Wayne A. Bowers

Implications of Starvation-Induced Change in Right Dorsal Anterior Cingulate Volume in Anorexia Nervosa

OBJECTIVE Converging evidence suggests a role for the anterior cingulate cortex (ACC) in the pathophysiology of anorexia nervosa (AN). This study sought to determine whether ACC volume was affected by starvation in active AN and, if so, whether this had any clinical significance. METHOD Eighteen patients with active AN and age- and gender-matched normal controls underwent magnetic resonance imaging (MRI). Sixteen patients (89%) with AN had intelligence quotients (IQ) testing at intake, 14 (78%) had repeat MRIs after weight normalization, and 10 (56%) had outcome data at 1-year posthospitalization. RESULTS Right dorsal ACC volume was significantly reduced in active AN patients versus controls and was correlated with lower performance IQ. While ACC normalization occurred with weight restoration, smaller change in right dorsal ACC volume prospectively predicted relapse after treatment. CONCLUSION Reduced right dorsal ACC volume during active AN relates to deficits in perceptual organization and conceptual reasoning. The degree of right dorsal ACC normalization during treatment is related to outcome.

A SLIMMING PROGRAM FOR EATING DISORDERS NOT OTHERWISE SPECIFIED: Reconceptualizing a Confusing, Residual Diagnostic Category

This study suggests that the category of EDNOS as currently defined is overly broad, representing many cases that could be more helpfully subsumed within AN or BN diagnostic criteria without changing the essential features of these categories but by rethinking the currently overly restrictive, perhaps research-derived criteria. The reconceptualizing of AN as a syndrome resulting from a decrement between setpoint versus illness-driven final weight avoids the inherent problems of imposing a category on a dimension. A rethinking of AN suggests that a specific female-only abnormality of reproductive hormone functioning, 3 months of amenorrhea, is too restrictive. Instead, a more encompassing criterion recognizing the multiple medical, social, and psychologic functional impairments that result from substantial starvation would be appropriate in its place. Clinicians who otherwise confidently treat AN and BN patients would welcome the clearer diagnostic categorization of the potentially confusing EDNOS category. Third party payers who currently, albeit wrongly, exclude EDNOS diagnoses from insurance payment, would have less difficulty with a smaller group of EDNOS. In summary, the currently overly broad category of EDNOS as currently used would benefit from a thoughtful dieting regimen.

Neuropsychological characteristics of patients in a hospital-based eating disorder program

The existence of cognitive deficits associated with eating disorders has been debated for some time. The present study investigated cognitive impairments in a large sample of patients with anorexia nervosa from an inpatient treatment program. Fifty-nine women with anorexia nervosa were given a battery of neuropsychological tests assessing multiple cognitive domains. Over half of the patients had mild cognitive impairments in two or more neuropsychological tasks and approximately one-third failed two or more tasks. Depression level and body mass were not associated with cognitive impairment. Whether effective restoration of weight and resolution of core psychopathology contribute to reversal of cognitive deficits requires further research.

Predictors of short-term treatment response in 66 patients with panic disorder

Short-term treatment response in panic disorder was studies in 66 subjects who had completed 3 weeks of treatment with fluvoxamine (n = 23), cognitive therapy (n = 20), or placebo (n = 23). Clinical and self-rated assessments were gathered at baseline, during, and after treatment. Using multiple logistic regression, treatment with fluvoxamine, a low panic attack severity score, and absence of a comorbid personality disorder were identified as significant predictors of recovery. Personality disorder was an important negative predictor to outcome with cognitive therapy. The results support the efficacy of fluvoxamine, and show that patients with low symptom severity and a normal personality respond well to treatment.

Cognitive therapy for anorexia nervosa

This case represents the use of Acceptance and Commitment Therapy (ACT) in the treatment of an eating disorder (see Heffner, Sperry, Eifert, & Detweiler, 2002) . The response presents a cognitive therapy model to treat eating disorders, focusing on the treatment of anorexia nervosa. The paper presents a cognitive perspective that includes a conceptualization of the disorder, a treatment plan, specific interventions, and adjunctive treatments such as family therapy and hospitalization. The use of a cognitive therapy model in the treatment of eating disorders integrates well with a multifaceted treatment utilizing interpersonal, psychodynamic, and family therapy models and would easily combine with ACT.

Cognitive therapy with inpatients: Review and meta-analysis.

