29
Bethesda, Maryland | September 19-21, 2013
to assess fractional anisotropy for WM integrity in 19 adolescents with
AN and 22 controls.
Results
Individuals with AN showed larger left
orbitofrontal, right insular, and bilateral temporal cortex GM, and increased
temporal lobe WM volumes compared to controls. WM integrity in
adolescents with AN was reduced (lower fractional anisotropy) in fornix,
posterior frontal, and parietal areas, but increased in anterior frontal,
orbitofrontal and temporal lobes. In individuals with AN, orbitofrontal GM
volume correlated negatively with sweet taste pleasantness. An additional
comparison of this study cohort with adult individuals with AN and healthy
controls supported greater orbitofrontal cortex and insula volume in AN
across age groups.
Conclusions
This study indicates larger orbitofrontal
and insular GM volumes, as well as lower fornix WM integrity in
adolescents with AN, similar to adults. The pattern of larger anteroventral
GM and WM volume as well as WM integrity, but lower WM integrity in
posterior frontal and parietal regions may indicate that developmental
factors such as GM pruning and WM growth could contribute to brain
alterations in AN.
T25
Efficacy and Safety of Lisdexamfetamine Dimesylate in Treatment
of Adults with Moderate to Severe Binge Eating Disorder: A
Randomized, Double-Blind, Placebo-Controlled Trial
Maria Gasior
1
,
Susan McElroy
2
,
James Mitchell
3
,
Denise Wilfley
4
,
M.
Celeste Ferreira-Cornwell
1
,
Joseph Gao
1
,
Jiannong Wang
1
,
James I
Hudson
5
1
Shire Development LLC, Wayne, PA, USA,
2
Lindner Center of HOPE,
Mason, OH, USA,
3
Neuropsychiatric Research Institute, Fargo, ND, USA,
4
Washington University School of Medicine, St. Louis, MO, USA,
5
McLean
Hospital/Harvard Medical School, Belmont, MA,
Introduction:
Effects of lisdexamfetamine dimesylate (LDX), a
d-amphetamine prodrug, on binge eating disorder (BED) were examined.
Methods:
In an 11-wk, double-blind trial, 271 adults with BED were
randomized to LDX (30, 50, or 70mg/d) or placebo. The primary efficacy
endpoint was change (baseline to wk 11) in log-transformed values
(
binge days/wk +1). Secondary measures included Three-Factor Eating
Questionnaire (TFEQ) and Yale-Brown Obsessive Compulsive Scale
for Binge Eating (YBOCS-BE). Safety assessments included treatment-
emergent adverse events (TEAEs) and vital signs.
Results:
58
of 271
participants withdrew. Improvement vs placebo was observed in: primary
endpoint of binge days/wk for LDX 50- and 70-mg/d (each
P
<.001) but not
30-
mg/d (
P
=.35); all TFEQ factors for LDX groups vs placebo (
P
≤.034 for
all); and YBOCS-BE score for LDX groups (
P
<.002 for all). TEAEs were
reported for 57.6% of placebo and 82.4% of LDX (all doses) participants.
No placebo participant had a serious TEAE or withdrew for TEAEs; 1.5%
on LDX had a serious TEAE and 2.9% withdrew due to TEAEs. An LDX-
treated participant died due to methamphetamine toxicity, considered
unrelated to study drug. In all groups, small mean changes in blood
pressure and pulse were observed.
Conclusions:
LDX decreased binge
eating and related behaviors vs placebo. LDX safety profile was consistent
with its known safety profile. Confirmation with additional large trials is
needed. Clinical research was funded by Shire Development LLC.
T26
Patient Characteristics vs. Type of Support Offered: What Matters
More in Determining Social Support Satisfaction?
Josie Geller
1,2
,
Suja Srikameswaran
1,2
,
Joanna Zelichowska
1,2
,
Erin C
Dunn
1
1
St. Paul’s Hospital, Vancouver, BC, Canada,
2
University of British
Columbia, Vancouver, BC, Canada
Introduction
:
Individuals with eating disorders describe the social support
they receive as inadequate, reporting smaller social networks and greater
dissatisfaction than do non-eating disordered controls. The purpose of
this study was to examine the relative contribution of client factors and
the manner in which support is delivered in accounting for variance
in social support satisfaction.
Methods
:
Individuals meeting DSM-IV
criteria for an eating disorder (
n
= 178) completed measures of eating
disorder and psychiatric severity, interpersonal functioning, social support
satisfaction, and frequency of collaborative vs. directive support.
