Evidence-based Clinical Guidelines for Eating Disorders: International Comparison

Purpose of review – This systematic review sought to compare available evidence-based clinical treatment guidelines for all specific eating disorders. Recent findings – Nine evidence-based clinical treatment guidelines were located through a systematic search. The international comparison demonstrated notable commonalities and differences among current evidence-based clinical guidelines for eating disorders. Consistency across guidelines was greatest for treatments with a larger evidence base, while those with a lower evidence base had recommendations that varied considerably. Summary – Evidence-based clinical guidelines represent an important step toward the dissemination and implementation of evidence-based treatments into clinical practice. Despite advances in clinical research on eating disorders, a growing body of literature demonstrates that individuals with eating disorders often do not receive an evidence-based treatment for their disorder. Regarding the dissemination and implementation of evidence-based treatments, current guidelines do endorse the main empirically validated treatment approaches with considerable agreement, but additional recommendations are largely inconsistent. An increased evidence base is critical in offering clinically reliable and consistent guidance for the treatment of eating disorders. Because developing and updating clinical guidelines is time-consuming and complex, an international coordination of guideline development, for example, across the European Union, would be desirable

Perceived expressed emotion in adolescents with binge-eating disorder

A sizeable body of research has documented Expressed Emotion (EE) to predict clinical outcomes in various psychiatric disorders, including eating disorders. Patients’ perceptions of relative’s EE, however, were found to play an important role in the processing of EE. This study aimed to examine the level of perceived EE in adolescent binge-eating disorder (BED) and its impact on eating disorder psychopathology. Adolescents (12 – 20 years) seeking treatment for BED (n = 40) were compared to adolescents without current or lifetime eating disorder (CG; n = 40). Both groups were stratified according to age, sex, body mass index (BMI, kg/m2), and socio-economic status. The Five Minute Speech Sample (FMSS) and the Brief Dyadic Scale of EE were administered to assess patients’ perceived maternal EE. Additionally, adolescents and mothers completed questionnaires on eating disorder and general psychopathology. On the FMSS, 37.5% of patients with BED perceived their mothers as high EE (vs. 12.5% in the CG). On the Brief Dyadic Scale of EE, patients with BED reported significantly higher levels of perceived maternal criticism, emotional overinvolvement, and lower levels of perceived warmth than controls. After controlling for the diagnosis of BED, perceived criticism and warmth, as assessed by questionnaire, significantly explained adolescents’ global eating disorder psychopathology. Negative perceptions of maternal behavior and emotional atmosphere towards the child are characteristic of adolescent BED. As documented for other eating disorders, family factors are likely to have substantial implications for the maintenance and treatment of adolescent BED

Abnormalities in the EEG power spectrum in bulimia nervosa, binge-eating disorder, and obesity: A systematic review

To provide a basis for electroencephalography (EEG) neurofeedback protocols for bulimianervosa (BN), binge-eating disorder (BED), and obesity, this systematic review investigates alterations in EEG-measured brain activity, specifically frequency bands. A systematic literature search with pre-defined search terms yielded N = 7 studies meeting the inclusion criteria. The risk of bias was assessed for all studies. In resting-state EEG, the beta activity was elevated in fronto-central regions in individuals with obesity and comorbid BED. In food-cue conditions, both obese individuals with and without BED showed increased beta activity, suggesting increased awareness of food cues and a heightened attentional focus towards food stimuli. The level of beta activity was positively correlated with eating disorder psychopathology in resting and food-cue conditions. In individuals with BN, there was no evidence for altered EEG spectral power. The results indicate specific alterations in EEGbased brain activity in individuals with BED and obesity. More high-quality studies are needed to further confirm these findings and to transfer them into EEG-based interventions

Executive Functions of Adults with Binge-Eating Disorder: The Role of Weight Status and Psychopathology

Findings on executive functions (EFs) in binge-eating disorder (BED) are inconsistent and possibly biased by associated comorbidities. This study aimed to identify whether distinct levels of physical and mental comorbidity are related to EFs in BED. General and food-specific EFs in n = 77 adults with BED were compared to population-based norms and associations with weight status, depressive symptoms, and eating disorder psychopathology were analyzed. To detect within-sample patterns of EF performance, k-means clustering was applied. The results indicated that participants’ general EFs were within the average range with slight deficits in alertness. While depression and eating disorder psychopathology were unrelated to EFs, weight status was associated with food-specific attentional bias that was significantly higher in obesity class 2 than in overweight/obesity class 1 and obesity class 3. Four meaningful clusters with distinct strengths and impairments in general and food-specific EFs but without differences in clinical variables were identified. Altogether, adults with BED showed few specific deficits compared to normative data. Performance was unrelated to depression and eating disorder psychopathology, while weight status was associated with food-specific EFs only. The results highlight the need for longitudinal studies to evaluate the relevance of EFs in BED development and maintenance in neurologically healthy adults

