Background: Anorexia nervosa (AN) is a debilitating psychiatric disorder associated with a wide a... more Background: Anorexia nervosa (AN) is a debilitating psychiatric disorder associated with a wide array of negative health complications and psychiatric comorbidity. Existing evidence for AN treatment in adults is weak, and no empirically supported treatment has been reliably established. The primary objective of this study is to gain knowledge about the effectiveness of enhanced cognitive behavioral therapy (CBT-E) for anorexia nervosa delivered in a public hospital setting. Baseline predictors of treatment outcome and dropout are studied. Furthermore, there will be collected blood and stool samples for a general biobank to be able to initiate research on possible pathophysiological mechanisms underlying AN. Methods: The study will assess the potency of outpatient CBT-E in a sample of patients suffering from AN (age >16) admitted to the Section for Eating Disorders at the Department for Psychosomatic Medicine, Haukeland University Hospital in Bergen, Norway. The study has a longitudinal design with five main assessment time points: before treatment, at 3 months, at the end of treatment, at 20 weeks, and at 12 months follow-up including biobank samples. A control group without an eating disorder will also be recruited. Discussion: Treatment research in a public hospital setting is important for gaining knowledge about the transportability of treatments evaluated in research clinics into ordinary clinical practice. Furthermore, biological material from the thoroughly described patient cohort will serve as a basis for further research on the pathophysiological mechanisms in AN. Trial registration: ClinicalTrials.gov Identifier: NCT02745067. Registered 14 April 2016.
Introduction The majority of research concerning cognitive functioning in eating disorders has fo... more Introduction The majority of research concerning cognitive functioning in eating disorders has focused on the symptomatic phase of illness in patients suffering from Anorexia Nervosa. There is a lack of longitudinal studies focusing on the possible effects of cognitive functioning on treatment outcome. Further, only a subgroup of studies control for the effects of depression and depressive symptoms in this field of research. Objective The main objective of the present study is to examine cognitive functioning in patients suffering Anorexia in a longitudinal perspective. Secondly, to examine and clarify the effects of depression on cognitive functioning in patients suffering Anorexia. Thirdly, the aim is to investigate cognitive functioning in Anorexia as a possible predictor for treatment outcome and retention. Methods Patients aged≥16years diagnosed with Anorexia Nervosa, admitted to outpatient treatment (CBT-E) at Section for Eating Disorders, Haukeland University Hospital, will be recruited to the study. A healthy control group and a comparison group of patients diagnosed with first episode major depressive disorder will also be included. The neuropsychological assessment consists of a comprehensive test battery including well-established neuropsychological tests known to have good psychometric properties. Depressive symptoms will be measured by the Montgomery Aasberg Depression Rating scale and eating disorder symptoms will be assessed with the EDE-Q. The neuropsychological assessment will be performed three times during the study: before treatment, post treatment and one year after discharge. The assessment will be performed at the Institute of biological and medical psychology, Section of clinical neuropsychology, University of Bergen.
An increasing number of patients are immunocompromised due to modern treatment of cancer, organ t... more An increasing number of patients are immunocompromised due to modern treatment of cancer, organ transplantations and HIV-infections. Opportunistic viral infections are common and may cause serious disease among these patients. New vaccines, immunomodulators and antiviral drugs make it possible to prevent and treat many of these infections. We review the host defence against viral infections and the most important viral infections. We also discuss prophylaxis, diagnosis and therapy.
The effect of insulin-like growth factor-1 (IGF-1) on highly enriched human apheresis CD34+ proge... more The effect of insulin-like growth factor-1 (IGF-1) on highly enriched human apheresis CD34+ progenitor cells was investigated in vitro. The progenitor cells were mobilized by treatment with cydophosphamide + granulocyte-colon y stimulating factor (G-CSF) in patients with multiple myeloma. CD34+ cells were cultured for 7 days in serumfree medium containing stem cell factor (SCF), granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin-3 (IL-3), and this is referred to as cytokine-dependent proliferation. After 7 days of cytokine-dependent proliferation the total number of viable cells increased 1.6-8.2 times, and subsets of cells expressing the granulocyte marker CD15, the myelomonocytic marker CD64 and the erythrocyte phenotype CD71high/CD64-were detected among the in vitro cultured cells. Addition of G-CSF together with SCF + IL-3 + GM-CSF increased the number of CD15+ and CD64+ cells, but without altering the number of erythroid cells. IGF-1 caused a dose-dependent increase in the number of CD15+, CD64+ and CD71high/CD64-cells, and this increase was detected when cells were cultured in both SCF + IL-3 + GM-CSF alone and G-CSF + SCF + IL-3 + GM-CSF. A minor subset of CD34+ cells could still be detected among in vitro cultured cells and the number of CD34+ cells was not altered by adding G-CSF and/or IGF-1. Morphologically recognizable mature granulocytes or erythroid cells could not be detected for any of the combinations investigated. We conclude that IGF-1 can enhance the in vitro proliferation of committed progenitor cells derived from apheresis CD34+ cells.
