| 1. |
- Daugaard Hemmingsen, Simone, et al.
(författare)
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Cognitive improvement following weight gain in patients with anorexia nervosa : A systematic review
- 2021
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Ingår i: European eating disorders review. - : John Wiley & Sons. - 1072-4133 .- 1099-0968. ; 29:3, s. 402-426
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Anorexia nervosa (AN) has been associated with cognitive impairment. While re-nutrition is one of the main treatment targets, the effect on cognitive impairments is unclear. The aim of this review was to examine whether cognitive functions improve after weight gain in patients with AN.Method: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines (PROSPERO CRD42019081993). Literature searches were conducted May 20th , 2019 in PubMed, EMBASE, PsychINFO and Cochrane Library. Pairs of reviewers screened reports independently based on titles/abstracts (N = 6539) and full texts (N = 378). Furthermore, they assessed the quality of reports, including whether practice effects were accounted for.Results: Twenty-four longitudinal reports were included featuring 757 patients and 419 healthy controls. Six studies examined children and adolescents. Four out of four studies found processing speed to improve above and beyond what could be assigned to practice effects and three out of four studies found that cognitive flexibility was unaffected after weight gain in children and adolescents. Results from studies of adults were inconclusive.Discussion: The literature on cognitive change in patients with AN following weight gain is sparse. Preliminary conclusions can be made only for children and adolescents, where weight gain appeared to be associated with improved processing speed.
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| 2. |
- Fahrenholtz, Ida Lysdahl, et al.
(författare)
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Risk of Low Energy Availability, Disordered Eating, Exercise Addiction, and Food Intolerances in Female Endurance Athletes
- 2022
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Ingår i: Frontiers in Sports and Active Living. - : Frontiers Media S.A.. - 2624-9367. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Relative energy deficiency in sport (RED-S) is a complex syndrome describing health and performance consequences of low energy availability (LEA) and is common among female endurance athletes. Various underlying causes of LEA have been reported, including disordered eating behavior (DE), but studies investigating the association with exercise addiction and food intolerances are lacking. Therefore, the aim of this cross-sectional study was to investigate the association between DE, exercise addiction and food intolerances in athletes at risk of LEA compared to those with low risk. Female endurance athletes, 18-35 years, training >= 5 times/week were recruited in Norway, Sweden, Ireland, and Germany. Participants completed an online-survey comprising the LEA in Females Questionnaire (LEAF-Q), Exercise Addiction Inventory (EAI), Eating Disorder Examination Questionnaire (EDE-Q), and questions regarding food intolerances. Of the 202 participants who met the inclusion criteria and completed the online survey, 65% were at risk of LEA, 23% were at risk of exercise addiction, and 21% had DE. Athletes at risk of LEA had higher EDE-Q and EAI scores compared to athletes with low risk. EAI score remained higher in athletes with risk of LEA after excluding athletes with DE. Athletes at risk of LEA did not report more food intolerances (17 vs. 10%, P = 0.198), but were more frequently reported by athletes with DE (28 vs. 11%, P = 0.004). In conclusion, these athletes had a high risk of LEA, exercise addiction, and DE. Exercise addiction should be considered as an additional risk factor in the prevention, early detection, and targeted treatment of RED-S among female endurance athletes.
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| 3. |
- Hemmingsen, Simone Daugaard, et al.
(författare)
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Case report : cognitive performance in an extreme case of anorexia nervosa with a body mass index of 7.7.
- 2020
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Ingår i: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Studies show that adult patients with anorexia nervosa display cognitive impairments. These impairments may be caused by illness-related circumstances such as low weight. However, the question is whether there is a cognitive adaptation to enduring undernutrition in anorexia nervosa. To our knowledge, cognitive performance has not been assessed previously in a patient with anorexia nervosa with a body mass index as low as 7.7 kg/m2.CASE PRESENTATION: We present the cognitive profile of a 35-year-old woman with severe and enduring anorexia nervosa who was diagnosed at the age of 10 years. She was assessed with a broad neuropsychological test battery three times during a year. Her body mass index was 8.4, 9.3, and 7.7 kg/m2, respectively. Her general memory performance was above the normal range and she performed well on verbal and design fluency tasks. Her working memory and processing speed were within the normal range. However, her results on cognitive flexibility tasks (set-shifting) were below the normal range.CONCLUSIONS: The case study suggests that it is possible to perform normally cognitively despite extreme and chronic malnutrition though set-shifting ability may be affected. This opens for discussion whether patients with anorexia nervosa can maintain neuropsychological performance in spite of extreme underweight and starvation.TRIAL REGISTRATION: ClinicalTrials.gov, NCT02502617. Registered 20 July 2015.
