The Cigna Group · NYSE:CI
The Cigna — Cigna — Investor Presentation (July 2012)
31 slides from The Cigna's investor presentation, July 2012
Slide 1: Understanding Predisposing and Precipitating Factors for Eating Disorders
Understanding Predisposing and Precipitating Factors for Eating Disorders: What Every Parent Needs to Know Cigna Educational Series July 2012 Ovidio B. Bermudez, MD, FAAP, FSAHM, FAED, CEDS Medical Director Child & Adolescent Services And Chief Medical Officer
Slide 2: Disclosures
Disclosures No conflict of interest or pertinent financial disclosures to report
Slide 3: Eating Disorders (EDs)
Eating Disorders (Eds) Biology Psychology Sociology Bio-psycho-social Illnesses
Slide 4: Fundamental Premises in conceptualizing EDs
Fundamental Premises in conceptualizing EDs Psychiatric illnesses with high medical morbidity and mortality Very limited evidence to support our interventions (but growing) Affect people from all walks of life, both genders, all races and ethnicities and nearly all ages
Slide 5: Topics for discussion
Topics for discussion What causes an eating disorder? Understanding predisposing factors Understanding precipitating factors
Slide 6: Topics for discussion
Topics for discussion What causes an eating disorder?
Slide 7: Eating Disorders Familial Genetics
Eating Disorders Familial Genetics If 1st or 2nd degree relative with ED, the increase in relative risk is: – 12-fold for Anorexia Nervosa (AN) – 4-fold for Bulimia Nervosa (BN)
Slide 8: Eating Disorders Molecular Genetics
Eating Disorders Molecular Genetics Linkage studies – Price Foundation and NIMH – Anorexia Nervosa – chromosome 1 – Bulimia Nervosa – chromosome 10
Slide 9: Heritability Estimates
Heritability Estimates Statistical analysis of the probability or impact of genetics, accounting for environmental factors It analyzes the interaction of – Genetic influence – Shared environment influence – Unique environment influence
Slide 10: Heritability Estimates
Heritability Estimates Disorder Heritability – Autism – 0.8 – 1.0 – Schizophrenia – 0.5 – 0.9 – Bipolar Disorder – 0.3 – 0.8 – AN / BN – 0.5 – 0.8 – early MDD – 0.5 – 0.75 – OCD – 0.5 – 0.7 – Obesity – 0.4 – 0.7 Treasure & Holland 1990; Fichter & Noegel 1990; Holland et al 1984, 1988; Hsu et al
Slide 11: Results from Twin Studies
Results from Twin Studies Heritability of Bulimia Nervosa – Genetic Effects: 59-83% – Shared Environmental Effects: 0% – Non-shared Environmental Effects: 17-41% Heritability of Anorexia Nervosa – Genetic Effects: 58-76% – Shared Environmental Effects: 0% – Non-shared Environmental Effects: 24-4
Slide 12: Heritability of Anorexia Nervosa
Heritability of Anorexia Nervosa Non-identical twins 5% Identical twins 56% – Bulik et al, 2006
Slide 13: Gene x Environment Interaction
Gene x Environment Interaction
Slide 14: Concept of Gene x environment interaction
Concept of Gene x environment interaction Probability of depression at age 26; stressful life events between 22-26 s/s s/l l/l 45 Probability (%) of MDD episode 40 35 30 25 20 15 10 5 0 0 1 2 3 4 # stressful life events Caspi et al, Science 2003;301:386
Slide 15: Causes of Eating Disorders Genetic Liability
Causes of Eating Disorders Genetic Liability Is there an Anorexia Nervosa or Bulimia Nervosa Gene? – Unlikely – Historical evolution of ED symptoms seems to be culturally influenced – Crossover phenomenon 30-63% of AN → BN 8-25% BN → AN – Spectrum of eating disordered pathology is growing
Slide 16: Causes of Eating Disorders Genetic Liability
Causes of Eating Disorders Genetic Liability How are eating disorders inherited? – Complex heritability: interaction of heritable vulnerability factors and protective factors – Influence of constitutionality: personality and temperamental traits – Influence of the environment: protective vs. promo
Slide 17: Eating Disorders: genetics and environment
Eating Disorders: genetics and environment Promoting Incidence of eating disorders environment Protective environment Resistant Prone Genetic Predisposition
Slide 18: Topics for discussion: Understanding predisposing factors
Topics for discussion Understanding predisposing factors
Slide 19: Predisposing Factors for EDs
Predisposing Factors for EDs Temperamental traits Psychiatric vulnerability
Slide 20: Eating Disorders in Children
Eating Disorders in Children Predisposing Factors – Temperamental traits Harm avoidance (AN and BN) Novelty seeking (low AN, high BN) Reward dependence (AN > BN) Persistence (high in ANR) – Characterological Cognitive Schemes Self directedness Cooperation Transcendence
Slide 21: National Comorbidity Survey
NATIONAL COMORBIDITY SURVEY MEDIAN AGE OF ONSET – Anxiety disorder 11y.o. – Impulse disorder 11y.o. – Substance abuse 20y.o. – Mood disorder 30y.o. – 1/2 of all lifetime cases by age 14 – ¾ of all lifetime cases by age 24
Slide 22: Topics for discussion: Understanding precipitating factors
Topics for discussion Understanding precipitating factors
Slide 23: APA Survey: Stress in America
APA Survey: Stress in America
Slide 24: Eating Disorders in Children
Eating Disorders in Children Precipitating Factors
Slide 25: Eating Disorders in Children
Eating Disorders in Children Precipitating Factors – Puberty – Dieting and exercise as neurobiological triggers – High risk activities Judged vs. Refereed activities – Points for physique
Slide 26: Eating Disorders in Children
Eating Disorders in Children Precipitating Factors – Teasing – Bullying – Social shunning – Social contagion – War on obesity
Slide 27: In Summary
In Summary Eating Disorders are serious illnesses Younger children are being affected Early recognition and timely intervention are critical Parents and caretakers have an important role in – Recognizing children at risk – Seeking assessment and treatment on a timely basis – Working with tre
Slide 28: 119% increase in hospitalizations for children under 12
119% increase in hospitalizations for children <12 years old with eating disorders between 1999-2006 (AHRQ)
Slide 29: www.aedweb.org
EATING == DISORDERS »-setsenon
Slide 30: Core References
Core References AAP – Policy Statement: Identifying and Treating Eating Disorders, 2003 – Rome et al. Children and Adolescents with Eating Disorders: the State of the Art. Pediatrics. 2003;111:e 98-108 SAM – Background Paper and Position Statement, SAM, 1995 – Position Paper: Eating Disorders in
Slide 31: Thanks…
Thanks…