The psychedelic afterglow phenomenon: a systematic review of subacute effects of classic serotonergic psychedelics

Background: Classic serotonergic psychedelics have anecdotally been reported to show a characteristic pattern of subacute effects that persist after the acute effects of the substance have subsided. These transient effects, sometimes labeled as the ‘psychedelic afterglow’, have been suggested to be associated with enhanced effectiveness of psychotherapeutic interventions in the subacute period. Objectives: This systematic review provides an overview of subacute effects of psychedelics. Methods: Electronic databases (MEDLINE, Web of Science Core Collection) were searched for studies that assessed the effects of psychedelics (LSD, psilocybin, DMT, 5-MeO-DMT, mescaline, or ayahuasca) on psychological outcome measures and subacute adverse effects in human adults between 1950 and August 2021, occurring between 1 day and 1 month after drug use. Results: Forty-eight studies including a total number of 1,774 participants were eligible for review. Taken together, the following subacute effects were observed: reductions in different psychopathological symptoms; increases in wellbeing, mood, mindfulness, social measures, spirituality, and positive behavioral changes; mixed changes in personality/values/attitudes, and creativity/flexibility. Subacute adverse effects comprised a wide range of complaints, including headaches, sleep disturbances, and individual cases of increased psychological distress. Discussion: Results support narrative reports of a subacute psychedelic ‘afterglow’ phenomenon comprising potentially beneficial changes in the perception of self, others, and the environment. Subacute adverse events were mild to severe, and no serious adverse events were reported. Many studies, however, lacked a standardized assessment of adverse effects. Future studies are needed to investigate the role of possible moderator variables and to reveal if and how positive effects from the subacute window may consolidate into long-term mental health benefits

The psychedelic afterglow phenomenon: a systematic review of subacute effects of classic serotonergic psychedelics

Background: Classic serotonergic psychedelics have anecdotally been reported to show a characteristic pattern of subacute effects that persist after the acute effects of the substance have subsided. These transient effects, sometimes labeled as the ‘psychedelic afterglow’, have been suggested to be associated with enhanced effectiveness of psychotherapeutic interventions in the subacute period. Objectives: This systematic review provides an overview of subacute effects of psychedelics. Methods: Electronic databases (MEDLINE, Web of Science Core Collection) were searched for studies that assessed the effects of psychedelics (LSD, psilocybin, DMT, 5-MeO-DMT, mescaline, or ayahuasca) on psychological outcome measures and subacute adverse effects in human adults between 1950 and August 2021, occurring between 1 day and 1 month after drug use. Results: Forty-eight studies including a total number of 1,774 participants were eligible for review. Taken together, the following subacute effects were observed: reductions in different psychopathological symptoms; increases in wellbeing, mood, mindfulness, social measures, spirituality, and positive behavioral changes; mixed changes in personality/values/attitudes, and creativity/flexibility. Subacute adverse effects comprised a wide range of complaints, including headaches, sleep disturbances, and individual cases of increased psychological distress. Discussion: Results support narrative reports of a subacute psychedelic ‘afterglow’ phenomenon comprising potentially beneficial changes in the perception of self, others, and the environment. Subacute adverse events were mild to severe, and no serious adverse events were reported. Many studies, however, lacked a standardized assessment of adverse effects. Future studies are needed to investigate the role of possible moderator variables and to reveal if and how positive effects from the subacute window may consolidate into long-term mental health benefits.Peer Reviewe

