Daniel Rigaud

Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France

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Publications (46)76.12 Total impact

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    ABSTRACT: Anorexia nervosa (AN) is a chronic and often severe eating disorder, which could have a serious impact on various life domains. AN may lead to physical, mental, behavioural and socioprofessional impairment. Thus, one could expect a poor quality of life (QoL) in AN patients. QoL is certainly a key factor to provide quantitative measurement of treatment efficacy that will facilitate clinical decision-making and treatment planning. Despite that QoL was rarely prospectively analyzed in AN patients, one could conclude that AN patients showed reduced QoL, as compared to normal controls and other psychiatric-disordered patients. It seems that mental health components of QoL are more impaired than the physical ones in AN patients, who showed a modest impact in the physical domain. Thus, our aim was to analyse the QoL using a new, French, questionnaire, the QUAVIAM (qualité de vie dans l’anorexie mentale). After a bibliography research (including EDE, EDI, SF-36, QOL.ED), the choice of 12 themes, regrouped in six scores, was made by three eating disorder specialists and two recovered patients. For each score, 10 to 15 questions were written by the experts, and then corrections and validation were made by the five experts and 21 patients. After this, we prospectively determined the reproducibility (3 days interval), the specificity, and the sensitivity for short-term change in patients exhibiting an “active” AN (n = 54, mean age: 31 ± 9 yrs, mean BMI: 14.1 ± 2.8 kg/m2, AN duration: 2.6 ± 1.9 yrs), and again after cognitive behavioral therapy (CBT). We also analyzed the QUAVIAM score and subscores in 48 recovering patients and in 56 subjects without eating disorder. The QUAVIAM final version (61 questions) was collected in 76 patients and the 56 healthy controls matched for sex and age. Its reproducibility was 91% (intra-questionnaire) and 94% (inter-questionnaire), its specificity 98% (versus controls; P < 0.0001) and its sensitivity 99%. The QUAVIAM global score of the AN patients was more impaired (389 ± 87) than that of the recovering patients (157 ± 82) and the normal controls (89 ± 49; P < 0.0001). Each of the six subscores was higher (more altered) in active AN than in recovering AN patients and in normal subjects: the somatic, the psychological, the hedonic, the socioprofessional, the affective and the TCA-related ones (P < 0.001 for each comparison). The QUAVIAM global score and its subscores were significantly improved (decreased) by the 3-month CBT: 385 ± 25 before and 189 ± 30 after CBT (P < 0.0001). The changes were observed for all the subscales (P < 0.0001). The somatic subscore did not decrease less than the other subscores. Thus, the present study permits proposing the QUAVIAM for analysis of physical, mental, behavioural and socioprofessional impairment or improvements in AN patients.
  • Daniel Rigaud
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    ABSTRACT: Weight restoration is crucial for successful treatment of anorexia nervosa (AN). Without it, patients may face serious or even fatal complications of severe starvation. Renutrition should take into account clinical characteristics unique to these patients, such as gastroparesis and fear of gaining body weight. The efficacy of tube feeding and home-tube feeding (Home-TF) has been suggested in AN and proven in bulimia nervosa (BN). TF and home-TF allow a better body weight gain (mainly fat-free mass) in AN patients and a strong decrease in the frequency and the intensity of binge-eating/purging episodes at relatively short-term (1 year) in BN patients. In AN, home-TF does not increase anxiety, depression, or worsen the eating behavior. In BN patients, home-TF decreases anxiety and depressive state and improves the quality of life. The goal of home-TF is not to cure the patients, but only to avoid serious malnutrition and its complications and to insure a better investment of the patients for their psychotherapy. Home-TF must be associated with psychotherapy, namely cognitive behavioural therapy and family therapy in adolescents. If the fear of gaining body weight is too high, the risk of failure of home-TF, because of poor compliance, is increasing. In any case, the aims and the goals of home-TF should be extensively explained.
