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Porto, Portugal | September 20-22, 2012
33
weight differences between AN subtypes caused by the lower
body weight of AN-R patients during colder months.
T29
Body mass index in adolescent anorexia nervosa pa-
tients in relation to age, time point and site of admission:
Longitudinal data from 2001 to 2009 and a comparison of
units in Germany
Beate Herpertz-Dahlmann
1
, Linda von Ribbeck
1
, Reinhild
Schwarte
1
, Karin Egberts
2
, Ernst Pfeiffer
3
, Christian Fleis-
chhaker
4
, Christoph Wewetzer
5
, Lieven Kennes
6
, Katharina
Bühren
1
1
Department of Child and Adolescent Psychiatry, Psychoso-
matics and Psychotherapy, University Clinics RWTH Aachen,
Aachen, Germany,
2
Department of Child and Adolescent
Psychiatry, Psychosomatics and Psychotherapy, University of
Wuerzburg, Wuerzburg, Germany,
3
Department of Child and
Adolescent Psychiatry, Psychosomatics and Psychotherapy,
Charité Berlin, Berlin, Germany,
4
Department of Child and
Adolescent Psychiatry, Psychosomatics and Psychotherapy,
University of Freiburg, Freiburg, Germany,
5
Department of
Child and Adolescent Psychiatry, Psychosomatics and Psy-
chotherapy, Köln-Holweide, Köln, Germany,
6
Department of
Medical Statistics, University of Aachen, Aachen, Germany
Introduction:
Body mass index (BMI) at admission is an
important predictor of outcome in adolescent anorexia
nervosa (AN). Few studies have investigated BMI at admis-
sion, its changes in recent years, or modifying factors, such
as duration of illness, age at onset and admission criteria in
different geographical regions. This study aimed to investi-
gate changes in BMI at admission over the last decade in
one clinic, differences in BMI between various treatment sites
and the influence of duration of illness and age at onset.
Methods:
We assessed age-related BMI at admission, age
at onset and duration of illness in 154 adolescent female AN
patients admitted between 2001 and 2009 to a major universi-
ty hospital and in 169 adolescent female AN patients recruited
in a multicenter study between 2007 and 2010.
Results:
The
two samples did not differ significantly in BMI at admission.
There was a small but significant increase in the age-adapt-
ed BMI score at admission over the course of the study and
a positive association between year of admission and age
at admission. Older patients had a lower age-adapted BMI
score at admission and a longer duration of illness.
Conclu-
sion:
The age-adapted BMI score at admission, which is an
important predictor of outcome in AN, has increased slightly
during the last ten years. Education strategies for parents
and professionals should continue to be improved to further
shorten the duration of illness before admission, especially for
older adolescents.
T30
PATTERNS OF BRAIN ACTIVATION DURING THE
PERFORMANCE OF AN EXECUTIVE FUNCTION TASK
IN WOMEN WITH RESTRICTIVE AND BULIMIC EATING-
DISORDER VARIANTS: AN fMRI STUDY.
Mimi Israel
1
, Howard Steiger
1
, Kenneth R. Bruce
1
, Marcelo
Berlim
2
, Jens Pruessner
2
, Michael Spilka
1
, Michael Klein
1
,
Simona Efanov
1
, Anne-Sophie Ouellete
1
1
Eating Disorders Program, Douglas University Institute: Psy-
chiatry Department, McGill University., Montreal, QC, Canada,
2
Douglas University Institute: Psychiatry Department, McGill
University., Montreal, QC, Canada
Available evidence frequently associates Anorexia Nervosa
with “over-regulation” (and excessive frontostriatal activa-
tion), Bulimia Nervosa with “dysregulation” (and frontostriatal
under-activation).
Methods:
Using fMRI, we compared brain
activation patterns across individuals with “restrictive” and
“binger-purger” eating syndromes while they performed a
novel Nback task, designed to make very high demands upon
executive processing and working memory. We expected the
“binger-purger” women to show poorer overall task perfor-
mance and correspondingly lower activation of fronto-striatal
circuits.
