Clinical Briefs
Recognizing Binge Eating Disorder
SOURCE: Kornstein SG. Epidemiology and recognition of binge-eating disorder in psychiatry and primary care. J Clin Psychiatry 2017;78(Suppl 1):3-8.
The diagnostic criteria for binge eating disorder includes at least weekly episodes of binge eating for at least three months.
Binge eating is described as ingesting, in a circumscribed period, a significantly larger amount of food than is typical; characteristically, sufferers feel a lack of control over how much they eat during the episode, and are not driven by sustained hunger.
In contradistinction from anorexia nervosa or bulimia nervosa, post-meal purging (or other compensatory measures such as hyper exercising or excessive laxative use) is not part of the diagnosis.
Binge eating disorder is more common than anorexia and bulimia, the two most well-known eating disorders. Part of the lack of recognition of binge eating disorder stems from its relatively recent inclusion as a specific eating disorder.
There are screening tools available for binge eating disorder appropriate for use in primary care settings, and Kornstein suggested inclusion of at least one screening question in routine care about eating habits such as “Do you ever feel a loss of control over how much you eat?”
Psychological as well as pharmacologic therapies (primarily antidepressants) have been demonstrated to produce some benefit for binge eating disorder. Because binge eating disorder is more common in persons with obesity, screening potentially is more useful in this population.
Antisocial Behavioral Syndromes in the United States
SOURCE: Goldstein RB, Chou SP, Saha TD, et al. The epidemiology of antisocial behavioral syndromes in adulthood: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. J Clin Psychiatry 2017;78:90-98.
The National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) has provided data about the prevalence of antisocial behavioral syndromes in the United States. The societal burden incurred from persons with antisocial personality disorder is substantial, since the disorder is associated with impulsive aggressive behaviors for which the sufferer lacks remorse. Consequences include acts of violence as well as unstable personal, marital, and societal relationships.
From a large diverse cross-sectional population sample (n = 36,309), interviewers used a National Institute on Alcohol Abuse and Alcoholism tool known as Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. This tool helps researchers identify not only alcohol misuse, but also drug use disorders, mood disorders, anxiety, and personality disorders.
This survey found that 4.3% of adults fulfilled criteria for antisocial personality disorder. Rates were highest in younger adult white and Native American males.
Treatments for antisocial personality disorder are labor intensive. Antisocial personality disorder tends to remit over time.
Whether treatment for the numerous other comorbidities, such as substance abuse associated with antisocial personality disorder, will hasten time to remission is an area of needed research.
Preventing Sickle Cell Disease Pain Crises
SOURCE: Ataga KI, Kutlar A, Kanter J, et al. Crizanlizumab for the prevention of pain crises in sickle cell disease. N Engl J Med 2017;376:429-439.
P-selectin is a protein within endothelial cells, megakaryocytes, and platelets that functions during inflammation to enhance adhesion of leukocytes and other cells to the site of inflammation. In sickle cell disease, platelets, erythrocytes, monocytes, and neutrophils can aggregate to compound circulatory flow problems, which lead to painful vaso-occlusive crises symptoms. In animal models of sickle cell anemia, deficiency in P-selectin (and E-selectin) is protective from vaso-occlusive episodes.
Crizanlizumab is a monoclonal antibody that blocks interaction between P-selectin and its receptor. In a double-blind, randomized, placebo-controlled trial of crizanlizumab, subjects (n = 198) who had experienced at least two sickle-cell pain crises within the prior 12 months were in enrolled and followed for one year.
Patients on crizanlizumab enjoyed a 45% reduction in painful crises compared to placebo. Adverse events potentially related to treatment included arthralgia, diarrhea, pruritus, vomiting, and chest pain. Crizanlizumab has been demonstrated to be highly effective in reducing painful crises related to sickle cell disease.
In this section: recognizing signs of binge eating disorder; a closer look an antisocial behavioral problems; and treating sickle cell pain.
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