Cognitive therapy has shown promise as a treatment for depressed outpatients. Despite recent increases in its use with inpatients, the treatment itself has not been well substantiated empirically. This article reviews the literature on cognitive-behavior therapy (CBT) with inpatients, and uses meta-analysis to assess the efficacy of this approach to treatment. The results suggest that CBT can be beneficial with inpatients both as a primary treatment and as an adjunct to antide-pressant medication. More controlled research needs to be completed to fully confirm CBT’s role in an inpatient setting.

Inpatient Treatment of Anorexia Nervosa: Review and Recommendations

&NA; Inpatient treatment of anorexia nervosa, difficult and at times complex, has been shown to promote enduring change. An integrated treatment approach that includes medical, psychological, nursing, and social interventions can restore patients to a healthy weight, improve abnormal eating behaviors, and ameliorate many of the central psychopathological attitudes and illness‐driven behaviors characteristic of the disorder. This article reviews inpatient treatment of anorexia nervosa, evaluating empirical studies and providing a critique of their methodology and potential applicability, combining available published studies with clinical experience to suggest a comprehensive pragmatic treatment approach, and noting research needs for the future. More controlled double‐blind studies are urgently needed to assess virtually every aspect of inpatient care, especially methods for promoting safe and rapid weight restoration. Comparative studies on the efficacy of behavioral, psychotherapeutic, and pharmacological approaches and determination of the optimum step‐wise preparation for discharge into a weight‐preoccupied society are also needed.

Stability of neuropsychological performance in anorexia nervosa

INTRODUCTION We investigated the stability of neuropsychological performance and eating disorder (EDO) symptoms before, immediately after, and 2 years after inpatient treatment. We also examined relationships between neuropsychological and EDO measures. METHODS Sixteen women who were admitted for inpatient treatment of anorexia nervosa participated in three evaluations: (1) at admission to the hospital, (2) at discharge, and (3) at a follow-up exam approximately two years after discharge. RESULTS Body mass index increased significantly from each testing session to the next. Endorsement of eating disorder symptoms was significantly decreased at discharge and at follow-up compared to admission. In terms of cognitive performance, total scores on a brief neuropsychological battery (RBANS) were significantly greater at follow-up than at admission. We found no relationships between EDO symptoms and cognitive function at any of the three sessions. CONCLUSIONS The current findings suggest that EDO symptoms and cognitive performance in anorexia nervosa patients can show improvement as long as two years after hospitalization, but there is no evidence that EDO symptoms are related to neuropsychological performance.

The Effectiveness of Cognitive Behavioral Therapy on Changing Eating Disorder Symptoms and Psychopathology of 32 Anorexia Nervosa Patients at Hospital Discharge and One Year Follow-Up

BACKGROUND This study aims to assess changes in core eating disorder psychopathology (Eating Attitudes Test, EAT; Eating Disorders Inventory-2, EDI-2), depression (Hamilton Rating Scale, HRSD; Beck Depression Inventory, BDI) and general psychopathology (MMPI-2) after inpatient treatment and one-year follow-up among patients diagnosed with anorexia. METHODS Thirty-two patients were treated for anorexia nervosa on an inpatient unit, and were assessed before and after treatment. The inpatient milieu was designed to use cognitive therapy as the primary therapeutic intervention, along with weight restoration. RESULTS At discharge, all patients displayed significant change in core eating disorder psychopathology in their depressive symptoms, as well as in general aspects of psychopathology. At one-year follow-up, changes in some areas of core eating disorder psychopathology and depressive symptoms continued to be significantly different than from admissions. CONCLUSIONS The combination of CBT and weight restoration can significantly reduce eating disorder symptoms, depression, and general psychopathology during hospitalization, with some sustained benefit over a one year period. Future research is needed to identify the effect of CBT on anorexia nervosa during a wide variety of treatment settings. Also, research must focus on the influence of outpatient treatment in the outcome of anorexia nervosa.

Neuropsychological Impairment Among Anorexia Nervosa and Bulimia Patients

Abstract Seventy females consecutively admitted to a hospital for treatment of anorexia nervosa (AN, n = 40) or bulimia (BN, n = 30) were given a battery of psychological tests on admission to assess neuropsychological impairment. Comparisons were made to see whether there was a difference between the two diagnostic groups on neuropsychological impairment. The AN group had significantly more individuals impaired on neuropsychological testing than the BN group (62.5% vs. 30%). Neuropsychological testing indicated that some in the bulimic group were impaired.