Eating disorders are associated with several medical complications. Growth retardation and osteop... more Eating disorders are associated with several medical complications. Growth retardation and osteoporosis can cause permanent sequelae if treatment is delayed. Severe eating disorders are associated with significant mortality. Cardiac arrhythmias are the most common somatic cause of death. Hypokalaemia is a common complication and is associated with increased risk of cardiac arrhythmias. Occasionally, overzealous refeeding may induce a potentially life-threatening condition, the refeeding syndrome. In any patient with severe eating disorder, a physician should perform diagnostic evaluation including assessment of possible somatic complications. This is necessary in order to determine where and how the patient should be treated. Most of the somatic complications of eating disorders are partly or completely reversible if the patient receives adequate treatment in time.
Background: Anorexia nervosa (AN) in adults is difficult to treat, and no current treatment is su... more Background: Anorexia nervosa (AN) in adults is difficult to treat, and no current treatment is supported by robust evidence. A few studies, most of which were performed by highly specialized research units, have indicated that enhanced cognitive behaviour therapy (CBT-E) for eating disorders can be effective. However, the dropout rate is high and the evidence from non-research clinical units is sparse. Methods: This quality assessment project implemented CBT-E in an outpatient setting at a public hospital. Fortyfour patients with AN started therapy. Each patient received at least 40 sessions of CBT-E over a 12-month period. Their body mass index (BMI) was recorded at baseline and after 3, 6 and 12 months. Reasons for not starting therapy or for leaving therapy prematurely were recorded. Results: Half (n = 22) of the 44 patients who started outpatient CBT-E did not complete the treatment. In the remaining sample there was a large (and statistically significant) weight gain after 12 months. The percentage of patients achieving the target BMI of > 18.5 kg/m 2 was 36.4, 50.0 and 77.3% after 3, 6 and 12 months, respectively. Conclusions: This quality assessment project shows that it is possible to establish effective CBT-E in an outpatient eating-disorder unit at a public hospital. Although half of the patients did not complete CBT-E, the remaining patients achieved a significant increase in BMI at 1 year after the start of therapy.
Acta pathologica, microbiologica et immunologica Scandinavica, Aug 15, 2009
Receptors for sheep erythrocytes, for the Fc part of IgG (FcyR) and IgM (FcqR), and for component... more Receptors for sheep erythrocytes, for the Fc part of IgG (FcyR) and IgM (FcqR), and for components of activated human complement C3 (C3bR and C3dR) in thymus tissue from fetuses, infants and children were studied using haemadsorption to cryostat sections in a closed chamber. Sheep erythrocytes (SE) did not adhere to sections of thymus from fetuses at 10-1 I weeks of gestation, adhered weakly between 14 and 20 weeks, while they adhered in a dense monolayer in older fetuses. in infants and in children, denser in the cortex than in the medulla. Ox erythrocytes (OE), sensitized with IgG to demonstrate FcyR. adhered focally to both cortical and medullary areas. The adherence was more pronounced to the sections of fetal thymus than to the sections from infants and children. OE, sensitized with IgM to demonstrate FcpR, adhered focally to all thymus tissue sections, preferentially to the cortex. The adherence was most pronounced in fetal thymus. SE, sensitized with IgM and coated with complement. adhered to sections of fetal thymus, but the density decreased markedly during fetal life. Indicator cells demonstrating C3bR adhered focally also to sections from infants and children. while indicator cells demonstrating C3dR did not adhere to sections from individuals older than 38 weeks of gestation. Indicator cells demonstrating C3bR and C3dR adhered both to cortex and medulla.
: The effects of insulin‐like growth factor 1 (IGF‐1) on autonomous proliferation, cytokine‐depe... more : The effects of insulin‐like growth factor 1 (IGF‐1) on autonomous proliferation, cytokine‐dependent proliferation and constitutive cytokine secretion by acute myelogenous leukemia (AML) blasts were investigated using serum‐free in vitro conditions. IGF‐1 enhanced AML blast proliferation independent of the presence of other exogenous cytokines only for 2 of 21 patients, but for 10 additional patients IGF‐1 altered blast proliferation in the presence of certain exogenous cytokines or cytokine combinations. IGF‐1 had minor effects on AML blast cytokine secretion only for a subset of the patients (decreased levels for 1 patient, increased levels for 7 patients). Our in vitro observations indicate that IGF‐1 can modulate AML blast proliferation and/or cytokine secretion for a subset of patients.
