上海进食障碍患者的潜在类别研究（英文）

背景:进食障碍是一种文化相关疾病,东西方患者的临床表现有所不同,新版ICD-11指南即将出版,其喂养和进食障碍部分在中国进食障碍患者中的适用性尚不明确。目的:探索中国进食障碍患者的潜在类别结构,研究新版ICD-11指南中进食障碍相关部分在中国的跨文化适用性。方法:采用自制问卷和进食障碍问卷量表对379名2010-2016年于上海市精神卫生中心就诊的进食障碍患者的症状进行评估,使用SPSS20.0录入数据、处理人口学资料,通过Latent GOLD 4.5进行潜在剖面分析。结果:依据潜在剖面分析结果可以将进食障碍分成:极低体重限制进食组(23.17%),无怕胖暴食清除组(21.54%),低水平怕胖暴食组(19.27%),怕胖暴食组(19.27%),极低体重无怕胖组(16.76%)。在提取的临床症状表现中,BMI、有无暴食行为、有无催吐、有无服用导泻剂及怕胖观念存在显著性差异,而有无限制性进食并无显著性差异。结论:中国的进食障碍患者根据症状可以分成五个潜类别,基本符合ICD-11喂养和进食障碍的诊断分类。但进食障碍患者的怕胖观念标准和中国人群的低体重标准有待进一步完善。     

104例进食障碍患者临床特征分析

目的:了解住院进食障碍患者的临床特征. 方法:将符合国际疾病分类第10版(ICD-10)神经性厌食症(AN)和神经性贪食症(BN)诊断标准的104例住院进食障碍患者按不同临床类型分组,对两组患者心理、生理、社会三方面的临床特征进行回顾性比较. 结果:AN和BN患者的怕胖心理、闭经、误工误学时间及减少食物对身体影响的方式等临床特点差异无显著性(P>0.05).但是AN患者较BN患者发病年龄早,体象障碍比较多见(P均<0.01,或P均<0.05).BN患者比AN患者有更多抑郁症状,病程较长,就诊年龄晚(P<0.01). 结论:进食障碍两大综合征可能是一个疾病进程中的两个不同阶段,而贪食症的危害更应引起重视.     

进食障碍基于家庭的治疗北大核心CSCD

进食障碍(eating disorders,ED)主要指以反常的进食行为和心理紊乱为特征,并伴发显著体重改变和(或)生理功能紊乱的一组慢性难治性精神障碍[1]。其主要包括神经性厌食症(anorexia nervosa,AN)、神经性贪食症(bulimia nervosa,BN)和暴食障碍(binge eating disorders,BED)[2]。进食障碍好发于青少年和年轻女性[1-2],其中AN的发病年龄在13~20岁,发病的高峰年龄在13~14岁和17~18岁;BN的发病年龄在12~35岁,平均为18岁。该病呈现高病死率、高共病率、高疾病负担[3],且有证据显示我国近年来进食障碍患者数量有增多的趋势[4],因此寻求循证有效的进食障碍治疗方法是当务之急。     

进食障碍疗效的影响因素分析

目的:了解进食障碍住院患者疗效的影响因素. 方法:收集36例进食障碍患者住院治疗的临床资料并进行分析. 结果:根据疗效分组显示,疗效好的患者闭经时间短、住院时间长、体质量(体重)增加明显、鼻饲治疗者多(P均<0.05),而在病程、起病年龄、入院前体质量减轻情况,有否导泻,引吐,入院时汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评分、住院意向、住院病房模式等方面差异均无显著性(P均>0.05). 结论:进食障碍的患者需要及早、长程的综合治疗,对于治疗依从性差的患者,鼻饲治疗颇为有效.有自行导泻引吐症状可能是促使患者住院治疗的重要因素.     