Results:
To date, 37 women have completed this
ongoing study; 14 classified as “restricters” and 23 classified
as “bingers-purgers”. Our findings show the bingers-purgers
to be poorer than the restricters at high-demand levels of
the NBack, suggesting less effective planning and executive
function in the former group. Furthermore, during task perfor-
mance, bingers-purgers show significantly less activation than
restricters in the left premotor cortex (BA 6) and a right mid
dorsolateral region (BA 9, 46)—respectively believed to sub-
serve planning of motor responses and memory for temporal
aspects of stimuli.
Conclusions:
Our findings corroborate
the expectation that individuals with “binger-purger” disorders
would be less-successful than restricters on a high-demand
test of executive functions, and link performance differences
observed to interpretable differences in brain activation.
T31
Self induced re-feeding syndrome - a first presentation of
anorexia nervosa in an adult
Andrew Jamieson, Rachel Preston, Anthony Pelosi
South East Scotland Regional Esting Disorders Unit, Living-
ston, United Kingdom
Refeeding syndrome is a potentially fatal consequence of
regaining ideal body weight in patients with anorexia nervo-
sa. We report a case where diagnosis of anorexia nervosa is
made subsequent to presentation with self-induced re-feeding
syndrome.
Report
: A 43 year old white female presented to
her local hospital with symptoms of general malaise, fatigue
and dependent edema. At the time of presentation she was
emaciated although had significant peripheral edema, and
had biochemical features of re-feeding syndrome. Initial
management was complicated by any clear understanding
of the reason for the presentation and the patient suffered a
cardiac arrest and required 18 days in the intensive care unit.
Following recovery, a history suggestive of an undiagnosed
eating disorder became apparent and on further evaluation
a formal diagnosis of anorexia nervosa was established. The
patient had decided to attempt weight gain some 2 weeks
prior to presentation by resuming a 2600 kcal/day energy
intake after a 12 month period of dietary restriction averag-
ing 600 kcal/day.
Discussion
: This patient had a near fatal
episode of re-feeding syndrome and had no prior contact with
services and was initially thought to have an underlying “med-
ical” illness. Whilst late presentation of eating disorders is
uncommon, vigilance is required by physicians who encounter
severely malnourished patients with features in keeping with
refeeding syndrome to ensure a primary eating disorder is not
overlooked.
T32
SEROTONIN REGULATION AND SYMPTOMS OF ANXI-
ETY FOLLOWING WEIGHT RESTORATION IN ANOREXIA
NERVOSA
David C. Jimerson
1,2
, Devon P. Carroll
1
, Barbara E. Wolfe
1,2,3
1
Beth Israel Deaconess Med. Ctr., Boston, MA, USA,
2
Harvard
Medical School, Boston, MA, USA,
3
Boston College, Chestnut
Hill, MA, USA
Introduction. CNS serotonin dysregulation appears to per-
sist following weight restoration (WR) in anorexia nervosa
(AN), possibly contributing to residual symptoms and risk for
relapse. Thus, acute tryptophan (TRP) depletion was reported
to decrease anxiety ratings in WR-AN. This study assessed
anxiety-related symptoms in WR-AN following a two-week
intervention to lower CNS serotonin synthesis. Methods. Par-
ticipants included 15 medication-free, normal-weight women
(BMI 21.3 ± 2.5 kg/m
2
) who previously met DSM-IV criteria for
AN. Baseline assessments were followed by a two week ad
lib diet supplemented with a TRP-free mixture of branched-
chain amino acids (BCAA) using a randomized, placebo-con-
trolled, double-blind crossover design. Results. Participants
had significantly elevated baseline ratings on the Spielberger
State-Trait Anxiety Inventory and Herman-Polivy Restraint
Scale. Of note, state anxiety ratings were correlated with
the plasma ratio of TRP to other large neutral amino acids
(TRP/ΣLNAA ratio) at baseline (p<.05). Current analyses are
focused on symptom changes associated with the decrease in
TRP/ΣLNAA ratio (p<.01) achieved during BCAA administra-
tion. Conclusions. These new results point to an association
between persistent anxiety and CNS serotonin dysregulation
POSTER SESSION 1 ABSTRACTS