Shun'ichi Noma

Repeated administration of ghrelin to patients with functional dyspepsia: its effects on food intake and appetite.

BACKGROUND Ghrelin plays a major role in the regulation of food intake (FI), which makes it a strong candidate for the treatment of anorexia. OBJECTIVE We attempted to evaluate the clinical response to repeated ghrelin administration in patients with anorexia caused by functional disorders, such as functional dyspepsia (FD). SUBJECTS AND METHODS Subjects included in this study were those who 1) were diagnosed with functional anorexia, including FD and other eating disorders with the exception of anorexia nervosa; 2) were lean (body mass index (BMI)<22 kg/m(2)); and 3) exhibited decreased FI. Subjects received an i.v. infusion of ghrelin (3 microg/kg) for 30 min twice a day (before breakfast and dinner) for 2 weeks. We investigated the effects of ghrelin administration on FI, appetite, hormones, and metabolic parameters. RESULTS Six patients with FD were enrolled in this study. Ghrelin administration tended to increase daily FI in comparison with levels before and after completion of treatment, but this difference that was the primary endpoint of this study did not reach statistical significance (P=0.084). Hunger sensation was significantly elevated at the end of drip infusion (P<0.0001). No severe adverse effects were observed. CONCLUSIONS These results suggest that ghrelin administration is safe and that this treatment has stimulatory effects on appetite in patients with FD. Further studies are necessary to confirm the efficacy of ghrelin treatment for anorexia-related disorders.

Eating disorder symptoms among Japanese female students in 1982, 1992 and 2002

To study transcultural differences in eating disorders, we examined eating disorder symptoms and point prevalence of eating disorders among Japanese female students in 1982, 1992 and 2002. In 1982, 1992 and 2002, a total of 10,499 Japanese female students, aged 16-23 years, were asked to complete a self-administered questionnaire. Diagnosis of an eating disorder was made on the basis of DSM-IV criteria. On almost all measures, there were significant increases of a disordered attitude about fear of gaining weight, body perception disturbance and problematic eating behaviors over time. The point prevalence of anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified significantly increased over time. These results suggest that the prevalence of eating disorder symptoms and the point prevalence of eating disorders were increasing among Japanese female students in 2002. Changing socio-cultural factors in Japan may explain the dramatic increase of eating disorders over time.

Comparison between the SCOFF Questionnaire and the Eating Attitudes Test in patients with eating disorders

Objective: The SCOFF was developed as a simple, five-question screening tool for eating disorders to be used in primary care. The aim of this study was to examine the appropriateness of each question in comparison with the Eating Attitudes Test-26. Methods: The SCOFF and the EAT-26 were administered to 80 patients with eating disorders who had received treatment from May through October 2003 in Japan. Results: The scores of the SCOFF and those of the EAT-26 were positively correlated (P<0.001), and each question of the SCOFF was strongly associated with different items of the EAT-26. The detection rates with the SCOFF of the patients with anorexia nervosa or bulimia nervosa and that of the patients with eating disorders not otherwise specified (EDNOS) were 96.2 and 48.1%, respectively. The scores of the SCOFF and the values of body mass index were significantly correlated (P=0.041), and the detection rate with the SCOFF of patients with low body weight and EDNOS was low (10%). Conclusion: Each question of the SCOFF has been selected appropriately for reflecting characteristics of eating disorders, although one question about body weight loss should be modified to detect patients with anorexia nervosa more accurately.

Psychosocial predictors of psychiatric disorders after living donor liver transplantation

Objective. Adult recipients of living donor liver transplantation (LDLT) often have psychiatric disorders before and after surgery. The aim of this study was to investigate pretransplant psychosocial factors that can be used to predict psychiatric disorders after LDLT. Methods. The subjects were 67 recipients of adult-to-adult LDLT at Kyoto University Hospital, Japan, from November 2001 through July 2003. All subjects were interviewed and examined by means of the Beck Depression Inventory, State-Trait Anxiety Inventory, World Health Organization Quality-of-Life Assessment-26, and Psychosocial Assessment of Candidates for Transplantation (PACT) just before LDLT. The subjects were followed up for 90 days for the presence of psychiatric disorders. Results. Mood disorders in the past, inability to maintain a healthy lifestyle, family support instability, and suicidal ideation just before LDLT might be predictors of major depressive disorder after LDLT. Delirium just before LDLT might be a predictor of delirium after LDLT, while no psychosocial factors associated with posttransplant delirium could be found. Conclusion. Information about life history rather than any psychological examination is important for predicting the occurrence of posttransplant depression. PACT is useful for obtaining information about the life history of LDLT recipients.

