 2.70 (<20 years). DISCUSSION The global EDE-Q score showed high discriminant validity, and findings illustrate the particular importance of considering BMI and diagnosis when applying cut-offs based upon the EDE-Q.

Impairment due to eating disorder pathology: Identifying the cut-off score on the Clinical Impairment Assessment in a clinical and community sample

OBJECTIVE The Clinical Impairment Assessment (CIA) is a self-report measure of impairment secondary to eating disorder (ED) features. The purpose of this study was to identify the global CIA cut-off score that maximized sensitivity and specificity to discriminate impairment due to eating disorder pathology in a community versus clinical ED sample using receiver operating characteristic (ROC) analyses. METHOD Participants were 1,468 female community participants and 552 eating disorder patients. RESULTS Mean global CIA scores were 5.17 (SD 7.61) and 32.50 (SD 10.20). The ROC analysis demonstrated excellent accuracy of the global CIA score (AUC = 0.97; 95% CI: 0.96-0.98). A cut-off score of 16.0 yielded a sensitivity of 0.91 (95% CI: 0.88-0.93) and a specificity of 0.91 (95% CI: 0.89-0.93). DISCUSSION This study is the first to replicate findings from the original development study of the CIA and lends support to initial recommendations. Data provide strong evidence of the discriminant validity of the CIA and suggest the utility of assessing eating-disorder related impairment for classification purposes.

Eating disorders in men aged midlife and beyond.

Eating disorders are serious psychiatric illnesses which can occur across the lifespan. Men aged midlife and beyond are vulnerable to stigma, shame, and stereotypes portraying eating disorders as afflictions of youth and female gender. Historically, men have been neglected in the field of eating disorders owing to traditional and female-centric approaches to conceptualization and classification. In this literature review, we identified 16 case reports of eating disorders in males ranging from the age of 40 to 81 years. The majority of cases reported an earlier onset in life, followed by a variable course of illness with periods of relapse interspersed with remission. Diagnostic crossover or symptom fluctuation was common. High rates of comorbid depression were found, and several cases described a history of weight cycling and premorbid obesity. Precipitating factors included stressors which disproportionately occur in later life, including loss due to death or divorce, changes in financial or housing situation, and medical issues. Very little is known regarding the prevalence of eating disorders in older men, with initial population estimates ranging from 0.02% to 1.6%. Rates of subthreshold eating disordered behavior are higher and appear to be increasing among older individuals and males in the community. Recent revisions in the DSM-5 will likely increase the broader applicability of diagnostic criteria for eating disorders, stimulating improved recognition of diverse presentations occurring across the lifespan for both genders. Eating disorders should be included in the differential diagnosis of unexplained weight gain or weight loss irrespective of age or gender. Multi-site studies are needed for adequate sampling and to allow larger empirical investigations regarding how to improve clinical practices in screening and assessment, as well the provision of differential care for older men suffering from an eating disorder.

Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA): clinical norms and functional impairment in male and female adults with eating disorders

Abstract Aim: The aim of the current study was to collect clinical normative data for the Clinical Impairment Assessment questionnaire (CIA) and the Eating Disorder Examination Questionnaire (EDE-Q) from adult patients with eating disorders (EDs). This study also examined unique contributions of eating disorder (ED) symptoms on levels of ED-related impairment. Methods: A sample of 667 patients, 620 females and 47 males, was recruited from six specialist centres across Norway. The majority of the sample (40.3%) was diagnosed with eating disorder not otherwise specified (EDNOS), 34.5% had bulimia nervosa (BN), and 25.2% were diagnosed with anorexia nervosa (AN). Results: There were significant differences for global EDE-Q and CIA scores between females and males. In the female sample, significant differences were found on several EDE-Q sub-scales between the AN and BN group, and between the AN and EDNOS group. No significant differences were found between the diagnostic groups on the CIA. In the male sample, no significant differences were found between diagnostic groups on the EDE-Q or CIA. A multiple regression analysis revealed that 46.8% of the variance in impairment as measured by the CIA was accounted for by ED symptoms. Conclusions: Body mass index, Eating Concern, Shape/Weight Concern, and binge eating served as significant, unique predictors of impairment. The results from the present study contribute to the interpretation of EDE-Q and CIA scores in ED samples.

