Targeted prevention of excess weight gain and eating disorders in high-risk adolescent girls: a randomized controlled trial. Risk Factors That Predict Future Onset of Each DSM–5 Eating Disorder: Predictive Specificity in High-Risk Adolescent Females The natural course of bulimia nervosa and binge eating disorder in young women. Randomised controlled trial of a healthy lifestyle intervention among smokers with psychotic disorders: Outcomes to 36 months Medical burden in bipolar disorder: findings from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE). Efficacy trial of a selective prevention program targeting both eating disorders and obesity among female college students: 1- and 2-year follow-up effects. Treatment of binge eating disorder. Impact of substance use disorders on recovery from episodes of depression in bipolar disorder patients: prospective data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Web-Based Cognitive Behavioral Therapy for Female Patients With Eating Disorders: Randomized Controlled Trial Assisting Social Security Disability Insurance beneficiaries with schizophrenia, bipolar disorder, or major depression in returning to work. Depression and Anxiety: Their Predictive Function for Weight Loss in Obese Individuals Improving medical and psychiatric outcomes among individuals with bipolar disorder: a randomized controlled trial. Disordered eating behaviour and attitudes, associated psychopathology and health-related quality of life: results of the BELLA study Efficacy trial of a selective prevention program targeting both eating disorder symptoms and unhealthy weight gain among female college students. Association Between Muscular Strength and Cognition in People With Major Depression or Bipolar Disorder and Healthy Controls Family-focused treatment for caregivers of patients with bipolar disorder. Early physical and sexual abuse associated with an adverse course of bipolar illness Citalopram in the treatment of binge-eating disorder: a placebo-controlled trial. Lamotrigine in the treatment of binge-eating disorder with obesity: a randomized, placebo-controlled monotherapy trial Subsyndromal symptoms assessed in longitudinal, prospective follow-up of a cohort of patients with bipolar disorder. Binge eating disorder in extreme obesity Mental health first aid for eating disorders: pilot evaluation of a training program for the public Risk of depression and other mental health disorders in women with polycystic ovary syndrome: a longitudinal study.
BACKGROUND The high prevalence and incidence of obesity and eating disorders in US adolescent girls are serious health problems . Because of the shared risk factors for obesity and eating disorders , a targeted prevention of both conditions is a priority . OBJECTIVE We determined whether an adapted interpersonal psychotherapy prevention program is more efficacious for reducing excess weight gain and worsening disordered eating than health education in adolescent girls at high risk of obesity and eating disorders . DESIGN A parallel-group , r and omized controlled trial was conducted between September 2008 and January 2013 in a university-based laboratory and a federal research hospital . The study included 113 adolescent ( 12 - 17-y-old ) girls deemed at high risk of adult obesity and eating disorders because of a body mass index ( BMI ) between the 75th and 97th percentiles and reports of episodes of a loss of control over their eating . Girls were r and omly assigned to participate in an adapted interpersonal psychotherapy or a health-education group program for 12 weekly 90-min group sessions . Follow-up assessment s occurred immediately after group programs and at 6 and 12 mo . RESULTS Participation in both conditions was associated with decreases in expected BMI gain , age-adjusted BMI metrics , the percentage of fat by using dual-energy X-ray absorptiometry , symptoms of depression and anxiety , and the frequency of loss-of-control eating over 12 mo of follow-up ( Ps < 0.001 ) with no group difference . In follow-up analyses , interpersonal psychotherapy was more efficacious than health education at reducing objective binge eating at the 12-mo follow-up ( P < 0.05 ) . CONCLUSIONS The intervention with adolescent girls with loss-of-control eating is associated with lower age-adjusted BMI and percentage of adiposity as well as improved mood symptoms over 1 y. Interpersonal psychotherapy further reduced objective binge eating . Additional research is needed to eluci date the mechanisms by which physical and psychological improvements were observed . This trial was registered at clinical trials.gov as NCT00680979 Because no single report has examined risk factors that predict future onset each type of eating disorder and core symptom dimensions that crosscut disorders , we addressed these aims to advance knowledge regarding risk factor specificity . Data from 3 prevention trials that targeted young women with body dissatisfaction ( N = 1,272 ; Mage = 18.5 , SD = 4.2 ) and collected annual diagnostic interview data over 3-year follow-up were combined to identify predictors of subthreshold/threshold anorexia nervosa ( AN ) , bulimia nervosa ( BN ) , binge eating disorder ( BED ) , and purging disorder ( PD ) . Negative affect and functional impairment predicted onset of all eating disorders . Thin-ideal internalization , body dissatisfaction , dieting , overeating , and mental health care predicted onset of subthreshold/threshold BN , BED , and PD ; positive thinness expectations , denial of cost of pursuing the thin ideal , and fasting predicted onset of 2 of these 3 disorders . Similar risk factors predicted core eating disorder symptom onset . Low BMI and dieting specifically predicted onset of subthreshold/threshold AN or low BMI . Only a subset of factors showed unique predictive effects in multivariate models , likely due to moderate correlations between the risk factors ( M r = .14 ) . Results provide support for the theory that pursuit of the thin ideal and the result ing body dissatisfaction , dieting , and unhealthy weight control behaviors increase risk for binge/purge spectrum eating disorders , but suggest that youth who are inherently lean , rather than purpose ly pursuing the thin ideal , are at risk for AN . Impaired interpersonal functioning and negative affect are transdiagnostic risk factors , suggesting these factors should be targeted in prevention programs BACKGROUND Little is known about the relative course and outcome of bulimia nervosa and binge eating disorder . METHODS Two community-based cohorts were studied prospect ively over a 5-year year period . One comprised 102 participants with bulimia nervosa and the other 48 participants with binge eating disorder ( 21 % [ 9/42 ] of whom had comorbid