S-32-01

Genetic predictivity of the clinical and psychological effects of ssri treatments in disorders of eating behavior

P. Monteleone, A. Tortorella, M. Fabrazzo, E. Castaldo, A. Fuschino, C. Di Filippo, M. Maj. University of Naples SUN Psychiatry, Naples, Italy

Objective: Although selective serotonin reuptake inhibitors (SSRIs) are currently recommended as the first-line pharmacological treatment of bulimla nervosa (BN), a portion of patients do not respond to SSRIs. Since the 5HT transporter (5HTY) represents the prime target of SSRIs, the gene coding for this protein is an attractive candidate gene for pharmacogenetic SSRI studies. A long (L) and a short (S) variant of the promoter region of the 5-HTT gene, with different transcriptional efficiencies, have been identified. Therefore, we investigated whether 5-HTrLPR was associated to SSRI response in patients with BN.

Methods: Forty-seven bulimic women underwent a naturalistic treatment with SSRIs plus nutritional counselling. After 12 weeks, those patients presenting a reduction in the binge/purging frequency greater than 50% of the pretreatment value were defined as responder. Allelic variation in each subject was determined by using a PCR-based method.

Results: At the end of the observation period, 32 women were responder. Of the 10 SS subjects, 8 (80%) were nonresponder versus 6 (37.5%) of the 16 SL patients and 1 (0.4%) of the 21 LL subjects (c2 = 17.99, P=0.0001). When, we considered the S allele as dominant and compared subjects with either SS or SL genotype to those with LL genotype, the lack of response was significantly more frequent among those patients carrying at least one copy of the S allele as compared to LL subjects (Fisher exact P = 0.0003; Odd ratio: 23.33; 95% Confidence Intervals = 2.59 - 209.76).

Conclusion: Although these data must be considered cautiously because of the naturalistic nature of the study, they show for the first time that the S form of the 5HTTLPR seems to be associated with a poorer response to a combined treatment with SSRIs plus nutritional counselling

S-32-02

Biological background of the psychological effects of cognitivebebavioural therapy in anorexia nervosa

F. Brambilla, R. Dalle Grave, T. Todesco, D. Marazziti, P. Monteleone, S. Caluggi. University of Naples SUN Dept. of Psychiatry, Naples, Italy

Objective: Aim of the study is to see in anorexia nervosa patients whether or not neurotransmitter impairments, which have been suggested to represent the biological background of the disorder or of some of its specific symptoms, are modified by Cognitive-Behavioral Therapy (CBT) in parallel with anorexic symptomatology.

Methods: We examined BMI, psychological aspects (monitored by EDI-2, BITE, TCI, Yale Brown Cornell, Barrat, SCL-90, Hamilton for Depression, STAI Rating Scales), and we measured HVA (for DA), MHPG (for NE), paroxetine-binding (for 5-HT) blood concentrations before, after 1 and 3 ms of CBT.

Results: A significant increase of BMI and improvement of the anorexic psychopathology occurred after CBT in both hospitalized and outpatients anorexics, in parallel with changes of HVA, MHPG, and paroxetine-binding concentrations. Conclusion: The pathogenetic significance of the neurotransmitter concentrations before and after CBT will be discussed.

S-32-03

Implications of biological research for our understanding and definition of anorexia nervosa

J. Hebebrand. Marburg, Germany

S-32-04

Guided self-help for bulimic anorexia nervosa to reduce time in intensive treatment: A controlled study

M. M. Fichter,.M. Cebulla, N. Kranzlin, M. Fumi, S. Naab. Klinik Roseneck aft. Uni MUC, Prien, Germany

Objective: Anorexia nervosa (especially bulimic AN) has high rates of chronicity and mortality and there is a need for more effective treatments. In a controlled treatment study we assessed the efficacy of manualized therapist-guided self-help, administered via mail and weekly telephone sessions over 6 week before inpatient cognitive behavioral treatment.

Methods: 100 patients with anorexia nervosa of the bingeeating/ purging type according DSM-IV criteria were assigned to the experimental group (guided self-help prior to intensive inpatient treatment) or to the control-group (intensive inpatient treatment only). Patients were assessed 8 weeks before admission, on admission, at discharge and at six-month follow-up. Data on general psychopathology and eating pathology was obtained using structured interviews (SIAB-EX, SCID I, SCID II) and standardized questionnaires (SIAB-S, EDI, TFEQ, BDI, SCL90 etc.). Main hypotheses of the study were: 1) symptoms of general psychopathology as well as eating pathology symptoms are more rapidly reduced in the experimental group compared to the control group, 2) this effect is detectable also at six-month follow-up and 3) guided self-help reduces the duration of the intensive treatment and still maintains treatment quality and effects.

Results: The guided self-help approach preceding inpatient treatment was well accepted by the patients. Data show I) significant positive effects of the guided self-help intervention prior to inpatient treatment (as compared to the control group), 2) significant improvement during inpatient treatment in both groups and 3) fewer days in inpatient treatment for the intervention group as compared to the control group.

Conclusion: The self-help intervention had significant positive immediate effects and reduced the days of inpatient treatment.