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| 4. |
- Hemmingsen, Simone Daugaard, et al.
(författare)
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Cognitive flexibility in hospitalized patients with severe or extreme Anorexia nervosa : a case-control study
- 2023
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Ingår i: Journal of Personalized Medicine. - : MDPI. - 2075-4426. ; 13:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate whether cognitive inflexibility could be identified using the Wisconsin Card Sorting Test (WCST) in patients with severe and extreme anorexia nervosa (AN) compared to healthy control participants (HCs). Method: We used the WCST to assess 34 patients with AN (mean age: 25.9 years, mean body mass index (BMI): 13.2 kg/m2) 3–7 days after admission to a specialized nutrition unit and 34 HCs. The Beck Depression Inventory II and the Eating Disorder Inventory 3 were distributed.Results: The patients displayed more perseveration than HCs controlled for age and years of education, with moderate effect sizes (perseverative responses (%): adjusted difference = −7.74, 95% CI: −14.29–(−1.20), p-value: 0.021; perseverative errors (%): adjusted difference = −6.01, 95% CI: −11.06–(−0.96), p-value: 0.020). There were no significant relationships between perseveration and depression, eating disorder symptoms, illness duration, or BMI.Discussion: Patients with severe and extreme AN demonstrated lower cognitive flexibility compared to HCs. Performance was not related to psychopathology or BMI. Patients with severe and extreme anorexia nervosa may not differ from less severe patients in cognitive flexibility performance. As this study exclusively focused on patients suffering from severe and extreme AN, potential correlations might be masked by a floor effect.
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| 5. |
- Hemmingsen, Simone Daugaard, et al.
(författare)
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Cognitive performance in hospitalized patients with severe or extreme anorexia nervosa
- 2023
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Ingår i: Eating and Weight Disorders. - : Springer Nature. - 1124-4909 .- 1590-1262. ; 28:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Severe malnourishment may reduce cognitive performance in anorexia nervosa (AN). We studied cognitive functioning during intensive nutritional and medical stabilization in patients with severe or extreme AN and investigated associations between weight gain and cognitive improvement.Methods: A few days after admission to a specialized hospital unit, 33 patients with severe or extreme AN, aged 16–42 years, completed assessments of memory, cognitive flexibility, processing speed, and attention. Mean hospitalization was 6 weeks. Patients completed the same assessments at discharge (n = 22) following somatic stabilization and follow-up up to 6 months after discharge (n = 18).Results: The patients displayed normal cognitive performance at admission compared to normative data. During nutritional stabilization, body weight increased (mean: 11.3%; range 2.6–22.2%) and memory, attention, and processing speed improved (p values: ≤ 0.0002). No relationship between weight gain and cognitive improvement was observed at discharge or follow-up.Conclusions: Cognitive performance at hospital admission was normal in patients with severe or extreme AN and improved during treatment although without association to weight gain. Based on these results, which are in line with previous studies, patients with severe or extreme AN need not be excluded from cognitively demanding tasks, possibly including psychotherapy. As patients may have other symptoms that interfere with psychotherapy, future research could investigate cognitive functioning in everyday life in patients with severe AN.Trial registration number: The study is registered at clinicaltrials.gov (NCT02502617). Level of evidence: Level III, cohort study.
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| 6. |
- Hemmingsen, Simone Daugaard, et al.
