Article

Usefulness of amenorrhea in the diagnoses of eating disorder patients

Department of Obstetrics and Gynaecology, University of Sydney, Royal North Shore Hospital, NSW, Australia.
Journal of Psychosomatic Obstetrics & Gynecology (Impact Factor: 1.23). 09/2005; 26(3):211-5. DOI: 10.1080/01674820500064997
Source: PubMed

ABSTRACT We investigated the usefulness of amenorrhoea as a criterion in eating disorder diagnoses. Menstrual history, eating disordered behavior and weight history of 251 female eating disorder inpatients were assessed on admission to hospital. Menstrual status of 88 (35%) could not be assessed (80 taking hormonal contraception, 5 (< 16 years) had never menstruated, one hysterectomized, 2 postmenopausal). Of the remaining 163; 90 had secondary amenorrhoea (no periods for > 3 months), 19 irregular periods and 54 regular cycles. Some patients with recent changes in energy status, who warranted inpatient treatment for their eating disorder did not develop amenorrhoea until later during their admission. Menstrual disturbance is not limited to anorexia nervosa, 24% of patients with an eating disorder not otherwise specified (EDNOS) and 15% of bulimic patients had amenorrhoea/oligomenorrhoea on admission. The best predictors (82% cases, 83% noncases, R2 = 0.41) of secondary amenorrhoea at admission, were; current BMI < or = 18, and having rules for exercising. Menstrual status of women with an eating disorder diagnosis cannot always be assessed, is mostly measuring low body weight and exercise and is not useful in planning or initiating treatment. There is insufficient evidence to support the use of amenorrhoea as a criterion for any eating disorder.

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    • "It has been well established that MD patients present with abnormalities in HPA axis function (the majority of which present as hyperresponsive ) and normalization of HPA axis activity has been linked to remission and response to treatment ; however, the mechanisms by which a reduction in the hyper-responsive state of the HPA axis is achieved are unknown. There is little evidence to support meaningful clinical differences between patients with (or without) amenorrhoea (Abraham et al. 2005 ; Garfinkel et al. 1996). In other illnesses, including schizophrenia, where patients demonstrate no relationship between oestrogen function (e.g. "
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    ABSTRACT: Major depression (MD) and anorexia nervosa (AN) often present comorbidly and both share some affective symptoms, despite obvious phenotypic differences. In the illness phase, pathophysiological evidence indicates similar abnormalities in both clinical groups including dysfunction in the serotonin (5-HT) system (of which some abnormalities persist following recovery) and between 60% and 80% of patients in both groups present with significant hyperactivity of the hypothalamo-pituitary-adrenal (HPA) axis. First-line approach to treatment for MD involves modulation of the 5-HT system using selective serotonin reuptake inhibitors (SSRIs). For AN, treatment with SSRIs has been shown to be considerably less effective compared to MD. Both illnesses show marked dysregulation in the HPA axis. A consequence of SSRI treatment is a reduction and/or normalization of indices of the HPA axis [i.e. cortisol, adrenocorticotropic hormone (ACTH)], which is consistent with recovery levels in both clinical groups. Oestrogen (in high doses) has been shown to exert antidepressant effects and positively impact on MD symptoms as a treatment in its own right, or in combination with antidepressants, in women of menopausal age. It is proposed that a combination of SSRIs and oestrogen therapy may facilitate physiological normalization in MD in women of non-menopausal age and in AN. Preliminary evidence suggests oestrogen treatment alone is of some benefit to patients and it is proposed that a combination of SSRI and oestrogen will precipitate and potentially accelerate symptomatic remission. Should this approach be successful, it offers the capacity for improvement over traditional antidepressant use in women diagnosed with MD and a novel strategy for the treatment of AN, a serious clinical illness associated with the highest mortality of any psychiatric condition.
    The International Journal of Neuropsychopharmacology 05/2011; 14(4):553-66. DOI:10.1017/S1461145710000982 · 5.26 Impact Factor
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    • "Diagnostic criteria for AN does not encompass reward abnormalities, but includes weight relative to height (A), intense fear of gaining weight or becoming fat (B), body weight and shape distortions (C), and amenorrhea in postmenarcheal females (D) (DSM-IV-TR 2000), the latter demonstrating physiological dysfunction . With regard to amenorrhea, there are few differences in demographics, eating behaviors, body image perceptions, illness history, and psychiatric comorbidity distinguishing menstruating and nonmenstruating patients (Garfinkel et al. 1996; Abraham et al. 2005) with many questioning the relevance of this criterion to the illness (e.g., Roberto et al. 2008; Attia and Roberto 2009). Physiologically, elevated stress, hypothalamo-pituitary adrenal (HPA) axis activity is reported in the majority of patients with AN linked to their behaviors (Bergh and Sodersten 1996) and is logically consistent with hypothalamo-pituitary gonadal (HPG)-axis-suppressioninduced amenorrhea. "
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    ABSTRACT: In anorexia nervosa (AN), reward contamination likely plays a significant role in maintenance of the illness. Reward contamination is a context in which patients' behaviors of self-starvation and excessive exercise, while initially rewarding, become aversive, even punishing; but patients may not recognize the punishing and conflicted/contaminated behaviors. An emerging neurocircuit encompassing the anterior cingulate cortex (ACC) has been functionally linked to symptoms including reward contamination and body dysmorphic processing. Owing to the significantly greater prevalence of AN in females, evidence from clinical literature and preclinical models is spearheaded to provide a novel rationale for estrogen triggering sensitivity to the experience of stress and reward, precipitating AN disproportionately in females at the time of puberty. Paradoxically, however, estrogen may facilitate response to pharmacological interventions and (desensitization of the identified neurocircuits) via its contribution to serotonin modulation, hypothalamo-pituitary adrenal (HPA)-axis attenuation, and effects on dopamine.
    01/2011; 8(8):189-207. DOI:10.1007/7854_2010_99
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    • "The requirement of amenorrhea in the diagnosis of AN is invalid for prepubescent children (Nicholls et al., 2000) inappropriate for males (Abraham, Pettigrew, Boyd, Russell, & Taylor, 2005), and is not reliably reported by patients (Abraham et al., 2005; Swenne, Belfrage, Thurfjell, & Engstrom, 2005). The inadequacy of this criterion is widely accepted (National Institute for Clinical Excellence, 2004; Society for Adolescent Medicine, 2003) as research investigations with both adolescents and adults do not consistently require this feature in defining their clinical populations, (Lock, Couturier, & Agras, 2006; Walsh et al., 2006). "
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    ABSTRACT: Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self-report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms.
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