Usefulness of amenorrhea in the diagnoses of eating disorder patients
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.
Available from: Andrea B Goldschmidt
- "The DSM-IV-TR does not consider primary amenorrhea (i.e., failure of menses to start by age 15 while secondary sex characteristics such as breast development and growth of body hair are present, or within three years of the onset of secondary sexual characteristics) as part of the criteria for females with AN . Further, a significant proportion of female adolescents with AN continue to menstruate at low weights , while minimal differences have been found between amenorrheic and menstruating individuals on clinically relevant variables such as length of illness (LOI), eating-related psychopathology, number of previous hospitalizations, and discharge weight . "
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The resumption of menses (ROM) is considered an important clinical marker in weight restoration for patients with anorexia nervosa (AN). The purpose of this study was to examine ROM in relation to expected body weight (EBW) and psychosocial markers in adolescents with AN.
We conducted a retrospective chart review at The University of Chicago Eating Disorders Program from September 2001 to September 2011 (N = 225 females with AN). Eighty-four adolescents (Mean age = 15.1, SD = 2.2) with a DSM-IV diagnosis of AN, presenting with secondary amenorrhea were identified. All participants had received a course of outpatient family-based treatment (FBT), i.e., ~20 sessions over 12 months. Weight and menstrual status were tracked at each therapy session throughout treatment. The primary outcome measures were weight (percent of expected for sex, age and height), and ROM.
Mean percent EBW at baseline was 82.0 (SD = 6.5). ROM was reported by 67.9% of participants (57/84), on average at 94.9 (SD = 9.3) percent EBW, and after having completed an average of 13.5 (SD = 10.7) FBT sessions (~70% of standard FBT). Compared to participants without ROM by treatment completion, those with ROM had significantly higher baseline Eating Disorder Examination Global scores (p = .004) as well as Shape Concern (p < .008) and Restraint (p < .002) subscale scores. No other differences were found.
Results suggest that ROM occur at weights close to the reference norms for percent EBW, and that high pre-treatment eating disorder psychopathology is associated with ROM. Future research will be important to better understand these differences and their implications for the treatment of adolescents with AN.
Available from: Suzanne Abraham
- "The functional gastrointestinal disorders (FGIDs) are biopsychosocial disorders which, like other such disorders for example eating disorders (ED), present difficulties in assessment and measurement [1,2]. Description and categorization of the FGIDs according to the Rome criteria  presupposes that clusters of symptoms hold true across different populations; this is despite the fact that the presentation and form of these disorders are affected by a wide range of factors, including physical and psychological comorbidity [4,5]. "
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Gastrointestinal (GI) symptoms are common in patients with eating disorders. The aim of this study was to determine, using factor analysis, whether these GI symptom factors (clusters) in eating disorder patients hold true to the Rome II classification of functional gastrointestinal disorders (FGIDs).
Inpatients in a specialised eating disorder unit completed the Rome II questionnaire. Data from 185 patients were analysed using factor analysis of 17 questions cited as present in 30% to 70% of the patients.
Five factors emerged accounting for 68% of the variance and these were termed: ‘oesophageal discomfort’, ‘bowel dysfunction’, ‘abdominal discomfort’, ‘pelvic floor dysfunction’, and ‘self-induced vomiting’. These factors are significantly related to the Rome II FGID categories of functional oesophageal, bowel and anorectal disorders, and to the specific FGIDs of IBS, functional abdominal bloating, functional constipation and pelvic floor dyssynergia. Both heartburn and chest pain were included in the oesophageal discomfort factor. The ‘pelvic floor dysfunction’ factor was distinct from functional constipation.
The GI symptoms common in eating disorder patients very likely represent the same FGIDs that occur in non-ED patients. Symptoms of pelvic floor dysfunction in the absence of functional constipation, however, are prominent in eating disorder patients. Further investigation of the items comprising the ‘pelvic floor dysfunction’ factor in other patient populations may yield useful results.
Available from: Charlotte Keating
- "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.
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