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Over the last 30 years, several questionnaires have been developed and validated in order to assess many aspects of the motivation to eat that might be susceptible to impair adequate food intake and body weight control. A few of such questionnaires are described here, in particular, the "Three Factor Eating Questionnaire" also called the "Eating Inventory", and the "Dutch Eating Behavior Questionnaire". Critical aspects of the motivation to eat assessed by these tools are presented, such as dietary restraint, disinhibition, hunger, vulnerability to eat in response to external cues or emotional states, etc. These questionnaires were developed for use in the general population with the aim to identify critical aspects of the motivation to eat that might predispose to weight gain. They have been widely used in many countries and have allowed an improved understanding of the individual characteristics that predispose to body weight gain or resistance to weight loss. Originally, poor body weight control was attributed to a high level of dietary "restraint", or in other words, the tendency to deliberately restrict one's food intake for body weight control purposes. Such dietary restraint was suspected to lead to a number of physical and psychological difficulties, among which poor self-esteem and a paradoxical tendency to gain weight, resulting from the incapacity to maintain strict restraint over time. More recent studies have established that a motivational trait called "Disinhibition" is a strong predictor of body weight gain over time and of poor outcome of dieting. "Disinhibition" corresponds to a tendency to lose control over one's eating behavior and ingest excessively large quantities of food substances, in response to a variety of cues and circumstances. In addition to its untoward effect on weight, disinhibition also predicts various risk factors and pathologies, such as hypertension and diabetes. Other potentially critical dimensions for adequate body weight control are "emotional eating" and "externality", which represent an individual's vulnerability to eat in response to emotional states or external cues, respectively. These questionnaires have been translated into French and validated for the French population. Average data are available for normal weight and obese French men and women. A gender difference is often reported: women, and even young girls, tend to have higher scores than males for most dimensions. These questionnaires have been extensively used in populations without psychiatric disorders, with the only exception of diagnosed eating disorders such as anorexia and bulimia nervosa. The questionnaires have not been used until now in populations with other types of psychiatric disorders, such as schizophrenia or bipolar disease. Their relevance for such populations is now an important question, since last generation pharmaceutical treatments of such psychiatric disorders seem to adversely affect body weight control. It then becomes critical to know whether the psychological dimensions assessed by such questionnaires reflect the action of pharmacological agents that induce weight gain. A research project is now in progress at Sainte-Anne Hospital to investigate many dimensions of the motivation to eat, as assessed by the questionnaires, in psychiatric patients receiving various types of antipsychotic agents. The results of this original study might provide hints about the mechanisms that lead to body weight gain in patients receiving certain types of antipsychotic pharmacological agents and potentially help in preventing or reversing the weight gain associated with such treatments.
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PMID:[Assessing various aspects of the motivation to eat that can affect food intake and body weight control]. 1939 89

In recent years, there has been an increase in obesity in the general population in both adults and children. Certain mental disorders have been found to co-occur with overweight and obesity. These include binge-eating disorder and bulimia nervosa (nonpurging type), bipolar disorder, certain forms of major depressive disorder, and some severe, chronic mental illness (ie, schizophrenia and schizoaffective disorder). At the same time, some studies have also found that obesity co-occurs with certain mental disorders--specifically binge-eating disorder and mood disorders in females. The co-occurrence of psychiatric disorders (ie, mood and psychotic disorders), binge eating, and overweight or obesity has important public health implications for the treatment of patients with mental disorders, especially since many psychotropic agents can have adverse effects on appetite, binge eating, and weight. Physicians need to keep 2 key points in mind: 1) The treatment of mental disorders in patients with obesity may be different from the treatment of such patients who are not obese, and 2) The treatment of obesity that co-occurs with psychopathology may be different from obesity that is not comorbid with psychopathology.
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PMID:The relationship between severe mental illness and obesity. 1966 51

Despite evidence from case series, the comorbidity of eating disorders with psychosis is less investigated than their comorbidity with anxiety and mood disorders. We investigated the occurrence of symptoms of psychosis in 112 female patients diagnosed with DSM-IV eating disorders (anorexia nervosa=61, bulimia nervosa=51) and 631 high school girls in the same health district as the patients: the items of the SCL-90R symptom dimensions "paranoid ideation" and "psychoticism" were specifically examined. No case of co-morbid schizophrenia was observed among patients. Compared with controls, the patients with anorexia nervosa were more likely to endorse the item "Never feeling close to another person"; the patients with bulimia nervosa were more likely to endorse the item "Feeling others are to blame for your troubles". Both groups of patients were more likely than controls to endorse the item "Idea that something is wrong with your mind". The students who were identified by the EAT and the BITE as being "at risk" for eating disorders were more likely to assign their body a causative role in their problems. Symptoms of psychosis can be observed in patients with eating disorders, but these could be better explained within the psychopathology of the disorders rather than by assuming a link with schizophrenia.
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PMID:Symptoms of psychosis in anorexia and bulimia nervosa. 2002 83