    Nutrition Clinique et Métabolisme 12/2013; 27(4):244–248. DOI:10.1016/j.nupar.2013.05.002 · 0.62 Impact Factor
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    ABSTRACT: Aim There are few published studies on the triggers of binge eating in anorexia nervosa of binge/purging subtype (BPAN), bulimia nervosa (BN) and binge eating disorder (BED). Patients and methods We validated in 29 patients (10 BPAN, 10 BN and 9 BED) the perspicuity, the clarity and the intra- (doubles) and inter- (test-retest) reproducibility of a 24-item Start questionnaire on the triggers of binge eating. Then the Start questionnaire was administered to 176 patients (65 BPAN, 62 BN and 59 BED patients) being 27.5 + 9.1 yr old, having 15 + 9 binge eating (BE) episodes/week, with a mean binge duration of 1 hr 36 min (+ 38 min)/day. Results BE episodes occurred mainly during the second part of the day: afternoon after work (67% of the patients), “tea” time (55%), evening after dinner (42%) and at night (22%). The principal place for BE episodes was at home (96%). The BED patients avoided binges at the parents’ home (89%) more often than the BPAN (62%, P < 0.02). The binges occurred mainly in the living room (44%), in the kitchen (43%), and less in the bedroom (31%). Hunger pangs seemed to be a trigger of binges in 31% of the patients, and a stronger trigger in BED (42%) than in the BPAN and BN patients (24%; P = 0.04). Binge eating episodes could occur despite a high satiety level (just after lunch or dinner) in 29% of the BN and in 16% of the BED patients (P < 0.02). Concerning food, the major triggers were high energy-density food (77%) and comfort food (60%), such as chocolate, cakes, bread and pasta. The food consumed for binge episodes (in-binge food) was more often a strong trigger than the other food (not used for binges): olfaction (19% versus 10%), sight (52% versus 25%) and placing in the mouth (71% versus 26%; P < 0.02 for all, in the 3 groups). Being tired could be a strong trigger in 37% of the patients, but “being aroused” in the other 38 % of the patients. Stressful events (65%), anxiety (74%), “being under pressure” or irritated (51% and 55%) were of course major triggers in a majority of the patients, as well as sadness (61%), feeling of powerlessness (62%), inefficiency (73%) and depressive state (71%). Flashback from traumatism (sexual trauma in 17% of the patients) was a strong trigger of binges more often in BPAN and BED (44%) than in BN (23%; P < 0.05). The binge eating was painful (and “not at all a pleasure”) in 69% of the patients, but could also be a relaxing behavior in 31% of the patients, more often in the BED (43%) than in the BPAN patients (20%; P < 0.05). The binge eating behavior was quoted as obsessive in 63% of BPAN, 92% of BN and only 34% of BED patients (P < 0.001). The patients said that they were unable to avoid the binge (76% of the patients), more often in BPAN and BN than in BED patients (P < 0.01). As a whole, 62% of BPAN, 89% of BN and only 4 % of BED patients (P < 0.05) were unable to avoid purging (vomiting). In 12% of the cases, there was a pleasure felt when binging. For the other patients, shame, filth and incapacity were the feelings related to binges in 58% of the BPAN, 45% of BN and 43% of BED patients (P < 0.04). The global score of addiction (zero = not addicted, 10 = very addicted) was 8.56 + 1.2 in BPAN, 8.42 + 1.5 in BN and 6.74 + 1.1 in BED patients (NS between BPAN and BN; P < 0.01 between BPAN and BN on the one hand and BED on the other). Conclusion The present study has demonstrated the usefulness of the Start questionnaire. It also evidences the key role of intrinsic factors, both metabolic and emotional, as strong triggers for binge eating episodes in BPAN, BN and BED. It has also demonstrated the role of environmental determinants.
