33
Bethesda, Maryland | September 19-21, 2013
5
Institute of Child Health, University College, London, United Kingdom,
6
Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund,
Sweden
Introduction
:
The long-term effects of teenage-onset anorexia nervosa
(
AN) and the impact of autism spectrum disorder (ASD) need further
elucidation. The aim was to evaluate group differences, time trends
and effect of co-existing ASD on outcome in a representative sample
of teenage-onset AN and a matched comparison group.
Methods
:
The
full multinomial distribution of responses for each scale/subscale in the
Morgan-Russell Outcome Assessment Schedule was evaluated using
exact nonparametric statistical methods at each follow-up (6-, 10-, and
18-
year). The impact of increasing levels of ASD on outcome in AN was
evaluated in a dose-response model.
Results
:
Food intake and menstrual
pattern was initially different between groups, but normalised over
time, mainly owing to a positive change in the AN group. Mental state
was much worse in the AN group and did not improve over time. In the
psychosexual domain ‘attitudes’ and ‘aims’ showed lasting problems in the
AN group. In the socioeconomic domain the scales ‘personal contacts’,
‘
social activities’ and ‘employment record’ showed highly significant
between-group differences at all follow-ups. A negative dose-response
relationship, i.e. the more the ASD the worse the outcome, was found
in the domains ‘mental state’, ‘psychosexual state’ and ‘socio-economic
state’.
Conclusions
:
Outcome of teenage-onset AN is unfavourable with
respect to mental state, psychosexual and social functioning. Outcome is
worse if ASD is present.
T46
Bulimia Nervosa and the Positive Value of Illness: An Investigation of
the Differential Motivation Towards Illness-Specific Cues
Caitlin B. O’Hara, Ulrike Schmidt, Iain Campbell
Institute of Psychiatry, King’s College London, London, United Kingdom
Introduction:
Several behaviours associated with bulimia nervosa (BN)
are hypothesised to be highly salient and rewarding. Accordingly, this
study examined the motivational processes involved in the valued nature
of BN symptomatology.
Methods:
In 21 women with BN and 20 healthy
controls (HC), subjective and objective motivation towards BN-specific
cues (e.g., thinness, food) and behaviours (e.g., exercise, binge/purge)
were measured using a BN-related picture rating task, a progressive ratio
(
PR) exercise breakpoint task, and a startle eyeblink modulation task.
Results:
Relative to HC, women with BN rate images of underweight
women as significantly more attractive (M=2.38, SD=1.49; M=4.43,
SD=2.43) and more desirable (M=2.49, SD=1.74; M=5.36, SD= .49) than
images of healthy women (p<0.005). They also show a trend toward
increased exercise breakpoint scores (M=225.1, SD = 333.2) relative to
HC (M=91.0, SD=59.8) (p=0.084; effect size Cohen’s d=0.57), suggesting
an increased willingness to sustain effort for exercise reward in BN.
Startle eyeblink modulation data are being analysed to infer unconscious
motivation towards BN-related cues; women with BN are predicted to
show an exaggerated appetitive response (startle inhibition) relative to HC.
Conclusions:
Results indicate that BN is associated with a heightened
motivation towards illness-related stimuli. This is consistent with proposals
that altered reward processing is involved in the pathology and in the
maintenance of BN.
T47
A Longitudinal Test of Internalizing and Externalizing Pathways to
Early Eating Disorder Onset
Carolyn M Pearson, Gregory T Smith
University of Kentucky, Lexington, KY, USA
Introduction
.
The very early engagement in bulimic behaviors, such
as loss of control binge eating, may be influenced by factors typically
considered characteristic of externalizing dysfunction (such as addictive
behaviors) as well as by factors typically considered characteristic of
internalizing dysfunction (such as depression). Using a longitudinal design,
we tested for the simultaneous operation of both processes as children
transition from elementary to middle school.
Methods
.
In a sample of
1,906
children, we sampled risk factors associated with externalizing
dysfunction (negative urgency and eating expectancies) and with
internalizing dysfunction (negative affect and depressive symptomatology)
and loss of control binge eating behavior at three time points: spring of 5
th
grade, fall of 6
th
grade, and spring of 6
th
grade.
Results
.
Both pathways
were present. Mediation tests found that fall, 6
th
grade eating expectancies
mediated the predictive influence of 5
th
grade negative urgency on spring,
6
th
grade binge eating (z = 2.45, p <.01) and that fall, 6
th
grade depressive
symptoms mediated the influence of 5
th
grade negative affect on spring,
6
th
grade binge eating (z = 2.04, p. <.05).
Conclusions
.
Personality and
behavioral tendencies associated with both distress-driven impulsive
action and depressive symptoms predicted early loss of control
binge eating. This problem behavior may have characteristics of both
externalizing and internalizing dysfunction.
T48
Gonadotropins and Neurocognitive Function in Adolescent Females
with Eating Disorders
Rebecka Peebles
1
,
Kathleen K Fitzpatrick
2
,
Melissa Riegel
1
,
Debra
Katzman
3
,
James Lock
2
1
The Childrens Hospital of Philadelphia, Philadelphia, PA, USA,
2
Stanford
University School of Medicine, Palo Alto, CA, USA,
3
SickKids, Toronto,
ON, Canada
Neurocognitive endophenotypes have been suggested as putative
pathways for development of eating pathology. In adolescents, brain
maturation and the development of executive functioning skills are linked
to pubertal status. Inconsistent data have been reported with respect to
neurocognitive factors over the age span and their relationship to eating
disordered behaviors, as well as malnourishment and pubertal biomarkers.
