Search

Objective: To elucidate maladaptive central processing of food cues during recognition tasks in anorexia nervosa (AN), while considering influences of nutritional preload and presentation modality (word versus picture)., Methods: Event-related potentials to food-related word and pictorial stimuli were assessed during recognition tasks in 16 patients with AN, 16 control participants with food intake before the study, and 16 control participants with a fasting period before the study., Results: Patients with AN showed a P3b amplitude reduction especially at the midline parietal site compared with satiated controls (5.7 [standard deviation = 3.3] versus 8.7 [3.1] μV, p < .03). Subtle recognition deficits in patients with AN were indicated by smaller "old/new" effects compared with satiated (p = .049) and fasting controls (p < .003) for pictorial stimuli. Hunger-modulated enhanced old/new effects for food pictures compared with neutral pictorial stimuli could be observed in fasting controls only (2.7 [2.6] versus 0.8 [2.2] μV, p < .01)., Conclusions: The presented data provide evidence for a midline parietal P3b amplitude reduction in patients with AN, which might point to reduced network activation in AN even during satiety. Observed subtle recognition deficits either represent a stable trait characteristic or a "scar" effect of chronic starvation that may play a role in the development and/or persistence of the disorder.

Functional disturbances within cortico-striatal control systems have been implicated in the psychobiology (i.e. impaired cognitive-behavioral flexibility, perfectionist personality) of anorexia nervosa. The aim of the present study was to investigate the morphometry of brain regions within cortico-striatal networks in acute anorexia nervosa (AN) as well as long-term weight-restored anorexia nervosa (AN-WR) patients. A total of 39 participants: 12 AN, 13 AN-WR patients, and 14 healthy controls (HC) underwent high-resolution, T1-weighted magnetic resonance imaging (MRI), a cognitive-behavioral flexibility task, and a psychometric assessment. Group differences in local grey matter volume (GMV) were analyzed using whole brain voxel-based morphometry (VBM) and brain-atlas based automatic volumetry computation (IBASPM). Individual differences in total GMV were considered as a covariate in all analyses. In the regional brain morphometry, AN patients, as compared to HC, showed decreased GMVs (VBM and volumetry) in the anterior cingulate cortex (ACC), the supplementary motor area (SMA), and in subcortical regions (amygdala, putamen: VBM only). AN-WR compared to HC showed decreased GMV (VBM and volumetry) in the ACC and SMA, whereas GMV of the subcortical region showed no differences. The findings of the study suggest that structural abnormalities of the ACC and SMA were independent of the disease stage, whereas subcortical limbic-striatal changes were state dependent., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: Women with anorexia nervosa (AN) have aberrant cognitions about food and altered activity in prefrontal cortical and somatosensory regions to food images. However, differential effects on the brain when thinking about eating food between healthy women and those with AN is unknown., Methods: Functional magnetic resonance imaging (fMRI) examined neural activation when 42 women thought about eating the food shown in images: 18 with AN (11 RAN, 7 BPAN) and 24 age-matched controls (HC)., Results: Group contrasts between HC and AN revealed reduced activation in AN in the bilateral cerebellar vermis, and increased activation in the right visual cortex. Preliminary comparisons between AN subtypes and healthy controls suggest differences in cortical and limbic regions., Conclusions: These preliminary data suggest that thinking about eating food shown in images increases visual and prefrontal cortical neural responses in females with AN, which may underlie cognitive biases towards food stimuli and ruminations about controlling food intake. Future studies are needed to explicitly test how thinking about eating activates restraint cognitions, specifically in those with restricting vs. binge-purging AN subtypes.

Objective: Anorexia nervosa (AN) is a serious eating disorder marked by self-induced underweight. In patients with AN, the avoidance of emotions appears to be a central feature that is reinforced during the acute state of the disorder. This single case study investigated the role of emotional avoidance of a 25-year-old patient with AN during her inpatient treatment., Method: Throughout the course of 96 days, the patient answered questions daily about her emotional avoidance, pro-anorectic beliefs, perfectionism, and further variables on an electronic diary. The patient's daily self-assessment of emotional avoidance was described in terms of mean value, range, and variability for the various treatment phases. Temporal relationships between emotional avoidance and further variables were determined using a time series approach (vector autoregressive (VAR) modelling)., Results: Diary data reflect that the patient's ability to tolerate unpleasant emotions appeared to undergo a process of change during inpatient treatment. Results of the time series analysis indicate that the more the patient was able to deal with negative emotions on any one day (t-1), the less she would be socially avoidant, cognitively confined to food and eating, as well as feeling less secure with her AN, and less depressive on the following day (t)., Conclusions: The findings show that for this patient emotional avoidance plays a central role in the interacting system of various psychosocial variables. Replication of these results in other patients with AN would support the recommendation to focus more on emotional regulation in the treatment of AN.

Objective: In anorexia nervosa (AN) patients immunologic alterations are known, although their clinical significance remains a matter of debate. Currently, no recommendation can be given on the safety and immunogenicity of indicated vaccinations in this malnourished population., Method: In this exploratory study, 10 AN patients' (eight female, two male, mean age 31.1 years, SD 16.3 years; mean BMI 14.8 kg/m(2), SD 1.6 kg/m(2)) antibody levels against H1N1 influenza were measured before vaccination, and were followed-up for two and three weeks after vaccination. They were compared with the immunological response in normal weight population, as reported in the literature. Clinical and socio-demographical data were collected., Results: In the AN group, H1N1 vaccination showed to be sufficiently immunogenic and safe, comparable to published data of normal weight population., Discussion: The findings provide preliminary evidence that vaccination seems recommendable even in extremely underweight AN patients. Further studies are needed to corroborate the present findings., (Copyright © 2011 Wiley Periodicals, Inc.)

