27
Bethesda, Maryland | September 19-21, 2013
POSTER SESSION 1 ABSTRACTS
T13
The Ravello Profile in Adolescent Girls with Anorexia Nervosa
Controlling for Co-Morbidity and IQ
Agnes Chevalier
2
,
Mark Rose
1, 3
,
Andrew Cooper
2
,
Bryan Lask
1, 4
1
Great Ormond Street Hospital for Children, NHS Foundation Trust,
London, United Kingdom,
2
Department of Psychology, Goldsmiths,
University of London, London, United Kingdom,
3
The Huntercombe Group,
Maidenhead, United Kingdom,
4
Care UK, London, United Kingdom
A growing literature has reported group differences between young
girls with and without anorexia nervosa (AN) on neuropsychological
tests, which has implications for both understanding its aetiology and
treatment. The Ravello Profile is a recently developed neuropsychological
assessment battery for use in this population (Rose, David, Frampton
&
Lask, 2011). The aim of the study was to assess the extent to which
the tasks selected were able to discriminate cases from controls, whilst
taking into account differences in comorbidity and IQ. Logistic Regression
was used to predict caseness in a sample of 78 female adolescents
with Anorexia Nervosa and 78 age-matched healthy controls. Only two
measures, the Tower task and the Central Coherence Index, successfully
discriminated between groups. This study suggests the specificity of
planning difficulties and weak Central Coherence to AN.
T14
Qualitative Differences in Loss of Control Eating Episodes Between
Boys and Girls
L. Adelyn Cohen
1,2
,
Marian Tanofsky-Kraff
1,2
,
Kelly R. Theim
1,2
,
Lauren
Shomaker
1,2
,
Anna Vannucci
1,2
,
Louise Hannallah
1,2
,
Amanda Krause
2
,
Nicole Sedaka
2
,
Tania Condarco
2
,
Sheila Brady
2
,
Susan Z. Yanovski
2
,
Jack
A. Yanovski
2
1
Uniformed Services University of the Health Sciences, Bethesda, MD,
USA,
2
National Institutes of Health, Bethesda, MD, USA
Binge eating disorder is common in men. Likewise, boys, as well as
girls, report loss of control (LOC) eating. Yet, there are limited data on
sex differences in youth who report LOC eating. We studied children
and adolescents (N=360, 47% male; age 14.1±2.6y; BMIz=1.1±1.6; 59%
non-Hispanic White) participating in healthy volunteer (89%) or obesity
intervention (11%) studies. The presence of LOC eating was assessed
via EDE and youth were queried regarding the behavioral and emotional
correlates of their most pathological eating episode in the past month.
One-hundred-thirteen youth (31%) reported LOC eating in the past month
and 247 (69%) reported no LOC. More girls reported LOC than boys
(37%
vs. 26%, p=.03). Across episodes, regardless of LOC status, boys
were more likely than girls to endorse eating more than others during
their episode (p<.001), whereas girls were more likely to report eating
in the absence of hunger (p=.029), controlling for age, race, BMIz, and
study type. Among girls, but not boys, LOC episodes were more often
characterized by eating rapidly (p=.005), negative emotions before eating
(
p=.012), and feelings of shame/guilt/regret (p=.005), after controlling
for the same covariates. We conclude that girls’ LOC episodes may be
characterized by negative emotions and features of disinhibited eating,
more so than for boys. Future data are required to characterize the nature
of reported LOC eating in boys to inform assessment, outcome, and
intervention response.
T15
Eating Disorder Treatment Outcome in Individuals with Type 1
Diabetes
Patricia A Colton
1,2
,
Marion P Olmsted
1,2
,
Harmonie Wong
1
,
Gary M
Rodin
1,2
1
University Health Network, Toronto, ON, Canada,
2
University of Toronto,
Toronto, ON, Canada
Purpose
.
Women with type 1 diabetes (T1D) are at high risk for eating
disorders, a dangerous combination which can compromise diabetes
management and increase medical complications and mortality. Since
little is known about the response to treatment in this population, we
assessed clinical presentation and treatment outcome in a large case
series.
Methods
.
A chart review at the Ambulatory Care for Eating
Disorders Program at Toronto General Hospital identified 100 individuals
with T1D assessed 1990-2012.
Results
.
Diagnosis at consultation was:
bulimia nervosa 45%, anorexia nervosa 14%, EDNOS 36%, and no eating
disorder 5%. Insulin omission for weight loss was reported at consultation
by 68%, and by 78.4% (29/37) of day hospital attenders, reflected in very
poor blood sugar control (A1c 11.6 ± 2.4). 37 individuals attended day
hospital at least once, and 32 completed ≥ 4 weeks treatment. 18.8% had
a good treatment outcome (weight restored and symptom-free for last 28
days of treatment), 37.5% had a poor outcome (still meeting diagnostic
criteria at discharge), and 43.8% had an intermediate outcome. This is
significantly poorer than program outcomes in non-diabetic individuals
(
chi
2
=14.9; p=0.0006).
Conclusion
.
The majority of those with T1D
offered day hospital treatment are not able to achieve symptom remission.
Factors influencing treatment outcome should be further studied and used
to improve treatment results in this high-risk group.
