First Published Tuesday, 24 March 2009

Kate Hilpern 23 March 2009 14:03

First Published Tuesday, 24 March 2009

First Published Wednesday, 25 March 2009

First Published Wednesday, 25 March 2009

Images of the right and left hemispheres of the brain, as viewed from the side. The colors represent the differences in cortical thickness between the high-risk group, which has a family history of depression, and the low-risk group, which has no known risk. Blue and purple represent the thinning of the cortex, with purple regions having the greatest thinning. Green areas show no significant differences between the two groups.

Published: March 24, 2009

Scientists who have been following families with a history of depression have found structural differences in family members’ brains — specifically, a significant thinning of the right cortex, the brain’s outermost surface. The thinning may be a trait or a marker of vulnerability to depression, the researchers suggested.

The scientists’ brain imaging study found the thinning in descendants of depressed parents and grandparents, whether or not the individuals themselves had ever suffered a depressive episode or an anxiety disorder, researchers said.

“That’s what is so extraordinary. You’re seeing it two generations later, and you’re seeing it in both children and adults,” said Dr. Bradley S. Peterson, a professor of psychiatry at Columbia College of Physicians and Surgeons and the paper’s first author. “And it’s present even if those offspring themselves have not yet become ill.”

While people may assume that a familial trait is genetic, that is not necessarily the case, Dr. Peterson added. “We don’t know if this has a genetic origin or if it’s a consequence of growing up with parents or grandparents who are ill. Studies have shown that when parents are depressed, it changes the environment in which children are growing up.”

The paper, to be published in the Proceedings of the National Academy of Sciences, is an outgrowth of research started 27 years ago by Dr. Myrna Weissman to investigate the familial roots of depression. Dr. Weissman is the paper’s senior author.

The scientists conducted brain imaging of 131 individuals, including children and adults ages 6 to 54, about half of whom were considered at high risk for depression because of their family history and half of whom were in a low-risk group. Maps of cortical thickness showed significant thinning of 28 percent on average across broad expanses of the right cerebral hemisphere in the high-risk group, compared with the low-risk group, the paper reported.

The cerebral cortex is the region of the brain centrally involved in reasoning, planning and mood, and thinning of the cortex may affect an individual’s ability to pay attention to and interpret social and emotional cues, scientists suggested.

“If you have thinning in this portion of the brain, it interferes with the processing of emotional stimuli,” Dr. Peterson said. “We think that’s what makes them vulnerable to developing anxiety and depression — it essentially isolates them in an emotional world.”

While thinning in the right hemisphere was not associated with actual depression, additional thinning in the same region of the left hemisphere was, and “seems to tip you over from having a vulnerability to depression to actually developing symptoms,” Dr. Peterson said.

Dr. Helen Mayberg, a professor of psychiatry and neurology at Emory University, said that the study’s size was impressive and that it provided “another piece of the puzzle that identifies some brain areas for us to pay more attention to.”

“Is it a risk factor? A sign of depression? A sign you will get depression?” Dr. Mayberg asked. “These are really complicated and interesting questions.”

Source:   http://www.nytimes.com/2009/03/25/health/25brain.html?_r=1&ref=health

First Published Thursday, 26 March 2009

A University of Iowa study found that when a friend of a friend attempts suicide, at-risk teens are more likely to seriously consider doing so. But at-risk teens are less likely to be suicidal if they hold summer jobs.

In fact, summer employment is more of a deterrent than holding a job during the school year, attending church, participating in sports or living in a two-parent home, according to the research by Rob Baller, associate professor of sociology in the University of Iowa College of Liberal Arts and Sciences, who co-authored the study with Kelly Richardson, a data analyst at the Iowa City VA Medical Center.

“Summer employment is thought to be beneficial because it creates self-esteem while reducing isolation and substance abuse, and it does not conflict with school work in the way a job during the school year could,” Baller said.

