Pamela Bean

Treatment Issues and Outcomes for Males With Eating Disorders

The aim of this article is to discuss critical issues in treating males with eating disorders, and to present assessment and treatment outcome data for 111 males who received residential treatment for moderate to severe eating disorders. Males with eating disorders are often not included in eating disorder research as the population of individuals with eating disorders has historically been predominantly female. Whether this is due to actual lower prevalence of this disorder among males or to fewer males seeking treatment is not clear. In any case, there is limited empirical research on the particular treatment issues of males, and in treatment environments males are frequently in the minority. We have found that an all-male treatment environment is helpful in allowing males to benefit from treatment with less stigma. Data are presented which characterize psychiatric co-morbidity, excessive exercise, body image, sexuality, and spirituality in males. Treatment outcomes for males in this environment are positive.

New Drug Targets for HIV

A significant number of human immunodeficiency virus (HIV) infections have become resistant to antiretroviral treatment, which means that there is a paramount need for novel drug targets to defeat the virus. Until recently, all HIV drugs inhibited HIV replication by mechanisms operating inside infected cells. In contrast, new antiretroviral drugs operate outside infected cells. Their mechanism of action consists in inhibiting entry of the virus into cells, thereby halting the very first step of HIV replication. Examples of this new class of drugs include entry inhibitors, coreceptor antagonists, and fusion inhibitors. In addition to their novel mechanism of action, this new class of drugs also has potential action against drug-resistant HIV strains, causes minimal adverse effects, and may be administered in a simplified, once-daily dosing regimen. New classes of anti-HIV drugs--and new drugs in existing classes--represent the best hope for people infected with HIV, especially those who have exhausted current therapies.

Evolution of symptom severity during residential treatment of females with eating disorders

Objectives:The overall objective of this study was to measure the evolution of symptom severity in a residential programme based on a multidimensional approach to treatment that includes cognitive-behavioural, interpersonal, experiential and family therapies. The specific aims of the study were: 1) to evaluate changes in symptom severity in bulimic and anorexic patients between admission and discharge; 2) to compare the severity of these symptoms with those of non-patient college females (control group); and 3) to monitor the progression of symptom changes six months after discharge.Methods:The evolution of symptom severity was measured by comparing the mean raw scores of the Eating Disorder Inventory (EDI original inventory, 1983 version), which was administered at the beginning and end of the residential treatment. A subgroup of patients was also administered the EDI six months after discharge. The study involved 99 females: 47 with bulimia and 52 with anorexia as diagnosed by means of a clinical interview using DSM-IV criteria. The mean raw EDI scores in the control group (FC1, female college students) were obtained from the EDI manual. The population means were compared using the t-test for paired data (Microsoft Excel, version 2000).Results:The overall results for the population as a whole show that the eight subscales of the EDI improved significantly with treatment (<0.001). The subscales with the largest numerical improvements were drive for thinness, ineffectiveness and interoceptive awareness. When divided on the basis of diagnosis, the mean feelings of perfectionism score of the bulimic patients was less than that of the control female college sample; the symptoms of bulimia in the anorexic patients were similar to those found in the control group. The fact that the mean follow-up scores for a number of the EDI subscales remained similar to those recorded at the time of discharge suggests that some of the improvements in symptoms remained for at least six months.Conclusions:The results of our study show that multidimensional residential treatment leads to statistically significant changes in the severity of the symptoms manifested by females with eating disorders.

Using the EDAC test to monitor abstinence and relapses during outpatient treatment.