Studien zu den kaiserzeitlichen Privatportraits aus Athen

Gegenstand der Untersuchung sind die in der römischen Kaiserzeit in Athen errichteten, rundplastischen Privatportraits. Im Fokus der Arbeit stehen die stilistische und ikonografische Analyse der Bildnisse sowie die Frage nach den Formen der statuarischen Repräsentation, den konkreten Aufstellungskontexten und schließlich, soweit möglich, nach Bedeutung und Funktion der einzelnen Monumente. Von zentralem Interesse war, inwieweit die Privatportraits in Athen an die Kaiserbildnisse oder an andere, auch lokalspezifische Vorbilder angeglichen sind. Ziel war es, zu klären, ob auf dem Gebiet der Bildniskunst, der Vorbilder und der Aufstellungspraktiken Unterschiede zu anderen Gegenden des Imperium Romanum, insbesondere Rom selbst, bestehen, inwiefern also Athen eine Sonderstellung einnahm und wie dies vor dem Hintergrund der besonderen Rolle der Stadt als Bildungszentrum in der römischen Kaiserzeit zu erklären ist. Im Ergebnis zeigte sich, dass sich die kaiserzeitlichen Privatportraits aus Athen sowohl hinsichtlich des Stils als auch der Ikonografie weitgehend an der stadtrömischen Bildniskunst orientierten. Schon von augusteischer Zeit an, als Rom sich längst als Hegemonialmacht in Griechenland etabliert hatte, lässt sich eine große stilistische Ähnlichkeit zu den stadtrömischen Portraits beobachten, die nicht zuletzt darauf zurückgehen dürfte, dass die im klassizistischen Sinne wohlproportionierten Gesichter der Angehörigen des iulisch-claudischen Kaiserhauses dem griechischen Geschmack in besonderer Weise entsprachen. Im Rahmen der zunehmenden Konsolidierung des Imperiums im Verlauf der mittleren Kaiserzeit, die zur Entfaltung der griechisch-römischen Kultur in nahezu allen Provinzen führte, verschmolz schließlich die Kunst der jeweiligen Regionen noch stärker miteinander. Auch in Bezug auf die Ikonografie ergibt sich im Wesentlichen ein der Stadt Rom vergleichbares Bild: in den meisten Fällen bezog sich die athenische Oberschicht in ihrer Darstellung auf die Angehörigen des Kaiserhauses. Der Befund lässt dabei keinen Zusammenhang zwischen der Popularität eines Kaisers beziehungsweise seinen Aktivitäten in Griechenland und der Häufigkeit beziehungsweise Intensität der Übernahme seiner ikonografischen Charakteristika ins Privatportrait erkennen. Die Bezugnahme auf andere Vorbilder wie griechische Intellektuellenbildnisse der klassischen und hellenistischen Zeit lässt sich erst dann fassen, nachdem die Protagonisten der ruhmreichen Vergangenheit Athens in Rom auf breiter Ebene zu gesellschaftlichen Vorbildern wurden, an die Privatleute sich in ihren Bildnissen anglichen. Obwohl in Athen diese retrospektiven Strömungen durchaus auch als Ausdruck des lokalspezifischen kulturellen Selbstverständnisses zu interpretieren sind, zeigt all dies, dass sich die Stadt auf dem Gebiet der Portraitkunst nicht zu einem ‚Trendsetter’ entwickelte. Vielmehr wurden die von Rom ausgehenden Impulse weitgehend und in großer Einheitlichkeit übernommen. Dennoch lassen sich sowohl in formaler und ikonografischer Hinsicht als auch bezüglich der Aufstellungspraktiken bestimmte charakteristische Eigenheiten der athenischen Portraits greifen, die zeigen, dass sich die Stadt eine gewisse Eigenständigkeit auf diesem Gebiet bewahrte

Therapist adherence and therapeutic alliance in individual cognitive-behavioural therapy for adolescent binge-eating disorder

To evaluate psychological treatments for adolescent binge-eating disorder (BED), reliable information on therapeutic process factors is needed. This study examines therapist adherence and therapeutic alliance and their associations in cognitive-behavioural therapy (CBT) for adolescents with BED. In a randomised-controlled efficacy trial, adherence and alliance were objectively determined based on 247 audio-taped CBT sessions from a sample of N = 64 adolescents with BED. Variability of adherence and alliance, explained by treatment module, patient, and therapist were examined using multilevel modeling. Although adherence and alliance were excellent and unaffected by treatment module and therapist, there was significant between-patient variability for both concepts. Adherence was negatively associated with patient's treatment expectation. Alliance was negatively associated with the number of loss of control eating episodes and positively associated with adherence. Excellent adherence supported the internal validity of CBT for adolescent BED. Associations between process factors and patient characteristics demand adequate supervision in CBT

Interaction Effects of Child Weight Status and Parental Feeding Practices on Children’s Eating Disorder Symptomatology

(1) Background: Research on parental feeding practices and non-normative eating behavior including loss of control (LOC) eating and eating disorder psychopathology indicated separate associations of these variables with child weight status, especially in early childhood. This study cross-sectionally examined interaction effects of restriction, monitoring, pressure to eat, and children’s weight status on disordered eating in children aged 8–13 years. (2) Methods: A population-based sample of N = 904 children and their mothers completed the Eating Disorder Examination Questionnaire for Children and the Child Feeding Questionnaire. Child anthropometrics were objectively measured. Hierarchical linear and logistic regression analyses were conducted for cross-sectionally predicting global eating disorder psychopathology and recurrent LOC eating by feeding practices and child weight status for younger (8–10 years) and older (11–13 years) ages. (3) Results: Restriction x Child weight status significantly predicted global eating disorder psychopathology in younger children and recurrent LOC eating in older children. Monitoring x Child weight status significantly predicted eating disorder psychopathology in older children. A higher versus lower child weight status was associated with adverse eating behaviors, particularly in children with mothers reporting high restriction and monitoring. (4) Conclusions: Detrimental associations between higher child weight status and child eating disorder symptomatology held especially true for children whose mothers strongly control child food intake