    L Encéphale 09/2013; 40(4). DOI:10.1016/j.encep.2013.06.008 · 0.60 Impact Factor
  • Tao Jiang · Daniel Rigaud · Benoist Schaal
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    ABSTRACT: Anorexia nervosa (AN) is a chronic and often severe eating disorder, which could have a serious impact on various life domains. AN may lead to physical, mental, behavioural and socioprofessional impairment. Thus, one could expect a poor quality of life (QoL) in AN patients. QoL is certainly a key factor to provide quantitative measurement of treatment efficacy that will facilitate clinical decision-making and treatment planning. Despite that QoL was rarely prospectively analyzed in AN patients, one could conclude that AN patients showed reduced QoL, as compared to normal controls and other psychiatric-disordered patients. It seems that mental health components of QoL are more impaired than the physical ones in AN patients, who showed a modest impact in the physical domain. Thus, our aim was to analyse the QoL using a new, French, questionnaire, the QUAVIAM (qualité de vie dans l'anorexie mentale). After a bibliography research (including EDE, EDI, SF-36, QOL.ED), the choice of 12 themes, regrouped in six scores, was made by three eating disorder specialists and two recovered patients. For each score, 10 to 15 questions were written by the experts, and then corrections and validation were made by the five experts and 21 patients. After this, we prospectively determined the reproducibility (3days interval), the specificity, and the sensitivity for short-term change in patients exhibiting an "active" AN (n=54, mean age: 31±9yrs, mean BMI: 14.1±2.8kg/m(2), AN duration: 2.6±1.9yrs), and again after cognitive behavioral therapy (CBT). We also analyzed the QUAVIAM score and subscores in 48 recovering patients and in 56 subjects without eating disorder. The QUAVIAM final version (61 questions) was collected in 76 patients and the 56 healthy controls matched for sex and age. Its reproducibility was 91% (intra-questionnaire) and 94% (inter-questionnaire), its specificity 98% (versus controls; P<0.0001) and its sensitivity 99%. The QUAVIAM global score of the AN patients was more impaired (389±87) than that of the recovering patients (157±82) and the normal controls (89±49; P<0.0001). Each of the six subscores was higher (more altered) in active AN than in recovering AN patients and in normal subjects: the somatic, the psychological, the hedonic, the socioprofessional, the affective and the TCA-related ones (P<0.001 for each comparison). The QUAVIAM global score and its subscores were significantly improved (decreased) by the 3-month CBT: 385±25 before and 189±30 after CBT (P<0.0001). The changes were observed for all the subscales (P<0.0001). The somatic subscore did not decrease less than the other subscores. Thus, the present study permits proposing the QUAVIAM for analysis of physical, mental, behavioural and socioprofessional impairment or improvements in AN patients.
    L Encéphale 06/2013; DOI:10.1016/j.encep.2013.03.003 · 0.60 Impact Factor
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    ABSTRACT: To report the prognosis in 41 anorexia nervosa (AN) patients suffering from very severe malnutrition (mean BMI: 10.1 ± 0.57 kg/m(2)). Compared with 443 less malnourished AN patients, the 41 patients were older (27.8 ± 5.4 vs 22.4 ± 2.1 yrs), their AN was longer (9.6 ± 3.4 vs 5.0 ± 1.5 yrs) and more often of the restrictive subtype (P < 0.05). In 27% of the patients, all nutritional marker levels were in normal range. All patients received a prudent tube-refeeding: energy was increased from 12 to 40 kcal/kg/day, protein from 1.0 to 1.5 g/kg/day within 10 days. During stay, 1 patient died, 2 others suffered from myocardial infarction, 2 others from acute pancreatitis, and 5 from mental confusion. Compared with the other 443 AN patients, the 40 remaining patients had worse 6-yr prognosis: 2 died (7% vs 1.2%), 29% had severe outcome (vs 10%), and only 41% recovered (vs 62%). In AN patients with BMI < 11 kg/m(2), a prudent tube-refeeding could avoid short-term mortality, but long-term prognosis was bad.
    Clinical nutrition (Edinburgh, Scotland) 03/2012; 31(5):693-8. DOI:10.1016/j.clnu.2012.02.016 · 3.94 Impact Factor
  • D. Rigaud · D. Perrin · M.C. Brindisi
    Cahiers de Nutrition et de Diététique 12/2011; 46:S97. DOI:10.1016/S0007-9960(11)70177-8
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    ABSTRACT: In many binge-eating/vomiting patients, abstinence could not be obtained from classical treatments. Since the authors showed that tube feeding (TF) reduced such episodes in anorexia nervosa (AN)-hospitalized patients, they carried out a randomized trial on the efficacy of TF plus cognitive behavioral therapy (CBT) vs CBT alone in AN and bulimia nervosa adult outpatients. The authors randomly assigned 103 ambulatory patients to receive 16 sessions of CBT alone (n = 51) or CBT plus 2 months of TF (n = 52). The main goal was abstinence of binge-eating/vomiting episodes. Other criteria were gains in fat-free mass and muscle mass improvements in nutrition markers, and quality of life (SF-36 Health Survey), depression (Beck Depression Inventory), and anxiety (Hamilton Anxiety Rating Scale) scores. Evaluations were performed at 1, 2 (end of treatment), 5, 8, and 14 months (analysis of variance). TF patients were rapidly and more frequently abstinent at the end of treatment (2 months) than the CBT patients: 81% vs 29% (P < .001). Fat-free mass, biological markers, depressive state (-58% vs -26%), anxiety (-48% vs -15%), and quality of life (+42% vs +13%) were more improved in the TF group than in the CBT group (P < .05). One year later, more TF patients remained abstinent (68% vs 27%, P = .02); they were less anxious, were less depressed, and had better quality of life than the CBT patients (P < .05). TF combined with CBT offered better results than CBT alone.
