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Objective: To assess the risk of somatic diseases in connection with anorexia nervosa (AN)., Method: This matched cohort study was based on Danish registries of all patients born 1961-2008 with a first-time diagnosis of AN in 1994-2018 at age 8-32 and matched controls without an eating disorder. For 13 somatic disease categories, time from inclusion date to time of first somatic diagnosis, accounting for censoring, was studied by use of time-stratified Cox models., Results: A total of 9985 AN patients born 1961-2008 and 49,351 controls were followed for a median (interquartile range) of 9.0 (4.4-15.7) years. During the first 2 years after entry there was a 60% higher hazard for any somatic disease among patients with AN than among controls, while the ratio from three to 11 years was reduced to 1.18. Regardless of age at diagnosis, the hazard among patients and controls were no different at approximately a decade after diagnosis of AN and the cumulative risk for patients for 12 of 13 disease categories was always higher or no less that for controls. For all disease categories, the hazard ratio (HR) was higher when close to entry. For most disease categories, age at diagnosis of AN did not modify the effect., Discussion: While around 90% of all individuals had any somatic disease at the end of follow-up, the cumulative incidence over time was higher for patients with AN than for controls. Large HRs were seen in the early years after diagnosis during which patients require extensive medical interventions., Public Significance: Based on Danish registries, a large sample of almost 10,000 patients with AN born 1961-2008 and almost 50,000 matched controls were followed for a median of 9 years. While around 90% of all individuals had any somatic disease at the end of follow-up, the cumulative incidence over time was higher for patients with AN than for controls., (© 2022 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: Comorbid mental disorders in anorexia nervosa during long-term course require detailed studies., Method: This matched cohort study was based on nationwide Danish register data of all patients born 1961-2008 with a first-time ICD-10 diagnosis of anorexia nervosa (AN) between 1994 and 2018 at age 8-32 and matched controls taken from all individuals without an eating disorder (ED). For nine categories of non-eating mental disorders, time from date of first AN-diagnosis (inclusion date) to time of first diagnosis, accounting for censoring, was studied by use of time-stratified Cox models., Results: A total of 9,985 patients with AN (93.5% females) and 49,351 matched controls were followed for a median (IQR) of 9.0 (4.4-15.7) years. For patients, there was about 25% and 55% risk of receiving any non-ED disorder during the first 2 years and two decades after inclusion, respectively. A hazard ratio (HR) of seven for any non-ED was found for the first 12 months after inclusion, a ratio that reduced to two at five or more years after inclusion. During the first years, large HRs ranging in 6-9 were found for affective, autism spectrum, personality, and obsessive-compulsive disorders with the latter displaying the highest continuous increased risk. The HR at 12 months after inclusion was highest for any non-ED disorder and affective disorders in patients aged 8-13 at diagnosis., Discussion: Comorbid mental disorders in AN are most frequently diagnosed in the first years after diagnosis of AN and on longer terms imply a double immediate risk., (© 2021 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Background: Treating patients with anorexia nervosa (AN) remains a major challenge. The choice between an inpatient or an outpatient care setting is an essential issue for the patients and for their relatives with major health economic implications. However, health services-related studies are lacking. The present study was a descriptive exploration of time-trends in treatment modes of patients with free and equal access to health services., Methods: The study was based on a nationwide cohort of patients diagnosed for the first time with AN, each followed for 5 years in the registers covering the years 1994-2018. The per patient number of hospital admissions, cumulated number of days of hospitalization and number of outpatient visits during the first 5 years after initial diagnosis were considered., Results: The cohort of patients with AN with at least 5 years of follow-up amounted to N = 7,505. A clear trend was observed in the per patient five-year cumulated number of inpatient days, decreasing by 6% per year after adjustment for age at diagnosis, parental mental diagnosis, and family income. The five-year number of hospital admissions after initial diagnosis decreased by 2% per year, while no trend was observed for outpatient visits., Conclusions: The per patient number of hospitalizations and cumulated days of hospitalization during 5 years after diagnosis were reduced for patients initially diagnosed with AN while there was no change in the number of outpatient visits. The factors contributing to these changes of treatment modes over time are in need of further study., (© 2020 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: To study recent time trends in the incidence of diagnosed anorexia nervosa (AN) and bulimia nervosa (BN) based on nationwide psychiatric register data., Method: The Danish Psychiatric Central Research Registry was used to identify the incidence of diagnosed cases with AN and BN at the ages of 4-65 years from 1995 to 2010. Age- and sex-adjusted incidence rates per 100,000 person-years were calculated and were adjusted for time trends in the total number of people diagnosed in psychiatry. Time trends were analyzed using JoinPoint regression analysis., Results: A total of N = 5,902 persons had a first-time incidence of AN, and a total of N = 5,113 had first-time incidence of BN. Incidence rates increased for AN from 6.4 to 12.6 per 100,000 person-years, and for BN from 6.3 to 7.2 per 100,000 person-years. In 2010, the male-to-female ratio was 1:8 for AN, and 1:20 for BN. There was an earlier onset for AN than for BN, and age at incidence decreased during the observation period for AN but not for BN. A sizeable part of the increasing incidence rates for AN and in particular, the younger AN age groups, could be attributed to an increase in the total number of N = 249,607 persons with first-time diagnoses in psychiatry., Discussion: Incidence rates had increased slightly for AN, but were stable for BN across 16 years in this nationwide study and to a large extent were reflective of a general increase in diagnosed mental disorders., (© 2015 Wiley Periodicals, Inc.)