联合雌激素治疗对神经性厌食症患者的疗效

目的:探索联合雌激素治疗对年轻未治疗女性神经性厌食症(AN)患者临床常规治疗的增效作用。方法:将80例符合《美国精神障碍诊断与统计手册》第4版(DSM-IV-TR)中AN诊断且处于低雌激素状态的女性患者随机分为雌激素治疗组(A组:雌激素治疗+常规治疗,n=38)与常规治疗组(B组,n=42),并在治疗4周、12周后进行随访评估,使用体质量指数(BMI)、进食障碍检查问卷(EDE-Q)总分、进食态度量表(EAT-26)总分、贝克抑郁量表(BDI)总分、贝克焦虑量表(BAI)总分(该4个量表总分简称症状量表总分)评估患者的临床症状,比较治疗前后两组疗效及差异。A组分别有25例和20例患者完成4周和12周随访,B组分别有23例和21例患者完成4周随访和12周随访。结果:两组AN患者在治疗前后的临床症状总分的减分率变化均差异无统计学意义(P0.05);两组AN患者的临床症状总分随时间均有显著变化(P0.05)。结论:对低体质量女性AN患者联合雌激素治疗并不能明显增加疗效。     

急性硬膜下血肿的选择性非手术治疗

目前对体积小而症状轻微的急性硬膜下血肿(ASDH)有采用非手术治疗的趋势,但尚缺乏这方面的系统研究资料。为此作者对83例症状轻微、GCS在11～15分(平均14分)的患者进行了对照研究:58例(70％)采用非手术治疗,25例(30％)进行手术治疗。非手术及手术两组相比,局限性神经功能障碍的发生率,脑池(环池)的开放率及小ASDHs(最大厚度≤1cm)所占比例分别为12％:40％、90％:28％和92％:62％。结果非手术组93％的病人有神经功能恢复,而手术组为84％。病人年龄及损伤严重度评分(ISS)与预后显著相关(P<0.01),血肿大小,有无合并其它脑损伤及脑池状态等亦与预后明显相关,而手术时间则与预后无     

亚急性联合变性病程不同时期MRI上病灶出现率及临床表现的差别

目的 探讨亚急性联合变性(SCD)在病程不同时期MRI上病灶出现率及临床表现的差别.方法 根据病程将SCD患者分为两组,一组病程＜6m,一组病程＞6m,比较两组患者MRI上病灶出现率及临床表现的差别.结果 本组SCD患者共30例,其中11例在MRI上发现病灶,病灶出现率为36.7％,病程＜6m时,MRI病灶出现率为55.6％ (10/18),病程＞6m时,MRI病灶出现率为8.3％ (1/12),差异有统计学意义(P＜0.05);首发症状为四肢麻木有16例,占53.3％,其中病程＜6m 9例(50.0％),病程＞6m 7例(58.3％),差异无统计学意义(P＞0.05);首发症状为行走不稳有9例,占30.0％,其中病程＜6m有3例(16.7％),病程＞6m有6例(50.0％),差异无统计学意义(P＞0.05);病程中出现二便障碍有11例,占36.7％,其中病程＜6m 2例(11.1％),病程＞6m 9例(75.0％),差异有统计学意义(P＜0.01).结论 SCD在病程早期,MRI上更易发现病灶;病程晚期,更易出现二便障碍.     

中国人WD基因12号外显子突变研究

目的:研究中国人Wilson病(WD)基因第12外显子突变特征。方法:应用聚合酶链反应-单链构象多态型(PCR-SSCP)银染技术研究70例无亲缘关系的WD患者和30例正常组的WD基因12外显子,对有异常泳动者经DNA自动测序技术证实其突变性质和位置。结果:正常组未见异常。患者组发现11例异常(11/70占15.7％),二种错义突变,其中9例为Thr935Met突变(9/70,占12.9％),2例为Lys952Arg突变(2/70占2.8％)。结论:第12外显子是中国人WD基因突变热区之一,发现一种未见报道的新型错义突变。     