obesity ) . All participants were female and aged between 16 and 35 years at recruitment . The assessment s were at 15-month intervals and addressed eating disorder features , general psychiatric symptoms , and social functioning . RESULTS Both cohorts showed marked initial improvement followed by gradual improvement thereafter . Between half and two thirds of the bulimia nervosa cohort had some form of eating disorder of clinical severity at each assessment point , although only a minority continued to meet diagnostic criteria for bulimia nervosa . Each year about a third remitted and a third relapsed . The outcome of the binge eating disorder cohort was better , with the proportion with any form of clinical eating disorder declining to 18 % ( 7 of 40 ) by the 5-year follow-up . The relapse rate was low among this cohort . There was little movement of participants across the 2 diagnostic categories and few sought treatment . Both groups gained weight , with 39 % of the binge eating disorder cohort ( 14 of 36 ) meeting criteria for obesity at 5-year follow-up . CONCLUSIONS These findings suggest that , among young women in the community , bulimia nervosa and binge eating disorder have a different course and outcome . Whereas the prognosis of those with bulimia nervosa was relatively poor , the great majority of those with binge eating disorder recovered Objective : People living with psychotic disorders ( schizophrenia spectrum and bipolar disorders ) have high rates of cardiovascular disease risk behaviours , including smoking , physical inactivity and poor diet . We report cardiovascular disease risk , smoking cessation and other risk behaviour outcomes over 36 months following recruitment into a two-arm r and omised controlled trial among smokers with psychotic disorders . Methods : Participants ( N = 235 ) drawn from three sites were r and omised to receive nicotine replacement therapy plus ( 1 ) a Healthy Lifestyles intervention  delivered over approximately 9 months or ( 2 ) a largely telephone-delivered intervention ( design ed to control for nicotine replacement therapy provision , session frequency and other monitoring ) . The primary outcome variables were 10-year cardiovascular disease risk and smoking status , while the secondary outcomes included weekly physical activity , unhealthy eating , waist circumference , psychiatric symptomatology , depression and global functioning . Results : Significant reductions in cardiovascular disease risk and smoking were detected across the 36-month follow-up period in both intervention conditions , with no significant differences between conditions . One-quarter ( 25.5 % ) of participants reported reducing cigarettes per day by 50 % or more at multiple post-treatment assessment s ; however , few ( 8.9 % ) managed to sustain this across the majority of time points . Changes in other health behaviours or lifestyle factors were modest ; however , significant improvements in depression and global functioning were detected over time in both conditions . Participants experiencing worse ‘ social discomfort ’ at baseline ( e.g. anxiety , mania , poor self-esteem and social disability ) had on average significantly worse global functioning , lower scores on the 12-Item Short Form Health Survey physical scale and significantly greater waist circumference . Conclusion : Although the telephone-delivered intervention was design ed as a comparison condition , it achieved excellent retention and comparable outcomes . Telephone-delivered smoking cessation support may potentially help to reduce smoking rates among people with psychotic disorders . Discomfort in social situations may also be a useful target for future health interventions , addressing confidence and social skills , and promoting social networks that reduce inactivity OBJECTIVES Individuals with bipolar disorder have high rates of other medical comorbidity , which is associated with higher mortality rates and worse course of illness . The present study examined common predictors of medical comorbidity . METHODS The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study ( Bipolar CHOICE ) enrolled 482 participants with bipolar I or bipolar II disorder in a six-month , r and omized comparative effectiveness trial . Baseline assessment s included current and lifetime DSM-IV-TR diagnoses , demographic information , psychiatric and medical history , severity of psychiatric symptoms , level of functioning , and a fasting blood draw . Medical comorbidities were categorized into two groups : cardiometabolic ( e.g. , diabetes , hyperlipidemia , and metabolic syndrome ) and non-cardiovascular ( e.g. , seizures , asthma , and cancer ) . Additionally , we looked at comorbid substance use ( e.g. , smoking and drug dependence ) . RESULTS We found that 96.3 % of participants had at least one other medical comorbidity . Older age predicted a greater likelihood of having a cardiometabolic condition . Early age of onset of bipolar symptoms was associated with a lower chance of having a cardiometabolic condition , but a greater chance of having other types of medical comorbidity . Additional predictors of other medical comorbidities in bipolar disorder included more time spent depressed , less time spent manic/hypomanic , and longer duration of illness . Medications associated with weight gain were associated with low high-density lipoprotein and abnormal triglycerides . CONCLUSIONS There appears to be a substantial medical burden associated with bipolar disorder , highlighting the need for collaborative care among psychiatric and general medical providers to address both psychiatric and other medical needs concomitantly in this group of patients OBJECTIVE Evaluate the effects of a prevention program targeting both eating disorders and obesity at 1- and 2-year follow-ups . METHOD Female college students at risk for these outcomes because of body image concerns ( N = 398 ) were r and omized to the Healthy Weight 2 group-based 4-hr prevention program , which promotes lasting healthy improvements to dietary intake and physical activity and nutrition science health behavior change principles , or an educational brochure control condition . RESULTS Intervention participants showed significantly less body dissatisfaction and eating disorder symptoms and lower eating disorder onset through 2-year follow-up versus controls , but the former 2 effects were small . There were no main effects for body mass index ( BMI ) , depressive symptoms , dieting , caloric intake , physical activity , or obesity onset . Moderator analyses revealed stronger eating disorder symptom effects for youths with initially elevated symptoms and lower pressure to be thin , stronger BMI effects for youths with initially elevated symptoms and BMI scores , and weaker eating disorder symptom effects for youths with initially elevated pressure to be thin . CONCLUSIONS The 60 % reduction in eating disorder onset over the 2-year follow-up was clinical ly significant and a novel effect for a prevention program , but the main effects on continuous outcomes were small , suggesting that adding nutrition science principles weakened the intervention efficacy . Effects on both eating disorder symptoms and BMI were greater for those with elevated eating disorder symptoms and BMI at pretest , implying that it might be useful to target these individuals in future trials The two specialty psychological therapies of CBT and IPT remain the treatments of choice for the full range of BED patients , particularly those with high levels of specific eating disorder psychopathology such as overvaluation of body shape and weight . They produce the greatest degree of remission from binge eating as well as improvement in specific eating disorder psychopathology and associated general psychopathology such as depression . The CBT protocol evaluated in the research summarized above was the original manual from Fairburn and colleagues . Fairburn has subsequently developed a more elaborate and sophisticated form of treatment , namely , enhanced CBT ( CBT-E ) for eating disorders . Initial research suggests that CBT-E may be more effective than the earlier version with bulimia nervosa and Eating Disorder Not Otherwise Specified patients .  CBT-E has yet to be evaluated for the treatment of BED , although it would currently be the recommended form of CBT . Of relevance in this regard is that the so-called broad form of the new protocol includes 3 optional treatment modules that could be used to address more complex psychopathology in BED patients . One of the modules targeted at interpersonal difficulties is IPT , as described earlier in this chapter . Thus , the broader protocol could represent a combination of the two currently most effective therapies for BED . Whether this combined treatment proves more effective than either of the components alone , particularly for a subset of BED patients with more complex psychopathology , remains to be tested . CBT-E also includes a module design ed to address what Fairburn terms “ mood intolerance ” ( problems in coping with negative affect ) that can trigger binge eating and purging . The content and strategies of this mood intolerance module overlap with the emotional regulation and distress tolerance skills training of Linehan 's dialectical behavior therapy ( DBT ) . Two r and omized controlled trials have tested the efficacy of an adaptation of DBT for the treatment of BED ( DBT-BED ) featuring mindfulness , emotion regulation , and distress tolerance training . A small study by Telch and colleagues found that modified DBT-BED was more effective than a wait list control in eliminating binge eating . A second study showed that DBT-BED result ed in a significantly greater remission rate from binge eating at posttreatment than a group comparison treatment design ed to control for nonspecific therapeutic factors such as treatment alliance and expectations.50 This difference between the two treatments disappeared over a 12-month follow-up , indicating the absence of DBT-BED-specific influences on long-term outcomes . Both CBT and IPT have been shown to be more effective in eliminating binge eating than BWL in controlled , comparative clinical trials . Nonetheless , BWL has been effective in reducing binge eating and associated eating problems in BED patients in some studies and might be suitable for treatment of BED patients without high levels of specific eating disorder psychopathology . A finding worthy of future research is the apparent predictive value of early treatment response to BWL , indicating when BWL is likely to prove effective or not . No evidence supports the concern that BWL 's emphasis on moderate caloric restriction either triggers or exacerbates binge eating in individuals with BED . Initially , CBTgsh was recommended as a feasible first-line treatment that might be sufficient treatment for a limited subset of patients in a stepped care approach . More recent research , however , has shown that CBTgsh seems to be as effective as a specialty therapy , such as IPT , with a majority of BED patients . The subset of patients that did not respond well to CBTgsh in this research were those with a high level of specific eating disorder psychopathology , as noted . A plausible explanation for this moderator effect is that the original Fairburn CBTgsh manual does not include an explicit emphasis on body shape and weight concerns . Subsequent implementation of this treatment has incorporated a module that directly addresses overvaluation of body shape and weight . Future research should determine whether an exp and ed form of CBTgsh is suitable for the full range of patients with BED . CBTgsh is recommended as a treatment for BED on two other counts . First , its brief and focused nature makes it cost effective . Second , its structured format makes it more readily disseminable than other longer , multicomponent psychological therapies . It can be implemented by a wider range of treatment providers than more technically complex , time-consuming , and clinical expertise-dem and ing specialty therapies such as CBT-E and IPT . The latter evidence -based therapies are rarely available to patients with BED in routine clinical care setting s. Nevertheless , it must be noted that much of the research on CBTgsh to date has been conducted in an eating disorder specialty clinic setting . The degree to which the treatment can be adapted to a range of clinical service setting s remains to be determined . In addition , little is known about the specific provider qualifications and level of expertise required to implement CBTgsh successfully . Despite its brief and focal nature , specific provider skills regarding what and what not to address in treatment are required . Currently available pharmacologic treatments can not be recommended for treatment of BED . Aside from the inconsistent results of existing studies , the striking absence of controlled long-term evaluation of such treatment argues against its use . As summarized , the evidence -based treatments of CBT , IPT , and CBTgsh result in significant improvement and large treatment effects on multiple outcome measures aside from binge eating in overweight and obese patients . These include specific eating disorder psychopathology ( eg , overvaluation of body shape and weight ) , general psychopathology ( eg , depression ) , and psychosocial functioning . Moreover , these changes are typically well-maintained over 1 to 2 years of follow-up . The exception to this profile of improvement