Abstract The main objective of this study is to show the performance of the EDACTM test in monitoring alcohol consumption during outpatient treatment. The EDACTM is a new approach that uses routine laboratory tests to identify binge drinking as well as chronic drinking. The overall diagnostic performance of the EDACTM fluctuates around 80 to 90% for both specificity and sensitivity. Close to two thousand subjects have been tested by the EDACTM since the early eighties; 300 of these were patients undergoing treatment at different institutions across the U.S. This article selected five case studies to represent examples of classical drinking behaviors encountered in most outpatient clinics. The first four cases illustrate the use of the EDACTM alone and the last case represents the use of the EDACTM combined with CDT. These five case studies illustrate the use of the EDACTM to detect relapse episodes, to monitor abstinence during outpatient treatment and to recognize a slip early enough to prevent more severe drinking. The use of biomarkers to monitor drinking behavior in alcohol dependent patients is gaining popularity because they provide objective information on a patients drinking status when used as an adjunct to self-report.

The Early Detection of Alcohol Consumption (EDAC) Score in the Identification of Heavy and At-Risk Drinkers from Routine Blood Tests

Abstract The objective of this study was to use the EDAC score to detect heavy and at-risk drinking in young adults (mean age = 25 years) and compare the results to self-reports. The EDAC score is a linear discriminant function (LDF) derived from the analysis of a combination of up to 35 blood chemistry and hematology analytes ordered routinely in clinical settings. Subjects (N = 150) were recruited from medical care facilities at the University of Missouri, Columbia. Blood samples, obtained from males (N = 66) and females (N = 84), were sent to LabCorp (Burlington, NC) for analysis. The blood chemistry panels were evaluated using a Linear Discriminant Function method available through SPSS software to predict whether each individual was a Heavy Drinker or an At-Risk Drinker. Heavy Drinkers consumed on average > 4 drinks daily for males and > 3 drinks daily for females. At-Risk Drinkers consumed at least 14 drinks per week or drank more than 4 drinks on any occasion in the last 14 days if male and consumed at least 7 drinks per week or more than 3 drinks on any occasion if female. Not-Heavy Drinkers and Not-At-Risk Drinkers consumed less than the amounts above. The results showed 8/10 (80%) males and 2/2 women identified as Heavy Drinkers by both the EDAC score (priorprobability Not-Heavy vs. Heavy Drinker = 0.5:0.5) and self-report. Fifty of 56 (89%) males and 65/82 (79%) of females were identified as Not-Heavy Drinkers by both EDAC score and self-report. There were 6/54 (11%) males and 15/82 (18%) women with false positive results, of these, 14/21 (67%) met dependence criteria by DSM-IV. The EDAC test showed 30% sensitivity and 96% specificity when identifying At-Risk drinking males and 42% sensitivity and 90% specificity when identifying At-Risk drinking females. In females, the EDACs sensitivity was higher than any single traditional or new laboratory marker previously reported for diagnosis of alcohol abuse such as GGT, MCV and CDT. As a complement or a substitute to an interview, in subjects who are less candid about their drinking, the EDAC is a useful tool to assess heavy and at-risk alcohol consumption in young adults.

Gender differences in the progression of co-morbid psychopathology symptoms of eating disordered patients

This study examined the utility of the Personality Assessment Inventory (PAI) in screening for comorbid psychopathology in eating disordered males and females undergoing residential treatment. The PAI, a self-administered screening tool containing 344 items to provide information on 11 clinical constructs, was administered at admission and discharge to 181 patients, 154 females and 27 males. Average age was 26.88 years (SD=9.35) and average length of stay was 58.31 days (SD=39.94). The results showed that both male and female patients exhibit several comorbid disorders at admission to residential treatment and the severity of these symptoms was statistically significantly reduced over the course of treatment. When comparing differences among genders, the results show that females present with more psychopathology symptoms at the start of treatment but make better progress than males in reducing these symptoms over time. When comparing patients across eating disorder diagnoses, subjects with bulimia displayed more severe comorbid symptomatology as compared to those with anorexia or other eating disorders. A thorough clinical assessment of eating disordered patients including comorbid psychopathology disorders is relevant for clinical diagnosis, treatment planning, and perhaps ultimately the outcome of treatment.