辅助营养治疗对住院神经性厌食症患者治疗效果的对照研究

目的：探讨辅助营养治疗对住院神经性厌食症（ AN）患者的治疗效果。方法：41例符合《美国精神障碍诊断与统计手册第4版》AN诊断标准的患者随机分为研究组17例和对照组24例,分别给予常规抗抑郁治疗联合辅助营养治疗和仅常规抗抑郁治疗1个月。在治疗前后分别测定两组患者的体质量、身高并完成进食障碍调查问卷（ EDE-Q）的评定;比较两组各项指标改善情况。结果：治疗后研究组体质量指数（BMI）值高于治疗前,差异有统计学意义（F=18.42,P<0.05）;对照组治疗后BMI值高于治疗前,但差异无统计学意义（ F=9.71,P>0.05）。研究组治疗后EDE-Q量表在暴食频次（ F=217.5）、催吐频次（ F =157.3）及限制进食因子（ F =319.6）得分均低于对照组,差异有统计学意义（P均<0.05）。结论：辅助营养治疗在短期内对住院神经性厌食症患者疗效明显。     

不同治疗策略对动脉瘤性动眼神经麻痹的疗效

目的 探讨显微外科动脉瘤夹闭术、血管内介入栓塞术等治疗方法对动脉瘤性动眼神经麻痹(OMNP)疗效的影响.方法 分析新疆医科大学第一附属医院2018年1月-2020年10月收治的25例颅内动脉瘤伴OMNP患者的临床资料、随访结果,比较显微外科动脉瘤夹闭术和血管内介入栓塞术以及术前不同程度OMNP患者术后动眼神经功能恢复的情况.结果 该组患者术后平均住院(9.72±3.82)d,出院时OMNP症状完全恢复3例(12.0％),部分恢复10例(40.0％),无恢复12例(48.0％),无加重患者.术后6个月随访时OMNP症状完全恢复6/25例(24.0％),其中栓塞组2/10例(20％),夹闭组4/14例(28.6％);部分恢复10/25例(40.0％),其中栓塞组5/10例(50％),夹闭组5/14例(35.7％);无恢复9/25例(36.0％),其中栓塞组3/10例(30％),夹闭组5例/14(35.7％).结论 显微外科动脉瘤夹闭术和血管内介入栓塞术均可改善动脉瘤性OMNP.     

A taxometric investigation of the latent structure of eating disorders

The present study examined the latent structure of eating disorder symptoms in a large sample of patients with a diagnosis of anorexia nervosa restricting type, anorexia nervosa binge eating/purging type, and bulimia nervosa (n=3747). Three taxometric procedures (MAXimum EIGenvalue (MAXEIG), Mean Above Minus Below A (MAMBAC), and Latent-Mode Factor Analysis (L-Mode)) were applied to self-reported symptoms of bulimia, drive for thinness, body dissatisfaction, as well as body mass index. Taxometric analysis among patients with the restricting and binge eating/purging subtype of anorexia and those with bulimia nervosa supported a dimensional latent structure of eating disorder symptoms. Taxometric analysis also revealed a dimensional latent structure of eating disorder symptoms among patients with the restricting and binge eating/purging subtype of anorexia suggesting that the two anorexia subtypes may not represent discrete categories. These findings suggest that the diagnosis and assessment of eating disorder symptoms should be conceptualized from a dimensional framework.     

Profiling disordered eating patterns and body mass index (BMI) in the English general population

Purpose

Little national evidence exists on disordered eating patterns in the UK. This study examined the prevalence and nature of disordered eating patterns in the National Adult Psychiatric Morbidity Survey 2007.

Method

Responses to the screening tool for eating disorders (SCOFF) and body mass index (BMI) were analysed using latent class analysis (n = 7,001). Multinomial logistic regression explored the associations between latent classes and mental health comorbidities.

Results

The prevalence of possible eating disorders in England using the SCOFF was 6.3 %; this decreased to 1.6 % when accounting for the negative impact feelings about food had on the respondent’s life. Five latent classes were identified: classes 1 and 2 resembled known eating disorders (‘marginal anorexia’ relating to anorexia nervosa and ‘binge eaters’ relating to bulimia nervosa/binge eating disorder); class 3 consisted of people who were obese, but did not experience eating problems; class 4 was morbidly obese, with an elevated risk of anxiety disorders; class 5 was labelled as ‘normal eaters’, with a low probability of eating problems and a normal BMI.