Objective: This nation-wide register-based study investigated how often anorexia nervosa (AN) and co-morbid disorders occur in affected families compared with control families. Furthermore, the study addressed the impact of sex, year of birth, and degree of urbanization in terms of risk factors., Method: A total of N = 2,370 child and adolescent psychiatric subjects born between 1951 and 1996 and registered in the Danish Psychiatric Central Research Register (DPCRR) had any mental disorder before the age of 18 and developed AN at some point during their life-time. In addition, N = 7,035 controls without any psychiatric diagnosis before age 18 and matched for age, sex, and residential region were included. Psychiatric diagnoses were also obtained on the first-degree relatives as a part of the Danish Three Generation Study (3GS). A family load component was obtained by using various mixed regression models., Results: AN occurred significantly more often in case than in control families. AN Risk factors included having a sibling with AN, affective disorders in family members, and co-morbid affective, anxiety, obsessive-compulsive, personality, or substance use disorders. Furthermore, female sex, and ascending year of birth were significantly associated with having AN. Urbanization was not related to the family load of AN and case-relatives did not develop AN earlier than control relatives., Discussion: These findings based on a very large and representative dataset provide evidence for the family aggregation and further risk factors in AN., (© 2014 Wiley Periodicals, Inc.)

Background: This nationwide register-based study investigates how often obsessive-compulsive disorders (OCD) with different age at diagnosis occur in affected families compared to control families. Furthermore, the study addresses the impact of certain risk factors, that is, sex, degree of urbanization, year of birth, and maternal and paternal age at birth., Methods: A total of N = 2,057 child and adolescent psychiatric subjects born between 1952 and 2000 and registered in the Danish Psychiatric Central Research Register developed OCD before the age of 18. In addition, N = 6,055 controls without any psychiatric diagnosis before age 18 and matched for age, sex, and residential region were included. Psychiatric diagnoses were also obtained for the first-degree relatives as a part of the Danish Three-Generation Study. A family load component was obtained by using various mixed regression models., Results: OCD occurred significantly more often in case than in control families. Having a mother, father, sibling, or an offspring with the disorder was proven to be a risk factor. Maternal age above 35 years, male sex by tendency, and ascending year of birth were associated with having OCD. Furthermore, case relatives did not develop OCD earlier than control relatives. The risk of OCD in the case probands was significantly increased when first-degree family members had either OCD, or tic disorders, or affective disorders, or anxiety disorders., Conclusions: These findings based on a very large and representative dataset provide further and very solid evidence for the high family aggregation of OCD., (© 2013 Wiley Periodicals, Inc.)