remains weight loss and its maintenance over time . These specialty psychological treatments do not produce weight loss , although successfully eliminating binge eating might protect against future weight gain . BWL consistently produces short-term weight loss , the extent of which has varied across different studies . Long-term weight loss has yet to be demonstrated , however . In this regard , the findings with obese patients with BED are not different than those on the treatment of obesity in general , in which there is little robust evidence of enduring weight loss effects of BWL OBJECTIVE Bipolar disorder is highly comorbid with substance use disorders , and this comorbidity may be associated with a more severe course of illness , but the impact of comorbid substance abuse on recovery from major depressive episodes in these patients has not been adequately examined . The authors hypothesized that comorbid drug and alcohol use disorders would be associated with longer time to recovery in patients with bipolar disorder . METHOD Subjects ( N=3,750 ) with bipolar I or bipolar II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder ( STEP-BD ) were followed prospect ively for up to 2 years . Prospect ively observed depressive episodes were identified for this analysis . Subjects with a past or current drug or alcohol use disorder were compared with those with no history of drug or alcohol use disorders on time to recovery from depression and time until switch to a manic , hypomanic , or mixed episode . RESULTS During follow up , 2,154 subjects developed a new-onset major depressive episode ; of these , 457 subjects switched to a manic , hypomanic , or mixed episode prior to recovery . Past or current substance use disorder did not predict time to recovery from a depressive episode relative to no substance use comorbidity . However , those with current or past substance use disorder were more likely to experience switch from depression directly to a manic , hypomanic , or mixed state . CONCLUSIONS Current or past substance use disorders were not associated with longer time to recovery from depression but may contribute to greater risk of switch into manic , mixed , or hypomanic states . The mechanism conferring this increased risk merits further study Background Many patients with eating disorders do not receive help for their symptoms , even though these disorders have severe morbidity . The Internet may offer alternative low-threshold treatment interventions . Objective This study evaluated the effects of a Web-based cognitive behavioral therapy ( CBT ) intervention using intensive asynchronous therapeutic support to improve eating disorder psychopathology , and to reduce body dissatisfaction and related health problems among patients with eating disorders . Methods A two-arm open r and omized controlled trial comparing a Web-based CBT intervention to a waiting list control condition ( WL ) was carried out among female patients with bulimia nervosa ( BN ) , binge eating disorder ( BED ) , and eating disorders not otherwise specified ( EDNOS ) . The eating disorder diagnosis was in accordance with the Diagnostic and Statistical Manual of Mental Disorders , 4th edition , and was established based on participants ’ self-report . Participants were recruited from an open-access website , and the intervention consisted of a structured two-part program within a secure Web-based application . The aim of the first part was to analyze participant ’s eating attitudes and behaviors , while the second part focused on behavioral change . Participants had asynchronous contact with a personal therapist twice a week , solely via the Internet .  Self-report measures of eating disorder psychopathology ( primary outcome ) , body dissatisfaction , physical health , mental health , self-esteem , quality of life , and social functioning were completed at baseline and posttest . Results A total of 214 participants were r and omized to either the  Web-based CBT group ( n=108 ) or to the WL group ( n=106 ) stratified by type of eating disorder ( BN : n=44 ; BED : n=85 ; EDNOS : n=85 ) . Study attrition was low with 94 % of the participants completing the posttest assignment . Overall , Web-based CBT showed a significant improvement over time for eating disorder psychopathology ( F 97=63.07 , P<.001 , d=.82 ) and all secondary outcome measures ( effect sizes between d=.34 to d=.49 ) , except for Body Mass Index . WL participants also improved on most outcomes ; however , effects were smaller in this group with significant between-group effects for eating disorder psychopathology ( F 201=9.42 , P=.002 , d=.44 ) , body dissatisfaction ( F 201=13.16 , P<.001 , d=.42 ) , physical health ( F 200=12.55 , P<.001 , d=.28 ) , mental health ( F 203=4.88 , P=.028 , d=.24 ) , self-esteem ( F 202=5.06 , P=.026 , d=.20 ) , and social functioning ( F 205=7.93 , P=.005 , d=.29 ) . Analyses for the individual subgroups BN , BED , and EDNOS showed that eating disorder psychopathology improved significantly over time among Web-based CBT participants in all three subgroups ; however , the between-group effect was significant only for participants with BED ( F 78=4.25 , P=.043 , d=.61 ) . Conclusions Web-based CBT proved to be effective in improving eating disorder psychopathology and related health  among female patients with eating disorders . Trial Registration Nederl and s Trial Register ( NTR ) : NTR2415 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2415 ( Archived by WebCite at http://www.webcitation.org/6T2io3DnJ ) OBJECTIVE People with psychiatric impairments ( primarily schizophrenia or a mood disorder ) are the largest and fastest-growing group of Social Security Disability Insurance ( SSDI ) beneficiaries . The authors investigated whether evidence -based supported employment and mental health treatments can improve vocational and mental health recovery for this population . METHOD Using a r and omized controlled trial design , the authors tested a multifaceted intervention : team-based supported employment , systematic medication management , and other behavioral health services , along with elimination of barriers by providing complete health insurance coverage ( with no out-of-pocket expenses ) and suspending disability review s. The control group received usual services .  