This study addresses the question of whether frontal activation in response-inhibition tasks is specifically associated with the suppression of a motor response. An alternative model suggests a role in the detection of behaviorally relevant or salient events. For this purpose, we used functional MRI with an auditory go/no-go paradigm. This paradigm allowed the disentangling of inhibition-related from salience-related effects, which were associated with different frontal regions. Importantly, the right ventrolateral prefrontal cortex consistently showed sensitivity for salience but not for inhibition requirements. This reflects a more general salience-detection mechanism, which is not specific for response-inhibition tasks.

Objectives: Alterations in the central nervous system leading to higher pain sensitivity have been shown in both chronic back pain (CBP) and fibromyalgia syndrome (FMS). The aim of this study was to disclose commonalities and differences in the pathophysiology of FMS and CBP., Methods: We used the quantitative sensory testing protocol of the German Research Network on Neuropathic Pain to obtain comprehensive profiles of somatosensory functions. The protocol comprised thermal and mechanical detection and pain thresholds, vibration thresholds, and pain sensitivity to sharp and blunt mechanical stimuli. We studied 21 FMS patients (mean pain duration: 13.4 y), 23 CBP subjects (mean pain duration: 15.9 y), and 20 healthy controls (HCs). Each participant received the test battery on the back and on the dorsal hand (pain-free control site)., Results: On the back, FMS patients showed increased thermal and mechanical pain sensitivity compared with HCs and CBP participants. On the hand dorsum, FMS patients showed higher mechanical pain sensitivity compared with CBP participants and HCs and higher cold pain sensitivity compared with HCs. CBP participants showed increased pressure pain sensitivity and lower vibration sensitivity on the back, but no significant differences on the hand dorsum compared with HCs., Discussion: FMS patients showed increased sensitivity for different pain modalities at all measured body areas, suggesting central disinhibition as a potential mechanism. CBP participants in contrast, showed localized alterations within the affected segment possibly due to peripheral sensitization.

Background: Etiologic models of anorexia nervosa (AN) suggest that cognitive factors play a crucial role in the disorder's psychopathology. Attentional aspects of food processing in AN remain largely unknown. Both an early attentional bias (vigilance) and inattentiveness (avoidance) to food pictures have been reported in patients with eating disorders. The study's aim was to examine the vigilance-avoidance hypothesis concerning food information processing by unraveling the time course of attention deployment in individuals with AN., Methods: We used eye-tracking to examine continuous attention deployment in 19 individuals with AN during free visual exploration of food pictures versus nonfood pictures compared with 18 fasted and 20 nonfasted healthy control subjects., Results: Compared with healthy control subjects, AN patients allocated overall less attention to food pictures but showed no early attentional bias toward food pictures. Attentional engagement for food pictures was most pronounced in fasted healthy control subjects. The extent of attention deployment in AN patients was associated with indicators of the disorder's severity., Conclusions: Gaze data suggest that individuals with AN show no early vigilance but later avoidance when confronted with food information. This suggests that initially, AN patients perceive incentive salience from food information because they process food pictures in the same way healthy control subjects do. The time course of attention deployment suggests that it is only after a first phase of stimulus encoding and labeling as food that individuals with AN avoid food pictures. This pattern of attention deployment is probably mediated by disorder-specific dysfunctional cognitions., (Copyright © 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Anorexia nervosa (AN), at the stage of starvation and emaciation, is characterized by abnormalities in cognitive function, including memory performance. It is unclear whether memory impairment persists or is reversible following weight restoration, and whether memory function differs between AN subtypes. The aim of the present study was to investigate general memory performance in currently ill and fully weight-restored patients of different AN subtypes., Method: Memory performance was assessed using the Wechsler Memory Scale-Revised (WMS-R) in a total of 99 participants, including 34 restricting-type AN patients (AN-RESTR), 19 binge-eating/purging-type AN patients (AN-PURGE), 16 weight-restored AN patients (AN-W-R) and 30 healthy controls (CONTROL). Cognitive evaluation included a battery of standardized neuropsychological tasks for validating the findings on memory function., Results: Deficits were found with respect to immediate and delayed story recall in currently ill AN patients irrespective of AN subtype. These deficits persisted in weight-restored AN patients. Currently ill and weight-restored AN patients did not differ significantly from healthy controls with respect to working memory or other measures of neuropsychological functioning., Conclusions: The findings suggest that impaired memory performance is either a stable trait characteristic or a scar effect of chronic starvation that may play a role in the development and/or persistence of the disorder.

Objective: The processing of food cues in eating-disordered patients has recently been increasingly investigated. Outlined is current evidence from pictorial food stimuli studies., Method: PubMed and PsychINFO were searched for quantitative pictorial food stimuli studies investigating healthy controls and expert-diagnosed eating-disordered patients., Results: Patients with eating disorders (ED) demonstrated cue reactivity to food stimuli. Results from functional imaging suggest sensory disengagement and higher emotional involvement while self-reported data and facial EMG revealed that food pictures were perceived as less pleasurable. Different experimental paradigms have demonstrated an attentional bias for food cues in ED. Currently, psychophysiological data is widely inconclusive., Discussion: Evidence suggests cue reactivity to food pictures in eating-disordered patients. However, the overall picture is inconclusive because methodological problems and the integration of findings from different experimental approaches pose a challenge to the research field., (Copyright © 2009 Wiley Periodicals, Inc.)