Objective: The relevance of repeated body mass index (BMI) assessments for long-term outcome in anorexia nervosa (AN) was studied., Method: Two-hundred and twelve adolescent patients aged 10-18 (Mean 14.9) years from five sites were followed up for an average of 8.3 years after first admission. Various predictors of BMI at follow-up were analyzed., Results: In comparison to subjects with normal BMI (>17.5) at final follow-up, subjects with BMI <17.5 had significantly lower age-adjusted BMI prior to onset of the disorder and at discharge from first admission. In addition, all outcome scores indicated poorer functioning in the group with BMI < 17.5. The BMI prior to onset of AN, the BMI at first hospital admission and discharge, and the BMI at final follow up were significantly correlated across time. Higher BMI prior to onset of AN, higher BMI at first discharge, and lower age at first admission predicted a normal BMI (>17.5) at follow-up in a model of logistic regression., Conclusion: The long-term outcome of adolescent AN reflects the normal tracking of BMI over time. Presumably, the tracking in AN patients is somewhat reduced in comparison to healthy subjects., (2008 by Wiley Periodicals, Inc.)

Objective: The course and clinical predictors of rehospitalization were studied in a large sample of adolescent patients with anorexia nervosa who had been treated at five European sites and been followed-up., Method: Two-hundred and twelve adolescent patients first admitted for in-patient treatment, aged 10-18 (Mean 14.9) years and 94.8% female, were followed-up for an average of 8.3 years after first admission at sites in (former East and West Berlin, Zurich, Sofia, and Bucharest). Clinical history data were collected by use of standardized item-sheets at first admission. Semi-structured interviews including ratings of eating pathology and psychosocial outcome were performed at follow-up., Results: About 44.8% (95/212) of the patients required at least one readmission. Rates of rehospitalization were significantly higher at the Eastern sites (Sofia and Bucharest). Significant predictors of readmission were paternal alcoholism, history of anorexia nervosa in the family, eating disorder in infancy, periodic overactivity, lower weight increase at first admission, and lower BMI at first discharge. In a model of logistic regression analysis, five variables (paternal alcoholism, eating disorder in infancy, periodic overactivity, low weight increase during first admission, and low BMI at first discharge) correctly classified 69% of the participants into cases with single or repeated admissions. Patients with repeated admissions had a less favorable long term outcome and had higher rates of persisting psychopathology at follow-up., Conclusion: Rehospitalization reflects the chronic course in a sizable proportion of adolescent patients with anorexia nervosa. Family psychopathology may have an effect both in terms of genetic vulnerability and environmental stress leading to unfavorable courses. The strong effect of insufficient weight gain during first admission and lower BMI at first discharge emphasizes the importance of adequate interventions. Readmissions carry the risk for later poor psychosocial and psychiatric outcomes.

Objective: The current study investigated psychosocial correlates of abnormal adolescent eating behavior at three times during adolescence and young adulthood and its association with psychiatric diagnosis in young adulthood in a community sample., Method: Sixty-four (10.5%) high-risk subjects (mean age 15 years) with abnormal eating behavior were identified at Time 1, another 252 (16.9%) were identified at Time 2 (mean age 16.2 years), and 164 (16.9%) were identified at Time 3 (mean age 19.7 years) and compared with three control groups matched for age and gender. Dependent measures included emotional and behavioral problems, life events, coping capacities, self-related cognition, social network, and family functions. Outcome was measured additionally by structured psychiatric interviews, and stability of abnormal eating behavior was studied in a longitudinal sample of 330 subjects., Results: Few subjects showed more than one of five criteria of abnormal eating behavior. High-risk subjects shared a very similar pattern at all three times. They were characterized by higher scores for emotional and behavioral problems, more life events including more negative impact, less active coping, lower self-esteem, and less family cohesion. Among 10 major psychiatric disorders, only clinical eating disorders at Time 3 shared a significant association with abnormal eating disorder at the same time whereas high-risk status at Times 1 and 2 did not predict any psychiatric disorder at Time 3. Stability of abnormal eating behavior across time was very low. Stability of abnormal eating behavior across time was very low., Discussion: Abnormal eating behavior in adolescence and young adulthood is clearly associated with various indicators of psychosocial maladaption. In adolescence, it does not significantly predict any psychiatric disorder including eating disorder in young adulthood and it is predominantly a transient feature., ((c) 2005 by Wiley Periodicals, Inc.)