A synthetic analog of a hemoregulatory peptide associated with mature human granulocytes (HPSb) h... more A synthetic analog of a hemoregulatory peptide associated with mature human granulocytes (HPSb) has been investigated for inhibitory effects on various cell types in culture as compared to inhibitory action on mouse and human myelopoietic colonies (CFU-gm), which occurs from 1 X to 1 X 10-6 M in vitro. This includes colony formation by lymphoid T and B cells in capillary cultures, as well as mitogen activation of T, B and NK cells. At higher concentrations, i.e., above 1 X M, an inhibitory effect was found on colony formation. Neither the production of interleukin (IL) 3 by mitogenactivated T cells, nor the proliferation of the IL-3-dependent LIB cell line were affected by the peptide up to 1 X M on mouse 3T3 fibroblasts. A series of malignant cell lines was also tested. No effect was seen between 1 X lo-" and 1 x 10-7 M on human mammary carcinoma cells in culture. On Ehrlich ascites mouse mammary carcinoma cells a 30% inhibition was seen at M. On a human glioblastoma cell line (GaMg) no effect was seen, and on a rat glioma cell line (BT5C) an inhibitory effect was seen at 1 X 10-7 M and above. No significant inhibition of cell growth was seen on SCl mouse lymphoma cells from 1 X to 1 X l(rJ M during 7 days of culture. The investigated normal and malignant cell types in culture were thus not inhibited in very low concentrations which act on CFU-gm. However, a variable inhibitory effect was found at higher concentrations where the inhibition of myelopoiesis was maximal and at concentrations where the inhibition is released. The hemoregulatory peptide thus seems to be a concentrationdependent selective inhibitor of myelopoiesis. The finding that various malignant cells do not respond at lower concentrations supports the possibility of using the peptide as a protector of normal cells during cancer chemotherapy. M. A slight inhibitory effect was found above 1 X
The hemoregulatory peptide PyroGlu-Glu-Asp-Cys-Lys (HPSb), which inhibits myelopoietic colony for... more The hemoregulatory peptide PyroGlu-Glu-Asp-Cys-Lys (HPSb), which inhibits myelopoietic colony formation in vitro, is shown to be a sequence motif which is also part of the effector domain of Gi, proteins, Out of 8 synthetic peptides with sequence variations of HPSb, those with the closest similarity to the G,, sequence are biologically active. The inhibitory effect appears to be dependent on the blocked N-terminus. It is postulated that these peptides may interfere with signal transduction mediated by Gi= proteins.
Anorexia nervosa (AN) is a disabling, costly, and potentially deadly illness. Treatment failure a... more Anorexia nervosa (AN) is a disabling, costly, and potentially deadly illness. Treatment failure and relapse after treatment are common. Several studies have indicated the involvement of the gut microbiota–brain (GMB) axis. This narrative review hypothesizes that AN is driven by malnutrition-induced alterations in the GMB axis in susceptible individuals. According to this hypothesis, initial weight loss can voluntarily occur through dieting or be caused by somatic or psychiatric diseases. Malnutrition-induced alterations in gut microbiota may increase the sensitivity to anxiety-inducing gastrointestinal hormones released during meals, one of which is cholecystokinin (CCK). The experimental injection of a high dose of its CCK-4 fragment in healthy individuals induces panic attacks, probably via the stimulation of CCK receptors in the brain. Such meal-related anxiety attacks may take part in developing the clinical picture of AN. Malnutrition may also cause increased effects from appet...
Background: Anorexia nervosa (AN) has high rates of enduring disease and mortality. Currently, th... more Background: Anorexia nervosa (AN) has high rates of enduring disease and mortality. Currently, there is insufficient knowledge on the predictors of relapse after weight normalization and this is why a systematic literature review was performed. Methods: PubMed, EMBASE, PsychInfo, and Cochrane databases were searched for literature published until 13 July 2021. All study designs were eligible for inclusion if they focused on predictors of relapse after weight normalization in AN. Individual study definitions of relapse were used, and in general, this was either a drop in BMI and/or reccurrence of AN symptoms. Results: The database search identified 11,507 publications, leaving 9511 publications after the removal of duplicates and after a review of abstracts and titles; 191 were selected for full-text review. Nineteen publications met the criteria and included 1398 AN patients and 39 healthy controls (HC) from adults and adolescents (ages range 11–73 years). The majority used a prospe...
Introduction The majority of research concerning cognitive functioning in eating disorders has fo... more Introduction The majority of research concerning cognitive functioning in eating disorders has focused on the symptomatic phase of illness in patients suffering from Anorexia Nervosa. There is a lack of longitudinal studies focusing on the possible effects of cognitive functioning on treatment outcome. Further, only a subgroup of studies control for the effects of depression and depressive symptoms in this field of research. Objective The main objective of the present study is to examine cognitive functioning in patients suffering Anorexia in a longitudinal perspective. Secondly, to examine and clarify the effects of depression on cognitive functioning in patients suffering Anorexia. Thirdly, the aim is to investigate cognitive functioning in Anorexia as a possible predictor for treatment outcome and retention. Methods Patients aged≥16years diagnosed with Anorexia Nervosa, admitted to outpatient treatment (CBT-E) at Section for Eating Disorders, Haukeland University Hospital, will b...