Conclusions

Adults assigned to eating disorder type classes are at increased risk for mental health comorbidities and poorer social functioning. Information presented herein on clustering of disordered eating patterns may help clinicians identify those men and women risk for an eating disorder.     

Latent structure of eating disorder symptoms: a factor analytic and taxometric investigation

OBJECTIVE: The latent structure of eating disorder symptoms, as defined by DSM-IV, was tested in a group of 341 women with and without an eating disorder diagnosis. METHOD: The study group consisted of 201 participants with a diagnosis of anorexia nervosa, bulimia nervosa, binge eating disorder, or eating disorder not otherwise specified; 24 comparison subjects who were obese but did not have an eating disorder diagnosis; and 116 normal-weight comparison subjects. The presence and severity of DSM-IV eating disorder symptoms was assessed with the semi-structured Interview for the Diagnosis of Eating Disorders-IV. The study group was randomly divided into two subgroups for factor analytic studies, and the data were subjected to exploratory and confirmatory factor analysis. Pilot taxometric analyses were used to examine whether the obtained factors represented true dimensions or latent discrete classes. RESULTS: In exploratory factor analyses with data from subgroup 1, three factors were found to account for 66% of the variance in eating disorder symptoms: binge eating, fear of fatness/compensatory behaviors, and drive for extreme thinness. Confirmatory factor analysis cross-validated this factor structure with data from subgroup 2. The eating disorder groups and comparison groups were found to differ on at least one of the three factors. The results of the taxometric analyses were inconsistent with a strictly dimensional model of eating disorders and suggested that some features may be dimensional whereas others may be taxonic (discrete). DISCUSSION: The eating disorders, as defined by DSM-IV, can be conceptualized as having three latent features. Taxometric tests found empirical support for conceptualizing bulimia nervosa and binge eating disorder as discrete syndromes.     

Venlafaxine treatment of binge-eating disorder associated with obesity: a series of 35 patients

BACKGROUND: Binge-eating disorder is a newly recognized eating disorder characterized by recurrent episodes of binge eating without extreme weight loss behaviors. It commonly co-occurs with overweight and obesity. To preliminarily explore the effectiveness and tolerability of venlafaxine in binge-eating disorder, we retrospectively reviewed the response of 35 consecutive overweight or obese outpatients with binge-eating disorder presenting at the University of Cincinnati Physicians Weight Management Program, Cincinnati, Ohio, to clinical treatment with venlafaxine. METHOD: The medical charts of 35 consecutive outpatients with binge-eating disorder (DSM-IV criteria) and overweight (body mass index [BMI] = 25.0-29.9) or obesity (BMI > or = 30.0) who received clinical treatment with venlafaxine at a weight management program were reviewed. Response of binge-eating disorder symptoms was assessed by weekly binge frequency (the number of binges reported by the patient the week before the clinic appointment), the Clinical Global Impressions-Severity of Illness (CGI-S) scale, and categorical response (no response, mild, moderate, marked, or remission). Weight, BMI, waist circumference, comorbid Axis I diagnoses, vital signs, and side effects also were collected. RESULTS: Twenty-nine patients (83%) received venlafaxine as monotherapy and 6 (17%) received the drug adjunctively for a median of 120 days (range, 28-300 days). The mean +/- SD venlafaxine treatment dose was 222 +/- 63 mg/day (range, 75-300 mg/day). In the 33 patients who were actively binge eating at the time venlafaxine was begun, weekly binge frequency, severity of binge-eating and mood symptoms as measured by the CGI-S scale, weight, BMI, waist circumference, and diastolic blood pressure all showed statistically significant decreases over time (p < .05). Of these 33 patients, 29 (88%) displayed a moderate (50% reduction) or better response of binge-eating episodes. Fifteen (43%) of the 35 patients lost 5% or more of their baseline weight. In general, venlafaxine was well tolerated, with dry mouth, sexual dysfunction, insomnia, and nausea being the most frequently reported side effects. Sustained increases in blood pressure seen in 6 patients (17%) were considered clinically insignificant. No patients discontinued the drug. CONCLUSION: Venlafaxine may be an effective treatment for binge-eating disorder associated with overweight or obesity. Controlled studies of venlafaxine in binge-eating disorder appear warranted.     