Paid employment was the primary outcome measure , and overall mental health and quality of life were secondary outcome measures . RESULTS Overall , 2,059 SSDI beneficiaries with schizophrenia , bipolar disorder , or depression in 23 cities participated in the 2-year intervention . The teams implemented the intervention package with acceptable fidelity . The intervention group experienced more paid employment ( 60.3 % compared with 40.2 % ) and reported better mental health and quality of life than the control group . CONCLUSIONS Implementation of the complex intervention in routine mental health treatment setting s was feasible , and the intervention was effective in assisting individuals disabled by schizophrenia or depression to return to work and improve their mental health and quality of life Objective : To investigate the impact of current mental disorders on weight loss with special consideration of depressive and /or anxiety disorders as well as binge eating behavior in obese individuals undergoing different weight loss treatments . Methods : Three different sample s of obese individuals were investigated in a prospect i ve , longitudinal study : participants in a conventional weight loss treatment program ( CONV TREAT ; n = 250 ) , obesity surgery patients ( OBES SURG ; n = 153 ) , and obese control individuals ( OC ; n = 128 ) . Current mental disorders and BMI were assessed at baseline and at 4-year follow-up . Results : OBES SURG patients with a depressive and /or anxiety disorder  lost significantly less weight compared with those without a comorbid mental diagnosis . This result was not detected for CONV TREAT participants . A trend to gain weight was seen in OC participants with a depressive and /or anxiety disorder , whereas OC participants without current mental disorders at baseline lost some weight . Binge eating behavior at baseline did not predict weight loss at 4-year followup . Conclusions : These results underline the importance of addressing current depressive and anxiety disorders in obese patients , especially when such patients are undergoing obesity surgery OBJECTIVES Comorbid medical conditions , notably cardiovascular disease , occur disproportionately among persons with bipolar disorder ; yet the quality and outcomes of medical care for these individuals are suboptimal . This pilot study examined a bipolar disorder medical care model ( BCM ) and determined whether , compared with usual care , individuals r and omly assigned to receive BCM care had improved medical and psychiatric outcomes . METHODS Persons with bipolar disorder and cardiovascular disease-related risk factors were recruited from a large Department of Veterans Affairs mental health facility and r and omly assigned to receive BCM or usual care . BCM care consisted of four self-management sessions on bipolar disorder symptom control strategies , education and behavioral change related to cardiovascular disease risk factors , and promotion of provider engagement . Primary outcomes were physical and mental health-related quality of life ; secondary outcomes included functioning and bipolar symptoms . RESULTS Fifty-eight persons participated . Twenty-seven received BCM care , and 31 received usual care .  The mean+/-SD age was 55+/-8 years , 9 % were female , 90 % were white , and 10 % were African American . Repeated- measures analysis was used , and significant differences were observed between the two groups in change in scores from baseline to six months for the 12-Item Short-Form Health Survey ( SF-12 ) subscale for physical health ( t=2.01 , df=173 , p=.04 ) , indicating that the usual care group experienced a decline in physical health over the study period . Change in SF-12 scores also indicated that compared with the usual care group , the BCM group showed improvements in mental health-related quality of life over the six-month study period ; however , this finding was not significant . CONCLUSIONS Compared with usual care , BCM care may have slowed the decline in physical health-related quality of life . Further studies are needed to determine whether BCM care leads to long-term positive changes in physical and mental health-related quality of life and reduced risk of cardiovascular disease among persons with bipolar disorder Objective To identify disordered eating behaviour and attitudes in a large representative population in order to determine the relationship with body weight status , and to assess associated psychopathology and health-related quality of life . Methods A total of 11–17 year-old adolescents ( n = 1,895 ) were r and omly selected from the national representative sample of 17,641 families participating in the German Health Interview and Examination Survey for Children and Adolescents ( KiGGS ) . Weight and height were assessed by trained staff . Mental health problems and health-related quality of life were examined by means of a telephone interview and different question naires . Eating disordered behaviour and attitudes were identified by the SCOFF , an instrument consisting of five questions originally developed to screen for eating disorders in clinical setting s. Results About one third of the girls and 15 % of the boys reported disordered eating behaviour and attitudes , which were most prevalent in overweight youth . There was a significant association between the presence of disordered eating behaviour and psychopathology , which was comprised of internalising and externalising behavioural problems . In addition , adolescents with disordered eating behaviour reported reduced quality of life . Conclusion The high prevalence of disordered eating in the general population of Germany is of great concern . Health professionals should not only be aware of disordered eating in underweight adolescents , but in all youth , especially overweight individuals . Disordered eating behaviour is associated with a wide range of psychopathological and psychosocial concerns . Thus , youngsters engaging in disordered eating behaviour should also be explored for other serious mental or social problems OBJECTIVE Evaluate a selective prevention program targeting both eating disorder symptoms and unhealthy weight gain in young women . METHOD Female college students at high-risk for these outcomes by virtue of body image concerns ( N = 398 ; M age = 18.4 years , SD = 0.6 ) were r and omized to the Healthy Weight group-based 4-hr prevention program , which promotes gradual lasting healthy improvements to dietary intake and physical activity , or an educational brochure control condition . RESULTS Compared to controls , intervention participants showed significantly greater reductions in body dissatisfaction and eating disorder symptoms , and greater increases in physical activity , at posttest and significantly greater reductions in body mass index ( BMI ) and self-reported dieting at 6-month follow-up . Moderator analyses revealed significantly greater reductions in eating disorder symptoms for those with initially elevated symptoms and pressure to be thin and significantly greater reductions in BMI for those with initially elevated eating disorder symptoms . CONCLUSIONS Results indicate that this intervention reduced both eating disorder