Background The aim of this quality-assessment study was to determine the outcome of patients with... more Background The aim of this quality-assessment study was to determine the outcome of patients with severe and extreme anorexia nervosa (AN) in a real-world outpatient setting. Methods Twenty-one adults with AN and a body mass index (BMI) of < 16 were recruited from consecutive referrals to an outpatient clinic at a public hospital in Western Norway. All enrolled patients were provided with enhanced cognitive behaviour therapy (CBT-E) to treat their AN, commencing between January 2013 and December 2016. Their BMI was recorded at baseline, at the end of CBT-E and 1 year after the end of treatment. Results Ten patients completed the CBT-E treatment and achieved a large weight gain with the change remaining stable at follow-up. Eleven patients did not complete the treatment but had a significant increase in BMI at the premature end of treatment. One year after end of therapy 14/21 (66.7%) of the patients had BMI above 18.5 kg/m2. No severe complications were observed during therapy. C...
ObjectiveThe study aimed to assess outcomes in patients with severe and extreme anorexia nervosa ... more ObjectiveThe study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT‐E) in a real‐world outpatient setting.MethodThirty patients with anorexia nervosa and body mass index (BMI) <16 aged ≥17 years were recruited from consecutive referrals to an eating disorder service clinic offering outpatient CBT‐E. BMI and Eating Disorder Examination Questionnaire (EDE‐Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at admission, end of treatment, and 20‐ and 60‐week follow‐ups for treatment completers.ResultsTwenty patients (66.7%) completed the treatment and showed both considerable weight gain (Cohen's f = 1.43), and significantly reduced scores for clinical impairment (f = 1.26) and eating‐disorder (f = 1.03) and general psychopathology (f = 0.99). Changes remained stable at both follow‐ups. About half of the patients who completed treatment had a BMI ≥18.5 ...
Background: Anorexia nervosa (AN) in adults is difficult to treat, and no current treatment is su... more Background: Anorexia nervosa (AN) in adults is difficult to treat, and no current treatment is supported by robust evidence. A few studies, most of which were performed by highly specialized research units, have indicated that enhanced cognitive behaviour therapy (CBT-E) for eating disorders can be effective. However, the dropout rate is high and the evidence from non-research clinical units is sparse. Methods: This quality assessment project implemented CBT-E in an outpatient setting at a public hospital. Fortyfour patients with AN started therapy. Each patient received at least 40 sessions of CBT-E over a 12-month period. Their body mass index (BMI) was recorded at baseline and after 3, 6 and 12 months. Reasons for not starting therapy or for leaving therapy prematurely were recorded. Results: Half (n = 22) of the 44 patients who started outpatient CBT-E did not complete the treatment. In the remaining sample there was a large (and statistically significant) weight gain after 12 months. The percentage of patients achieving the target BMI of > 18.5 kg/m 2 was 36.4, 50.0 and 77.3% after 3, 6 and 12 months, respectively. Conclusions: This quality assessment project shows that it is possible to establish effective CBT-E in an outpatient eating-disorder unit at a public hospital. Although half of the patients did not complete CBT-E, the remaining patients achieved a significant increase in BMI at 1 year after the start of therapy.
Anorexia nervosa (AN) is a severe and often enduring condition of which the etiology is unknown. ... more Anorexia nervosa (AN) is a severe and often enduring condition of which the etiology is unknown. Studies on the gut microbiota in AN have found deviations from that of healthy individuals, which may imply a relation to pathophysiology, development and maintenance of the disorder via the gut-brain axis, which has been shown in other disorders. A narrative review of the gut microbiota studies in AN is presented. Several studies point to a dysbiosis in AN which may have implications for maintenance of a low body weight, immunological changes and a severely reduced food intake. An association may be found to clinical symptoms in AN. A pathophysiological model for disease is presented implying a role of the microbiota in maintenance of AN. Dysbiosis in AN may play an important role in the development and maintenance of AN.
The effect of insulin-like growth factor-1 (IGF-1) on highly enriched human apheresis CD34+ proge... more The effect of insulin-like growth factor-1 (IGF-1) on highly enriched human apheresis CD34+ progenitor cells was investigated in vitro. The progenitor cells were mobilized by treatment with cydophosphamide + granulocyte-colon y stimulating factor (G-CSF) in patients with multiple myeloma. CD34+ cells were cultured for 7 days in serumfree medium containing stem cell factor (SCF), granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin-3 (IL-3), and this is referred to as cytokine-dependent proliferation. After 7 days of cytokine-dependent proliferation the total number of viable cells increased 1.6-8.2 times, and subsets of cells expressing the granulocyte marker CD15, the myelomonocytic marker CD64 and the erythrocyte phenotype CD71high/CD64-were detected among the in vitro cultured cells. Addition of G-CSF together with SCF + IL-3 + GM-CSF increased the number of CD15+ and CD64+ cells, but without altering the number of erythroid cells. IGF-1 caused a dose-dependent increase in the number of CD15+, CD64+ and CD71high/CD64-cells, and this increase was detected when cells were cultured in both SCF + IL-3 + GM-CSF alone and G-CSF + SCF + IL-3 + GM-CSF. A minor subset of CD34+ cells could still be detected among in vitro cultured cells and the number of CD34+ cells was not altered by adding G-CSF and/or IGF-1. Morphologically recognizable mature granulocytes or erythroid cells could not be detected for any of the combinations investigated. We conclude that IGF-1 can enhance the in vitro proliferation of committed progenitor cells derived from apheresis CD34+ cells.