This study sought to explore associations between neurocognitive
functioning and hormone status among adolescent females diagnosed
with Anorexia Nervosa or Eating Disorders Not Otherwise Specified.
Participants (n=20, 12-19y) were administered a full neuropsychological
battery following the Ravello profile which included set-shifting and central
coherence measures. Spearman’s correlation and regression analyses
were performed to examine relationships between gonadotropins (LH,
FSH), estradiol, set-shifting and central coherence assessments. Number-
letter sequencing time and gonadotropin levels were positively correlated
(
LH: r=0.507, p=0.032; FSH: r=0.571, p=0.013), as was LH level and the
“
Copy” component of the Rey-O test (r of 0.522, p=0.032). Age was a
significant covariate when exploring the relationship between gonadotropin
values and number-letting sequencing. These preliminary findings
suggest indicate that age may be a moderator of the relationship between
gonadotropins and neurocognitive functioning in ED adolescent females.
T49
Binge Eating Among Adolescent Girls At-Risk for Type 2 Diabetes
Katie Pickworth
1
,
Lauren Shomaker
1,2,3
,
Amanda Krause
1
,
L Adelyn
Cohen
1,3
,
Louise Hannallah
1,3
,
Anna Vannucci
1,3
,
Rachel Miller
1,3
,
Kelly R
Theim
1,3
,
Tania Condarco
1
,
Sheila Brady
1
,
Marian Tanofsky-Kraff
1,3
,
Jack
Yanovski
1
1
Section on Growth and Obesity, NICHD, NIH, Bethesda, MD, USA,
2
Human Development and Family Studies, Colorado State University, Fort
Collins, CO, USA,
3
Medical and Clinical Psychology, Uniformed Services
University, Bethesda, MD, USA
The developmental period of adolescence is marked by increased binge
eating and a rise in insulin resistance, the key precursor to type 2 diabetes
(
T2D). Yet, there are limited data examining the connection between
binge eating and insulin resistance in adolescents. We investigated 54
adolescent girls at-risk for T2D (14.4±1.6y; 54.4% non-Hispanic Black)
participating in the baseline phase of a randomized controlled trial to
lessen depressive symptoms and improve insulin resistance. By design,
all girls had a T2D family history, were overweight (BMI %ile 96.9±3.3%),
and endorsed elevated depressive symptoms (Center for Epidemiological
Studies-Depression Scale 23.4±9.2). Binge eating (≥1 episode/month)
was assessed with the Eating Disorder Examination interview. Insulin
and glucose, measured during a 2-hour oral glucose tolerance test, were
used to calculate Whole Body Insulin Sensitivity Index. Body composition
was assessed with dual energy x-ray absorptiometry. Girls with binge
eating (22.2%) did not differ from those without binge eating in depressive
symptoms (25.7±10.1 vs. 25.2±7.8, p=.86), but those with binge eating
had more body fat (50.7±13.9 vs. 37.5±1.3 kg, p=.004) and poorer insulin
sensitivity (1.3±.5 vs. 2.5±1.5, p<.001). The link between binge eating and
insulin was explained by binge eaters’ greater body fat. Binge eating in
adolescents at-risk for T2D may confer an additional risk for worsening
insulin resistance and T2D onset via youths’ excess adiposity.
T50
Use of Psychopharmaceutical Drugs in a Large Patient Cohort with
Eating Disorders
Anu Raevuori
1,2,3
,
Jari Haukka
1,4
,
Milla Linna
1
,
Jaana Suvisaari
4
,
Mika
Gissler
4,5
,
Jaana Suokas
4,6
1
Hjelt Institute, Department of Public Health, University of Helsinki,
Helsinki, Finland,
2
Department of Adolescent Psychiatry, Helsinki
University Central Hospital, Helsinki, Finland,
3
Research Center of Child
Psychiatry, University of Turku, Turku, Finland,
4
National Institute for
Health and Welfare, Helsinki, Finland,
5
Nordic School of Public Health,
Gothenburg, Sweden,
6
Department of Psychiatry, Helsinki University
Central Hospital, Helsinki, Finland
Introduction
:
Purpose of this study was to assess psychopharmaceutical
drug use in large patient cohort treated for eating disorders (ED).
Methods:
Patients (N=2357, 4% males) treated at the eating disorder
clinic of Helsinki University Central Hospital in 1995-2010 were compared
with matched controls (N=9428). Diagnoses of anorexia nervosa (AN),
bulimia nervosa (BN) and their atypical forms based on ICD-10. Binge
eating disorder (BED) was defined according to DSM-IV research
criteria. Data on psychotropic drug use was derived from the medical
reimbursement register of the National Social Security Institution (follow-
up time 1994-2011).
Results:
Compared to controls, those treated for ED were significantly
POSTER SESSION 1 ABSTRACTS