Risk factors for teen suicide include heavy alcohol consumption, physical fights, obesity, same-sex attraction and rape victimization. Among adolescents with more of these risk factors, working a paid summer job 20 or more hours a week creates immunity against the friend-to-friend diffusion of suicidal thoughts and behaviors. At-risk teens who are 16 or younger can work just 10 hours a week in the summer to reap the same benefit.

Unemployment rates for teens have continued to climb throughout the economic downturn. The latest figures from the U.S. Bureau of Labor Statistics show the percentage of unemployed teens approaching 22 percent, far higher than the rates for adults.

“If unemployment continues to rise, teens may have a tough time finding jobs this summer,” Richardson said. “Possible solutions could include working for pay within the family or for a friend of the family.”

The researchers do offer one caveat: in order for summer employment to be beneficial, it must not expose troubled teens to additional problems. Working teens can be vulnerable to workplace harassment because of their inexperience and the ease with which they can be replaced, Baller said. E.J. Graff of the Schuster Institute for Investigative Journalism at Brandeis University found the problem of teen harassment in the workplace to be significant. Coverage of this issue can be viewed at http://www.pbs.org/now/shows/508/.

“Working teens should be empowered to be intolerant of workplace harassment,” Baller said. “Teens in the work force should be encouraged to speak openly with parents and supervisors if they experience it.”

The study was an analysis of data from the 1994-1996 National Longitudinal Study of Adolescent Health, which included information on friendship networks of 2,000 students at 15 junior and senior high schools. Effects of friends of friends attempting suicide were found controlling for suicide attempts by friends and family members, and the respondent’s prior suicidal thoughts, among other controls.

The study will be published in the September 2009 issue of the Journal of Health and Social Behavior. The research was supported the Center for Criminology and Socio-Legal Studies in the UI Department of Sociology.

Source:   http://www.medicalnewstoday.com/articles/143751.php

First Published Friday, 27 March 2009

Fifty-five percent of children who underwent an intensive so-called one-session treatment of three hours were freed from their phobia. The treatment is carried out on a single occasion, is quick and cost-effective, with no side effects. The treatment form is also culture-neutral and does not need to be adapted to the country or the place it is to be used.

“Children who are not cured of their phobias run a great risk of developing other areas of anxiety later on. It’s therefore important to find effective forms of treatment that can reduce this risk. The method we have now tested also functions for other types of phobias,” says Lena Reuterskiöld.

In a one-session treatment the children, together with their therapist, gradually approach what they are afraid of in a controlled and planned manner. The therapist describes and carefully demonstrates before the child is allowed to try. Because the children remain in the anxiety-inducing situation, they can experience how their anxiety and fear abates and how the expected catastrophe in fact does not occur. With the patient remaining in the situation for an extended period, without running away, new learning occurs, producing a development toward a new behavior. This is all done on a voluntary basis, which is also a precondition for successful treatment.

“One-session treatment has also proven to be effective over time. Adults who have been treated with this method have been able to notice the effects of the treatment more than a year after the session. And nothing indicates that the effect would taper off sooner in children, which we assume will soon be confirmed by a follow-up study,” says Lena Reuterskiöld.

Besides the time aspect, the treatment offers other positive consequences.

“In cases where there anxiety problems of another kind than that targeted by the treatment, they too were alleviated in connection with a one-session treatment. This seems to indicate that the children take with them the knowledge they attain from this brief intervention and apply it to other problem areas,” says Lena Reuterskiöld.

The dissertation is based on three empirical studies of children and adolescents with various specific phobias in Stockholm, Sweden, and in Virginia in the US. The overarching purpose of the treatment was to contribute to our understanding of fears, anxiety, and specific phobias in children and to evaluate the efficacy and the transferability of one-session treatment for specific phobias in children from one culture to another.

The most important answers in the study are that one-session treatment is an effective treatment for children and adolescents with different types of specific phobias, that the effects last for at least six months, and that such treatment appears to be transferable from one culture and country to another.

“Fears, anxiety, and specific phobias in children and adolescents are no new phenomena, but their incidence seems to be increasing. Fortunately our understanding and willingness to treat them has also grown,” says Lena Reuterskiöld.