(författare)
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Cortisol, Depression, and Anxiety Levels Before and After Short-Term Intensive Nutritional Stabilization in Patients With Severe Anorexia Nervosa
- 2022
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Depression and anxiety are well-known comorbid conditions in patients with anorexia nervosa (AN). Hypercortisolemia in patients with AN may be pathogenic and contribute to depression and anxiety symptomatology.Objective: The aim of this study was to investigate short-term changes in cortisol levels and depression and anxiety symptomatology following intensive re-nutrition in patients with severe AN and hospitalized in a specialized unit. Furthermore, we investigated the potential association between cortisol levels and psychometric parameters.Methods: A total of 36 patients with AN were enrolled in the study. Nine dropped out before follow-up. Patients underwent paraclinical and psychometric examinations at admission and discharge. Measurements included plasma cortisol, cortisol binding globulin (CBG), 24-h urine cortisol, and self-report questionnaires regarding eating disorder, depression, anxiety, and stress symptoms. Patients were hospitalized in the unit for somatic stabilization and intensive re-nutrition. Mean admission length was 41 days. The study was registered at ClinicalTrials.gov (NCT02502617).Results: Cortisol levels in blood and urine did not change from admission to discharge in patients with severe AN. Symptoms of depression, anxiety, stress, and eating disorder remained elevated at discharge. There were no associations between changes in cortisol levels and changes in psychometrics.Discussion: Our results suggest that short-term intensive re-nutrition did not alter hypothalamic-pituitary-adrenal axis activity or mental health in patients with severe AN. Long-term stabilization and longer follow-up after hospital discharge may be needed to detect changes in cortisol levels and whether these changes are associated with depression and anxiety symptomatology. Greater knowledge about cortisol levels and mental health in patients with severe AN may help in the development of new treatment choices for the chronically ill patients. Future studies could investigate whether cortisol-lowering drugs have a therapeutic effect on mental health in AN.
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| 7. |
- Kuettel, Andreas, et al.
(författare)
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Depressive Symptoms in Danish Elite Athletes Using the Major Depressive Inventory (MDI) and the Center for Epidemiological Studies Depression Scale (CES-D)
- 2022
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Ingår i: Scandinavian Journal of Sport and Exercise Psychology. - : Dansk Idrætspsykologisk Forum. - 2596-741X. ; 4:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- The prevalence of depressive symptoms among athletes is an ongoing debate inthe scientific literature. The aim of the current study was to assess the prevalence of depressive symptoms in Danish elite athletes and to evaluate the psychometric properties of the Major Depressive Inventory (MDI) and the Center for Epidemiological Studies Depression Scale (CES-D) in athletes.The total sample comprised 996 athletes from two cross-sectional studies using the MDI (n= 409) and the CES-D (n= 587). Using the original cut-off points, the MDI found 8.6% and the CES-D found 24.9% at risk of depression. Using alternative cut-off points, both instruments detected 10-11% of athletes at risk. No statistically significant differences were found related to age, injury, and type of sport between high risk and low risk groups, whereas female athletes were overrepresented in the high-risk groups. Principal component analyses confirmed a single factor structure in both instruments with sufficient item loadings on the first component and Cronbach αvalues of .89 and .88. We recommend regular screening of depressive symptoms in elite athletes, with MDI and CES-D as valid instruments for that purpose. The appropriateness of using different cut-off points in athletic samples is discussed.
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| 8. |
- Lichtenstein, Mia Beck, et al.
(författare)
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The Prevalence of Exercise Addiction Symptoms in a Sample of National Level Elite Athletes
- 2021
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Ingår i: Frontiers in Sports and Active Living. - : Frontiers Media S.A.. - 2624-9367. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Exaggerated exercise volumes, lack of control, withdrawal symptoms and conflicts with family and friends are core symptoms of exercise addiction. The condition can lead to health problems and social isolation because exercise is given the highest priority in any situation. The prevalence of the risk of exercise addiction has mostly been assessed in leisure time exercisers such as runners, fitness attendees and cyclists. The prevalence proportion ranges from 3 to 42% depending on the type of sport and the assessment tool. The proportion is greater among elite athletes, and increases with the level of competition. This study's primary aim was to assess the prevalence of exercise addiction among elite athletes competing at national level and its secondary aim was to evaluate the psychometric properties of the Exercise Addition Inventory (EAI) in elite sports. Participants (n = 417) from 15 sports disciplines and with 51% women completed an online survey. Results showed that 7.6% were at risk of exercise addiction. This group was younger, exhibited tendency to exercise despite pain and injury, felt guilty if not exercising enough, and reported substantial eating disorder symptoms. The reliability and validity of the EAI was good suggesting that the scale is appropriate for measuring the risk of exercise addiction in elite athletes.
