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Eating Disorders - Aspects of Treatment and Outcome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Eating disorders (ED) usually develop during adolescence, and intervention to stop further weight loss is believed to improve outcome and long-term prognosis. Adolescents with ED who do not receive effective treatment risk poor outcome and even untimely death as adults.

The first aim of this thesis was to investigate long-term mortality and causes of death in a series of female adults with chronic ED. The second aim was to study the one-year outcome of an unselected series of adolescent girls with anorexia nervosa (AN) and “other restrictive eating disorders” who had been treated within a specialist ED out-patient service focused on nutritional rehabilitation based on family therapy and without planned hospitalization. The third aim was to investigate the possible metabolic and hormonal side effects of olanzapine when used as an adjunct to facilitate nutritional rehabilitation. The fourth aim was to investigate the relationship between polyunsaturated fatty acid (PUFA) status and depression.

In adult women with chronic ED, a very low body mass index and psychiatric co-morbidity confer a substantially increased risk of premature death.

A treatment programme for adolescent ED with rapid access to assessment and prompt start of treatment with initial emphasis on nutritional rehabilitation proved efficient. The outcome was encouraging, as 43% of all patients with ED and 19% of those with AN did not have an ED at one-year follow-up. Of the remaining patients the vast majority had gained weight and regained menstruation, and were back in school on a full-time basis. Olanzapine was used to reduce anxiety, excessive exercise and rumination over weight and shape. Side effects were similar to those observed in normal-weight individuals, and do not preclude its use in underweight adolescents with ED. Low ω3 PUFA were associated with depression. The ω3 PUFA status improved during nutritional rehabilitation with ordinary foods and without supplementation.

The investigations indicate that adolescent ED can be successfully treated in an out-/day-patient setting. An essential feature of the service is rapid handling and weight gain. Further weight loss can be avoided, and chronic disease hopefully prevented.

 

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 67 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 916
Keyword [en]
Anorexia Nervosa, Eating Disorders, Mortality, Standard Mortality Ratio, Adolescent, Family-Based Treatment, Out-patient, Olanzapine, Omega-3
National Category
Psychiatry
Research subject
Child and Youth Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-204209ISBN: 978-91-554-8706-5 (print)OAI: oai:DiVA.org:uu-204209DiVA: diva2:638154
Public defence
2013-09-12, Rudbeck salen, Rudbeckslaboratoriet, ing. C, bv, Dag Hammarskjöldsväg 20, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2013-08-21 Created: 2013-07-24 Last updated: 2014-01-07Bibliographically approved
List of papers
1. Mortality of Eating Disorders: A Follow-Up Study of Treatment in a Specialist Unit 1974-2000
Open this publication in new window or tab >>Mortality of Eating Disorders: A Follow-Up Study of Treatment in a Specialist Unit 1974-2000
2011 (English)In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 44, no 4, 304-310 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To study excess mortality, causes of death, and co-morbidity in patients with eating disorder (ED), treated in a Swedish specialist facility. Method: A retrospective cohort study of 201 patients with ED followed from 1974 to year 2001 in the Swedish Causes of Death Register (SCODR). Standardized mortality ratio (SMR) was calculated with respect to the Swedish population, by gender, age, and calendar time. Results: In the complete follow-up of 201 patients, 23 had died. At a mean follow-up of 14.3 years the overall SMR was 10. Patients with body mass index (BMI) over 11.5 had an average SMR of about 7 and for those with BMI lower than 11.5 had SMR above 30. Six patients died from AN/starvation, nine due to suicide, and eight from other causes. Discussion: SMR in anorexia nervosa (AN) is high but not in bulimia nervosa. A risk stratification of AN, based on BMI is suggested.

Keyword
eating disorder, mortality, substance abuse, suicide, comorbidity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-153288 (URN)10.1002/eat.20827 (DOI)000289373900003 ()21472749 (PubMedID)
Available from: 2011-05-10 Created: 2011-05-10 Last updated: 2017-12-11Bibliographically approved
2. Favourable One-Year Outcome of Anorexia Nervosa and Restrictive Eating Disorders Not Otherwise Specified in Adolescent Girls Following Family-Based Treatment in an Out-/Day Patient Setting.
Open this publication in new window or tab >>Favourable One-Year Outcome of Anorexia Nervosa and Restrictive Eating Disorders Not Otherwise Specified in Adolescent Girls Following Family-Based Treatment in an Out-/Day Patient Setting.
(English)Manuscript (preprint) (Other academic)
Keyword
anorexia nervosa, eating disorder, adolescent, family-based treatment, out-patient treatment, day-care clinic, eating disorder unit it
National Category
Psychiatry
Research subject
Child and Youth Psychiatry
Identifiers
urn:nbn:se:uu:diva-204207 (URN)
Available from: 2013-07-24 Created: 2013-07-24 Last updated: 2014-01-07
3. No Unexpected Adverse Events and Biochemical Side Effects of Olanzapine as Adjunct Treatment in Adolescent Girls with Eating Disorders
Open this publication in new window or tab >>No Unexpected Adverse Events and Biochemical Side Effects of Olanzapine as Adjunct Treatment in Adolescent Girls with Eating Disorders
2011 (English)In: Journal of child and adolescent psychopharmacology, ISSN 1044-5463, E-ISSN 1557-8992, Vol. 21, no 3, 221-227 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Olanzapine has been recently tried to relieve anxiety and hyperactivity in adolescents with eating disorders (EDs). Presently, the side effects of the drug have been evaluated. Method: Forty-seven adolescents with EDs were followed up by repeated blood sampling before, during, and at 3 months after medication with olanzapine. Results: Olanzapine medication was discontinued in three patients because of galactorrhea, seizures, and raised liver enzyme activities, respectively. There was a normalization of glucose, insulin, and lipid profiles during treatment, which was related to weight gain and resumption of menstruations but not to medication. Increases in thyroid-stimulating hormone and prolactin were related to olanzapine medication and comedication with selective serotonine reuptake inhibitors. Three months after discontinuing medication, there were no persisting biochemical effects. Conclusion: The side effects observed were those previously described for olanzapine. Most biochemical changes were related to weight (change) and amenorrhea and not to medication. Placebo-controlled studies are needed to investigate the efficacy of olanzapine in adolescents with EDs.