Background: Anorexia nervosa (AN) is a debilitating psychiatric disorder associated with a wide a... more Background: Anorexia nervosa (AN) is a debilitating psychiatric disorder associated with a wide array of negative health complications and psychiatric comorbidity. Existing evidence for AN treatment in adults is weak, and no empirically supported treatment has been reliably established. The primary objective of this study is to gain knowledge about the effectiveness of enhanced cognitive behavioral therapy (CBT-E) for anorexia nervosa delivered in a public hospital setting. Baseline predictors of treatment outcome and dropout are studied. Furthermore, there will be collected blood and stool samples for a general biobank to be able to initiate research on possible pathophysiological mechanisms underlying AN. Methods: The study will assess the potency of outpatient CBT-E in a sample of patients suffering from AN (age >16) admitted to the Section for Eating Disorders at the Department for Psychosomatic Medicine, Haukeland University Hospital in Bergen, Norway. The study has a longitudinal design with five main assessment time points: before treatment, at 3 months, at the end of treatment, at 20 weeks, and at 12 months follow-up including biobank samples. A control group without an eating disorder will also be recruited. Discussion: Treatment research in a public hospital setting is important for gaining knowledge about the transportability of treatments evaluated in research clinics into ordinary clinical practice. Furthermore, biological material from the thoroughly described patient cohort will serve as a basis for further research on the pathophysiological mechanisms in AN. Trial registration: ClinicalTrials.gov Identifier: NCT02745067. Registered 14 April 2016.
Introduction The majority of research concerning cognitive functioning in eating disorders has fo... more Introduction The majority of research concerning cognitive functioning in eating disorders has focused on the symptomatic phase of illness in patients suffering from Anorexia Nervosa. There is a lack of longitudinal studies focusing on the possible effects of cognitive functioning on treatment outcome. Further, only a subgroup of studies control for the effects of depression and depressive symptoms in this field of research. Objective The main objective of the present study is to examine cognitive functioning in patients suffering Anorexia in a longitudinal perspective. Secondly, to examine and clarify the effects of depression on cognitive functioning in patients suffering Anorexia. Thirdly, the aim is to investigate cognitive functioning in Anorexia as a possible predictor for treatment outcome and retention. Methods Patients aged≥16years diagnosed with Anorexia Nervosa, admitted to outpatient treatment (CBT-E) at Section for Eating Disorders, Haukeland University Hospital, will be recruited to the study. A healthy control group and a comparison group of patients diagnosed with first episode major depressive disorder will also be included. The neuropsychological assessment consists of a comprehensive test battery including well-established neuropsychological tests known to have good psychometric properties. Depressive symptoms will be measured by the Montgomery Aasberg Depression Rating scale and eating disorder symptoms will be assessed with the EDE-Q. The neuropsychological assessment will be performed three times during the study: before treatment, post treatment and one year after discharge. The assessment will be performed at the Institute of biological and medical psychology, Section of clinical neuropsychology, University of Bergen.
An increasing number of patients are immunocompromised due to modern treatment of cancer, organ t... more An increasing number of patients are immunocompromised due to modern treatment of cancer, organ transplantations and HIV-infections. Opportunistic viral infections are common and may cause serious disease among these patients. New vaccines, immunomodulators and antiviral drugs make it possible to prevent and treat many of these infections. We review the host defence against viral infections and the most important viral infections. We also discuss prophylaxis, diagnosis and therapy.
The effect of insulin-like growth factor-1 (IGF-1) on highly enriched human apheresis CD34+ proge... more The effect of insulin-like growth factor-1 (IGF-1) on highly enriched human apheresis CD34+ progenitor cells was investigated in vitro. The progenitor cells were mobilized by treatment with cydophosphamide + granulocyte-colon y stimulating factor (G-CSF) in patients with multiple myeloma. CD34+ cells were cultured for 7 days in serumfree medium containing stem cell factor (SCF), granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin-3 (IL-3), and this is referred to as cytokine-dependent proliferation. After 7 days of cytokine-dependent proliferation the total number of viable cells increased 1.6-8.2 times, and subsets of cells expressing the granulocyte marker CD15, the myelomonocytic marker CD64 and the erythrocyte phenotype CD71high/CD64-were detected among the in vitro cultured cells. Addition of G-CSF together with SCF + IL-3 + GM-CSF increased the number of CD15+ and CD64+ cells, but without altering the number of erythroid cells. IGF-1 caused a dose-dependent increase in the number of CD15+, CD64+ and CD71high/CD64-cells, and this increase was detected when cells were cultured in both SCF + IL-3 + GM-CSF alone and G-CSF + SCF + IL-3 + GM-CSF. A minor subset of CD34+ cells could still be detected among in vitro cultured cells and the number of CD34+ cells was not altered by adding G-CSF and/or IGF-1. Morphologically recognizable mature granulocytes or erythroid cells could not be detected for any of the combinations investigated. We conclude that IGF-1 can enhance the in vitro proliferation of committed progenitor cells derived from apheresis CD34+ cells.