    Journal of Parenteral and Enteral Nutrition 05/2011; 35(3):356-64. DOI:10.1177/0148607110382422 · 3.14 Impact Factor
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    ABSTRACT: BACKGROUND: To study the long-term prognosis of anorexia nervosa (AN), 484 adult AN patients were followed on a mean duration of 13 years. RESULTS: The mortality rate was 1.2%. Eight factors were linked to the lack of recovery at 2 years: low BMI at discharge, low energy and fat intakes, high drive for excessive exercising, high score for perfectionism, for interpersonal distrust and for anxiety, use of tube-feeding and adhesion to treatment (P<0.02). Four factors explained the risk of the binge/purging form at 2 years: having had binge-eating disorder and overweight before AN, having had purging episodes within the first 2 years of AN; having had very high energy intakes through meals and being not treated by tube-feeding. During the 13-year follow-up, very few binge/purging patients turned out to have the restrictive form. Two main factors explained 67% of the variance of menses recovery: having a BMI>18.5 kg/m(2); and having no physical hyperactivity. The recovery rate increased with the elapsing of relapse-free time (P=0.02). After a 13.5-year follow-up, 292 out of the 484 patients were recovered (60.3%), 25.8% had a relatively good outcome, 6.4% a bad outcome and 6.4% a severe outcome. Very few factors were identified as predictors of a good outcome (binge-eating/purging subtype, personality disorder).
    Diabetes & Metabolism 02/2011; 37(4):305-11. DOI:10.1016/j.diabet.2010.11.020 · 2.85 Impact Factor
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    ABSTRACT: Clinical features of 238 eating disorder (ED) adult patients were compared, according to the subtype (restricting subtype of anorexia nervosa (RAN, binge eating/purging subtype (BPAN) and bulimia nervosa, BN). There were 75 RAN, 91 BPAN and 76 BN needing for hospitalization. BPAN and BN patients had had, before ED, higher BMI, higher frequency of obesity and binge eating and had been more often on slimming diet than RAN patients (p < 0.05). One third of BPAN and BN had begun with RAN. In 75% of the cases, a slimming diet preceded the ED. One quarter of BPAN and BN had had sexual trauma, vs 6% of the RAN (p < 0.01). In the family, there were more obesity, more ED, more anxiety, more depressive states than in population. The father or the mother had more often a thought of ideal thinness and of importance of sport. Meals were very often suppressed, food excluded (NS between groups). Binge/purging episodes occurred 16 ± 6 times a week and lasted 2,6 ± 1,1 h/day. Excessive exercise occurred in 60% of B and 70% of RAN and BPAN (NS) and lasted 2,7 ± 0,7 h/day. Obsessive compulsive disorders occurred in 50% of the cases (NS between groups) and lasted more in AN than in BN patients (BN: 1.9 ± 0.6 h, AN: 2,7 ± 0,8 h). Self-injury occurred in 32% of the cases (BN: 44%, AN: 23%). Smoking abuse was more frequent in BPAN and BN (40%) than in RAN (18%, p < 0.01). Among 18% of the patients received a disability pension from government health insurance. Chronic treated depression was observed in 27% (more in BPAN and BN than RAN, p < 0.05) and chronic treated anxiety in 52% of the patients. Quality of life was strongly impaired in all three eating disorders, and no more in AN than in BN, nor more in RAN than in BPAN: the QUAVIAM total score was similar in the three groups and in each very higher than that of 56 healthy subjects (405 ± 54 vs 88.6 ± 49; p < 0.0001) and than the QUAVIAM global score obtained in 49 recovered ED patients (157 ± 81; p < 0.0001). Each of the six sub-scores was higher (more deteriorated) than those of the healthy controls (p < 0.0001): physical, psychological, ED-related, hedonic, socioprofessional and emotional scores. Only two of the six subscores differed between AN and BN: the psychical and the ED-related subscores were less deteriorated in RAN than in BPAN and BN patients (p < 0.03).