Source:   http://www.sciencedaily.com/releases/2009/03/090326085222.htm

A Biochemical Pathway For Blocking Your Worst Fears?

A receptor for glutamate, the most prominent neurotransmitter in the brain, plays a key role in the process of “unlearning,” report researchers at the Salk Institute for Biological Studies. Their findings, published in the current issue of the Journal of Neuroscience, could eventually help scientists develop new drug therapies to treat a variety of disorders, including phobias and anxiety disorders, particularly post-traumatic stress disorder.

“Most studies focus on ‘learning,’ but the ‘unlearning’ process is probably just as important and much less understood,” says Stephen F. Heinemann, Ph.D., a professor in the Molecular Neurobiology Laboratory, who led the study. “Most people agree that failure to ‘unlearn’ is a hallmark of post-traumatic stress disorders and if we had a drug that affects this gene it could help soldiers coming back from the war to ‘unlearn’ their fear memories.”

Post-traumatic stress disorder or PTSD is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. PTSD is affecting approximately 5.2 million Americans, according to the National Institute of Health. As many as one in eight returning soldiers suffer from PTSD.

But you don’t have to be a combat soldier to develop anxiety disorders such as PTSD. Any bad experience in daily life is a learning experience that can result in anxiety disorders. If traumatic memories persist inappropriately, sensory cues, sometimes not even recognized consciously, trigger recall of the distressing memories and the associated stress and fear.

As a way of modeling anxiety disorders in humans, researchers train mice to fear a tone by coupling it with a foot shock. If this fear conditioning is followed by repeated exposure to the tone without aversive consequences, the fear will subside, a behavioral change called fear extinction or inhibitory learning.

Heinemann and his team were particularly interested in whether mGluR5, short for metabotropic glutamate receptor 5, which had been shown to be involved in several forms of behavioral learning, also plays a role in inhibitory learning. “Inhibitory learning is thought to be a parallel learning mechanism that requires the acquisition of new information as well as the suppression of previously acquired experiences to be able to adapt to novel situations or environments,” says Heinemann.

When senior research associate and first author Jian Xu, Ph.D., put mice lacking the gene for mGluR5 through the fear extinction-drill, they were unable to shake off their fear of the now harmless tone. “We could train the mice to be afraid of the tone but they were unable to erase the association between the tone and the negative experience,” he says.

In the second series of experiments, Xu tested whether deleting mGluR5 also affected animals’ ability to learn new spatial information. He first trained mice to find a hidden platform placed in a fixed location in the water maze. Although it took mutant mice slightly longer than control animals to remember the position of the submerged platform, after several days of training the mutants finally got the hang of it and were able to find it almost as quickly as the control animals.

Xu then moved the platform to a different location in the water maze and re-trained the animals. He observed that normal animals quickly adjusted their searching strategy once they realized that the platform had been moved to a different spot. The mice lacking mGluR5, however, just couldn’t get it into their heads that the platform was no longer there and kept coming back to the original location. It took them several more trials until they finally gave up searching in the old location.

“Mice without mGluR5 had severe deficits in tasks that required them to ‘unlearn’ what they had just learned,” explains Xu. “We believe that the same mechanism is perturbed in PTSD and that mGluR could provide a potential target for therapeutic intervention.”

Notes:

In addition to Xu and Heinemann, postdoctoral researchers Yongling Zhu, Ph.D., and Anis Contractor, Ph.D., contributed to the research.

The Salk Institute for Biological Studies in La Jolla, California, is an independent nonprofit organization dedicated to fundamental discoveries in the life sciences, the improvement of human health, and the training of future generations of researchers. Jonas Salk, M.D., whose polio vaccine all but eradicated the crippling disease poliomyelitis in 1955, opened the Institute in 1965 with a gift of land from the City of San Diego and the financial support of the March of Dimes.

