Nora Schneider

Cognitive flexibility and Agouti-related protein in adolescent patients with anorexia nervosa

INTRODUCTION Cognitive flexibility and the flexible learning and relearning of stimulus-reward-associations are important for decision-making and goal-directed behavior. Studies on patients with anorexia nervosa (AN) have shown difficulties in cognitive functions associated with malnutrition and extreme underweight. However, to date we find a lack of neuropsychological studies on cognitive flexibility among adolescent patients with AN. Furthermore, the underlying biological mechanisms remain unclear. Therefore, we aim to examine cognitive functions, especially reward association learning, as a measure of cognitive flexibility in adolescent patients with AN and investigate the relationship between Agouti-related protein (AGRP) and cognitive functions. METHODS The study population consists of 30 patients with AN (M(age)=16.2 ± 1.2) and a healthy control group (CG) of 28 female adolescents (M(age)=16.3 ± 1.3). All subjects completed a neuropsychological test battery including the probabilistic Object Reversal Task, the Digit Symbol Test and the Trail Making Test. Patients with AN were explored before and after weight gain, the CG initially and after 3 months. RESULTS Subtle deficits in cognitive flexibility were found in patients with AN compared to the CG. After weight gain, the AN group improved relative to their baseline values in most of the variables but did not reach CG values. They still showed slight impairments. Moreover the study revealed a clear association between AGRP levels and cognitive flexibility. DISCUSSION Cognitive flexibility plays an important role in AN and may be modulated by abnormal levels of the appetite-regulating peptide AGRP. Even subtle impairments in cognitive flexibility can be relevant for the ability to fully engage in therapy and therefore may hinder a prosperous treatment.

Etiological Role of Childhood Emotional Trauma and Neglect in Adolescent Anorexia Nervosa: A Cross-Sectional Questionnaire Analysis

Background: Most studies on the relationship between childhood trauma and anorexia nervosa (AN) have focused on the role of childhood sexual and physical trauma in adult patients. Little is known about the role of emotional trauma and eating disorders. The aim of the present study was to examine childhood sexual, physical, and emotional traumatization in adolescents with anorexia nervosa restricting type (AN-R) in comparison to those with anorexia nervosa binge-eating/purging type (AN-BP) and a healthy control group. Sampling and Methods: The sample included 50 patients with AN-R (mean age = 15.8 ± 1.6 years), 27 with AN-BP (mean age = 16.1 ± 1.1 years), and 44 healthy female control participants (mean age = 15.7 ± 1.3 years). AN diagnosis was confirmed by the Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-EX). Childhood sexual, physical, and emotional traumatization was assessed by a self-report questionnaire (Childhood Trauma Questionnaire; CTQ). Results: The results indicated higher rates of sexual, physical, and emotional abuse and physical and emotional neglect in patients with AN-BP than in patients with AN-R and healthy control participants. No significant differences in childhood traumatization were found between patients with AN-R and control participants. Conclusions: Our results underline the importance of detecting the full range of possible childhood traumatic experiences in adolescents with AN, rather than focusing simply on childhood sexual traumatization. Sexual, physical, and emotional childhood traumatization are particularly important in the history of adolescent patients with AN-BP, in contrast to patients with AN-R, and should be screened for in the diagnosis and therapy of eating disorders.

The role of leptin and cortisol in hyperactivity in patients with acute and weight-recovered anorexia nervosa.

INTRODUCTION In food-restricted rats, leptin as well as corticotropin releasing factor attenuate semistarvation-induced hyperactivity (SIH). Results from studies in patients with anorexia nervosa (AN) showed an association between excessive physical activity (PA) and leptin. One recent report suggests a role for cortisol in PA. In this study, we assessed the relationships between PA and both, cortisol and leptin levels at the same time in patients with acute anorexia nervosa (acAN) in comparison to recovered patients (recAN). METHODS Plasma leptin, plasma cortisol, body mass index (BMI), and expert-ratings of qualities of PA were assessed in 36 acAN patients, 27 recAN patients and 44 healthy control woman (HCW). Regression analyses were used to predict PA using BMI, leptin and cortisol levels as predictor variables. RESULTS Leptin levels but not cortisol significantly contributed to the prediction of PA in acAN. In recAN PA was not elevated and not related to endocrine parameters but correlated positively with core eating disorder symptoms. CONCLUSIONS Our work lends support to the proposed inverse association between peripheral leptin levels and excessive physical activity in AN. This relationship is specific to the state of semistarvation. The role of additional mediators remains to be clarified.