    Cahiers de Nutrition et de Diététique 02/2011; 46(1). DOI:10.1016/j.cnd.2010.07.001
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    ABSTRACT: Poster affiché ; http://www.jfn2010.com
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    ABSTRACT: Though it has been suggested that hedonic processing is altered in anorexia nervosa (AN), few studies have used objective measures to assess affective processes in this eating disorder. Accordingly, we investigated facial electromyographic, autonomic and subjective reactivity to the smell and sight of food and non-food stimuli, and assessed more particularly rapid facial reactions reflecting automatic processing of pleasantness. AN and healthy control (HC) women were exposed, before and after a standardized lunch, to pictures and odorants of foods differing in energy density, as well as to non-food sensory cues. Whereas the temporal profile of zygomatic activity in AN patients was typified by a fast drop to sensory cues within the 1000 ms following stimulus onset, HC showed a larger EMG reactivity to pictures in a 800-1000 ms time window. In contrast, pleasantness ratings discriminated the two groups only for high energy density food cues suggesting a partial dissociation between objective and subjective measures of hedonic processes in AN patients. The findings suggest that the automatic processing of pleasantness might be altered in AN, with the sensitivity to reward being modulated by controlled processes.
    Biological psychology 12/2010; 86(3):265-72. DOI:10.1016/j.biopsycho.2010.12.007 · 3.47 Impact Factor
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    ABSTRACT: Body weight gain is an important goal in anorexia nervosa (AN) patients, but inflation in body fluids could artificially increase body weight during refeeding. 42 malnourished adult AN patients were refed using a normal-sodium diet, then 176 other malnourished adult AN patients received a refeeding low-sodium diet (BMI of the 218 patients: 13.4 ± 1.9 kg/m(2)). Sodium balance, body composition by a 2-electrode impedance method (BIA, for assessment of total and extracellular water, fat-free mass, FFM), resting energy expenditure and energy intake were calculated. In the patients on normal-sodium diet, body weight, and total and extracellular water gains were higher than those of the low-sodium diet patients (P<0.01). Edema occurred more often in the former group (21% vs 6%; P<0.05). In almost all patients, BMI reached a plateau around 15-16 kg/m(2), then increased again. During this plateau, an increase in intracellular water and in "active FFM" was observed with BIA, together with a similar decrease in extracellular water. In AN patients, who are always afraid of gaining too much weight, in regard to their food intake, it will be useful to give a low-sodium diet until a 15-16 kg/m(2) BMI. This should be integrated into the cognitive behavioral therapy.
    Clinical nutrition (Edinburgh, Scotland) 12/2010; 29(6):749-55. DOI:10.1016/j.clnu.2010.05.007 · 3.94 Impact Factor
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    Tao Jiang · Robert Soussignan · Daniel Rigaud · Benoist Schaal
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    ABSTRACT: Although patients with anorexia nervosa have been suggested to be anhedonic, few experiments have directly measured their sensory pleasure for a range of food and non-food stimuli. This study aimed to examine whether restrictive anorexia nervosa (AN-R) patients displayed: i) a generalized decline in sensory pleasure or only in food-related sensory pleasure; ii) a modification of hedonic responses to food cues (liking) and of the desire to eat foods (wanting) as a function of their motivational state (hunger vs. satiety) and energy density of foods (high vs. low). Forty-six female participants (AN-R n=17; healthy controls (HC) n=29) reported before/after lunch their pleasure for pictures/odorants representing foods of different energy density and non-food objects. They also reported their desire to eat the foods evoked by the sensory stimuli, and completed the Physical Anhedonia Scale and the Beck Depression Inventory. AN-R and HC participants did not differ on liking ratings when exposed to low energy-density food or to non-food stimuli. The two groups also had similar physical anhedonia scores. However, compared to HC, AN-R reported lower liking ratings for high energy food pictures regardless of their motivational state. Olfactory pleasure was reduced only during the pre-prandial state in the AN-R group. The wanting ratings showed a distinct pattern since AN-R participants reported less desire to eat the foods representing both low and high energy densities, but the effect was restricted to the pre-prandial state. Taken together these results reflect more the influence of core symptoms in anorexia nervosa (fear of gaining weight) than an overall inability to experience pleasure.