Source:
Gina Kirchweger
Salk Institute

http://www.medicalnewstoday.com/articles/143702.php

First Published Friday, 27 March 2009

By Rick Nauert, Ph.D.
Senior News Editor
Reviewed by John M. Grohol, Psy.D. on March 26, 2009

A collaborative study has demonstrated a positive link between cognitive ability and cortical thickness in the brains of healthy 6- to 18-year-olds.

The correlation is evident in regions that integrate information from different parts of the brain.

The imaging study published this week in a special issue of scientific journal Intelligence is the largest and most comprehensive of its kind with a representative sample of healthy children and adolescents.

This study stems from the National Institutes of Health MRI Study of Normal Brain Development, for which the Montreal Neurological Institute was the data coordinating center. The database contains MRI scans and other data on the structure and function of the developing brains.

More than 500 children and adolescents from newborns to 18-year-olds had brain scans multiple times over a period of years as well as intelligence, neuropsychological, verbal, nonverbal and behavioral tests.

This information is now contained within the database allowing scientists to study how normal developmental changes in brain anatomy relate to motor and behavioral skills, such as motor coordination and language acquisition. Even higher-order skills like planning, IQ, and organizational skills can be assessed.

Previous studies have shown that intelligence and cognitive ability are correlated with regional brain structure and function. The association between regional cortical thickness and intelligence has been little studied and most previous studies of normal children had a relatively small sample.

So with improvements in MRI-based quantification of cortical thickness and a much larger sample, researchers aimed to examine this relationship and to further characterize and identify brain areas where cortical thickness was associated with cognitive performance.

Cortical thickness may in part reflect the amount of complex connections between nerve cells. In other words, thicker cortices are likely to have more complex connections with consequences on cognitive ability.

A positive link between cortical thickness and cognitive ability was detected in many areas of the frontal, parietal, temporal and occipital lobes. The regions with the greatest relationship were the ‘multi-modal association’ areas, where information converges from various regions of the brain for processing.

“A principal finding of this study is that it supports a distributed model of intelligence where multiple areas of the brain are involved with cognitive ability difference instead of the view that there is just one center or structure important for intelligence differences in the brain,” says Dr. Sherif Karama, psychiatrist at the MNI and co-investigator in the study.

“Previous studies have shown a link between intelligence differences and individual brain structure or function. This is the first time that a correlation between a general cognitive ability factor and essentially most, if not all, cortical association areas is demonstrated in the same study.”

A deeper insight into normal cognitive functioning and abilities is an important first step in the understanding of cognitive decline observed in the elderly as well as in those with various pathologies ranging from multiple sclerosis to schizophrenia, depression and mental retardation.

Such an understanding may eventually lead to interventions that may be able to prevent or alleviate the decline or complications in cognitive function.

Source: McGill University

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First Published Friday, 27 March 2009

Friday, Sep 5 (Psych Central) —

Feeling a connection to others is a critical component of a person’s mental and physical health.

New studies show that a sense of rejection or isolation disrupts not only will power and perseverance, but also key cellular processes deep within the human body.

Chronic loneliness belongs among health risk factors such as smoking, obesity or lack of exercise.

Feeling connected to others is vital to a person’s mental well-being, as well as physical health, research at the University of Chicago shows.

The studies, reported in a new book, Loneliness: Human Nature and the Need for Social Connection, show that a sense of rejection or isolation disrupts not only abilities, will power and perseverance, but also key cellular processes deep within the human body.

The findings suggest that chronic loneliness belongs among health risk factors such as smoking, obesity or lack of exercise, according to lead author John Cacioppo, the Tiffany & Margaret Blake Distinguished Service Professor in Psychology at the University.

“Loneliness not only alters behavior, but loneliness is related to greater resistance to blood flow through your cardiovascular system,” Cacioppo said.

“Loneliness leads to higher rises in morning levels of the stress hormone cortisol, altered gene expression in immune cells, poorer immune function, higher blood pressure and an increased level of depression.

Loneliness also is related to difficulty getting a deep sleep and a faster progression of Alzheimer’s disease, said Cacioppo.

