Evidence for 'food addiction' in humans

ScienceDaily (July 12, 2011) — Research to be presented at the upcoming annual meeting of the Society for the Study of Ingestive Behavior (SSIB), the foremost society for research into all aspects of eating and drinking behavior, suggests that people can become dependent on highly palatable foods and engage in a compulsive pattern of consumption, similar to the behaviors we observe in drug addicts and those with alcoholism.

Using a questionnaire originally developed by researchers at Yale University, a group of obese men and women were assessed according to the 7 symptoms recommended by the American Psychiatric Association to diagnose substance dependence (e.g., withdrawal, tolerance, continued use despite problems), with questions modified by replacing the word food for drugs within the questions. Based on their responses, individuals were classified as 'food addicts' or non-addicts, and then the two groups were compared in three areas relevant to conventional addiction disorders: clinical co-morbidities, psychological risk factors, and abnormal motivation for the addictive substance.

While 'food addicts' did not differ from non-addicts in their age or body weight (controlled for height), they displayed an increased prevalence of binge-eating disorder and depression, and more symptoms of attention-deficit/hyperactivity disorder. They also were characterized by more impulsive personality traits, were more sensitive or responsive to the pleasurable properties of palatable foods, and were more likely to 'self-soothe' with food.

"These results strongly reinforce the view that food addiction is an identifiable condition with clinical symptoms, and is characterized by a psycho-behavioral profile that is similar to conventional drug-abuse disorders," said Dr. Davis. "The results also deliver much needed human support for the growing evidence of sugar and fat addiction in experimental animal research," she added. "These findings advance our search for clinically relevant subtypes of obesity that may possess different biological and psychological vulnerabilities to environmental risk factors. This type of information will help us develop personalized treatment approaches for those who struggle with overeating and escalating weight gain."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Society for the Study of Ingestive Behavior.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here sciencedaily.com

Limitations of evidence base for prescribing aripiprazole in maintenance therapy of bipolar disorder

ScienceDaily (May 3, 2011) — The evidence base for the prescribing of aripiprazole in maintenance treatment of bipolar disorder is limited to a single trial, sponsored by the manufacturer of aripiprazole, according to a rigorous appraisal of the evidence for its use led jointly by Alexander Tsai of Harvard University, Boston USA, and Nicholas Rosenlicht of the University of California San Francisco, USA. In the paper, published in PLoS Medicine, the authors describe key limitations of the trial, which were not identified in most subsequent review articles and guidelines for the treatment of bipolar disorder in which the trial was cited.

Bipolar disorder (also known as manic depression) is a common and serious psychiatric illness. Individuals with bipolar disorder experience mood swings with manic episodes (where they may feel euphoric, restless, and behave impulsively), along with depressive episodes where they may feel low, worthless, and suicidal. Aripiprazole is a second-generation antipsychotic medication and the newest of such drugs to have received approval by the US Food and Drug Administration (FDA) for use both in treatment of acute episodes and, more recently, for maintenance therapy.

Drs. Tsai and Rosenlicht and their colleagues conducted a systematic search to find all published and unpublished studies relating to use of aripiprazole for maintenance therapy of bipolar disorder, including a request to the FDA under Freedom of Information Act legislation. They critically appraised this evidence and then used citation searches to examine how the primary evidence was subsequently referenced in the medical literature. The authors found only a single trial describing the use of aripiprazole during the maintenance phase of bipolar disorder. Further, they found significant limitations of this trial that constrain its interpretation as supporting the use of aripiprazole for this indication. First, the trial duration was too short to show that the drug was truly helpful in maintaining initial benefit or preventing mood swings over the long term. Second, very few participants in the trial completed the entire study. Third, the trial was based on a select minority of subjects who had shown an initial response to the drug, making it difficult to extrapolate these findings to patients with bipolar disorder more widely. Fourth, the trial had a design whereby patients assigned to placebo were abruptly taken off aripiprazole treatment given to them during a previous "run-in" phase and reassigned to placebo; differences in risk of relapse seen between trial arms may thus also reflect the potentially harmful effects of rapid drug withdrawal in patients given placebo.

Despite these shortcomings, the authors found that this single trial was subsequently cited by 104 review articles and treatment guidelines, with very few mentioning the study's limitations.

The authors comment that "…alternative modifications or study designs may improve the probability of generating more useful data from studies in this vulnerable patient population to inform the treatment of similar patients in the future."

Patients (or their family members) who may learn of this study's findings are urged to contact their physician if concerned about what these findings may mean for their treatment. Specifically, the findings do not mean patients should cease their medication; despite the limitations of the evidence described here, this drug may be helpful to them. In addition, the study did not assess the evidence for the use of aripiprazole in acute treatment of bipolar disorder.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Public Library of Science, via EurekAlert!, a service of AAAS.

Journal Reference:

Alexander C. Tsai, Nicholas Z. Rosenlicht, Jon N. Jureidini, Peter I. Parry, Glen I. Spielmans, David Healy. Aripiprazole in the Maintenance Treatment of Bipolar Disorder: A Critical Review of the Evidence and Its Dissemination into the Scientific Literature. PLoS Medicine, 2011; 8 (5): e1000434 DOI: 10.1371/journal.pmed.1000434

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here