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The Lancet. Psychiatry Dec 2015Anorexia nervosa is an important cause of physical and psychosocial morbidity. Recent years have brought advances in understanding of the underlying psychobiology that... (Review)
Review
Anorexia nervosa is an important cause of physical and psychosocial morbidity. Recent years have brought advances in understanding of the underlying psychobiology that contributes to illness onset and maintenance. Genetic factors influence risk, psychosocial and interpersonal factors can trigger onset, and changes in neural networks can sustain the illness. Substantial advances in treatment, particularly for adolescent patients with anorexia nervosa, point to the benefits of specialised family-based interventions. Adults with anorexia nervosa too have a realistic chance of achieving recovery or at least substantial improvement, but no specific approach has shown clear superiority, suggesting a combination of re-nourishment and anorexia nervosa-specific psychotherapy is most effective. To successfully fight this enigmatic illness, we have to enhance understanding of the underlying biological and psychosocial mechanisms, improve strategies for prevention and early intervention, and better target our treatments through improved understanding of specific disease mechanisms.
Topics: Anorexia Nervosa; Humans; Psychotherapy; Randomized Controlled Trials as Topic
PubMed: 26514083
DOI: 10.1016/S2215-0366(15)00356-9 -
British Journal of Hospital Medicine... Jun 2020Anorexia nervosa is an eating disorder with peak onset in adolescence, which carries the highest mortality rate of all psychiatric illnesses. It is commonly comorbid... (Review)
Review
Anorexia nervosa is an eating disorder with peak onset in adolescence, which carries the highest mortality rate of all psychiatric illnesses. It is commonly comorbid with other physical and mental health problems, yet training on management of people with eating disorders and working knowledge of clinicians working with underweight adolescents is inconsistent. This review of anorexia nervosa in adolescents provides an overview of the presentation, aetiology and treatment of this disorder, with a particular focus on the assessment and management of physical health risks, including refeeding syndrome.
Topics: Adolescent; Anorexia Nervosa; Arrhythmias, Cardiac; Body Mass Index; Bradycardia; Dehydration; Early Diagnosis; Early Medical Intervention; Humans; Hypothermia; Incidence; Prognosis; Refeeding Syndrome; United Kingdom; Water-Electrolyte Imbalance
PubMed: 32589532
DOI: 10.12968/hmed.2020.0099 -
Current Problems in Pediatric and... Apr 2017Anorexia nervosa has the highest mortality rate among all psychiatric illnesses, as it can result in significant psychopathology along with life-threatening medical... (Review)
Review
Anorexia nervosa has the highest mortality rate among all psychiatric illnesses, as it can result in significant psychopathology along with life-threatening medical complications. Atypical anorexia nervosa is a new variant described in the latest DSM edition, which has much in common with anorexia nervosa and also can result in significant morbidity and mortality. The evolution of the criteria for these illnesses is reviewed, and the two are compared and contrasted in this article. Important labs to monitor for in those with these illnesses, along with an emphasis on the monitoring of vital signs and weight, are reviewed here. The necessity for close psychiatric monitoring of safety concerns, including suicidal thoughts, is also stressed. The etiology and the treatment of these illnesses are reviewed from a biopsychosocial approach; and lastly, the prognosis of these illnesses is discussed.
Topics: Anorexia Nervosa; Comorbidity; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Humans; Mental Disorders; Prevalence; Risk Factors
PubMed: 28532965
DOI: 10.1016/j.cppeds.2017.02.003 -
Endocrine, Metabolic & Immune Disorders... 2018There is great interest, supported by clinical experience, in the relationship between Eating Disorders (EDs) and psychiatric symptoms and diseases. The psychopathology... (Review)
Review
BACKGROUND AND OBJECTIVE
There is great interest, supported by clinical experience, in the relationship between Eating Disorders (EDs) and psychiatric symptoms and diseases. The psychopathology of EDs is also referred to many risk and protective factors, and there is some evidence in the literature, also about genetic and neurobiological factors involved. The aim of this review is to examine and synthesize the recent scientific literature on this topic, in particular the complex relationship between Anorexia Nervosa and Neuropsychiatric Disorders.