One of the founders of a new discipline called social neuroscience, Cacioppo used functional Magnetic Resonance Imaging (fMRI) brain scans and advanced scientific techniques to document the roles of loneliness and social connection as central regulatory mechanisms in human physiology and behavior.

The authors traced the need for connection to its evolutionary roots. In order to survive, humans needed to bond to rear their children. In order to flourish, they needed to extend their altruistic and cooperative impulses beyond narrow self-interest and immediate kin. But in the environment of evolutionary adaptation, the only real safety was in numbers.

Just as physical pain is a prompt to change behavior (such as moving a finger away from the fire), loneliness evolved as a prompt to action, signaling an ancestral need to repair the social bonds. Feelings of loneliness take a variety of forms, Cacioppo said.

“There are three core dimensions to feeling lonely—intimate isolation, which comes from not having anyone in your life you feel affirms who you are; relational isolation, which comes from not having face-to-face contacts that are rewarding; and collective isolation, which comes from not feeling that you’re part of a group or collective beyond individual existence,” he said.

It is not solitude or physical isolation itself, but rather the subjective sense of isolation that Cacioppo’s work shows to be so profoundly disruptive. Yet, outward circumstances such as moving to a new community or losing an intimate partner can trigger loneliness. And as the authors make clear, today’s culture is not always conducive to promoting strong social bonds.

The problem of social isolation will likely grow as conventional societal structures fade. The average household size is decreasing, and by 2010, 31 million Americans—roughly 10 percent of the population—will live alone. Sociologists also have found that people report significantly fewer close friends and confidants than those a generation ago.

Cacioppo and Patrick also demonstrate how loneliness creates a feedback loop that reinforces social anxiety, fear and other negative feelings. By learning more about what underlies this experience, then learning to reframe their response, lonely individuals can reverse the feedback loop, overcome fear and find ways to reconnect.

“We try to offer some help for those who’ve become stuck,” said Patrick. “The process begins in rediscovering those positive, physiological sensations that come during the simplest moments of human contact. But that means overcoming the fear and reaching out.”

“Lonely people feel a hunger,” Cacioppo added. “The key is to realize that the solution lies not in being fed, but in cooking for and enjoying a meal with others.”

Source: University of Chicago

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First Published Friday, 27 March 2009

According to a leading expert, severe cases of anorexia may be the result of undetected autism in women.

Professor Christopher Gillberg, of the University of Strathclyde, says that autism, characterised by defects in communication and social interaction, also makes many anorexic patients unresponsive to traditional treatments and may be responsible for anorexia’s low recovery rates.

Professor Gillberg believes that although autism is thought to be predominately a male problem, affecting up to four times more boys than girls, the disorder has been overlooked in women because their autistic traits present themselves differently.

For example an obsession with counting calories may be an outward sign of autism.

He says their research has shown that a small but important minority of all teenage girls, with anorexia nervosa in the general population, meet the diagnostic criteria for autistic disorder, Asperger syndrome or atypical autism.

He has apparently seen quite a number of cases where the anorexia has become completely entrenched because people have not understood that underlying the eating disorder is autism.

Professor Gillberg says anorexic patients with autism tend to be severe cases because traditional treatment for eating disorders proved ineffective.

A good example is family therapy, a popular psychotherapy in which family members discuss eating with the sufferer which is all but useless for autistic patients.

People with an autism spectrum disorder have great difficulty even understanding basic concepts about other people’s thoughts and feelings, which means that anything said in a family-therapy session is likely to be misconstrued by the affected individual who will not grasp what is going on in that particular context.

They need far more concrete, one-to-one interventions.

A spokesman for the Eating Disorder Association welcomed the research and said it could help develop more effective treatments for eating disorders.

About 5 per cent of anorexic patients die from complications of the disorder and only 40 per cent make a full recovery.

Ten per cent of the 1.1 million reported anorexia cases in the UK are in men, and Professor Gillberg says autism is behind the majority of male anorexia cases.

He says his clinical impression over the past 30 years has been that males struck by anorexia nervosa very often have autism spectrum disorders.