Eating disorders are associated with several medical complications. Growth retardation and osteop... more Eating disorders are associated with several medical complications. Growth retardation and osteoporosis can cause permanent sequelae if treatment is delayed. Severe eating disorders are associated with significant mortality. Cardiac arrhythmias are the most common somatic cause of death. Hypokalaemia is a common complication and is associated with increased risk of cardiac arrhythmias. Occasionally, overzealous refeeding may induce a potentially life-threatening condition, the refeeding syndrome. In any patient with severe eating disorder, a physician should perform diagnostic evaluation including assessment of possible somatic complications. This is necessary in order to determine where and how the patient should be treated. Most of the somatic complications of eating disorders are partly or completely reversible if the patient receives adequate treatment in time.
Background: Anorexia nervosa (AN) in adults is difficult to treat, and no current treatment is su... more Background: Anorexia nervosa (AN) in adults is difficult to treat, and no current treatment is supported by robust evidence. A few studies, most of which were performed by highly specialized research units, have indicated that enhanced cognitive behaviour therapy (CBT-E) for eating disorders can be effective. However, the dropout rate is high and the evidence from non-research clinical units is sparse. Methods: This quality assessment project implemented CBT-E in an outpatient setting at a public hospital. Fortyfour patients with AN started therapy. Each patient received at least 40 sessions of CBT-E over a 12-month period. Their body mass index (BMI) was recorded at baseline and after 3, 6 and 12 months. Reasons for not starting therapy or for leaving therapy prematurely were recorded. Results: Half (n = 22) of the 44 patients who started outpatient CBT-E did not complete the treatment. In the remaining sample there was a large (and statistically significant) weight gain after 12 months. The percentage of patients achieving the target BMI of > 18.5 kg/m 2 was 36.4, 50.0 and 77.3% after 3, 6 and 12 months, respectively. Conclusions: This quality assessment project shows that it is possible to establish effective CBT-E in an outpatient eating-disorder unit at a public hospital. Although half of the patients did not complete CBT-E, the remaining patients achieved a significant increase in BMI at 1 year after the start of therapy.
Acta pathologica, microbiologica et immunologica Scandinavica, Aug 15, 2009
Receptors for sheep erythrocytes, for the Fc part of IgG (FcyR) and IgM (FcqR), and for component... more Receptors for sheep erythrocytes, for the Fc part of IgG (FcyR) and IgM (FcqR), and for components of activated human complement C3 (C3bR and C3dR) in thymus tissue from fetuses, infants and children were studied using haemadsorption to cryostat sections in a closed chamber. Sheep erythrocytes (SE) did not adhere to sections of thymus from fetuses at 10-1 I weeks of gestation, adhered weakly between 14 and 20 weeks, while they adhered in a dense monolayer in older fetuses. in infants and in children, denser in the cortex than in the medulla. Ox erythrocytes (OE), sensitized with IgG to demonstrate FcyR. adhered focally to both cortical and medullary areas. The adherence was more pronounced to the sections of fetal thymus than to the sections from infants and children. OE, sensitized with IgM to demonstrate FcpR, adhered focally to all thymus tissue sections, preferentially to the cortex. The adherence was most pronounced in fetal thymus. SE, sensitized with IgM and coated with complement. adhered to sections of fetal thymus, but the density decreased markedly during fetal life. Indicator cells demonstrating C3bR adhered focally also to sections from infants and children. while indicator cells demonstrating C3dR did not adhere to sections from individuals older than 38 weeks of gestation. Indicator cells demonstrating C3bR and C3dR adhered both to cortex and medulla.
: The effects of insulin‐like growth factor 1 (IGF‐1) on autonomous proliferation, cytokine‐depe... more : The effects of insulin‐like growth factor 1 (IGF‐1) on autonomous proliferation, cytokine‐dependent proliferation and constitutive cytokine secretion by acute myelogenous leukemia (AML) blasts were investigated using serum‐free in vitro conditions. IGF‐1 enhanced AML blast proliferation independent of the presence of other exogenous cytokines only for 2 of 21 patients, but for 10 additional patients IGF‐1 altered blast proliferation in the presence of certain exogenous cytokines or cytokine combinations. IGF‐1 had minor effects on AML blast cytokine secretion only for a subset of the patients (decreased levels for 1 patient, increased levels for 7 patients). Our in vitro observations indicate that IGF‐1 can modulate AML blast proliferation and/or cytokine secretion for a subset of patients.