Anorexia nervosa (AN) patients are characterized by perfectionism and obsessional personality traits. This anorectic personality type is associated with an exaggerated cognitive control and impaired cognitive-behavioral flexibility. Neuropsychological studies addressing flexibility have supported an impaired cognitive set-shifting (i.e., concrete and rigid behaviors to changing rules) as well as an impaired behavioral response shifting (i.e., stereotyped or perseverative behaviors) in AN patients independent of nutritional status and body weight. Furthermore, impaired set-shifting was found in healthy sisters of AN patients suggesting that cognitive inflexibility is a trait marker in AN patients. Brain imaging studies have provided new insights in striatocortical circuit dysfunctions that may underlie both the clinical symptoms of obsessive-compulsive personality traits and the neuropsychological observations of impaired cognitive-behavioral flexibility. The conceptualization of AN as a neurodevelopmental striatocortical disorder may help to develop new promising treatment approaches for this severe disorder.

Background: Previous fMRI studies show that women with eating disorders (ED) have differential neural activation to viewing food images. However, despite clinical differences in their responses to food, differential neural activation to thinking about eating food, between women with anorexia nervosa (AN) and bulimia nervosa (BN) is not known., Methods: We compare 50 women (8 with BN, 18 with AN and 24 age-matched healthy controls [HC]) while they view food images during functional Magnetic Resonance Imaging (fMRI)., Results: In response to food (vs non-food) images, women with BN showed greater neural activation in the visual cortex, right dorsolateral prefrontal cortex, right insular cortex and precentral gyrus, women with AN showed greater activation in the right dorsolateral prefrontal cortex, cerebellum and right precuneus. HC women activated the cerebellum, right insular cortex, right medial temporal lobe and left caudate. Direct comparisons revealed that compared to HC, the BN group showed relative deactivation in the bilateral superior temporal gyrus/insula, and visual cortex, and compared to AN had relative deactivation in the parietal lobe and dorsal posterior cingulate cortex, but greater activation in the caudate, superior temporal gyrus, right insula and supplementary motor area., Conclusions: Women with AN and BN activate top-down cognitive control in response to food images, yet women with BN have increased activation in reward and somatosensory regions, which might impinge on cognitive control over food consumption and binge eating.

We report on a patient suffering from chronic anorexia nervosa who in the course of treatment showed elevated high-sensitive troponin T, creatine kinase and most markedly N-terminal pro-brain natriuretic peptide (NT-proBNP). Elevated enzymes improved significantly throughout the course of treatment without cardiac specific medication but exceeded the normal range for weeks. Abnormally high myocardial enzymes and NT-proBNP in cachectic anorectic patients might resemble conditions of cardiac cachexia. A review of the available literature is provided. Further research is required to explain the pathophysiological meaning of the abnormal laboratory findings., (Copyright © 2011 S. Karger AG, Basel.)

Background: Congestive heart failure (CHF) is a complex clinical syndrome with autonomic dysbalance and increased plasma levels of inflammatory cytokines, which further worsen the syndrome. Experimental data have shown that stimulation of certain acupoints decreases autonomic dysbalance., Objective: To test the therapeutic potential of acupuncture for life-threatening diseases such as CHF., Methods: 17 stable patients with CHF (New York Heart Association class II-III, ejection fraction <40%) receiving optimised heart failure medication were randomised into a verum acupuncture (VA) and placebo acupuncture (PA) group. Cardiopulmonary function, heart rate variability and quality of life were explored., Results: No improvements of the cardiac ejection fraction or peak oxygen uptake were observed, but the ambulated 6 min walk distance was remarkably increased in the VA group (+32+/-7 m) but not the PA group (-1+/-11 m; p<0.01). Accordingly, post-exercise recovery after maximal exercise and the VE/VCO(2) slope, a marker of ventilatory efficiency, were improved after VA but not PA. Furthermore, heart rate variability increased after VA, but decreased after PA. The 'general health' score and 'body pain' score of the quality-of-life questionnaire SF-36 tended to be improved after VA., Conclusion: Acupuncture may become an additional therapeutic strategy to improve the exercise tolerance of patients with CHF, potentially by improving skeletal muscle function.

Body dissatisfaction is an important precipitating and maintenance factor in anorexia nervosa (AN) and behavioral studies suggest that a cognitive-affective component and a perceptual component (perceptual disturbance of one's own body) are both important in this pathophysiology. However, the functional neuroanatomy of body dissatisfaction in AN is largely unknown. This study has investigated self-other body-shape comparison to establish neural correlates of body dissatisfaction in patients with AN. 17 women with AN and 18 age and sex-matched healthy control (HC) subjects were scanned using functional magnetic resonance imaging while comparing themselves with images of slim idealized female bodies (active condition) or viewing images of interior home designs (control condition). Participants were asked to compare their body shape or room design with those presented. Patients with AN (in comparison to the HC group) showed greater anxiety to the self-other body-shape comparison, and they were less satisfied with their current body shape. In the patient group (in comparison to the HC group) the self-other body-shape comparison induced more activation of the right sensorimotor brain regions (insula, premotor cortex) and less activation of the rostral anterior cingulate cortex (ACC). Insula hyperactivation along with ACC hypoactivation may be critical for altered interoceptive awareness to body self-comparison and/or for altered implicit motivation to thin-idealized body images in AN patients., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