Results
:
Greater interpersonal difficulties and higher psychiatric distress were
associated with lower support satisfaction. Higher levels of concerned and
encouraging support approaches and lower levels of unsolicited opinions
were associated with higher support satisfaction. Multiple regression
analyses indicated that support approach accounted for greater variance
in social support satisfaction than did client factors.
Conclusions:
The
type of approach used by loved ones may play a central role in satisfaction
with support received. This research suggests that in addition to
what
is
offered,
how
support is delivered may also be a critical component to the
care of individuals with eating disorders.
T27
Neuroticism is Associated with Increased Behavioral Severity at
Admission and Predicts Longer Inpatient-Partial Hospital Length of
Stay in Underweight Patients
Angela S. Guarda
1
,
Colleen C. Schreyer
1
,
Saniha Makhzoumi
1,2
,
Graham
W. Redgrave
1
,
Janelle W. Coughlin
1
1
Johns Hopkins School of Medicine, Baltimore, MD, USA,
2
University of
Maryland Baltimore County, Baltimore, MD, USA
Personality traits are implicated in the etiology, maintenance, and
outcome of eating disorders. High neuroticism in particular is an identified
risk factor for disordered eating. We hypothesized that neuroticism
would be associated with higher frequencies of eating behaviors and
decreased likelihood of completing hospital-based treatment. Underweight
participants (N = 240) completed the NEO-FFI. Clinical data included
SCID diagnosis, admission and discharge BMI, inpatient (IP) and partial
hospital (PH) length of stay (LOS), rates of weight gain, and achievement
of target weight. The majority of participants were adults (73.4%) with AN
(75%).
Controlling for admission BMI and years of illness, neuroticism
was positively correlated with eating disordered behavioral frequencies
(
restricting, bingeing, vomiting and exercise) in the 8-weeks prior to
admission (p’s <.01). Neuroticism positively predicted discharge BMI,
IP and PH LOS, as well as LOS following achievement of target weight
(
p <.03). Neuroticism also predicted reaching target weight (p = .008);
however this relationship was mediated by the association between
neuroticism and total LOS (IP + PH). As predicted, after controlling for
admission BMI and chronicity, neuroticism was related to greater eating
behavior severity. Contrary to our hypothesis, higher neuroticism was
associated with completion of treatment, but this association was mediated
by longer LOS, which suggests difficulty transitioning to a lower level of
care.
T28
Attentional Biases Toward Palatable Foods in Children with and
Without Loss of Control Eating
Louise Hannallah
1,2,
Eric E. Nelson
3
,
Lauren B. Shomaker
1,2
,
Lisa M.
Ranzenhofer
1,2
,
Camden Elliott
1,2
,
Scott Engel
4
,
W. Kyle Simmons
5
,
Sarah
S. Berger
1,2
,
Daniel S. Pine
3
,
Marian Tanofsky-Kraff
1,2
,
Jack A. Yanovski
2
1
Department of Medical and Clinical Psychology, USUHS, Bethesda, MD,
USA,
2
Section on Growth & Obesity, PDEGEN, NICHD, NIH, Bethesda,
MD, USA,
3
National Institutes of Mental Health, NIH, Bethesda, MD, USA,
4
Neuropsychiatric Research Institute, Fargo, ND, USA,
5
Laureate Institute
for Brain Research, Tulsa, OK, USA
Emerging data indicate that adults with binge eating may exhibit an
attentional bias toward highly palatable foods. However, it is unknown
whether children and adolescents with loss of control (LOC) eating
patterns display a similar bias. We therefore studied 66 youth (14.6±2.2y;
84.7%
female; BMIz 1.7±.75) with and without LOC eating as assessed
by the Eating Disorder Examination interview. Following a standardized
breakfast to reduce hunger, youth participated in a computerized
measure of attentional bias to assess reaction time to viewing high and
low palatable foods vs. neutral household objects. Shorter reaction time
represented an attentional bias to stimuli. Analysis of variance revealed
a main effect for LOC eating status (p=.03) such that LOC youth (n=42)
displayed greater attentional bias toward palatable foods vs. nonfood
objects compared to no LOC youth (n=26). There was no main effect
for BMIz (p>.20). However, there was an interaction between BMIz and
LOC (p=.01); among youth with LOC eating, BMIz was positively related
to attentional bias such that heavier children attended to palatable food
vs. neutral object pictures more quickly than less heavy youth. The
relationship of BMIz and attentional bias was not observed among youth
without reported LOC eating. We conclude that a bias toward highly
palatable foods may contribute to the development and maintenance of
disordered eating and excessive weight gain observed in children with
reported LOC eating.
POSTER SESSION 1 ABSTRACTS