A synthetic analog of a hemoregulatory peptide associated with mature human granulocytes (HPSb) h... more A synthetic analog of a hemoregulatory peptide associated with mature human granulocytes (HPSb) has been investigated for inhibitory effects on various cell types in culture as compared to inhibitory action on mouse and human myelopoietic colonies (CFU-gm), which occurs from 1 X to 1 X 10-6 M in vitro. This includes colony formation by lymphoid T and B cells in capillary cultures, as well as mitogen activation of T, B and NK cells. At higher concentrations, i.e., above 1 X M, an inhibitory effect was found on colony formation. Neither the production of interleukin (IL) 3 by mitogenactivated T cells, nor the proliferation of the IL-3-dependent LIB cell line were affected by the peptide up to 1 X M on mouse 3T3 fibroblasts. A series of malignant cell lines was also tested. No effect was seen between 1 X lo-" and 1 x 10-7 M on human mammary carcinoma cells in culture. On Ehrlich ascites mouse mammary carcinoma cells a 30% inhibition was seen at M. On a human glioblastoma cell line (GaMg) no effect was seen, and on a rat glioma cell line (BT5C) an inhibitory effect was seen at 1 X 10-7 M and above. No significant inhibition of cell growth was seen on SCl mouse lymphoma cells from 1 X to 1 X l(rJ M during 7 days of culture. The investigated normal and malignant cell types in culture were thus not inhibited in very low concentrations which act on CFU-gm. However, a variable inhibitory effect was found at higher concentrations where the inhibition of myelopoiesis was maximal and at concentrations where the inhibition is released. The hemoregulatory peptide thus seems to be a concentrationdependent selective inhibitor of myelopoiesis. The finding that various malignant cells do not respond at lower concentrations supports the possibility of using the peptide as a protector of normal cells during cancer chemotherapy. M. A slight inhibitory effect was found above 1 X
The hemoregulatory peptide PyroGlu-Glu-Asp-Cys-Lys (HPSb), which inhibits myelopoietic colony for... more The hemoregulatory peptide PyroGlu-Glu-Asp-Cys-Lys (HPSb), which inhibits myelopoietic colony formation in vitro, is shown to be a sequence motif which is also part of the effector domain of Gi, proteins, Out of 8 synthetic peptides with sequence variations of HPSb, those with the closest similarity to the G,, sequence are biologically active. The inhibitory effect appears to be dependent on the blocked N-terminus. It is postulated that these peptides may interfere with signal transduction mediated by Gi= proteins.
Anorexia nervosa (AN) is a disabling, costly, and potentially deadly illness. Treatment failure a... more Anorexia nervosa (AN) is a disabling, costly, and potentially deadly illness. Treatment failure and relapse after treatment are common. Several studies have indicated the involvement of the gut microbiota–brain (GMB) axis. This narrative review hypothesizes that AN is driven by malnutrition-induced alterations in the GMB axis in susceptible individuals. According to this hypothesis, initial weight loss can voluntarily occur through dieting or be caused by somatic or psychiatric diseases. Malnutrition-induced alterations in gut microbiota may increase the sensitivity to anxiety-inducing gastrointestinal hormones released during meals, one of which is cholecystokinin (CCK). The experimental injection of a high dose of its CCK-4 fragment in healthy individuals induces panic attacks, probably via the stimulation of CCK receptors in the brain. Such meal-related anxiety attacks may take part in developing the clinical picture of AN. Malnutrition may also cause increased effects from appet...
Background: Anorexia nervosa (AN) has high rates of enduring disease and mortality. Currently, th... more Background: Anorexia nervosa (AN) has high rates of enduring disease and mortality. Currently, there is insufficient knowledge on the predictors of relapse after weight normalization and this is why a systematic literature review was performed. Methods: PubMed, EMBASE, PsychInfo, and Cochrane databases were searched for literature published until 13 July 2021. All study designs were eligible for inclusion if they focused on predictors of relapse after weight normalization in AN. Individual study definitions of relapse were used, and in general, this was either a drop in BMI and/or reccurrence of AN symptoms. Results: The database search identified 11,507 publications, leaving 9511 publications after the removal of duplicates and after a review of abstracts and titles; 191 were selected for full-text review. Nineteen publications met the criteria and included 1398 AN patients and 39 healthy controls (HC) from adults and adolescents (ages range 11–73 years). The majority used a prospe...
Introduction The majority of research concerning cognitive functioning in eating disorders has fo... more Introduction The majority of research concerning cognitive functioning in eating disorders has focused on the symptomatic phase of illness in patients suffering from Anorexia Nervosa. There is a lack of longitudinal studies focusing on the possible effects of cognitive functioning on treatment outcome. Further, only a subgroup of studies control for the effects of depression and depressive symptoms in this field of research. Objective The main objective of the present study is to examine cognitive functioning in patients suffering Anorexia in a longitudinal perspective. Secondly, to examine and clarify the effects of depression on cognitive functioning in patients suffering Anorexia. Thirdly, the aim is to investigate cognitive functioning in Anorexia as a possible predictor for treatment outcome and retention. Methods Patients aged≥16years diagnosed with Anorexia Nervosa, admitted to outpatient treatment (CBT-E) at Section for Eating Disorders, Haukeland University Hospital, will b...