    Psychiatry Research 11/2010; 180(1):42-7. DOI:10.1016/j.psychres.2010.04.041 · 2.68 Impact Factor
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    ABSTRACT: Introduction In the aim to explore the efficacy of tube feeding (TF) in ambulatory anorexia nervosa (AN) patients, we prospectively treated 60 AN patients by tube feeding (TF) at home, using a nasogastric tube. Methods nutritional (clinical, biological) and psychological (Hamilton and Beck scores) markers were assessed before and after 2 months of NEAD. Results While the patient's body weight was decreasing during the previous 2 months, it significantly increased (P < 0.001) during the 2-month TF, both in the restrictive and the binge/purging form: +3,42 ± 2,39 kg in the restrictive ones and +2,82 ± 2,17 kg in the binge/purging ones. Patients were rapidly (48 h) and frequently abstinent from binge/purging during TF: 90% had no more binge/purging episodes (P < 0.0001). TF did not worse the eating behavior, and did increase neither anxiety nor depressive levels (Hamilton and Beck scores). Biological nutritional markers were normal before TF and remained so (2nd month), except haptoglobin which was low before and reached normal range during TF (P < 0,01). Conclusion ambulatory TF seems to be useful in AN patients at home. This could permit to avoid hospitalization, but needs to be confirmed by a randomized trial.
    La Presse Médicale 12/2009; 38(12):1739-1745. DOI:10.1016/j.lpm.2009.04.009 · 1.17 Impact Factor
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    R Soussignan · T Jiang · D Rigaud · J P Royet · B Schaal
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    ABSTRACT: To investigate hedonic reactivity and the influence of unconscious emotional processes on the low sensitivity to positive reinforcement of food in anorexia nervosa (AN). AN and healthy women were exposed to palatable food pictures just after a subliminal exposure to facial expressions (happy, disgust, fear and neutral faces), either while fasting or after a standardized meal (hunger versus satiety). Both implicit [facial electromyographic (EMG) activity from zygomatic and corrugator muscles, skin conductance, heart rate, and videotaped facial behavior] and explicit (self-reported pleasure and desire) measures of affective processes were recorded. In contrast to healthy women, the AN patients did not display objective and subjective indices of pleasure to food pictures when they were in the hunger states. Pleasure to food cues (liking) was more affected than the desire to eat (wanting) in AN patients. Subliminal 'fear faces' increased corrugator muscle reactivity to food stimuli in fasting AN patients, as compared to controls. The results suggest that unconscious fear cues increase the negative appraisal of alimentary stimuli in AN patients and thus contribute to decreased energy intake.
    Psychological Medicine 08/2009; 40(3):503-14. DOI:10.1017/S0033291709990377 · 5.43 Impact Factor
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    ABSTRACT: In the aim to explore the efficacy of tube feeding (TF) in ambulatory anorexia nervosa (AN) patients, we prospectively treated 60 AN patients by tube feeding (TF) at home, using a nasogastric tube. Nutritional (clinical, biological) and psychological (Hamilton and Beck scores) markers were assessed before and after 2 months of NEAD. While the patient's body weight was decreasing during the previous 2 months, it significantly increased (P<0.001) during the 2-month TF, both in the restrictive and the binge/purging form: +3,42 +/- 2,39 kg in the restrictive ones and +2,82 +/- 2,17 kg in the binge/purging ones. Patients were rapidly (48 h) and frequently abstinent from binge/purging during TF: 90% had no more binge/purging episodes (P<0.0001). TF did not worse the eating behavior, and did increase neither anxiety nor depressive levels (Hamilton and Beck scores). Biological nutritional markers were normal before TF and remained so (2nd month), except haptoglobin which was low before and reached normal range during TF (P<0,01). Ambulatory TF seems to be useful in AN patients at home. This could permit to avoid hospitalization, but needs to be confirmed by a randomized trial.
    La Presse Médicale 07/2009; 38(12):1739-45. · 1.17 Impact Factor