***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study was intended to establish the pathogenic significance of sport and exercise in the development of eating disorders . Hospitalized eating disordered patients and an age-matched control group were assessed . Historical and current physical activity data were collected . An indepth interview was also conducted to ascertain the age of onset of the diagnostic symptoms for eating disorders , and to determine whether : ( i ) exercising pre date d dieting ; ( ii ) patients had been involved in competitive athletics ; ( iii ) exercise was excessive ; and ( iv ) weight loss was inversely related to level of exercise . The results indicated that patients were more physically active than controls from adolescence onwards , and prior to the onset of the primary diagnostic criteria for anorexia nervosa . A content analysis of the interview data indicated that 78 % of patients engaged in excessive exercise , 60 % were competitive athletes prior to the onset of their disorder , 60 % reported that  sport or exercise pre- date d dieting  , and 75 % cl aim ed that physical activity levels steadily increased during the period when food intake and weight loss decreased the most . Together our results suggest that overactivity should not be routinely viewed as a secondary symptom in anorexia nervosa , equivalent to other behaviours . For a number of anorexic women , sport/exercise is an integral part of the pathogenesis and progression of self-starvation Anorexia nervosa ( AN ) and obsessive-compulsive disorder ( OCD ) are highly comorbid , and appear to share a common neurophysiological dysfunction that contributes to the obsessional thoughts and compulsive behaviours seen in both disorders . Obsessive-compulsive personality ( OCP ) traits are also important risk factors for AN . Since excessive exercise has also been associated with greater obsessionality , we hypothesised that AN patients with a hyperactive behavioural profile represent a phenotype more closely linked to OCD than their non-exercising counterparts . We examined prospect ively 50 female AN-Restrictor patients whom we classified as " excessive " or " non-excessive " based on their exercise status i ) at admission and ii ) over the lifetime of their illness . Vali date d measures of OCD symptoms and OCP traits were obtained at admission and after refeeding at discharge . On both classification methods , excessive exercisers had greater OCD symptoms and OCP traits than the non-excessive group , but did not differ on body mass index . OCD symptoms , but not OCP traits , decreased between admission and discharge . Findings support our prediction that AN patients with excessive physical activity constitute a subtype of the disorder with strong links to OCD . Indeed , this phenotype may be a culture-bound variant of OCD OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND Anorexia nervosa is a disorder of unknown etiology with a high rate of relapse and no known treatment . Because anorexia nervosa shares some similarities with obsessive compulsive disorder , we hypothesized that a serotonin-specific medication might be useful in the treatment of this illness . METHOD We administered an open trial of fluoxetine to 31 patients with DSM-III-R anorexia nervosa . Most anorexics were started on fluoxetine treatment after inpatient weight restoration and then discharged from the hospital and followed up as out patients . RESULTS At the time of follow-up ( 11 + /- 6 months on fluoxetine ) , 29 of the 31 patients had maintained their weight at or above 85 % average body weight ( 97 % + /- 13 % average body weight for the group ) . We judged response as good in 10 , partial in 17 , and poor in 4 anorexics as measured by improvements in eating behavior , mood , and obsessional symptoms . Restrictor anorexics responded significantly better than bulimic and /or purging-type anorexics . CONCLUSION This open trial suggests that fluoxetine may help patients with anorexia nervosa maintain a healthy body weight as out patients . The reasons for the positive effects of fluoxetine are uncertain , but the agent may help by improving eating behavior and /or reducing obsessionality , depression , and anxiety . It is important to emphasize that this was not a double-blind , placebo-controlled study . Thus we can not be certain of the efficacy of fluoxetine and caution that fluoxetine should not be used as the sole treatment of anorexia nervosa at this time OBJECTIVE This study considered whether the prevalence and type of anxiety and psychoactive substance use disorder ( PSUD ) diagnoses differ between women with spectrum anorexia nervosa ( AN ) ( N=40 ) and women with major depressive disorder ( N = 58 ) participating in outpatient clinical trials . METHOD Anxiety and PSUD diagnoses ( according to criteria in the 3rd Rev. ed . of the Diagnostic and Statistical Manual of Mental Disorders ) were assessed using structured clinical interviews . Comparisons were made between AN subtypes ( restricting or binge eating/purging ) and by history of depression within the AN sample . RESULTS A high prevalence of obsessive-compulsive disorder ( OCD ) was found in women with AN . However , social phobia , simple phobia , and PSUD were significantly elevated in both women with depression and women with AN . Prevalences were similar for anxiety and PSUD diagnoses between AN subtypes . DISCUSSION Women with anorexia or depression were comparable in all respects , except for the elevated OCD prevalence in AN , emphasizing the need to use clinical comparison groups to avoid inadvertently attributing elevated prevalences of comorbid conditions to specific disorders In the present study , the structure of obsessive-compulsive symptoms was investigated by means of the Padua Inventory ( PI ) . Simultaneous Components Analysis on data from obsessive-compulsives ( n = 206 ) , patients with other anxiety disorders ( n = 222 ) , and a non clinical sample ( n = 430 ) revealed a five-factor solution . These factors are : ( I ) impulses ; ( II ) washing ; ( III ) checking ; ( IV ) rumination ; and ( V ) precision . Forty-one items were selected as measure of these factors . The reliability for the five subscales , assessing each of the five factors , was found to be satisfactory to excellent . Four subscales ( washing , checking , rumination and precision ) discriminated between panic disorder patients , social phobics and normals on the one h and and obsessive compulsives on the other . The Impulses subscale discriminated between obsessive-compulsives on the one h and and normals on the other , but not between obsessive-compulsives and social phobics or panic patients . Some evidence in support of the construct validity was found . The Padua Inventory-Revised ( 41-items ) appears to measure the structure of obsessive compulsive symptoms : The main types of behaviours and obsessions as seen clinical ly are assessed by this question naire , apart from obsessional slowness 
    Output:
    
Conclusion There is evidence from the literature to suggest that there is a positive relationship between OCPD and excessive exercise in patients with AN .