Background The aim of this quality-assessment study was to determine the outcome of patients with... more Background The aim of this quality-assessment study was to determine the outcome of patients with severe and extreme anorexia nervosa (AN) in a real-world outpatient setting. Methods Twenty-one adults with AN and a body mass index (BMI) of < 16 were recruited from consecutive referrals to an outpatient clinic at a public hospital in Western Norway. All enrolled patients were provided with enhanced cognitive behaviour therapy (CBT-E) to treat their AN, commencing between January 2013 and December 2016. Their BMI was recorded at baseline, at the end of CBT-E and 1 year after the end of treatment. Results Ten patients completed the CBT-E treatment and achieved a large weight gain with the change remaining stable at follow-up. Eleven patients did not complete the treatment but had a significant increase in BMI at the premature end of treatment. One year after end of therapy 14/21 (66.7%) of the patients had BMI above 18.5 kg/m2. No severe complications were observed during therapy. C...
ObjectiveThe study aimed to assess outcomes in patients with severe and extreme anorexia nervosa ... more ObjectiveThe study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT‐E) in a real‐world outpatient setting.MethodThirty patients with anorexia nervosa and body mass index (BMI) <16 aged ≥17 years were recruited from consecutive referrals to an eating disorder service clinic offering outpatient CBT‐E. BMI and Eating Disorder Examination Questionnaire (EDE‐Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at admission, end of treatment, and 20‐ and 60‐week follow‐ups for treatment completers.ResultsTwenty patients (66.7%) completed the treatment and showed both considerable weight gain (Cohen's f = 1.43), and significantly reduced scores for clinical impairment (f = 1.26) and eating‐disorder (f = 1.03) and general psychopathology (f = 0.99). Changes remained stable at both follow‐ups. About half of the patients who completed treatment had a BMI ≥18.5 ...
Background: Anorexia nervosa (AN) in adults is difficult to treat, and no current treatment is su... more Background: Anorexia nervosa (AN) in adults is difficult to treat, and no current treatment is supported by robust evidence. A few studies, most of which were performed by highly specialized research units, have indicated that enhanced cognitive behaviour therapy (CBT-E) for eating disorders can be effective. However, the dropout rate is high and the evidence from non-research clinical units is sparse. Methods: This quality assessment project implemented CBT-E in an outpatient setting at a public hospital. Fortyfour patients with AN started therapy. Each patient received at least 40 sessions of CBT-E over a 12-month period. Their body mass index (BMI) was recorded at baseline and after 3, 6 and 12 months. Reasons for not starting therapy or for leaving therapy prematurely were recorded. Results: Half (n = 22) of the 44 patients who started outpatient CBT-E did not complete the treatment. In the remaining sample there was a large (and statistically significant) weight gain after 12 months. The percentage of patients achieving the target BMI of > 18.5 kg/m 2 was 36.4, 50.0 and 77.3% after 3, 6 and 12 months, respectively. Conclusions: This quality assessment project shows that it is possible to establish effective CBT-E in an outpatient eating-disorder unit at a public hospital. Although half of the patients did not complete CBT-E, the remaining patients achieved a significant increase in BMI at 1 year after the start of therapy.
Anorexia nervosa (AN) is a severe and often enduring condition of which the etiology is unknown. ... more Anorexia nervosa (AN) is a severe and often enduring condition of which the etiology is unknown. Studies on the gut microbiota in AN have found deviations from that of healthy individuals, which may imply a relation to pathophysiology, development and maintenance of the disorder via the gut-brain axis, which has been shown in other disorders. A narrative review of the gut microbiota studies in AN is presented. Several studies point to a dysbiosis in AN which may have implications for maintenance of a low body weight, immunological changes and a severely reduced food intake. An association may be found to clinical symptoms in AN. A pathophysiological model for disease is presented implying a role of the microbiota in maintenance of AN. Dysbiosis in AN may play an important role in the development and maintenance of AN.
The effect of insulin-like growth factor-1 (IGF-1) on highly enriched human apheresis CD34+ proge... more The effect of insulin-like growth factor-1 (IGF-1) on highly enriched human apheresis CD34+ progenitor cells was investigated in vitro. The progenitor cells were mobilized by treatment with cydophosphamide + granulocyte-colon y stimulating factor (G-CSF) in patients with multiple myeloma. CD34+ cells were cultured for 7 days in serumfree medium containing stem cell factor (SCF), granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin-3 (IL-3), and this is referred to as cytokine-dependent proliferation. After 7 days of cytokine-dependent proliferation the total number of viable cells increased 1.6-8.2 times, and subsets of cells expressing the granulocyte marker CD15, the myelomonocytic marker CD64 and the erythrocyte phenotype CD71high/CD64-were detected among the in vitro cultured cells. Addition of G-CSF together with SCF + IL-3 + GM-CSF increased the number of CD15+ and CD64+ cells, but without altering the number of erythroid cells. IGF-1 caused a dose-dependent increase in the number of CD15+, CD64+ and CD71high/CD64-cells, and this increase was detected when cells were cultured in both SCF + IL-3 + GM-CSF alone and G-CSF + SCF + IL-3 + GM-CSF. A minor subset of CD34+ cells could still be detected among in vitro cultured cells and the number of CD34+ cells was not altered by adding G-CSF and/or IGF-1. Morphologically recognizable mature granulocytes or erythroid cells could not be detected for any of the combinations investigated. We conclude that IGF-1 can enhance the in vitro proliferation of committed progenitor cells derived from apheresis CD34+ cells.
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