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Assessment of psychological predictors of weight loss:How and what for?

World Journal of Psychiatry 2015年第1期5卷 56-67页

作者： lisa lazzeretti Francesco Rotella Laura Pala Carlo Maria Rotella Psychiatric Unit Careggi University Hospital Psychiatric Unit and Diabetes Agency Careggi University Hospital Endocrinology Unit Careggi University Hospital Department of Biomedical Experimental and Clinical Sciences Obesity AgencyCareggi University Hospital

Obesity is a multifactorial disease and the prominent factors playing a role in its pathogenesis are biological, environmental and psychological. There is a growing interest in understanding psychological functioning of obese subjects and the influence of psychological factors on treatment outcome. The aim of the present narrative review is to critically analyze the current literature, in order to point out the most common psychological constructs studied in obesity and to give an overview of the main existing tools investigating psychological features which have been considered significant for the prediction of success in weight loss and maintenance programs in obese patients. In this framework, the most common psychological constructs studied are: self-motivation, self-efficacy, locus of control, health related quality of life, self-esteem, self-control, concerns about body image, outcome expectations, and personality traits. These features have been explored through a wide variety of psychometric instruments. However, as an overall, studies evaluating the association between psychological features and treatment outcome failed to give consistent results. A possible explanation may consist on the fact that many tools widely used to explore psychological features were not specifically designed for obese patients and none of them was comprehensive of all possible psychological features involved. The identification of well-defined subgroups of patients and the validation of more reliable and comprehensive tools, specifically designed for obese subjects, should be forecasted in order to reach a better knowledge of psychological functioning of obese individuals and to improve the outcome of weight loss programs.

关键词： Obesity Eating behaviors Psychometrics Psychological assessment Psychological predictors

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Childhood stressful events, HPA axis and anxiety disorders

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World Journal of Psychiatry 2012年第1期2卷 13-25页

作者： Carlo Faravelli Carolina Lo Sauro Lucia Godini Lorenzo Lelli Laura Benni Francesco Pietrini lisa lazzeretti Gabriela Alina Talamba Giulia Fioravanti Valdo Ricca Department of Psychology University of Florence Psychiatric Unit Department of Neuropsychiatric Sciences Florence University School of Medicine

Anxiety disorders are among the most common of all mental disorders and their pathogenesis is a major topic in psychiatry, both for prevention and treatment. Early stressful life events and alterations of hypothalamic pituitary adrenal(HPA) axis function seem to have a significant role in the onset of anxiety. Existing data appear to support the mediating effect of the HPA axis between childhood traumata and posttraumatic stress disorder. Findings on the HPA axis activity at baseline and after stimuli in panic disordered patients are inconclusive, even if stressful life events may have a triggering function in the development of this disorder. Data on the relationship between stress, HPA axis functioning and obsessive-compulsive disorder(OCD) are scarce and discordant, but an increased activity of the HPA axis is reported in OCD patients. Moreover, normal basal cortisol levels and hyperresponsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally,abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. While several hypothesis have attempted to explain these findings over time, currently the most widely accepted theory is that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology. All theories are reviewed and the authors conclude that childhood life events and HPA abnormalities may be specifically and transnosographically related to all anxiety disorders, as well as, more broadly, to all psychiatric disorders.

关键词： Anxiety disorders Early stressful life events Childhood traumata Cortisol Hypothalamic pituitary adrenal axis Vulnerability Psychopathology

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Association between resting energy expenditure, psychopathology and HPA-axis in eating disorders

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World Journal of Clinical Cases 2014年第7期2卷 257-264页

作者： Giovanni Castellini Walter Castellani Lorenzo Lelli Carolina Lo Sauro Carla Dini lisa lazzeretti Lorenza Bencini Edoardo Mannucci Valdo Ricca Department of Neuroscience PsychologyDrug Research and Child HealthUniversity of Florence50134 FirenzeItaly Department of Respiratory Physiopathology Palagi Hospital50134 FirenzeItaly Department of Health Science University of Florence50134 FirenzeItaly Nutrition Service University of Florence50134 FirenzeItaly Non Invasive Cardiology Department of Heart and VesselsUniversity of Florence50134 FirenzeItaly

AIM: To investigate the complex relationships between resting energy expenditure(REE), eating psychopathology, and Hypothalamus Pituitary Adrenal axis functioning in patients with eating disorders. METHODS: The study was designed as a crosssectional survey, and it was planned by the Clinic for Eating Disorders of the University of Florence(Italy). The protocol was approved by the Ethics Committee of the Institution. Twenty two anorexia nervosa and twenty one Bulimia Nervosa patients were assessed by means of a clinical interview and the structured clini-cal interview for diagnostic and statistical manual of mental disorders, fourth edition. Eating attitudes and behaviour were specifically investigated by means of the eating disorder examination questionnaire(EDE-Q). Patients were also evaluated by means of the symptom checklist(SCL 90-R), REE was measured by means of indirect calorimetry, and blood cortisol morning levels were evaluated. RESULTS: Both anorexia nervosa and bulimia nervosa patients showed a reduced REE as compared with predicted REE. Body mass index(BMI) was positively associated with resting energy expenditure in Bulimics, whereas a strong, negative association between BMI and REE was observed in Anorectics. The pattern of associations between variables supported a mediation model, where shape concern accounted for variations in REE and cortisol levels(mediator), and variations in the mediator significantly accounted for variations in REE. When these associations where taken into account together, the relationship between shape concern and REE was no longer significant, whereas the association between cortisol levels and REE retained its significance, showing strong evidence for a single, dominant mediator. Anorectics and Bulimics showed an opposite pattern of association between BMI and REE. In Anorectics only, a higher REE was associated with a more severe eating disorder specific psychopathology, and cortisol levels represent a possible mediating

关键词： Anorexia nervosa Bulimia nervosa Cortisol Psychopathology Resting energy expenditure

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