symptoms and unhealthy weight gain , but suggest it should be improved to produce stronger and more persistent effects , and that it may be useful to target young women with both body image and eating disturbances Importance Objective physical fitness measures , such as h and grip strength , are associated with physical , mental , and cognitive outcomes in the general population . Although people with mental illness experience reduced physical fitness and cognitive impairment , the association between muscular strength and cognition has not been examined to date . Objective To determine associations between maximal h and grip strength and cognitive performance in people with major depression or bipolar disorder and in healthy controls . Design , Setting , and Participants In a multicenter , population -based study conducted between February 13 , 2005 , and October 1 , 2010 , in the United Kingdom , cross-sectional analysis was conducted of baseline data from 110 067 participants in the UK Biobank . Data analysis was performed between August 3 and August 18 , 2017 . Invitations were mailed to approximately 9.2 million UK homes , recruiting 502 664 adults , all aged 37 to 73 years . Clinical ly vali date d measures were used to identify individuals with major recurrent depression ( moderate or severe ) or bipolar disorder ( type I or type II ) and healthy controls ( those with no indication of present or previous mood disorders ) . Main Outcomes and Measures H and grip dynamometry was used to measure muscular function . Cognitive functioning was assessed using computerized tasks of reaction time , visual memory , number memory , reasoning , and prospect i ve memory . Generalized linear mixed models assessed the association between h and grip strength and cognitive performance , controlling for age , educational level , sex , body weight , and geographic region . Results Of the 110 067 participants , analyses included 22 699 individuals with major depression ( mean [ 95 % range ] age , 55.5 [ 41 - 68 ] years ; 7936 [ 35.0 % ] men ) , 1475 with bipolar disorder ( age , 54.4 [ 41 - 68 ] years ; 748 [ 50.7 % ] men ) , and 85 893 healthy controls ( age , 53.7 [ 41 - 69 ] years ; 43 000 [ 50.0 % ] men ) . In those with major depression , significant positive associations ( P < .001 ) between maximal h and grip strength and improved performance on all 5 cognitive tasks were found , including visual memory ( coefficient , −0.146 ; SE , 0.014 ) , reaction time ( coefficient , −0.036 ; SE , 0.002 ) , reasoning ( coefficient , 0.213 ; SE , 0.02 ) , number memory ( coefficient , 0.160 ; SE , 0.023 ) , and prospect i ve memory ( coefficient , 0.341 ; SE , 0.024 ) . Similar results were found in healthy controls . Among participants with bipolar disorder , h and grip strength was positively associated with improved visual memory ( coefficient , −0.129 ; SE , 0.052 ; P = .01 ) , reaction time ( coefficient , −0.047 ; SE , 0.007 ; P < .001 ) , prospect i ve memory ( coefficient , 0.262 ; SE , 0.088 ; P = .003 ) , and reasoning ( coefficient , 0.354 ; SE , 0.08 ; P < .001 ) . Conclusions and Relevance Grip strength may provide a useful indicator of cognitive impairment in people with major depression and bipolar disorder . Future research should investigate causality , assess the functional implication s of h and grip strength in psychiatric population s , and examine how interventions to improve muscular fitness affect neurocognitive status and socio-occupational functioning OBJECTIVES Family members of patients with bipolar disorder experience high rates of subjective and objective burden which place them at risk for adverse physical health and mental health outcomes . We present preliminary efficacy data from a novel variation of Family Focused Treatment [ Miklowitz DJ . Bipolar Disorder : A Family-Focused Treatment Approach ( 2(nd ) ed . ) . New York : The Guilford Press , 2008 ] that aim ed to reduce symptoms of bipolar disorder by working with caregivers to enhance illness management skills and self-care . METHODS The primary family caregivers of 46 patients with bipolar I ( n = 40 ) or II ( n = 6 ) disorder , diagnosed by the Structured Clinical Interview for DSM-IV Axis I Disorders , were assigned r and omly to receive either : ( i ) a 12 - 15-session family-focused , cognitive-behavioral intervention design ed to provide the caregiver with skills for managing the relative 's illness , attaining self-care goals , and reducing strain , depression , and health risk behavior [ Family-Focused Treatment-Health Promoting Intervention ( FFT-HPI ) ] ; or ( ii ) an 8- to 12-session health education ( HE ) intervention delivered via videotapes . We assessed patients pre- and post-treatment on levels of depression and mania and caregivers on levels of burden , health behavior , and coping . RESULTS R and omization to FFT-HPI was associated with significant decreases in caregiver depressive symptoms and health risk behavior . Greater reductions in depressive symptoms among patients were also observed in the FFT-HPI group . Reduction in patients ' depression was partially mediated by reductions in caregivers ' depression levels . Decreases in caregivers ' depression were partially mediated by reductions in caregivers ' levels of avoidance coping . CONCLUSIONS Families coping with bipolar disorder may benefit from family interventions as a result of changes in the caregivers ' ability to manage stress and regulate their moods , even when the patient is not available for treatment BACKGROUND There is growing awareness of the association between physical and sexual abuse and subsequent development of psychopathology , but little is known , however , about their relationship to the longitudinal course of bipolar disorder . METHODS We evaluated 631 out patients with bipolar I or II disorder for general demographics , a history of physical or sexual abuse as a child or adolescent , course of illness variables , and prior suicide attempts , as well as SCID-derived Axis I and patient endorsed Axis II comorbidity . RESULTS Those who endorsed a history of child or adolescent physical or sexual  abuse , compared with those who did not , had a history of an earlier onset of bipolar illness , an increased number of Axis I , II , and III comorbid disorders , including drug and alcohol abuse , faster cycling frequencies , a higher rate of suicide attempts , and more psychosocial stressors occurring before the first and most recent affective episode . The retrospectively reported associations of early abuse with a more severe course of illness were vali date d prospect ively . CONCLUSIONS Greater appreciation of the association of early traumatic experiences and an adverse course of bipolar illness should lead to preventive and