Background: In recent years, electronic diaries are increasingly used in medical research and practice to investigate patients' processes and fluctuations in symptoms over time. To model dynamic dependence structures and feedback mechanisms between symptom-relevant variables, a multivariate time series method has to be applied., Methods: We propose to analyse the temporal interrelationships among the variables by a structural modelling approach based on graphical vector autoregressive (VAR) models. We give a comprehensive description of the underlying concepts and explain how the dependence structure can be recovered from electronic diary data by a search over suitable constrained (graphical) VAR models., Results: The graphical VAR approach is applied to the electronic diary data of 35 obese patients with and without binge eating disorder (BED). The dynamic relationships for the two subgroups between eating behaviour, depression, anxiety and eating control are visualized in two path diagrams. Results show that the two subgroups of obese patients with and without BED are distinguishable by the temporal patterns which influence their respective eating behaviours., Conclusion: The use of the graphical VAR approach for the analysis of electronic diary data leads to a deeper insight into patient's dynamics and dependence structures. An increasing use of this modelling approach could lead to a better understanding of complex psychological and physiological mechanisms in different areas of medical care and research.

The neural processing of reward can be differentiated into two sub-components with different functions, "wanting" (i.e., the expectation of a reward which includes appetitive and motivational components) and "liking" (i.e., the hedonic impact experienced during the receipt of a reward), involving distinct neural systems. We hypothesize that variability in neural reward processing previously observed in healthy subjects could reflect inter-individual differences in personality. Therefore, the aim of this study was to investigate how the neural processing during expectation and reception of a reward depends on interpersonal differences in reward sensitivity, more specifically the tendency to approach vs. avoid reward-related situations. We employed event-related functional magnetic resonance imaging during a monetary incentive delay task. Subjects with a high approach motivation showed more activation of the Ventral Striatum (VS) during the receipt of a reward, and more medial orbitofrontal activity during both the receipt and omission of a reward. Subjects with a high behavioral inhibition showed less activation in the VS during the receipt of a reward. These findings indicate that the tendency to approach or avoid reward-related situations exhibits a distinct relation with neural reward processing. Specifically, subjects with high behavioral approach appear to be sensitive mainly to positive outcomes and to a lesser extent to the omissions of rewards, whereas subjects with low behavioral approach as well as those with a high inhibition tendency display a blunted response to rewards.

Objective: Impaired cognitive-behavioral flexibility is regarded as a trait marker in anorexia nervosa patients. The authors sought to investigate the neural correlates of this deficit in executive functioning in anorexia nervosa., Method: Fifteen women with anorexia nervosa and 15 age-matched healthy comparison women underwent event-related functional MRI while performing a target-detection task. The task distinguished between shifts in behavioral response and shifts in cognitive set. It involved infrequent target and non-target distractor stimuli embedded in a sequence of prepotent standard stimuli., Results: Relative to comparison subjects, anorexia nervosa patients showed a significantly higher error rate in behavioral response shifting, independent of whether those runs also involved cognitive set shifting. During behavioral response shifting, patients showed reduced activation in the left and right thalamus, ventral striatum, anterior cingulate cortex, sensorimotor brain regions, and cerebellum that differed significantly from the comparison group but showed dominant activation in frontal and parietal brain regions. These differential activations in patients and comparison subjects were specific to shifts in behavioral response: except for thalamic activation, they were not observed in response to non-target distractor trials that required no alteration in behavioral response., Conclusion: Impaired behavioral response shifting in anorexia nervosa seems to be associated with hypoactivation in the ventral anterior cingulate-striato-thalamic loop that is involved in motivation-related behavior. In contrast, anorexia nervosa patients showed predominant activation of frontoparietal networks that is indicative of effortful and supervisory cognitive control during task performance.

Background: Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition and suicide. The seriousness of the disorder requires extensive knowledge of effective treatment options. However, evidence for treatment efficacy in this area is remarkably weak. A recent Cochrane review states that there is an urgent need for large, well-designed treatment studies for patients with anorexia nervosa. The aim of this particular multi-centre study is to evaluate the efficacy of two standardized outpatient treatments for patients with anorexia nervosa: focal psychodynamic (FPT) and cognitive behavioural therapy (CBT). Each therapeutic approach is compared to a "treatment-as-usual" control group., Methods/design: 237 patients meeting eligibility criteria are randomly and evenly assigned to the three groups - two intervention groups (CBT and FPT) and one control group. The treatment period for each intervention group is 10 months, consisting of 40 sessions respectively. Body weight, eating disorder related symptoms, and variables of therapeutic alliance are measured during the course of treatment. Psychotherapy sessions are audiotaped for adherence monitoring. The treatment in the control group, both the dosage and type of therapy, is not regulated in the study protocol, but rather reflects the current practice of established outpatient care. The primary outcome measure is the body mass index (BMI) at the end of the treatment (10 months after randomization)., Discussion: The study design surmounts the disadvantages of previous studies in that it provides a randomized controlled design, a large sample size, adequate inclusion criteria, an adequate treatment protocol, and a clear separation of the treatment conditions in order to avoid contamination. Nevertheless, the study has to deal with difficulties specific to the psychopathology of anorexia nervosa. The treatment protocol allows for dealing with the typically occurring medical complications without dropping patients from the protocol. However, because patients are difficult to recruit and often ambivalent about treatment, a drop-out rate of 30% is assumed for sample size calculation. Due to the ethical problem of denying active treatment to patients with anorexia nervosa, the control group is defined as "treatment-as-usual".