The combined presence of obsessive compulsive behaviors in males and females with eating disorders account for longer lengths of stay and more severe eating disorder symptoms

The goal of this study was to analyze the impact of obsessive compulsive behaviors (OCB) in eating disorder males and females admitted for residential treatment in terms of length of stay and severity of symptoms. Patients (N=384) were separated into four groups based on gender and the score obtained for the Maudsley Obsessive-Compulsive Inventory at admission. The instrument used to assess severity of eating disorder symptoms was the Eating Disorder Inventory (EDI-2) at admission and discharge. The results showed that the presence of comorbid OCB in eating disordered males and females account for longer length of stay (LOS) and an increased severity of eating disorder symptoms. Clinically, these findings point to the need for development of more targeted residential programs that are equipped for and adept at treating the comorbid eating disorder/OCB patient population.

Using routine laboratory tests to detect heavy drinking in the general population.

Abstract This article describes a new biomarker known as the Early Detection of Alcohol Consumption (EDAC) test, which has been steadily penetrating the U.S. market. The EDAC uses routine laboratory tests to make a prediction of heavy drinking in any given person. When tested in mainstream insurance populations, the EDAC has shown twice the specificity of the traditional liver enzyme tests and is significantly more sensitive than the CDT test, which is expected because the EDAC uses a combination of laboratory tests. Maximum diagnostic accuracy is achieved when the CDT test is used to confirm a positive EDAC test. Since brief interventions have proven successful, the early identification of alcohol problems becomes a vital role for physicians. Improved awareness of alcohol misuse can certainly be accomplished through an increased use of biomarkers, with and without concomitant self-report. The ultimate goal is to facilitate early intervention and the successful management of patients diagnosed with heavy drinking.

Sex differences in the effects of residential treatment on the quality of life of eating disorder patients.

AimsThis study compared the effects of residential treatment on improving health-related quality of life (HRQOL) between males and females diagnosed with eating disorders (EDs) from admission to discharge and at follow-up. This study also analyzed the association between changes in HRQOL and changes in the severity of ED pathology, depression, and trait anxiety.Methods145 consecutive patients (34 males and 111 females) admitted to a residential ED unit completed a panel of surveys at admission and discharge. The survey panel included the Eating Disorders Quality of Life Survey (EDQLS), the Eating Disorder Examination Questionnaire, the Quick Inventory of Depressive Symptomatology and the State-Trait Anxiety Inventory. An online follow-up survey was also conducted for the EDQLS. Mixed-factorial ANOVA was used to examine sex differences and changes in HRQOL between admission, discharge and post-treatment follow-up. Multiple regression analysis was used to investigate the relationship between sex, change in HRQOL, and changes in all other variables studied.ResultsBy the end of residential treatment, both males and females had made similar statistically significant improvements in HRQOL from admission to discharge, which persisted after treatment. Greater decreases in ED pathology and trait anxiety significantly predicted greater increases in HRQOL during residential treatment while sex and changes in depression did not.ConclusionThe data show that residential treatment is an effective approach to improving HRQOL in both males and females with EDs. Greater improvements in trait anxiety and ED pathology contributed to greater improvement in HRQOL in these patients.

Clinical Observations of the Impact of Maudsley Therapy in Improving Eating Disorder Symptoms, Weight, and Depression in Adolescents Receiving Treatment for Anorexia Nervosa

This article describes a comparison of adolescent patients with a diagnosis of anorexia nervosa receiving treatment with and without family-based therapy. Sixteen patients with anorexia nervosa were evaluated and compared pretreatment and post-treatment. The family-based program used is an adaptation of the Maudsley approach; a parallel treatment program used the standard multidisciplinary treatment at Rogers Memorial Hospital. The outcome measures in both programs were depression, eating disorder symptoms, weight, and body mass index. Individuals treated with the Maudsley approach made significant improvements in all outcomes measured. These preliminary findings support the notion that parental involvement in the treatment of anorexia nervosa is effective in significantly reducing overall eating disorder behaviors, decreasing symptoms of depression, and improving weight.