T16
Gastric Bypass Surgery: Partial Rebound of Weight and Binge Eating
From 2 to 5 Years
Paul M Copeland
1,2,3
,
Sofija E Zagarins
4
,
Ankit Kansagra
1
,
Sandra S
Skinner
1
1
North Shore Medical Center, Salem, MA, USA,
2
Massachusetts General
Hospital, Boston, MA, USA,
3
Harvard Medical School, Boston, MA, USA,
4
Baystate Medical Center, Springfield, MA, USA
PURPOSE
:
While the short-term efficacy of Roux-en-Y gastric bypass
surgery (GBS) is widely recognized, long-term efficacy is less established.
We have examined outcomes up to 5 years post-GBS at a community
hospital.
METHODS
:
GBS patients were evaluated pre-surgery and at
regular intervals post-surgery (1, 4, 8, 12, 24, 36, and 60 months) in a
comprehensive follow-up program, assessing clinical and laboratory
measures, co-morbidities, symptoms, binge eating (Gormally Binge Eating
Scale, BES), and quality of life (Frisch, Pearson Assessments, QOL).
RESULTS
:
For the 1030 patients we monitored, the time of maximal
improvement on measured parameters ranged from 8 to 24 months, with
rebound effects observed following the nadir. For the 141 patients for
whom we have 60 mo data, BMI decreased from 51.9+7.5 pre-surgery to
32.9
+6.2 kg/m
2
at 24 mo, but rose to 36.6+7.4 at 60 mo (both p<.01). BES
score decreased from 16.2+6.6 pre-surgery to 8.3+5.7 at 24 mo (p<.01)
but rose to 11.0+8.7 at 60 mo (p=.03). QOL improved from 37.2+27.3
pre-surgery to 57.9+30.0 at 24 mo (p<.01) but fell to 51.5+31.1 at 60
mo (p=.04). Binge eating was correlated with less weight loss at 24 mo
(
r=.17, p<.01), and with weight regain from 24 to 60 mo (r=.48, p<.01).
CONCLUSIONS
:
GBS has long-term benefits at 5 years, but there
was a significant increase in weight and binge eating from 2 to 5 years.
Less binge eating was associated with improved weight reduction and
maintenance.
T17
Cognitive Remediation Therapy (CRT) as a Treatment Enhancer in
Eating Disorders and Obsessive Compulsive Disorders
Unna N Danner
1
,
Annemarie A van Elburg
1,2
,
Lot Sternheim
1,3
,
Alexandra E
Dingemans
4
,
Eric F van Furth
4,5
,
Danielle C Cath
6,3
1
Altrecht eetstoornissen Rintveld, Zeist, Netherlands,
2
Universitair Medisch
Centrum Utrecht, Utrecht, Netherlands,
3
FSW, Universiteit Utrecht,
Utrecht, Netherlands,
4
Centrum Eetstoornissen Ursula, Rivierduinen,
Leidschendam, Netherlands,
5
Leids Universitair Medisch Centrum, Leiden,
Netherlands,
6
Academisch Angst Centrum Altrecht, Utrecht, Netherlands
Introduction:
Treatment is only moderately successful in ED and OCD.
A striking underlying shared deficit is patients’ cognitive inflexibility. New
evidence indicates that CRT successfully enhances flexible thinking styles,
enhancing benefit from symptom-based therapies and improvement
of quality of life. The present objectives: 1)To investigate the treatment
enhancing effect of CRT, especially in OCD; 2)To investigate cost
effectiveness and budget impact; 3)To investigate markers of treatment
enhancement.
Methods:
This placebo-controlled multicenter trial will start
in June 2013 and will involve 64 adult patients with ED, and 64 patients
with OCD, randomized to 10 bi-weekly sessions with either CRT or a
placebo control condition, followed by TAU. Disorder-specific symptom
severity, Quality of Life, cognitive flexibility, healthcare use costs, budget
impact, and loss of work productivity will be assessed at baseline, post
CRT, and after 6 months TAU.
Results:
Treatment effect will be analyzed
using linear mixed model analyses. A Markov modeling approach will be
applied for the economic evaluation. Cost utility analyses will be performed
from a societal perspective estimating the cost per QALY. The budget
impact analysis will be conducted from a payers and societal perspective.
Conclusions:
Prior research provided first evidence for the effectiveness
of CRT in ED. The present study will elaborate on these findings by
examining the (cost)effectiveness of CRT in ED and OCD
T18
A Preliminary Investigation of a Nonpurging Compensatory Eating
Disorder
Heather A. Davis
1,2
,
Lauren A. Holland
2
,
Pamela K. Keel
2
1
University of Kentucky, Lexington, KY, USA,
2
Florida State University,
Tallahassee, FL, USA
Introduction:
Excessive exercise and fasting represent unhealthy and
potentially harmful weight-control strategies. Although much is known
about the clinical significance of excessive exercise and fasting among
individuals with AN or BN, not all individuals who engage in nonpurging
compensatory behaviors fulfill diagnostic criteria for these disorders.
This study sought to evaluate the clinical significance and distinctiveness
of a compensatory eating disorder (CED) characterized by recurrent
nonpurging compensatory behaviors in the absence of objectively large
binge episodes among normal weight individuals who endorse undue
influence of weight/shape on self-evaluation.
Method:
Women with CED
(
n=20), women with bulimia nervosa (BN) (n=20), and controls (n=20)
completed an interview and questionnaires assessing eating disorder
and general psychopathology and weight history.
Results:
Compared
to controls, women with CED reported significantly greater body image
disturbance and disordered eating, higher anxiety proneness, increased