Characteristics of Avoidant/Restrictive Food Intake Disorder in a Cohort of Adult Patients

OBJECTIVE To assess and compare clinical symptoms and psychometric analysis of adult patients with avoidant/restrictive food intake disorder (ARFID) with those with anorexia nervosa (AN). METHOD We completed a retrospective review of adult patients with a feeding and eating disorder assessed between 1990 and 2005 that qualified for a diagnosis of ARFID. Patients with ARFID were compared with those with AN, with respect to the demographics, clinical symptoms and psychometric analysis. RESULTS Using the criteria of the fifth edition of the Diagnostic and Statistical Manual, 95 (9.2%) of 1029 patients with a feeding and eating disorder met the criteria for ARFID. All patients with ARFID were women. The ARFID group had a significantly shorter duration of illness, lower rates of hospital admission history and less severe psychopathology than the AN group. CONCLUSIONS Adult patients with ARFID in this study were clinically distinct from those with AN and somewhat different from paediatric patients with ARFID in previous studies. Copyright

Eating Disorder Examination Questionnaire (EDE‐Q): Norms for Undergraduate Japanese Women

The aim of the present study was to provide normative data for the Eating Disorder Examination Questionnaire (EDE-Q) among undergraduate Japanese women and to compare these data to norms obtained from previous studies. Undergraduate Japanese women (n = 289), aged 18-24 years, were administered the EDE-Q. The mean global score in the present study was 1.55 (SD = 1.03). Japanese women reported significantly higher scores of shape concern and weight concern in spite of lower body mass index but a significantly lower score of restraint, compared with women in other normative studies. There were significant differences with respect to the occurrence of some specific eating disorder behaviours between Japanese women and women in the previous studies. Differences in normative data for the EDE-Q between young Japanese women and young women in the previous studies suggest that there may be certain cultural differences in eating disorder psychopathology.

Clinical presentation and outcome of avoidant/restrictive food intake disorder in a Japanese sample

We conducted a study of the clinical presentation and outcome in patients with avoidant/restrictive food intake disorder (ARFID), aged 15-40years, and compared this group to an anorexia nervosa (AN) group in a Japanese sample. A retrospective chart review was completed on 245 patients with feeding and eating disorders (FEDs), analyzing prevalence, clinical presentation, psychopathological properties, and outcomes. Using the DSM-5 criteria, 27 (11.0%) out of the 245 patients with a FED met the criteria for ARFID at entry. All patients with ARFID were women. In terms of eating disorder symptoms, all patients with ARFID had restrictive eating related to emotional problems and/or gastrointestinal symptoms. However, none of the ARFID patients reported food avoidance related to sensory characteristics or functional dysphagia. Additionally, none of them exhibited binge eating or purging behaviors, and none of them reported excessive exercise. The ARFID group had a significantly shorter duration of illness, lower rates of admission history, and less severe psychopathology than the AN group. The ARFID group reported significantly better outcome results than the AN group. These results suggest that patients with ARFID in this study were clinically distinct from those with AN and somewhat different from pediatric patients with ARFID in previous studies.

Outcome of Eating Disorders in a Japanese Sample: A 4- to 9-year Follow-up Study

OBJECTIVE The aim of this study was to compare the outcome of eating disorders (EDs) in Japan with that in Western countries. METHOD Two hundred and thirty-three Japanese women with an ED were followed for 4 to 9 years. We identified fully recovered women (good outcome group), partially recovered women (intermediate outcome group) and women with an active ED (poor outcome group) based on physical, behavioural and psychological indices. RESULTS Ninety-seven subjects were categorized as having a good outcome, 58 as intermediate and 61 as poor, and 17 had died. There was a significant difference in outcome results among the types of ED at intake. Women with both anorexia nervosa and bulimia nervosa, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, at intake had the worst recovery rates. CONCLUSIONS These results suggest that the outcome of EDs in Japan is relatively similar to that in Western countries, irrespective of sociocultural background and health systems.

Differences in neural responses to reward and punishment processing between anorexia nervosa subtypes: An fMRI study

Anorexia nervosa (AN) includes the restricting (AN‐r) and binge‐eating/purging (AN‐bp) subtypes, which have been reported to differ regarding their underlying pathophysiologies as well as their behavioral patterns. However, the differences in neural mechanisms of reward systems between AN subtypes remain unclear. The aim of the present study was to explore differences in the neural processing of reward and punishment between AN subtypes.

The impact of DSM-5 on the diagnosis and severity indicator of eating disorders in a treatment-seeking sample

OBJECTIVE To examine the impact of the DSM-5 on the diagnoses and severity indicators of eating disorders, we conducted a comparative study on the classification of eating disorders including subtypes of anorexia nervosa (AN) between the DSM-IV and DSM-5 criteria. In addition, we studied the association of the DSM-5 severity criteria and clinical variables. METHOD Participants were 304 outpatients, aged 16-45 years, with eating disorders, diagnosed using semi-structured clinical interviews and the eating disorder examination questionnaire (EDE-Q). The severity of AN, bulimia nervosa (BN), and binge-eating disorder (BED) was rated from mild to extreme using the DSM-5 severity criteria. RESULTS The DSM-5 remarkably reduced the number of diagnoses in the residual category from 37.5% to 9.2% and effectively differentiated the diagnostic groups in eating disorder psychopathology. Unexpectedly, however, the scores of all the EDE-Q subscales significantly decreased as severity ratings increased in the DSM-5 AN. Furthermore, while the AN binge-eating/purging group reported significantly lower severity ratings than the AN restricting group, the former displayed more severe eating disorder psychopathology than the latter. In the BN and BED groups, the level of eating concern increased as severity ratings increased, but the severity groups did not differ on other eating pathology variables. DISCUSSION The DSM-5 effectively reduced the reliance on residual categories and differentiated the diagnostic groups in eating disorder psychopathology. However, our findings show limited support for the DSM-5 severity specifiers for eating disorders. It is necessary to test additional clinical or functional variables for severity specifiers across eating disorders.