Obesity and binge eating disorder are common in individuals with psychotic disorders. Eating and weight-related cognitions are known to influence eating behaviors. The study was designed to assess the psychometric properties of the Mizes Anorectic Cognitions Questionnaire (MAC-R) in patients with psychotic disorders. Binge eating disorder (BED), body mass index (BMI), the MAC-R and the three factor eating questionnaire (TFEQ) were assessed in 125 patients with a diagnosis of schizophrenia or schizoaffective disorder. Whereas the MAC-R has not acceptable psychometric properties, a brief version of the MAC-R (BMAC) has good psychometrical properties and is correlated with TFEQ and BMI. Binge eating disorder is also correlated to the Rigid Weight Regulation and Fear of Weight Gain subscale. The BMAC is a useful brief measure to assess eating and weight related cognitions in people with psychotic disorders.
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PMID:A measure of dysfunctional eating-related cognitions in people with psychotic disorders. 2003 30

Neurotrophins, particularly, NGF and BDNF are now well recognized to mediate a dizzying number of trophobiological effects, ranging from the Rita Levi-Montalcini's neurotrophic through immunotrophic to metabotrophic effects.These are implicated in the pathogenesis of various diseases including neuropsychiatric and cardiometabolic diseases, such as dementia, depression, type 2 diabetes and obesity that may express a common phenotype and coexistence. Recently, adipobiology (adiposcience) as become a focus of numerous studies showing that the adipose tissue is the body's largest endocrine organ producing multiple signaling proteins, including NGF and BDNF, all these dubbed adipokines. On the basis of our and other authors' evidence that low NGF and/or BDNF levels are found in cardiometabolic diseases (atherosclerosis, obesity, type 2 diabetes, metabolic syndrome), a hypothesis of a critical role of neuro-metabotrophic deficit in the pathogenesis of these diseases has been raised. Since NGF and BDNF also exerts various synaptotrophic effects involved in cognitive enhancement, this hypothesis might also be related to neuropsychiatric diseases such as dementia, depression, schizophrenia, autism, Rett syndrome, anorexia nervosa, and bulimia nervosa. Finally, NGF- and BDNF-based therapeutic approach, including ampakines, antidepressants, selective deacetylase inhibitors, statins, peroxisome proliferator-activated receptor gamma agonists, and "brain food" and calorie restriction, is outlined.
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PMID:NGF and BDNF: from nerves to adipose tissue, from neurokines to metabokines. 2006 8

This article reports on a meta-analysis of Cloninger's temperament dimensions (novelty seeking, harm avoidance, reward dependence, and persistence) in individuals with lifetime psychiatric disorders compared with controls and on interdisorder comparisons between these disorders. Nine disorders from 75 studies were included in the meta-analyses. The most consistent feature was elevated harm avoidance: compared with the controls, harm avoidance was higher in all diagnostic groups studied except for those with alcohol use disorders. The increase in effect sizes in harm avoidance scores varied from a very large (d = 2.66) in social phobia to a small effect (effect size, d = 0.29) in alcohol use disorders. In other dimensions, differences between cases and controls were relatively small. However, in pairwise comparisons, notable differences also in other dimensions emerged: in novelty seeking, the lowest scores were in social phobia (d = -0.87) and the highest in bulimia nervosa (d = 0.33); in reward dependence, the lowest scores were in schizophrenia (d = -0.36) and the highest in social phobia (d = 0.12); and in persistence, the lowest scores were in social phobia (d = -0.30) and the highest in anorexia nervosa (d = 0.49). The provided data should be taken into account in the future studies on suggestive vulnerability markers for psychiatric morbidity.
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PMID:A meta-analysis of temperament in axis I psychiatric disorders. 2156 34