Objective: Maladaptive processing of food cues is considered pivotal in the psychopathology of anorexia nervosa. However, the influence of hunger and differences in processing because of the type of stimuli remain largely unclear., Method: Memory bias for food-related pictorial and semantic stimuli was assessed in a recognition and a free recall test in 16 anorexia nervosa (AN) patients, 16 control participants with food intake prior to the study (CG-FI) and 16 control participants with a fasting period prior to the study (CG-NF)., Results: Compared with CG-FI participants, both AN and CG-NF participants responded faster to food-related as compared with neutral words (p < .001) in the recognition test. Differences were found for word but not for pictorial stimuli. No group differences were observed with respect to the number of correct retrievals in either the recognition or the free recall test., Conclusion: The present study found behavioral indications of abnormal processing of food-related and neutral stimuli in anorectic patients similar to those found in fasted healthy controls. Results are discussed in terms of self-schemata in eating disorders, competitive interference, and levels of processing., ((c) 2008 by Wiley Periodicals, Inc.)

Fitting multilevel models to diary data allows the analysis of development trends, group differences, and breakpoints in time trends. The aim of this study is the application of multilevel modelling to determine time trends in the diary data of a group of obese patients with and without binge eating disorder (BED). Throughout the course of a four-month multi-modal intervention program, the patients answered questions daily on handheld computers about their eating behaviour as well as their psychological and physical states. Multilevel analysis of the diary data shows that initially the trend of the eating behaviour over time decreases but increases towards the end of the therapy. Results of the application of a relatively new method to identify break points in linear trends indicate that the 85 (th) day of the therapy is a break point in the trend over time of the eating behaviour. Significant differences in the development of the eating behaviour over time were found for the subgroups of patients with and without BED.

Intra-individual reaction time variability (IIV) in neuropsychological task performance reflects short term fluctuations in performance. Increased IIV has been reported in patients with schizophrenia and could be related to a deficient neural timing mechanism, but the role of IIV in adult patients with other psychiatric disorders has not been established. Therefore, we compared IIV measures obtained in a Go/Nogo task from patients with schizophrenia, major depression and borderline personality disorder. IIV was increased for patients with schizophrenia. When correcting for differences in mean reaction time, depressive and borderline patients also showed increased IIV. Importantly, all groups showed a strong association between IIV and accuracy of task performance. This suggests that increased IIV might be a sensitive marker for the efficiency of top-down attentional control in all diagnostic groups. Aside from these similarities, the complete results including measures of IIV, mean reaction time and accuracy show differential patterns for patients with schizophrenia compared to those with borderline personality disorder or depression. These results are discussed with respect to common versus disorder-specific neural mechanisms underlying increased IIV.

Objectives: Quality of life (QoL) improvement in patients with irritable bowel syndrome (IBS) during acupuncture (AC) treatment seems to be due to a placebo effect. The aim was to explore if acupuncture has some specific influence on the neuroendocrinic and autonomic nervous system (ANS)., Design/setting: Patients with IBS were randomly assigned to receive either acupuncture (AC) or sham acupuncture (SAC) using the so-called "Streitberger needle". QoL was measured with the functional quality of life diseases quality of life questionnaire (FDDQL) and SF-36. The effect on ANS was evaluated by measuring salivary cortisol and by cardiovascular responses on a tilt table before and after 10 AC treatments. Complete data sets of tilt table and salivary morning cortisol were available for 9 patients in the AC and 12 in SAC group., Results: QoL increased in both groups (p=0.001) with no group differences. Salivary cortisol decreased in all groups (F=10.55; p=0.006). However, the decrease was more pronounced in the AC group (F=4.07; p=0.033) (ANOVA repeated measures model). Heart rate response decreased during orthostatic stress in the AC group while it increased in the SAC group (F=9.234; p=0.005), indicating an increased parasympathetic tone in the AC group. Improvement of pain was positively associated with increased parasympathetic tone in the AC group (F=10.1; p=0.006), but not in the SAC group., Conclusions: The acupuncture specific physiological effects are in contrast to the unspecific improvement of QoL in both AC and SAC groups. Thus, different mechanisms seem to be involved in placebo and real-acupuncture driven improvements. The specific mechanism of action of acupuncture on the ANS remains unclear and deserves further evaluation.

The aim of the present study was to assess the impact of images of slim female fashion models on healthy young women. Brain responses to images of slim-idealized bodies (active condition) and interior designs (control condition) were measured using functional neuroimaging in 18 healthy young women. Instructions encouraged the participants to compare their own body shape/own home with the one in the images. Participants rated the level of anxiety that they experienced while exposed to the images. In the active relative to the control condition, participants activated body shape processing networks, including the lateral fusiform gyrus on both sides, the right inferior parietal lobule, the right lateral prefrontal cortex and the left anterior cingulate. The level of reported anxiety during the exposure to slim bodies correlated with established measures of shape and weight concern and with brain activations in bilateral basal ganglia, left amygdala, bilateral dorsal anterior cingulate, and left inferior lateral prefrontal cortex. Brain networks associated with anxiety induced by self-comparison to slim images may be involved in the genesis of body dissatisfaction and hence with vulnerability to eating disorders.

