Psychiatry - Research Publications
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ItemArterial stiffness in underweight and weight-restored anorexia nervosa(WILEY, 2021-11)Cardiovascular complications have been demonstrated in patients with anorexia nervosa (AN) in both the state of starvation and during weight restoration, however, the underlying mechanisms remain unclear. The current study aimed to assess arterial stiffness via carotid-femoral pulse wave velocity (cfPWV) in the acute and weight-restored states of AN. The study also aimed to determine the association between psychological distress and cfPWV. The sample included 37 participants; 10 participants with AN, 17 who were weight-restored (AN-WR; minimum body mass index >18.5 for at least 12 months) and 10 healthy controls (HCs). cfPWV via applanation tonometry was conducted to assess arterial stiffness. Psychological distress was assessed using the depression anxiety stress scale (DASS-21) and the state-trait anxiety inventory (STAI). Between-group comparisons were performed to determine differences between groups, a two-stage hierarchical regression model was performed to determine the contribution of physiological and psychological variables on cfPWV and correlation analyses were also performed. Vascular stiffness was significantly increased in the AN and AN-WR groups, relative to HCs. The total DASS score was the only significant predictor of cfPWV across the sample. There were positive associations between cfPWV and depression, anxiety and stress, as assessed by the DASS. Furthermore, cfPWV was positively associated with STAI trait anxiety. Arterial stiffness was increased in individuals in the acute and weight-restored states of AN, demonstrating early signs of the development of arteriosclerotic cardiovascular disease. Increased arterial stiffness was associated with increased psychological distress, which may be a contributing mechanism to the increased cardiovascular risk in AN.
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ItemWhat is OSFED? The predicament of classifying 'other' eating disorders(CAMBRIDGE UNIV PRESS, 2021-08-12)The transition from DSM-IV to DSM-5 relaxed diagnostic criteria for anorexia nervosa and bulimia nervosa, and recognised a third eating disorder, binge eating disorder. However, a large proportion of cases remain in the ill-defined category of 'other specified feeding and eating disorders'. We sought to investigate the utility of a proposed solution to classify this group further, subdividing based on the dominant clinical feature: binge eating/purging or restraint. Cluster analysis failed to identify clusters in a treatment-seeking sample based on symptoms of restraint, binge eating, purging and over-evaluation of shape and weight. Further investigation of this highly heterogeneous group is required.
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ItemAutonomic Nervous System Function in Anorexia Nervosa: A Systematic Review(FRONTIERS MEDIA SA, 2021-06-28)Background: Autonomic nervous system (ANS) dysfunction has been suggested to contribute to the high prevalence of cardiovascular complications in individuals with anorexia nervosa (AN), yet has not been thoroughly investigated. The current review aimed to synthesize the evidence of basal ANS function in individuals with a current diagnosis of AN and those with a previous diagnosis who had achieved weight restoration, as compared to controls. Methods: A systematic review of nine databases was conducted and studies that were published in a peer-review journal, in English, that included at least one assessment of ANS function in individuals with a current or previous diagnosis of AN were selected. Forty-six studies were included with a total of 811 participants with a current diagnosis of AN and 123 participants with a previous diagnosis of AN. Results: ANS function was assessed through heart rate variability (n = 27), orthostatic challenge, blood pressure variability or baroreflex sensitivity (n = 11), adrenergic activity (n = 14), skin conductance level (n = 4), and pupillometry (n = 1). Individuals with AN demonstrated increased parasympathetic activity and decreased sympathetic activity, suggestive of autonomic dysregulation. Following weight restoration, autonomic function trended toward, or was equivalent to, control levels. Discussion: Autonomic dysregulation is indicated through a range of assessments in individuals with AN. Future investigations should utilize a variety of assessments together in order to conclusively establish the nature of autonomic dysfunction in AN, and following extended weight restoration. Moreover, investigation into the co-occurrence of ANS function and cardiovascular risk is required.
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ItemPeer mentoring for eating disorders: results from the evaluation of a pilot program(BMC, 2019-06-03)BACKGROUND: Eating disorders (EDs) are serious psychiatric illnesses that have high rates of morbidity and mortality, and low long-term recovery rates. Peer mentor programs (PMPs) have been associated with reduced psychiatric hospitalisation and shorter lengths of stay for those with other severe mental illnesses. The present study evaluated the feasibility and preliminary efficacy of a PMP for individuals with EDs in improving symptomatology and quality of life. METHODS: Thirty mentees and seventeen mentors were recruited. The PMP involved thirteen sessions over 6 months. Participants completed measures assessing ED symptomatology, quality of life (QoL), mood and perceived disability. Changes in symptomatology before and after the PMP were tested by Wilcoxon signed rank tests. Semi-structured interviews were conducted for qualitative evaluation of the PMP. RESULTS: The program was deemed to have moderate feasibility with eight of 30 mentees, and two of 17 mentors withdrawing. Completion rates ranged from 2 to 16 sessions, and between 3 and 45 weeks. Mentees demonstrated improvements in body mass index, QoL, ED symptomatology, mood (depression, anxiety and tension/stress) and perceived disability from pre- to post-program. Mentors demonstrated significant increases in ED symptomatology, but no worsening of QoL, mood or perceived disability. Qualitative findings from both mentees and mentors were positive: emergent themes included hope for recovery, a sense of agency and inspiration gained from interaction with someone with lived experience of an ED. CONCLUSIONS: This pilot study suggests feasibility of the PMP for individuals with EDs. Mentees demonstrated improvements in ED symptomatology, QoL, mood and perceived disability. However, the increase in ED symptomatology reported by the mentors over the PMP highlights potential risks and the need for thorough monitoring while preliminary evaluation is undertaken. The mentoring relationship was a positive experience for both mentees and mentors, instilling an increased hope for recovery in mentees and an opportunity for mentors to reflect on their own recovery with increased confidence. The novel relationship formed throughout mentorship highlights a potential gap in current clinical support services, which warrants further exploration within a controlled trial. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registration Number: ACTRN12617001412325. Retrospectively registered: 05/10/2017. Date of first enrolment: 20/01/2017. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373741&isReview=true.
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ItemPeer mentoring for individuals with an eating disorder: a qualitative evaluation of a pilot program(BMC, 2020-07-01)BACKGROUND: After receiving intensive medical treatment; individuals with eating disorders often require ongoing care to maintain their recovery, build social networks, and reduce risk of relapse. METHODS: To address this important transition period, a six-month peer mentoring program was developed and piloted in Melbourne, Australia. Twelve adults with a past history of an eating disorder (mentors) were paired with 14 individuals with a current eating disorder (mentees). Pairs met for thirteen mentoring sessions in community settings. Throughout the program mentees and mentors completed reflective questions online. Upon completion of the program, qualitative interviews were conducted. Both online reflections and interviews explored themes relating to perceived benefits and challenges of participation in the peer mentoring program, and the differences between mentoring and traditional treatment. RESULTS: Thematic analysis identified several benefits for mentees; including hope, reconnection with others, and re-engaging with the world. The majority of mentees described their mentor as uniquely supportive due to their past experience of an eating disorder. Mentors reported experiencing benefits such as increased connection with self and others, and indicated that the experience helped them positively reframe their past experience of an eating disorder. Ending the relationship at the completion of the program was a significant challenge for both groups, and managing boundaries was deemed a main challenge by mentors. CONCLUSIONS: Overall, results indicated that this mode of informal support may be worthy of further investigation as an adjunct to clinical treatment programs for this population. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials registration number - ACTRN12617001412325 - Date of registration - 05/10/2017 (Retrospectively registered).