Psychiatric and medical comorbidities of eating disorders : findings from a rapid review of the literature

Background: Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is signifcantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders. Methods: This paper forms part of a rapid review) series scoping the evidence base for the feld of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised. Results: A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specifc EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED. Conclusions: This review provides a thorough overview of the comorbid psychiatric and medical conditions cooccurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identifcation and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes

Informing the development of Australia's national eating disorders research and translation strategy : a rapid review methodology

Background Eating disorders (EDs) are highly complex mental illnesses associated with significant medical complications. There are currently knowledge gaps in research relating to the epidemiology, aetiology, treatment, burden, and outcomes of eating disorders. To clearly identify and begin addressing the major deficits in the scientific, medical, and clinical understanding of these mental illnesses, the Australian Government Department of Health in 2019 funded the InsideOut Institute (IOI) to develop the Australian Eating Disorder Research and Translation Strategy, the primary aim of which was to identify priorities and targets for building research capacity and outputs. A series of rapid reviews (RR) were conducted to map the current state of knowledge, identify evidence gaps, and inform development of the national research strategy. Published peer-reviewed literature on DSM-5 listed EDs, across eight knowledge domains was reviewed: (1) population, prevalence, disease burden, Quality of Life in Western developed countries; (2) risk factors; (3) co-occurring conditions and medical complications; (4) screening and diagnosis; (5) prevention and early intervention; (6) psychotherapies and relapse prevention; (7) models of care; (8) pharmacotherapies, alternative and adjunctive therapies; and (9) outcomes (including mortality). While RRs are systematic in nature, they are distinct from systematic reviews in their aim to gather evidence in a timely manner to support decision-making on urgent or high-priority health concerns at the national level. Results Three medical science databases were searched as the primary source of literature for the RRs: Science Direct, PubMed and OVID (Medline). The search was completed on 31st May 2021 (spanning January 2009-May 2021). At writing, a total of 1,320 articles met eligibility criteria and were included in the final review. Conclusions For each RR, the evidence has been organised to review the knowledge area and identify gaps for further research and investment. The series of RRs (published separately within the current series) are designed to support the development of research and translation practice in the field of EDs. They highlight areas for investment and investigation, and provide researchers, service planners and providers, and research funders rapid access to quality current evidence, which has been synthesised and organised to assist decision-making

Hemispheric Contributions to Language Comprehension: Word and Message-level Processing Mechanisms of the Right Cerebral Hemisphere

Recent research into hemispheric differences in sentence comprehension has produced a puzzling disparity between the results from behavioral studies on neurologically normal individuals and studies utilizing other methods such as electrophysiology, neuroimaging and the investigation of neuropsychological patients. The former approach tends to produce results that indicate a restriction of the right hemisphere (RH) to lower-level processing mechanisms that are comparatively less sensitive to context than the left hemisphere (LH), while the combined findings of the latter approaches suggest that not only is the RH capable of processing language at a higher level, it is particularly sensitive to contextual information and, furthermore, this may form part of the special role of the RH in language tasks. Accordingly, the present series of studies employed a normal-behavioral approach to further investigate the underlying processing mechanisms of the RH during sentence comprehension tasks. In each of the four experiments, right-handed adult participants completed a computer-based lexical decision task where reaction time and error rates were recorded. Stimuli were always centrally-presented, followed by a laterally-presented target word or non-word. In the first experiment, the sensitivity of the RH to message-level meaning was investigated by assessing whether it benefits from additional contextual information in sentences that was not the result of simple word-level associations. The remaining experiments aimed to examine several current models of RH language processing; specifically, they examined the applicability of the coarse-coding hypothesis (Beeman, 1993) and the integrative processing model (Federmeier, 2007) to RH sentence processing. The combined results of the four experiments lead to several conclusions. Firstly, this series of investigation consistently demonstrated that the RH does display a sensitivity to message-level processing that appears to be at least equivalent to that of the LH. This conclusion is uncommon in the normal-behavioral literature, but is consistent with evidence produced by other methodologies. Secondly, the coarse-coding hypothesis is insufficient in explaining RH language processing at the sentential level. Although there is considerable evidence in support of the coarse-coding model of RH processing of individual words, the findings of the present investigations do not support its applicability beyond this level. Thirdly, the integrative/predictive distinction between RH/LH language processing also appears to have limited applicability beyond sentence fragments and may instead be reflective of higher-level processing differences (e.g., wherein the RH may utilize a para-linguistic situation-model processing method whereas the LH may rely purely on a linguistic mechanism). Based on these conclusions, the present series of investigations appears to have resolved the inconsistent finding previously prominent in normal-behavioral literature and goes some way in determining the applicability of current models of RH language processing