early intervention approaches that may lessen the associated risk of a poor outcome BACKGROUND Binge-eating disorder is a newly recognized eating disorder characterized by recurrent episodes of binge eating without compensatory weight loss behaviors . It commonly co-occurs with depressive disorders and obesity . Citalopram is a highly selective serotonin reuptake inhibitor antidepressant . The purpose of this study was to assess the efficacy and safety of citalopram in the treatment of binge-eating disorder . METHOD Thirty-eight out patients with a DSM-IV diagnosis of binge-eating disorder were enrolled in the study between August 2000 and July 2001 and were r and omly assigned to receive either citalopram ( N = 19 ) or placebo ( N = 19 ) in a 6-week , double-blind , flexible-dose ( 20 - 60 mg/day ) study . The primary measure of efficacy was frequency of binge-eating episodes . Secondary measures included frequency of binge days , body mass index ( BMI ) , weight , Clinical Global Impressions-Severity of Illness scale scores , Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating ( YBOCS-BE ) scores , Hamilton Rating Scale for Depression ( HAM-D ) scores , and response categories . The outcome measures were analyzed using 2 r and om regression methods , with a time trend analysis ( primary analysis ) and an endpoint analysis . In addition , response categories were analyzed using an exact trend test . RESULTS Compared with placebo-treated subjects , subjects receiving citalopram ( mean dose of 57.9 mg/day ) had a significantly greater rate of reduction in frequency of binge eating ( p = .003 ) , frequency of binge days ( p < .001 ) , BMI ( p < .001 ) , weight ( p < .001 ) , severity of illness ( p = .028 ) , and YBOCS-BE score ( p = .007 ) and a marginally significant rate of reduction in HAM-D score ( p = .053 ) . Differences between groups in response categories were marginally significant ( p = .068 for intent-to-treat analysis ) . CONCLUSION In a 6-week , placebo-controlled , flexible-dose trial , citalopram was efficacious in reducing binge-eating frequency , weight , and severity of illness and was generally well tolerated in subjects with binge-eating disorder This study evaluated the efficacy and safety of lamotrigine in binge-eating disorder ( BED ) associated with obesity . Fifty-one out patients with BED by Diagnostic and Statistical Manual of Mental Disorders , fourth edition criteria , and obesity were r and omized to receive either lamotrigine ( N=26 ) or placebo ( N=25 ) in a 16-week , double-blind , flexible-dose study . Lamotrigine ( 236±150 mg/day ) and placebo had similar rates of reduction of weekly frequency of binge-eating episodes and binge days , weight and BMI , measures of eating pathology , obsessive – compulsive symptoms , impulsivity , and global severity of illness . However , lamotrigine was associated with a numerically greater amount of weight loss ( 1.17 vs. 0.15 kg ) and significant reductions in fasting levels of glucose , insulin , and triglycerides . It was also well tolerated and associated with no serious adverse events . As a result of an exceptionally high placebo response , it is likely that for efficacy measures except for body weight and metabolic indices , the study was incapable of detecting potentially clinical ly important drug – placebo difference BACKGROUND Many patients with bipolar disorder ( BD ) do not regain full function following an acute illness episode , but the extent to which this impairment is the result of persistent symptoms has not been well established . This study examined factors associated with persistent subsyndromal symptoms in a well characterized group of BD patients who were prospect ively followed for an average of 3 years . METHODS Detailed life charting data from 138 patients with BD were review ed . Patients were categorized into euthymic , subsyndromal or syndromal groups according to the clinical state during their most recent year of follow-up . The three groups were then examined with respect to comorbidity , function and treatment received . RESULTS Patients with subsyndromal symptoms had high rates of comorbid anxiety disorders , and were more likely to have increased rates of eating disorders as well . Patients with subsyndromal symptoms had lower global assessment of function ( GAF ) scores than euthymic patients , and had as many clinic contacts and medication trials as patients with full episodes of illness . CONCLUSIONS Persistent subsyndromal symptoms in BD patients are associated with high rates of comorbidity that is important to recognize and treat in order to optimize mood and functioning OBJECTIVE : To determine whether extremely obese binge eating disorder ( BED ) subjects ( BED defined by the Eating Disorder Examination ) differ from their extremely obese non-BED counterparts in terms of their eating disturbances , psychiatric morbidity and health status . DESIGN : Prospect i ve clinical comparison of BED and non-BED subjects undergoing gastric bypass surgery (GBP).SUBJECTS  : Thirty seven extremely obese ( defined as BMI ≥40 kg/m2 ) subjects ( 31 women , six men ) , aged 22–58 y. MEASUREMENTS : Eating Disorder Examination 12th Edition ( EDE ) , Three Factor Eating Question naire ( TFEQ ) , Structured Clinical Interview for the Diagnostic and Statistical Manual-IV ( SCID-IV ) , Short-Form Health Status Survey ( SF-36 ) , and  24 h Feeding Paradigm . RESULTS : Twenty-five percent of subjects were classified as BED ( 11 % met full and 14 % partial BED criteria ) and 75 % of subjects were classified as non-BED . BED ( full and partial ) subjects had higher eating disturbance in terms of eating concern and shape concern ( as found by the EDE ) , higher disinhibition ( as found by the TFEQ ) , and they consumed more liquid meal during the 24 h feeding paradigm . No difference was found in psychiatric morbidity between BED and non-BED in terms of DSM-IV Axis I diagnosis . The health status scores of both BED and non-BED subjects were significantly lower than US norms on all subscales of the SF-36 , particularly the BED group . CONCLUSION : Our findings support the validity of the category of BED within a population of extremely obese individuals before undergoing GBP . BED subjects differed from their non-BED counterparts in that they had a greater disturbance in eating attitudes and behavior , a poorer physical and mental health status , and a suggestion of impaired hunger/satiety control . However , in this population of extremely obese subjects , the stability of BED warrants further study Background Eating disorders cause significant burden that may be reduced by early and appropriate help-seeking . However , despite the availability of effective treatments , very few individuals with eating disorders