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| 9. |
- Sjögren, Magnus, et al.
(författare)
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Trauma experiences are common in anorexia nervosa and related to eating disorder pathology but do not influence weight-gain during the start of treatment
- 2023
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Ingår i: Journal of Personalized Medicine. - : MDPI. - 2075-4426. ; 13:5
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The main characteristics of Anorexia Nervosa (AN) in adults are restriction of energy intake relative to requirements leading to significant weight loss, disturbed body image, and intense fear of becoming fat. Traumatic experiences (TE) have been reported as common, although less is known about the relationship with other symptoms in severe AN. We investigated the presence of TE, PTSD, and the relation between TE, eating disorder (ED) symptoms, and other symptoms in moderate to severe AN (n = 97) at admission to inpatient weight-restoration treatment. All patients were enrolled in the Prospective Longitudinal all-comer inclusion study on Eating Disorders (PROLED).Methods: TE were assessed using the Post-traumatic stress disorder checklist, Civilian version (PCL-C), and ED symptoms using the Eating Disorder Examination Questionnaire (EDE-Q); depressive symptoms were assessed using the Major Depression Inventory (MDI), and the presence of Post-traumatic Stress Disorder (PTSD) was diagnosed according to ICD-10 criteria.Results: The mean score on PCL-C was high (mean 44.6 SD 14.7), with 51% having a PCL-C score at or above 44 (n = 49, suggested cut-off for PTSD), although only one individual was clinically diagnosed with PTSD. There was a positive correlation between baseline scores of PCL-C and EDE-Q-global score (r = 0.43; p < 0.01) as well as of PCL-C and all EDE-Q subscores. None of the included patients were admitted for treatment of TE/PTSD during the first 8 weeks of treatment.Conclusions: In a group of patients with moderate to severe AN, TE were common, and scores were high, although only one had a diagnosis of PTSD. TE were related to ED symptoms at baseline, but this association diminished during the weight restoration treatment.
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| 10. |
- Torstveit, Monica K, et al.
(författare)
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Exercise dependence, eating disorder symptoms and biomarkers of Relative Energy Deficiency in Sports (RED-S) among male endurance athletes
- 2019
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Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 5:1, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To explore associations betweenexercise dependence, eating disorder (ED) symptoms and biomarkers of Relative Energy Deficiency in Sports (RED-S) among male endurance athletes.Methods Fifty-three healthy well-trained male cyclists, triathletes and long-distance runners recruited from regional competitive sports clubs were included in this cross-sectional study. The protocol comprised the Exercise Dependence Scale (EXDS), the ED Examination Questionnaire (EDE-Q), measurements of body composition, resting metabolic rate, energy intake and expenditure and blood analysis of hormones and glucose.Results Participants with higher EXDS score displayed a more negative energy balance compared with subjects with lower EXDS score (p<0.01). EXDS total score was positively correlated with EDE-Q global score (r=0.41, p<0.05) and the subscale score for restraint eating (r=0.34, p<0.05) and weight concern (r=0.35, p<0.05). EXDS total score and the subscales lack of control and tolerance were positively correlated with cortisol (r=0.38, p<0.01, r=0.39, p<0.01 and r=0.29, p<0.05, respectively). The EXDS subscales withdrawal and tolerance were negatively correlated with fasting blood glucose (r=−0.31 and r=−0.32, p<0.05, respectively), while intention effect was negatively correlated with testosterone:cortisol ratio (r=−0.29, p<0.05) and positively correlated with cortisol:insulin ratio (r=0.33, p<0.05).Conclusion In this sample of healthy male athletes, we found associations between higher EXDS scores, ED symptoms and biomarkers of RED-S, such as a more pronounced negative energy balance and higher cortisol levels.
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