Objective: There is a controversial discussion in the literature as to whether individuals with subthreshold binge eating disorder (subBED) differ clinically significantly from individuals with full-syndrome binge eating disorder (BED). This study was designed to compare eating-related and general psychopathology at baseline and in response to a multimodal treatment program in obese people with subBED compared with BED., Research Methods and Procedures: A total of 96 obese participants (BMI > or = 30 kg/m(2)) were assessed for eating-related and general psychopathology at baseline. Thirty-nine participants meeting criteria for BED and 19 participants meeting criteria for subBED attended a 15-session outpatient group therapy including cognitive behavioral therapy extended by interpersonal therapy, nutritional counseling, and a supervised walking exercise. Participants with eating disorders were reassessed at the end of treatment and at 3-month follow-up. The obese control group without an eating disorder (n = 38) was assessed once. This was not a randomized controlled trial., Results: Intent-to-treat analyses revealed no differences between subBED and full-syndrome BED participants with regard to eating-related and general psychopathology at baseline and with regard to treatment outcome. All participants experienced substantial improvements, and the results remained stable during follow-up (except for dietary restraint). At follow-up, participants with subBED and BED remained different from non-eating disorder controls in eating-related but not general psychopathology., Discussion: The findings indicate that our multimodal treatment program is equally effective in obese subBED and BED participants, suggesting that a differentiation currently seems not to be of clinical significance.

Background: Abnormal perceptions of food and shape underpin the cognitive behavioural model of eating disorders (EDs). The aim of this study was to investigate motivational processing of disorder-specific and standard emotional cues in anorexia (AN) and bulimia nervosa (BN) using startle eyeblink modulation (SEM). SEM was used because it is sensitive to motivational states of approach (appetitive response) and withdrawal (aversive response), which are independent of conscious intentional control., Method: Acoustically elicited SEM and subjective anxiety ratings were measured in 30 female patients with an ED (n=15 AN, n=15 BN) and 30 female control subjects while they viewed ED-relevant stimuli (food, female bodies) and standardized emotional pictures., Results: BN subjects showed an appetitive response (startle inhibition) to food relative to neutral cues that differed significantly from AN subjects. By contrast, self-reports indicated significantly increased anxiety related to food cues across both ED groups. To female body picture (relative to neutral) cues, no significant between-group differences were found for SEM. ED subjects unexpectedly showed an aversive response (startle potentiation) to positive cues, in contrast to controls, who showed the established startle attenuation., Conclusions: These preliminary results suggest that BN patients demonstrated an exaggerated appetitive response to food but not to standardized positive cues, whereas SEM in AN patients points to a generalized failure to activate the appetitive motivational system. Differences in motivational salience to food cues are in line with distinctions between AN and BN in eating behaviour and food consumption and support differential treatment requirements.

Anorexia nervosa differs distinctly from other psychogenic eating disorders. Well known for the past 300 years, anorexia occurs consistently and is one of the most serious illnesses to be found for a certain age group. Three-quarters of the patients are healed or improve their condition long-term; one-quarter has a chronic course frequently including somatic complications and death. Because of the long healing process as well as the extensive chronification and complication rate, an individual treatment plan should be set up at the beginning of therapy to allow for a long-term structure of the course of therapy. Depending on the severity, phase and co-morbidity, inpatient and ambulant therapies are indicated. Depending on the duration of therapy, adequate weight (BMI > 15 kg/m2), good motivation, and lack of complications, an ambulant therapy is justified. Inpatient treatment is multimodal corresponding to the multifactorial etiology of anorexia nervosa. Weight gain is an important primary goal of therapy and a prerequisite for a conflict oriented, ambulant psychotherapy to be carried on after inpatient treatment. Ambivalent psychotherapy motivation and the necessity of symptom orientation demand technical modification both for inpatient as well as ambulant psychotherapy.

In 1994 binge eating disorder (BED) was included into the DSM-IV as provisional diagnostic category requiring further study. The prevalence in the general population is 2%; BED is 1.5 times more common in women than men. Up to 30% of participants in weight loss programs meet criteria for BED. As opposed to patients with bulimia nervosa (BN), restraint or restrictive eating is not a necessary antecedent in the development of BED. Eating-related as well as general psychopathology is significantly more common in obese patients with BED compared to obese patients without BED. In treating obese patients with BED there are several potential goals of treatment, including cessation of binge eating and improvement of eating-related psychopathology (e.g. concerns about weight and shape), weight loss or prevention of further weight gain, improvement of physical health, and reduction of psychiatric co-morbidity. Contrary to expectations weight loss programs do not appear to worsen the eating disorder and successful treatment of binge eating does not automatically promote weight loss. Controlled treatment studies could demonstrate that psychotherapeutic approaches and drug treatment are successful in reducing binge eating episodes in patients with BED. Remission rates are generally high (e.g., 50% and more with CBT) and the overall prognosis is better than for patients with BN. Patients who achieve complete abstinence from binge eating lose more weight compared to patients who remain symptomatic; however the degree of weight loss after CBT targeting binge eating is modest and does not meet with the expectations of the patients. The long-term treatment success of drug treatment remains unclear. It is currently discussed if BED represents a truly distinct diagnostic entity.