Judith Gould, director of the National Autistic Society’s Diagnostic Centre, agrees with the study’s findings, and feels autism in girls is being missed because it often manifests itself in females in different ways.

She agrees that anorexia, which is predominantly diagnosed in girls, could be linked to autism in an unknown proportion of cases.

About 500,000 people in the UK are thought to have some form of autism.

Source:   http://www.opposingviews.com/articles/research-undetected-autism-in-women-manifests-as-anorexia-nervosa

Psychiatric Disorders Are Common In Adults Who Have Had Anorexia

ScienceDaily (Mar. 26, 2009) — The study was initiated in 1985. A total of 51 teenagers with anorexia nervosa were studied, together with an equally large control group of healthy persons. The groups have been investigated and compared several times as the years have passed.

“This study is unique in an international perspective. It is the only study in the world that reflects the natural course of anorexia nervosa in the population”, says Elisabet Wentz, Associate Professor in Child and Adolescent Psychiatry at the Sahlgrenska Academy.

The research group has published new results from the study in two scientific journals: the British Journal of Psychiatry and the International Journal of Eating Disorders.

Three women have still not recovered from anorexia, 18 years after the start of the study. Thirteen people, or around 25%, are on disability benefit or have been signed off sick for more than six months due to an eating disorder or other psychiatric disorder.. Thirty-nine percent have at least one other psychiatric disorder, in addition to the eating disorder. The most common of these is obsessive compulsive disorder.

But the results also contain some positive surprises.

“Previous studies have shown that anorexia is a diagnosis with a very poor prognosis, with as many as one in five patients dying as a result of the disease. In contrast, we have not had a single death among the subjects of our study”, says Elisabet Wentz.

Other studies have also shown that infertility is a common complication for adult women who have had anorexia, as are increased risks of giving birth prematurely and of post-natal depression. The women in the two groups in this study have had essentially the same number of children, but the women who have had anorexia were younger when they had their first child. Such children had a lower birth weight than children of women in the control group.

“None of the women who had had children still suffered from an eating disorder, but it is still more common that they worry about whether their babies are putting on weight”, says Elisabet Wentz.

Brief Facts: Anorexia Nervosa

Anorexia nervosa is one of the most common psychiatric disorders among young women, and 1% of all teenage girls suffer from the condition. The figure for boys is 0.1%. The most common age range for being diagnosed with anorexia is 14-17 years, and the condition can continue for a very long time.

---

Journal references:

1. 1. Wentz E, Gillberg IC, Anckarsäter H, Gillberg C, Råstam M. Adolescent-onset anorexia nervosa: 18-year outcome. The British Journal of Psychiatry, 2009; 194 (2): 168 DOI: 10.1192/bjp.bp.107.048686
2. 2. Wentz et al. Reproduction and offspring status 18 years after teenage-onset anorexia nervosa-A controlled community-based study. International Journal of Eating Disorders, 2009; DOI: 10.1002/eat.20664

Source:  http://www.sciencedaily.com/releases/2009/03/090326134012.htm

New Family Approach Uses Milkshakes for Anorexia

By Rick Nauert, Ph.D.
Senior News Editor
Reviewed by John M. Grohol, Psy.D. on April 3, 2009

Friday, Apr 3 (Psych Central) —

Getting your teenager to drink a chocolate milkshake isn’t something most parents need to worry about. But this is just the approach used in one treatment for anorexia nervosa.

The technique, known as Behavioral Family Therapy, or the Maudsley Approach, calls for parents to supervise the eating habits of their anorexic child, feeding them high-calorie meals like milkshakes and macaroni and cheese until they regain a healthy weight.

For the first time, the Maudsley Approach is being compared with a more established treatment known as Family Systems Therapy as part of an ongoing National Institutes of Health (NIH)-funded treatment study at New York-Presbyterian Hospital/Westchester Division and five other centers nationally. Both are outpatient therapies for adolescents, aged 12 to 18.