Leptin and its associations with measures of psychopathology in patients with anorexia nervosa.

Apart from energy homeostasis leptin has been shown to be involved in a number of neuronal networks. The aim of this study was to investigate how the residual variance of leptin levels, after controlling for BMI, is linked to eating-disorder-specific psychopathology and sexual desire in patients with anorexia nervosa (AN) compared to healthy controls. The sample included 57 subjects with acute AN and 77 healthy controls. Psychopathology was determined by EDI-2 and SCL-90-R and sexual problems were rated according to the Structured Interview of Anorexia Nervosa and Bulimic Syndromes (SIAB-EX). Plasma leptin was assessed by ELISA. Patients with a high drive for thinness had lower leptin levels at a given BMI and low leptin levels were associated with sexual problems, i.e. the absence of sexual desire and intimate relationships. Our results are in accordance with recent animal experiments linking low leptin levels with decreased sexual interest irrespective of body weight.

Comparison of body size estimation in adolescents with different types of eating disorders.

OBJECTIVE To examine differences in body size estimation in adolescents with different types of eating disorders. METHOD A total of 129 patients with eating disorders (M(age) = 16.0 +/- 1.8) and 354 healthy control participants (CP) (M(age) = 15.2 +/- 2.1) completed the EDI-2 and were asked to estimate the circumference of selected body parts by using string (BID-CA). RESULTS CP showed an average overestimation of 8-16%, depending on the estimated body part. Eating disorder patients overestimated their body parts on average by about 30%. Thigh and waist estimations were the best variables for discriminating between patients with eating disorders and CP. No significant differences were found between bulimia nervosa and anorexia nervosa patients. CONCLUSIONS Body image distortion plays an important role in both anorexia nervosa and bulimia nervosa. The BID-CA is well suited to discriminate between healthy and disordered overestimation of body parts.

Psychometrische Gütekriterien des Eating Disorder Inventory (EDI-2) bei Jugendlichen

The present study examines the psychometric properties of the German version of the Eating Disorder Inventory EDI-2 (1997) in 371 adolescents aged 13 to 18 years. Internal consistency, convergent and divergent validity were examined and a confirmatory factor analysis was conducted. Internal consistency was high for the group of patients and satisfactory for both control groups. Associations with other clinical instruments point in the expected direction and support the external validity of the EDI-2. The EDI-2 differentiated very well between the group of eating disorder patients (n=71) and the female (n=150) and male control groups (n=150). A discriminant analysis demonstrated that 86.0% of the cases were correctly classified, and a confirmatory factor analysis largely supported the six-factor structure generated by the German version of the EDI-2 (Thiel et al., 1997).

Agouti-related protein in patients with acute and weight-restored anorexia nervosa.

BACKGROUND An imbalance in appetite-regulating neuropeptides of the central nervous system has been associated with anorexia nervosa (AN), but the mechanisms of action are poorly understood. Agouti-related protein (AGRP), an orexigenic mediator of the hypothalamus, increases food intake and decreases energy expenditure in times of negative energy balance. The aim of the present study was to investigate AGRP in acute and fully weight-restored patients with AN, as well as during weight gain. METHOD Plasma AGRP and leptin levels were assessed using an enzyme-linked immunosorbent assay kit in a total of 175 female participants, including 75 patients with acute AN, 37 weight-restored AN patients and 63 healthy controls. Of the patients with acute AN, 33 were reassessed after partial weight gain. RESULTS In weight-restored AN patients plasma AGRP levels were similar to those in healthy controls, whereas in patients with acute AN, AGRP was elevated. AGRP was inversely correlated with indicators of undernutrition such as body mass index and plasma leptin. In addition, AGRP levels normalized during weight gain of longitudinally assessed AN patients. CONCLUSIONS Our results underline the significance of undernutrition and hypoleptinemia for the interpretation of peripheral AGRP concentrations. This provides support for the hypothesis that abnormal AGRP plasma levels in AN patients reflect undernutrition, rather than disease-specific traits.