Empirically derived classes of eating pathology in male and female college students

Background: The empirical structure of eating disorder (ED) pathology has often been studied in female, clinical samples, leaving questions about the structure of ED pathology in males and nonclinical samples. Method: A latent class analysis was performed on data combined from two different studies (N = 1,751) using the behavioral items in the Eating Disorder Examination Questionnaire (EDE-Q; binge eating, self-induced vomiting, laxative use, and excessive exercise), with the addition of an item representing restraint. Validation analyses examined weight, shape, and eating concern among the classes. Results: Three similar classes emerged for both the men and women’s models: very low ED behaviors, binge eating, and high ED behaviors. Discussion: These results suggest that binge eating occurs within the context of lower symptom and higher symptom presentations, and that the empirical structure of ED symptoms does not differ in men and women in the nonclinical population. Further research is needed to clarify whether ED phenotypes differ in men and women.     

Application of a latent class analysis to empirically define eating disorder phenotypes

CONTEXT: Diagnostic criteria for eating disorders influence how we recognize, research, and treat eating disorders, and empirically valid phenotypes are required for revealing their genetic bases. OBJECTIVE: To empirically define eating disorder phenotypes. DESIGN: Data regarding eating disorder symptoms and features from 1179 individuals with clinically significant eating disorders were submitted to a latent class analysis. The resulting latent classes were compared on non-eating disorder variables in a series of validation analyses. SETTING: Multinational, collaborative study with cases ascertained through diverse clinical settings (inpatient, outpatient, and community). PARTICIPANTS: Members of affected relative pairs recruited for participation in genetic studies of eating disorders in which probands met DSM-IV-TR criteria for anorexia nervosa (AN) or bulimia nervosa and had at least 1 biological relative with a clinically significant eating disorder.Main Outcome Measure Number and clinical characterization of latent classes. RESULTS: A 4-class solution provided the best fit. Latent class 1 (LC1) resembled restricting AN; LC2, AN and bulimia nervosa with the use of multiple methods of purging; LC3, restricting AN without obsessive-compulsive features; and LC4, bulimia nervosa with self-induced vomiting as the sole form of purging. Biological relatives were significantly likely to belong to the same latent class. Across validation analyses, LC2 demonstrated the highest levels of psychological disturbance, and LC3 demonstrated the lowest. CONCLUSIONS: The presence of obsessive-compulsive features differentiates among individuals with restricting AN. Similarly, the combination of low weight and multiple methods of purging distinguishes among individuals with binge eating and purging behaviors. These results support some of the distinctions drawn within the DSM-IV-TR among eating disorder subtypes, while introducing new features to define phenotypes.     

Food-independent tendency to disadvantageous decisions in obese individuals with regular binge eating

Objective

The objective of this study was to explore whether or not obese patients with and without regular binge eating differ with regard to their decision-making abilities.

Methods

Decision-making was measured by using a computerized version of the Iowa Gambling task (IGT) in 34 obese patients with regular binge eating (BE⁺) and 34 obese individuals without binge eating (BE⁻) matched for age and sex. In addition, computerized versions of the Auditory Verbal Learning Test and the Corsi Block Tapping Test were administered. Participants further answered questionnaires concerning eating disorder symptoms (Eating Disorder Examination-Questionnaire) and depression (Patient Health Questionnaire depression scale).