Background and Aims: Despite occasional positive reports on the efficacy of acupuncture (AC) on functions of the gastrointestinal tract, there is no conclusive evidence that AC is effective in the treatment of irritable bowel syndrome (IBS)., Patients and Methods: Forty three patients with IBS according to the Rome II criteria were randomly assigned to receive either AC (n = 22) or sham acupuncture (SAC) (n = 21) using the so-called "Streitberger needle". Treatment duration was 10 sessions with an average of two AC sessions per week. The primary end point was improvement in quality of life (QOL) using the functional digestive diseases quality of life questionnaire (FDDQL) and a general quality of life questionnaire (SF-36), compared with baseline assessments. QOL measurements were repeated three months after treatment., Results: Both the AC and SAC groups improved significantly in global QOL, as assessed by the FDDQL, at the end of treatment (p = 0.022), with no differences between the groups. SF-36 was insensitive to these changes (except for pain). This effect was partially reversed three months later. Post hoc comparison of responders and non-responders in both groups combined revealed a significant prediction of the placebo response by two subscales of the FDDQL (sleep, coping) (F = 6.746, p = 0.003) in a stepwise regression model., Conclusions: Acupuncture in IBS is primarily a placebo response. Based on the small differences found between the AC and SAC groups, a study including 566 patients would be necessary to prove the efficacy of AC over SAC. The placebo response may be predicted by high coping capacity and low sleep quality in individual patients.

Objective: Obese individuals with a binge eating disorder (BED) differ from obese non-binge eaters (NBED) with respect to (a) eating behaviour, (b) psychiatric comorbidity and (c) level of psychosocial distress. The aim of the study was to explore whether these three factors have an influence on cardiac parasympathetic function, that is independent of obesity: as alterations in cardiac parasympathetic function may have a role in the higher cardiovascular mortality that is present in obese individuals., Methods: In total, 38 obese women (BMI>30 kg/m(2)), with a BED and 34 age and BMI matched healthy controls (NBED) completed a laboratory stress protocol that incorporated a baseline resting period, Head-up Tilt Testing (HUT) and two challenging mental tasks. Heart rate and blood pressure were measured continuously during the protocol. Parasympathetic cardiac regulation was assessed as the high frequency component of heart rate variability (HRV-HF)., Results: Mental challenge led to an augmented reduction of HRV-HF in obese binge eaters, which was linked to the binge eating frequency and hunger perception, but not to psychiatric comorbidity. During baseline conditions and HUT, no significant differences in parasympathetic measures were observed between the two subject groups., Conclusion: Subjects with a BED showed greater reduction in parasympathetic cardiac control (HRV-HF) during mental stress, suggesting higher stress vulnerability in women with a BED. Longitudinal investigations are necessary to evaluate whether this is associated with an increased cardiovascular mortality.

Background: Abnormalities in perception and evaluation of body shape are a hallmark of eating disorders., Methods: Brain responses to line drawings of underweight, normal weight, and overweight female bodies were measured with functional magnetic resonance imaging in 9 women with bulimia nervosa, 13 with anorexia nervosa, and 18 healthy women. Participants rated the stimuli for fear and disgust., Results: In the three groups, the lateral fusiform gyrus, inferior parietal cortex, and lateral prefrontal cortex were activated in response to body shapes compared with the control condition (drawings of houses). The responses in the lateral fusiform gyrus and in the parietal cortex were less strong in patients with eating disorders compared with healthy control subjects. Patients with eating disorders rated the body shapes in all weight categories as more aversive than did healthy women. In the group with eating disorders, the aversion ratings correlated positively with activity in the right medial apical prefrontal cortex., Conclusions: Processing of female body shapes engages a distributed neural network, parts of which are underactive in women with eating disorders. The considerable variability in subjective emotional reaction to body shapes in patients with eating disorders is associated with differential activity in the prefrontal cortex.

Aim: The aim of the present study was to evaluate to what extent the orthostatic dysregulation of FMS patients can be attributed primarily to reduced baroreceptor-mediated activation of the sympathetic nervous system and whether a hyporeactive sympathetic nervous system can also be confirmed for mental stress., Patients and Methods: A total of 28 patients with primary FMS were examined and compared with 15 healthy subjects. Diagnostic investigations of the autonomic nervous system were based on measuring HRV in frequency range and assessing spontaneous baroreflex sensitivity (sBRS) under mental stress and passive orthostatism., Results: Both under orthostatic and mental stress FMS patients exhibited reduced activation of the sympathetic nervous system as measured by the spectral power of HRV in the low-frequency range and the mean arterial blood pressure or heart rate. The present study provided no indications for dysregulation of sBRS., Conclusion: The results obtained confirm the hypothesis of a hyporeactive stress system in FMS patients for both peripherally and centrally mediated stimulation of the sympathetic nervous system.

Objective: In a long-term follow-up of anorexia nervosa (AN) patients, somatic, psychological and social variables at clinical presentation should be investigated using a multilevel approach., Methods: This study isolated predictors known from the literature over longer time periods and carried out a separate investigation of predictors in a sample of 81 AN patients of the Heidelberg-Mannheim study over a mean period of 12 years (range 9-19 years). Separate hierarchic regression analyses on the basis of the course of the Morgan-Russell categories were calculated for four individually recorded areas: anamnestic, psychological, somatic and social data sets., Results: Age at the onset of the disease, purging behavior, low serum albumin, high glutamic-oxalo acetic transaminase (GOT) psychopathology (ANSS) and social pathology had the highest predictive value qualities. In survival analysis overall assessment of all six main predictors at clinical presentation could differentiate all patients who recovered from those who remained ill (log-rank test P = 0.019)., Conclusion: A small number of variables were important for detecting a good or poor long-term course of AN. At onset of the disease, it seems necessary to evaluate these psychological, somatic and social predictors.