Objective: This is a study of prevalence rates for anorexia nervosa (AN) and bulimia nervosa (BN) in an epidemiological sample of Swiss adolescents., Method: A two-stage approach was used which involved the screening of a large sample of adolescents aged 14-17 and subsequent interviews of screen-positive and control subjects., Results: The prevalence rates for adolescent girls were 0.7% for AN and 0.5% for BN., Discussion: Full clinical syndromes of AN and BN in adolescents are by far less frequent than individual symptoms of eating disorders. There is more cross-cultural variation for prevalence rates in BN than in AN.

Objective: As part of the International Collaborative Study of Eating Disorders in Adolescence, with sites in West and East Berlin, Zurich, and Sofia, eating attitudes and disorders were studied in four Bulgarian samples., Method: The Eating Attitude Test (EAT) and the Eating Disorders Inventory (EDI) were used in this study. Besides a clinical group of anorectic patients, students attending either a special secondary school, a standard secondary school, or a sports school participated in this study., Results: Findings revealed excellent discriminant validity of the EAT total score and the three subscales. This also applied to four out of eight subscales of the EDI. Discriminant validity was less satisfactory in three further scales and entirely missing for Maturity Fears., Discussion: The findings are discussed in a transcultural perspective.

A consecutive series of 60 adolescent patients with eating disorders was followed up after a mean period of 58 months. At intermediate follow-up, 4 (6.65) of the former patients were reported deceased, and 6 could either not be traced or refused to cooperate. Follow-up assessment revealed the following diagnostic pattern in 50 patients who were followed up: 5 (10%) of the patients still suffered from anorexia nervosa, 2 (4%) from anorexia nervosa with bulimia, 7 (14%) from partial syndromes of anorexia nervosa, 2 (4%) from partial syndromes of bulimia nervosa, and 34 (68%) had recovered. Questionnaire findings indicated that the improvements that occurred during inpatient treatment were intact at follow-up. No significant findings were revealed by the analysis of a large scale of potential prognostic factors.

Questionnaire scores were compared across three outcome groups in a follow-up of eating-disordered patients with onset of the disease during adolescence. Among a total of 40 patients, 7 continued to suffer from either anorexia or bulimia nervosa. Seven additional patients displayed partial syndromes and 26 had recovered. Both a semantic differential measuring body image and the Eating Attitudes Test (EAT) demonstrated limited evidence of clinical sensitivity by differentiating the three outcome groups. The Eating Disorders Inventory (EDI) did not discriminate the three outcome groups. Obviously, clinical interviews and self-report questionnaires tackle different facets of the eating disorders and, therefore, both should be used in outcome studies.

Forty German adolescent anorectic patients were assessed with regard to self-image components as measured by the Offer Self-Image Questionnaire (OSIQ). The profile of this group deviated negatively from the German standardization group of healthy subjects on measures of impulse control, emotional tone, body image, social relationships, sexual attitudes, and psychopathology. In addition, the OSIQ profile of this German sample was remarkably similar to the profiles of samples reported in two American studies. Finally, it was found that inpatient treatment served to improve the psychological condition of the patients with regard to certain but not all self-image components. Despite a trend of improvement, some of the scores did not fully normalize in this sample.

Paediatric, neurological and psychiatric examinations were done in 71 children with the fetal alcohol syndrome (FAS). A subgroup of these patients underwent psychiatric assessment and psychological testing. Psychopathology was also studied in a matched control group. After three to four years various subgroups were re-examined. With increasing age dysmorphic signs were less apparent. Neurological performance improved and EEG recordings revealed fewer pathological patterns. The psychiatric status and cognitive functions of the patients also improved, but they did not become normal in all psychiatric areas. Hyperactivity and distractibility seem to be the major handicaps preventing these children from having a normal school career.