Results

The BE⁺ group reported more eating disorder and depressive symptoms than the BE⁻ group but did not differ with regard to BMI, working memory deficits, depressive symptoms, somatic comorbidity (i.e., hypertension, diabetes, sleep apnea, hyperlipidemia, pain disorder), or education. Binge eating participants showed poorer decision-making abilities based on the total IGT net scores. However, they did not differ from those without regular binge eating in improving their choice behavior over the task.

Conclusions

The group difference in total IGT net scores suggests more general, food-independent decision making problems in obese individuals with regular binge eating compared to those without. Treatment of obese patients with BED could be enhanced by training them to better control risky decisions, to delay gratification in an effortful way and to activate appropriate alternative behaviors.     

A Measure of Dysfunctional Eating-Related Cognitions in People with Psychotic Disorders

Obesity and binge eating disorder are common in individuals with psychotic disorders. Eating and weight-related cognitions are known to influence eating behaviors. The study was designed to assess the psychometric properties of the Mizes Anorectic Cognitions Questionnaire (MAC-R) in patients with psychotic disorders. Binge eating disorder (BED), body mass index (BMI), the MAC-R and the three factor eating questionnaire (TFEQ) were assessed in 125 patients with a diagnosis of schizophrenia or schizoaffective disorder. Whereas the MAC-R has not acceptable psychometric properties, a brief version of the MAC-R (BMAC) has good psychometrical properties and is correlated with TFEQ and BMI. Binge eating disorder is also correlated to the Rigid Weight Regulation and Fear of Weight Gain subscale. The BMAC is a useful brief measure to assess eating and weight related cognitions in people with psychotic disorders.     

Early maladaptive schemas and body mass index in subgroups of eating disorders: a differential association

OBJECTIVE: The objectives were (1) to examine whether 3 eating disorder subgroups, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) classification system, exhibit a specific profile in terms of early maladaptive schema (EMS) factors, and (2) to investigate the relationship between body mass index (BMI) and EMS factors in each of the individual eating disorder subgroups. METHODS: The presence of EMS was measured by the Young Schema Questionnaire Long Form among patients affected by restrictive anorexia nervosa, binge/purging-type anorexia nervosa, and bulimia nervosa. Principal component factor analysis was used to investigate the factor structure of the EMS across eating disorder subgroups. General linear model analysis was applied to examine the differences of the subgroups in terms of their EMS factors. Differential association between BMI and schema factors was tested by analysis of covariance. RESULTS: Four EMS factors were extracted, which accounted for approximately 72% of the variance. The 3 eating disorder subgroups differed in terms of their EMS factor profiles. The analysis of covariance resulted in a significant negative relationship between BMI and EMS factor 2 in the bulimia nervosa group (P < .0099), indicating that higher severity on defectiveness, failure, dependence, enmeshments, subjugation, approval-seeking (EMS factor 2) was associated with lower values on BMI. CONCLUSION: The findings of this study indicate that EMSs based on Young's conceptualization of EMS, as measured by the Young Schema Questionnaire, differ significantly among eating disorder subgroups defined by the phenomenological approach used by the DSM-IV diagnoses. These results are consistent with the notion that dysfunctional cognitions may play an important role in the development and maintenance of the symptoms that underlie the DSM-IV classification of the eating disorder subtypes.     

A comparison of black and white women with binge eating disorder

OBJECTIVE: Binge eating disorder was introduced in DSM-IV as a psychiatric disorder needing further study. This community-based study describes the relationship between race and clinical functioning in black and white women with and without binge eating disorder. METHOD: A group of 150 women with binge eating disorder (52 black, 98 white) and a race-matched group of 150 healthy comparison subjects were recruited from the community. Eating and psychiatric symptoms were assessed through interviews and self-report. RESULTS: Black and white women with binge eating disorder differed significantly on numerous eating disorder features, including binge frequency, restraint, history of other eating disorders, treatment-seeking behavior, and concerns with eating, weight, and shape. Black and white healthy comparison subjects differed significantly in obesity rates. CONCLUSIONS: For both black and white women, binge eating disorder was associated with significant impairment in clinical functioning. Yet, racial differences in clinical presentation underscore the importance of considering race in psychopathology research.