Anorexia athletica in pre-professional ballet dancers.

Abstract Competitive sport has been under increasing discussion as a possible favourable factor in the development of eating disorders among children and adolescents. The aim of this study was to determine the frequency of sport-specific eating disorders, in line with the concept of anorexia athletica. This prospective field study included one experimental group and two control groups (disease and healthy). Fifty-two pre-professional ballet dancers aged 13–20 years were tested for clinical eating disorders, anorexia athletica criteria, eating disorder related psychopathology and self-concept, and were compared with 52 patients with anorexia nervosa and 44 non-athletic controls of the same age. The study was conducted using semi-structured interviews as well as self-report questionnaires. A clinical eating disorder diagnosis was made in 1.9% of the ballet dancers versus 0% of the high school students; anorexia athletica was diagnosed in 5.8% of the dancers versus 2.3% of the students. Ballet dancers scored lower than patients with anorexia nervosa with regard to eating disorder related psychopathology and higher than the patients with regard to self-concept. We conclude that more sensitive tools to differentiate between sport-specific (eating) patterns, anorexia athletica and clinically relevant eating disorders are needed, especially for aesthetic sports such as ballet. It remains an important goal to identify athletes with symptoms of anorexia athletica irrespective of their physique and/or sport.

Dialektisch Behaviorale Therapie (DBT) und Kognitiv Behaviorale Therapie (CBT) für Jugendliche mit Anorexia und Bulimia nervosa im Vergleich

Ziel der vorliegenden randomisierten kontrollierten Studie war die Uberprufung der Wirksamkeit der Kognitiv Behavioralen Therapie (CBT) sowie der Dialektisch Behavioralen Therapie (DBT-AN/BN) bei Patienten mit einer Anorexia nervosa (AN) und Bulimia nervosa (BN). 50 weibliche Patienten (12;4 – 21;0 Jahre) nahmen an der Untersuchung teil. 19 Patientinnen absolvierten eine 25-wochige CBT, 16 eine 25-wochige DBT-AN/BN und 15 wurden fur 3 Monate einer Wartekontrollgruppe (WKG) zugeordnet. Am Ende der Behandlung erfullten in der CBT-Gruppe noch 42.1 %, in der DBT-AN/BN-Gruppe 37.5 % und in der WKG alle Patienten die Kriterien einer Essstorung nach DSM-IV. Sowohl die CBT als auch die DBT-AN/BN fuhrten verglichen mit der WKG zu einer Reduktion der Kalorienvermeidung, der unregelmasigen Nahrungsaufnahme und der aktuellen psychischen Belastung sowie zu einer Erhohung des BMI. Bezogen auf die Korperbildstorung, die Autonomieentwicklung, die Emotionsregulation sowie den Perfektionismus konnten nur geringe positive E...

Aromatic amino acids in weight-recovered females with anorexia nervosa.

OBJECTIVE Most previous studies investigating amino acid levels in anorexia nervosa (AN) have focused on acutely underweight patients. The present study assessed the availability of aromatic amino acids in the plasma of weight-recovered outpatients with AN (recAN) in comparison to acutely underweight AN patients (acAN) and healthy control woman (HCW). METHOD Plasma tryptophan (TRP), tyrosine (TYR), and phenylalanine (PHEN) as well as leptin concentration were determined in 32 recAN, 32 acAN, and 32 HCW. RESULTS Both recAN and acAN patients showed significantly lower levels of TRP and PHEN when compared to HCW. TYR was reduced in acAN patients only. DISCUSSION Normal weight and normal leptin levels but lower availability of TRP and PHEN in recAN patients might indicate that outside a tightly controlled setting these patients still engage in abnormal eating patterns. Reduced peripheral availability of these precursor amino acids could impact on 5-HT and catecholamine functioning in the brain.