The study is focused on two research questions: What are the public's estimates of the prevalence of depression, schizophrenia, bulimia nervosa and anorexia nervosa? What is the relationship between the estimated prevalence of the mental disorders and the public's desire for social distance? Analyses are based on a telephone survey in two large German cities (Hamburg and Munich, N=2014, response rate 51%). Vignettes with typical signs and symptoms suggestive of a depression, schizophrenia, bulimia nervosa and anorexia nervosa were presented. Respondents were asked about the lifetime prevalence of the mental disorders and their desire for social distance. Across all four disorders under study the respondents markedly overestimate the rates of lifetime prevalence. Increasing prevalence estimation is associated with a significant decrease in the desire for social distance in case of schizophrenia. As for depression, anorexia nervosa and bulimia nervosa there are no significant associations. Many campaigns aimed at reducing stigma emphasize the high prevalence of mental disorders. The assumption of these campaigns is that reduction of the perceived distinction leads to a decrease of the desire for social distance towards those afflicted. Our results indicate that this may not generally be an effective way to reduce stigma.
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PMID:Estimated prevalence of mental disorders and the desire for social distance--results from population surveys in two large German cities. 2362 51

Psychostimulants play a central role in the management of ADHD. Here we review the evidence pertaining to the use of methylphenidate, dexamphetamine and related amphetamine salts, the prodrug lisdexamfetamine and modafinil for the management of comorbid ADHD and non-ADHD indications. There is a growing consensus that stimulant medications are helpful at improving the emotional dysregulation and lability, and oppositional and conduct symptoms that are often associated with ADHD. There is some evidence that psychostimulants may improve outcomes in those with treatment resistant depression, reduce negative symptoms and improve cognitive performance in schizophrenia, and that methylphenidate may reduce binge eating in those with bulimia nervosa. In general medicine, whilst the evidence is at times contradictory, psychostimulants have been shown in some studies to be effective treatments for chronic fatigue and narcolepsy, and to improve outcomes post stroke, post head injury, in dementia and various cancers. It seems likely that these effects often result from a combination of, reduction in fatigue, improvements in concentration and cognitive functioning and a lifting of mood which may be a direct or indirect consequence of the medication. Further studies seem warranted and these should focus on efficacy, effectiveness and long term safety. This article is part of the Special Issue entitled 'CNS Stimulants'.
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PMID:The use of stimulant medications for non-core aspects of ADHD and in other disorders. 2495 55

Recent evidence indicates that perinatal exposure to maternal obesity, metabolic disease, including diabetes and hypertension, and unhealthy maternal diet has a long-term impact on offspring behavior and physiology. During the past three decades, the prevalence of both obesity and neuropsychiatric disorders has rapidly increased. Epidemiologic studies provide evidence that maternal obesity and metabolic complications increase the risk of attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, anxiety, depression, schizophrenia, eating disorders (food addiction, anorexia nervosa, and bulimia nervosa), and impairments in cognition in offspring. Animal models of maternal high-fat diet (HFD) induced obesity also document persistent changes in offspring behavior and impairments in critical neural circuitry. Animals exposed to maternal obesity and HFD consumption display hyperactivity, impairments in social behavior, increased anxiety-like and depressive-like behaviors, substance addiction, food addiction, and diminished cognition. During development, these offspring are exposed to elevated levels of nutrients (fatty acids, glucose), hormones (leptin, insulin), and inflammatory factors (C-reactive protein, interleukin, and tumor necrosis factor). Such factors appear to permanently change neuroendocrine regulation and brain development in offspring. In addition, inflammation of the offspring brain during gestation impairs the development of neural pathways critical in the regulation of behavior, such as serotoninergic, dopaminergic, and melanocortinergic systems. Dysregulation of these circuits increases the risk of mental health disorders. Given the high rates of obesity in most developed nations, it is critical that the mechanisms by which maternal obesity programs offspring behavior are thoroughly characterized. Such knowledge will be critical in the development of preventative strategies and therapeutic interventions.
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PMID:The role of maternal obesity in the risk of neuropsychiatric disorders. 2615 Jul 67

Accurate interpretation and appropriate expression of emotions are key aspects of social-cognition. Several mental disorders are characterised by transdiagnostic difficulties in these areas and, recently, there has been increasing interest in exploring the effects of oxytocin on social-emotional functioning. This review consists of 33 studies. Fifteen of the studies included people with autism spectrum disorder, schizophrenia, borderline personality disorder, frontotemporal dementia, anorexia nervosa, bulimia nervosa, post-traumatic stress disorder, depression, and opioid and alcohol dependence. We conducted ten meta-analyses examining the effects of intranasal oxytocin on expression of emotions, emotional theory of mind, sensitivity to recognise basic emotions, and recognition of basic emotions. A single dose of intranasal oxytocin significantly improved the recognition of basic emotions, particularly fear, and increased the expression of positive emotions among the healthy individuals. Oxytocin did not significantly influence theory of mind or the expression of negative emotions among the healthy individuals. Finally, intranasal oxytocin did not significantly influence interpretation or expression of emotions among the clinical populations.
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PMID:Meta-analysis of the effects of intranasal oxytocin on interpretation and expression of emotions. 2846 93


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