“Anorexia is a life-threatening condition. Treating it early is very important since it is during the teenage years that this disorder usually takes hold,” says Dr. Katherine Halmi, founder of the Eating Disorders Program at New York-Presbyterian Hospital/Westchester Division and professor of psychiatry at Weill Cornell Medical College.

“Traditionally, patients with anorexia have been treated in a hospital setting or through one-on-one outpatient therapy. While inpatient treatment is still appropriate in acute cases, we have increasingly seen the value of family-oriented outpatient therapy for adolescents.”

The current study is designed to compare two different therapeutic approaches that involve the family — one is a behavioral therapy initially focused on weight gain, and the other examines various underlying issues in the family dynamic.

In the Maudsley Approach, named after the hospital in London where it was developed in the 1980s, the anorexic teenager attends therapy sessions together with parents and siblings. Parents work with the Maudsley therapist to develop ways in which they can monitor their child’s intake, choosing the amounts and types of foods necessary for them to regain to a healthy weight.

Siblings are encouraged to act as a support system for their sister or brother. Once patients achieve a healthy weight, they graduate toward taking more responsibility for their intake. At this point, family and developmental issues relevant to the patient maintaining a healthy weight are addressed.

In Family Systems Therapy, families also attend regular therapy sessions, but discussions do not necessarily focus on eating. Instead, family members are free to broadly explore and challenge any problematic communication patterns or stressors within the family unit.

“In Maudsley, food is medicine that restores the body and mind. When the body is starving, the mind also weakens, becoming more susceptible to anorexia’s rigid, often obsessive logic. Supervised feeding helps to break this vicious cycle. With the anorexia in charge, the adolescent really cannot regain the weight on his or her own. Nutritional rehabilitation gives the brain the nutrition it needs to re-establish healthy eating habits,” says Dr. Dara Bellace, a clinical psychologist at New York-Presbyterian Hospital/Westchester Division and an instructor of psychology in psychiatry at Weill Cornell Medical College.

“This approach does not blame parents, but rather calls on their ability to nurse their child back to health. It requires a strong commitment to be with them for every meal — something that can mean rearranging schedules and taking a tag-team approach to sharing the responsibility,” adds Dr. Bellace.

“The adolescent must also dedicate themselves to the therapy, understanding that, until they regain the weight, their parents will be feeding them much as they did when they were younger, deciding what and how much they eat and making sure they finish.”

Previous research has shown the Maudsley Approach successfully prevented hospitalization and helped adolescents recover their normal weights, with at least 75 percent of patients maintaining their recovery after five years.

A total of 240 adolescents aged 12 to 18 are being recruited for the study at six centers: New York-Presbyterian/Westchester; Stanford University in Palo Alto, Calif.; Sheppard Pratt in Baltimore, Md.; University of California at San Diego; University of Toronto; and Washington University in St. Louis.

Those eligible must be medically stable individuals ages 12 to 18 with a body weight between 75 percent and 87 percent of its healthy range. Families are randomized to receive either the Maudsley Approach or Family Systems Therapy. In each family treatment, they attend 16 one-hour sessions over the course of nine months. Sessions are held weekly for the first seven to eight weeks, bimonthly for the next six sessions, and monthly for the remaining sessions.

Anorexia nervosa is an eating disorder characterized by extreme low body weight and body image distortion with an obsessive fear of gaining weight. The condition largely affects adolescent females, who make up more than 40 percent of all cases. As much as 3 percent of American girls and women are anorexic. Contributing causes may include genetics, personality type, hormones, stress and societal pressures.

Anorexia carries the highest mortality rate of any psychiatric condition. Previous research by Dr. Halmi found that 7 percent of affected women died within 10 years. In a Swedish study that followed patients for 30 years, 18 percent to 20 percent of the women died. Even when anorexia is not fatal, it can cause long-term complications, including damage to the heart and bones.

For more information, eligible participants can e-mail the study coordinator, Samantha Berthod, at sab2024@med.cornell.edu.

Source:Cornell University

http://psychcentral.com/news/2009/04/03/new-family-approach-uses-milkshakes-for-anorexia/5139.html

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