Pharmacological approaches for the treatment of cardioinhibitory vasovagal syncope are controversially discussed in the literature. In acute treatment of neurocardiogenic syncope, anticholinergics (atropine) are used effectively. Randomised and placebo-controlled clinical trials evaluating the preventive significance of anticholinergic agents in the therapy of cardioinhibitory vasovagal syncope are still missing. We report the case of an 18-year-old male patient with recurrent convulsive, cardioinhibitory neurocardiogenic syncope. Vasovagal syncope occurred predominantly as centrally induced syncope triggered by negative emotions such as fear or by seeing blood. Under resting conditions, the patient revealed increased parasympathetic tone with nocturnal bradycardia of 38 beats/min. In the course of head-up tilt table testing a cardioinhibitory syncope with an asystolic pause of 10 seconds occurred without any prodromes after 10 minutes of upright positioning. In order to inhibit parasympathetic tone, medication with ipratropiumbromide was initiated. Time-variant analysis of heart rate variability (autoregressive model) during head-up tilt table testing showed under the medication with ipratropiumbromide a vagal mediated cardioinhibition to 56 beats/min, but no further sinus arrest. Throughout clinical follow-up of 6 months the patient remained syncope-free under the medication. The usefulness of ipratropiumbromide in inhibiting vagal mediated cardioinhibition will be discussed referring to the case report and to studies evaluating anticholinergic agents in the treatment of neurocardiogenic syncope.

In the course of a year the prevalence of psychiatric comorbidity as well as the effect of psychiatric comorbidity on the length of stay on two internal medical wards we investigated. When examined by separate methods, the prevalence of psychiatric comorbidity reached 36 % (ICD-10 diagnosis) in a sample of 511 medical inpatients of a university hospital. The study shows that patients with psychiatric comorbidity have a significantly longer length of stay - up to 8.2 days compared with inpatients with mere internal diagnosis. This association was not influenced by the length and the severity of the illness. The findings lead to the conclusion that psychiatric comorbidity is a central contributor to one of the most important factors of medical costs - the length of stay.

Studies on the reinnervation of split skin grafts have produced contradictory results. As the difference in sensitivity may be caused by the method of grafting, sensory reinnervation was studied in split skin grafted by two different methods. Thirty-nine patients given split skin grafts after the excision of malignant melanoma took part in the study. In 17 patients, split skin was grafted on to the intact muscle fascia. In another 22 patients the skin was grafted directly on to the muscle after the fascia had been removed. In all patients, sensitivity (to touch, heat/cold, and pain) was tested on the grafts and the skin from the opposite side. Sensory functions on grafted skin were generally reduced. Patients with split skin grafted on to the intact muscle fascia had better reinnervation than the ones in whom the fascia had been removed. However, individual patients from both groups showed surprisingly good reinnervation of transplanted skin. The reasons for this finding are not clear, but it is quite possible that the characteristics of the grafted skin have some influence on the reinnervation.

63 transcutaneous measurements of oxygen pressure and 36 series of infrared thermograms in 9 hypoxic wounds showed that topical administration of tetrachlorine decaoxide (TCDO) results in increased oxygen supply of the wound. This effect is associated with improvement of the skin temperature and decrease of the pathological temperature difference between the wound and the surrounding tissue. TCDO can induce physiological wound healing, since it improves the mechanisms of the immune defence system, wound cleansing, granulation, and epithelialization in slow-healing wounds.

If the skin is not cooled, dermabrasion induces local hyperthermia of 36 to 41 degrees C. This temperature goes down again after one minute and is not considered the cause of postoperative hypertrophic scarring. Yet, cooling of the skin during dermabrasion is generally recommended. In small as well as in large excoriated areas, high speed dermabrasion causes a temperature decrease (delta T) of about 2 to 3 degrees C due to the evaporation of exudate. If we assume that the vascular capillary plexus in the stratum papillare is seriously damaged, the subsequent reparation of the upper skin layers must be clinically and thermographically interpreted as wound healing (latent and proliferative period). The exothermic reaction of the early phase of wound healing is superimposed by the cooling effect due to exudation. The covering of the skin defect with the fine-meshed polyvinyl alcohol hydrogel polyester netfoil, Cutinova, seems to have a favorable influence on the wound healing process, if the covering is regularly changed every one or to days. This may be due to the temperature increase caused by the prevention of the evaporation of the exudate. Measurements of sensitivity (to pressure, temperature, and pain) showed that the cutaneous sensation almost completely recovered after about 15 days.

The publications on the physiology of the free full thickness skin autograft are reported with special reference to the newer ones as a synopsis of literature. Emphasis is placed upon the interesting findings on plastic surgery and especially upon the operative treatment of alopecia.

A simple, easy and effective wound closure following dermabrasion was carried out by fixation of Transite over the Epidermal-cutaneous defect and Allevyn over this Mesh-Graft-Like biologic dressing. Transite shows very little adherence to the wound surface. It is not damaging the wound at removal. The dressing removal is painless.