seek treatment . Training in mental health first aid is known to be effective in increasing mental health literacy and supportive behaviours , in the social networks of individuals with mental health problems . Increases in these domains are thought to improve the likelihood that effective help is sought . However , the efficacy of mental health first aid for eating disorders has not been evaluated . The aim of this research was to examine whether specific training in mental health first aid for eating disorders was effective in changing knowledge , attitudes and behaviours towards people with eating disorders . Methods A repeated measures , uncontrolled trial was conducted to establish proof of concept and provide guidance on the future design of a r and omised controlled trial . Self-report question naires , administered at baseline , post-training and 6-month follow-up , assessed the effectiveness of the 4-hour , single session , mental health first aid training . Results 73 participants completed the training and all question naires . The training intervention was associated with statistically significant increases in problem recognition and knowledge of appropriate mental health first aid strategies , which were maintained at 6-month follow-up . Sustained significant changes in attitudes and behaviours were less clear . 20 participants reported providing assistance to someone with a suspected eating disorder , seven of whom sought professional help as a result of the first aid interaction . Results provided no evidence of a negative impact on participants or the individuals they provided assistance to . Conclusions This research provides preliminary evidence for the use of training in mental health first aid as a suitable intervention for increasing community knowledge of and support for people with eating disorders to seek appropriate help . Trial registration Australian New Zeal and Clinical Trials Registry OBJECTIVE To determine the conversion risk and predictors for depression in women with polycystic ovary syndrome . DESIGN Prospect i ve longitudinal study . SETTING University practice . PATIENT(S ) Subjects with polycystic ovary syndrome who had participated in a previous study . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) The Primary Care Evaluation of Mental Disorders Patient Health Question naire was used to diagnose major depressive disorder and other depressive syndromes , anxiety syndromes , and binge eating disorder . Subjects completed a question naire on knowledge about polycystic ovary syndrome and treatment satisfaction . RESULT ( S ) A total of 60 of 103 subjects responded to the second survey . Mean time between the two surveys was 22 months ( range 12 - 26 months ) . The overall prevalence of depression was 40 % ( 24/60 ) . Of these , 10 women screened positive for major depressive disorder or other depressive syndromes and 14 were receiving antidepressant medications  . There were 11 new cases identified in the second survey ( 19 % conversion ) . Total subjects with mood disorders in this study were 34/60 ( 56.6 % ) , including 11.6 % with anxiety syndromes and 23.3 % with binge eating disorder . Difficulties with menstrual function , fertility , and body image ( weight , hirsutism , acne ) were not significantly different in women with and without depression . CONCLUSION ( S ) There is a significant risk for mood disorders ( defined by the Diagnostic and Statistical Manual of Mental Disorders-IV ) in women with polycystic ovary syndrome . This finding together with a high conversion risk for depression over a 1- to 2-year period underscores the importance of routine screening and aggressive treatment of mental health disorders in this population
These have been of limited long-term effectiveness , though early intervention post-first episode psychosis appears to be more promising [ 6 ] .
Hence , the effectiveness of Cognitive Behaviour Therapy ( CBT ) or
Background Eating disorders are understood to no longer be the remit of lean adolescent girls alone [ 1 ] , whatever pop culture offerings such as Netflix ’s To The Bone might continue to present .
Rather , people with eating disorders are much more diverse , often undiagnosed and often suffering in silence .
One patient population with a unique but poorly understood vulnerability to eating disorders , as well as obesity and poor physical health , is people with bipolar disorder .
Bipolar disorder is a complex , serious mental illness that confers significant functional impairment , primarily due to time spent in manic , depressed , or mixed state episodes , difficulty eliminating subthreshold depressive symptoms , and the financial , social and emotional sequelae of illness episodes .
One significant contributor to disability is physical ill health , with the average life expectancy of someone with bipolar disorder notably reduced due to cardiometabolic illnesses like heart disease and type two diabetes mellitus .
Furthermore , poorer physical health is associated with poorer mental health in this group , such as higher risk of depressive relapse [ 2 , 3 ] .
The past two decades has seen increased focus on preserving and improving the physical health of people with bipolar disorder , who are often prescribed long-term medication known to be conducive to weight gain [ 4 ] .
Trials of a number of interventions have attempted to implement lifestyle interventions to promote healthy eating , physical activity , and social connectedness , in order to prevent or reduce the adverse impact of obesity and improve physical health and psycho-social functioning [ 5 ] .
The role of disordered eating in contributing to physical and mental health outcomes among individuals with bipolar disorder has rarely been considered , despite the fact that approximately one in three people with bipolar disorder also meet criteria for binge eating disorder , bulimia nervosa , or variants of these disorders [ 7 , 8 ] .
Alongside studies question ing the impact of medication on weight gain in bipolar disorder [ 9 ] , identifying the role of weight-cycling in higher cardiovascular risk [ 10 ] , and showing that obesity risk pre- date s medication [ 11 ] , are reports of a link between eating disorders and high Body Mass Index ( BMI , kg/m ) [ 12 ] and evidence that baseline binge eating predicts medication-associated weight gain [ 13 ] .
With these recent developments in mind , the authors were curious about what novel interventions for eating disorders and weight disorder in bipolar disorder exist , and conducted a systematic review about their effectiveness .
In this search no treatments targeting eating disorders specifically were found to exist [ 14 ] , despite the movement of this area into the spotlight over 10 years ago [ 15 ] .