Neuropsychological assessment in adolescents with anorexia nervosa – exploring the relationship between self-report and performance-based testing

ObjectiveResearch investigating the relationship between neuropsychological test performances and self-reported cognitive functioning in patients with anorexia nervosa (AN) is limited, and existing experimental studies only demonstrate a low-to-moderate relationship between the performance based tests and everyday behaviour. The objective of the current study was to explore the association between neuropsychological test performance and self-reports of executive functioning in adolescents with AN.MethodTwenty adolescent females diagnosed with AN, aged 13 to 18, completed neuropsychological test battery “the Ravello Profile” and the self-report version of the Behaviour Rating Inventory of Executive Function (BRIEF-SR). The BRIEF Parent Form (BRIEF-PF) was employed to provide additional information of the patients’ executive functioning.ResultsBased on group level analyses, the results support the existing literature in failing to find consistent weaknesses in neuropsychological functioning in adolescents with AN. Further, with few exceptions, the Ravello Profile was insubstantially correlated with the majority of the BRIEF clinical scales, indicative of a lack of association between these two assessment methods.ConclusionThe current study accentuates the need for concern regarding the generalizability of neuropsychological assessments in adolescent patients with AN.

Labeling and defining severe and enduring anorexia nervosa: A systematic review and critical analysis

OBJECTIVE With anorexia nervosa (AN) having various presentations, attention has been directed towards particularly durable forms of the condition in both research and clinical contexts. A major hindrance in terms of advancing the field is the inconsistent labeling and defining of this subgroup. This has two implications; first, the inconsistent recruitment of participants when researching this sample, and second, the misdiagnosing of patients who may or may not have a durable course of the disease. The current research had the purpose of providing an overview of the current labels and criteria used for defining cases of severe and enduring AN, and critically analysing the implications of these findings. METHOD In accordance with PRISMA guidelines, a literature search was conducted using four electronic databases (PsycINFO, MEDLINE, Web of Science and Scopus) in order to identify 32 records that met the standards stipulated by the criteria. Data extraction included explicit labeling, the definition or criteria used to describe the subgroup, along with participant age and study design. RESULTS It was found that the terms chronic and severe and enduring were the most commonly used adjectives when referring to this subgroup. In terms of criteria, illness duration and the number of previously failed treatment attempts were the most common defining features within the literature. DISCUSSION It is the aim of the authors to inspire further research into what is the most appropriate label and defining features for the subgroup in order to facilitate a better approach and outcome for the individuals affected.

Verbal fluency in anorexia nervosa

Verbal fluency performance is commonly evaluated in clinical neuropsychology, in particular for assessment of executive functioning. Fluency is usually assessed by the person’s ability to produce as many words as possible from a given cue within a specific timeframe. The cues are typically phonemic, e.g. words beginning with a specific letter, or semantic, e.g. words within a given category. Important components underlying fluency performance include clustering (the production of words within subcategories) and switching (the switch between clusters). Previous studies have demonstrated good performance on verbal fluency tasks in patients with anorexia nervosa (AN), but have not investigated the underlying components of this performance. The aim of the present study was to compare phonemic fluency performance in patients with AN to healthy controls (HC) and to investigate the use of clustering and switching in the two groups. Fifty-two patients with AN were compared with 37 HC on a phonemic fluency task. The patient group produced more words in total but the results were not significantly different compared to the HC sample. There were no differences between the two groups with regard to clustering, but patients with AN performed significantly more switches. In addition, switching was significantly more related to total output score in the patient sample. In contrast with previous studies of other areas of cognitive flexibility in AN, patients with AN appear to have good verbal set-shifting skills.

Cognitive Remediation Therapy for Adolescents with Anorexia Nervosa—Treatment Satisfaction and the Perception of Change

Cognitive remediation therapy (CRT) has recently been developed for children and adolescents with anorexia nervosa (AN). It focuses on decreasing rigid cognitions and behaviors, as well as increasing central coherence. Overall, CRT has been proven feasible for young individuals with AN, but little is known regarding the specifics of its feasibility, and the perception of change associated with the intervention. Consequently, the aim of the current study was to explore service users’ perspective on CRT with a specific focus on treatment delivery, treatment content, and perceived change. Twenty adolescents (age 13–18) with AN participated in a 10-session course of CRT. A 20-item treatment evaluation questionnaire was administered at the end of treatment, focusing on four aspects of the intervention: (1) general attitudes towards treatment, (2) treatment specifics, (3) the perception of change and (4) the patient-therapist relation. The main findings suggest high levels of treatment satisfaction, but somewhat limited perceptions of change. The current study is one of the most detailed accounts of adolescents’ perspective on CRT published on eating disorders, and highlights several important aspects of the treatment viewed through the eye of the receiver.