National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:uu:diva-155587 (URN)10.1089/cap.2009.0098 (DOI)000291466000004 ()
Available from: 2011-06-28 Created: 2011-06-27 Last updated: 2017-12-11Bibliographically approved
4. Omega-3 polyunsaturated essential fatty acids are associated with depression in adolescents with eating disorders and weight loss
Open this publication in new window or tab >>Omega-3 polyunsaturated essential fatty acids are associated with depression in adolescents with eating disorders and weight loss
2011 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 12, 1610-1615 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To study the relationship between polyunsaturated fatty acids (PUFA) status and depression in adolescents with eating disorders (ED) and weight loss.

Methods: Erythrocyte membranes from 217 adolescents (209 girls, eight boys) with ED were analysed for fatty acids (FA). ED and depression were diagnosed by clinical interviews and supported by self-report instruments.

Results: Adolescents with ED and depression did not differ from those with ED only in terms of age, BMI, weight loss and duration of disease. In their FA profile, depressed adolescents had lower proportions of eicosapentanoic acid (EPA) and docosahexanoic acid (DHA), the end products of the omega 3 PUFA series. The ratio of long-chain (>18 carbons) omega 6/omega 3 PUFA was therefore higher in depressed adolescents. Indices of desaturase activities did not differ between depressed and not depressed adolescents.

Conclusion: Low omega 3 status is related to depression in adolescents with ED. This cannot be explained by differences in weight (loss) and duration of disease, nor by differences in PUFA processing by desaturases. Data suggest a lower dietary intake of omega 3 PUFA in those with depression. Further investigations should determine whether omega 3 PUFA status improves by refeeding only or whether supplementation with PUFA is warranted.

Keyword
Delta-5-desaturase, Delta-6-desaturase, Depression, Eating disorder, Essential fatty acids
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-162681 (URN)10.1111/j.1651-2227.2011.02400.x (DOI)000296899500026 ()21732977 (PubMedID)
Available from: 2011-12-07 Created: 2011-12-05 Last updated: 2017-12-08Bibliographically approved
5. Omega-3 essential fatty acid status is improved during nutritional rehabilitation of adolescent girls with eating disorders and weight loss
Open this publication in new window or tab >>Omega-3 essential fatty acid status is improved during nutritional rehabilitation of adolescent girls with eating disorders and weight loss
2012 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 8, 858-861 p.Article in journal (Refereed) Published
Abstract [en]

AIM:

Essential fatty acid status is altered in eating disorders with weight loss, and deficiencies in polyunsaturated omega-3 essential fatty acids have been implicated in the development of depression and other psychopathologies. Presently, recovery of essential fatty status during the treatment of adolescent girls with eating disorders has been investigated.

METHODS:

Fatty acids were analysed in erythrocyte membranes of 24 adolescents girls with eating disorders of short duration, and on the average >10 kg weight loss at presentation. Blood samples were obtained at presentation and following weight recovery on standard diet without supplementation with essential fatty acids.

RESULTS:

Alterations of essential fatty status observed at presentation largely normalized during treatment. Omega-3 status improved following weight gain.

CONCLUSION:

Adequate nutrition, normalization of eating behaviours, weight gain and the consequent return to normalization of metabolism and endocrine function are sufficient to ensure normalization of essential fatty acid status. Supplementation with omega-3 polyunsaturated fatty acids does not appear warranted.

National Category
Pediatrics Psychiatry
Identifiers
urn:nbn:se:uu:diva-196574 (URN)10.1111/j.1651-2227.2012.02684.x (DOI)000306398200029 ()22512506 (PubMedID)
Available from: 2013-03-11 Created: 2013-03-11 Last updated: 2017-12-06Bibliographically approved

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