METHODS
We analyzed the best of published literature on the topic, identifying keywords and MeSH terms in Pubmed and then searching them. The last search was performed on November 2017.
RESULTS
Psychiatric comorbidities are very common in anorexia nervosa. Mood disorders, major depressive disorders, anxiety disorders, obsessive-compulsive disorders, developmental disorders among autistic spectrum and attention-deficit hyperactivity disorder and even some personality disorders, substance abuse and borderline traits have been reported, and some observations suggest a positive genetic correlation between anorexia nervosa and schizophrenia.
CONCLUSION
The great amount of scientific articles dealing with the relationship between EDs and psychopathology confirms the complexity of these problems and the difficulties in diagnosis and treatment. An accurate diagnosis and assessment of clinical risk about psychological, psychiatric, nutritional and somatic aspects are therefore essential for an appropriate therapeutic management of patients affected by anorexia nervosa.
Topics: Adolescent; Adolescent Behavior; Affect; Age Factors; Anorexia Nervosa; Body Image; Child; Child Behavior; Comorbidity; Emotions; Feeding Behavior; Female; Humans; Male; Mental Health; Prognosis; Risk Factors; Self Concept; Young Adult
PubMed: 29437020
DOI: 10.2174/1871530318666180213111637 -
The American Journal of Medicine Jan 2016Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical... (Review)
Review
Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders.
Topics: Anorexia Nervosa; Bulimia Nervosa; Comorbidity; Humans
PubMed: 26169883
DOI: 10.1016/j.amjmed.2015.06.031 -
The New England Journal of Medicine Apr 2020
Review
Topics: Adolescent; Adult; Anorexia Nervosa; Body Mass Index; Bulimia Nervosa; Diagnosis, Differential; Female; Humans; Male; Practice Guidelines as Topic; Psychotherapy
PubMed: 32242359
DOI: 10.1056/NEJMcp1803175 -
Nursing Oct 2019Anorexia nervosa (AN) is an eating disorder that is difficult to treat, and relapse is common. This article addresses management strategies and nursing interventions for... (Review)
Review
Anorexia nervosa (AN) is an eating disorder that is difficult to treat, and relapse is common. This article addresses management strategies and nursing interventions for adolescents diagnosed with AN.
Topics: Adolescent; Anorexia Nervosa; Comorbidity; Humans; Mental Disorders; Nursing Diagnosis; Risk Factors
PubMed: 31568077
DOI: 10.1097/01.NURSE.0000580640.43071.15 -
Psychiatria Polska Oct 2019Refeeding syndrome (RS) is one of the serious complications during treatment of anorexia nervosa. It includes hormonal and metabolic changes that occur during the... (Review)
Review
Refeeding syndrome (RS) is one of the serious complications during treatment of anorexia nervosa. It includes hormonal and metabolic changes that occur during the process of refeeding in chronically malnourished patient when nutrition is introduced in an excessive and improper amount. RS manifests in water-electrolyte imbalances, including hypophosphatemia (the mostimportant diagnosticmarker), hypokalemia, hyponatremia, hypomagnesaemia, fluid retention, vitamin deficiency and metabolic acidosis. It applies to either oral and parenteral supplementation. In the treatment of malnourished patients with anorexia nervosa, it is essential to establish an initial caloric amount that will stimulate weight gain from the beginning of treatment, increase its effectiveness while minimizing the risk of RS. Recent research suggests that the current recommendations may be too stringent in this respect and require further updating. Awareness of the risks associated with RS, including significant mortality, appears to be currently insufficient also among physicians. There is a need for far more specialized multidisciplinary centers for patients with anorexia nervosa and also appropriate algorithms and standards of care for that population. The aim of this paper is to systematize the current knowledge about RS and RS prevention, to increase awareness of its occurrence and present the results of the latest research on safe resupplementation of patients suffering from anorexia nervosa.
Topics: Anorexia Nervosa; Feeding Methods; Humans; Refeeding Syndrome; Water-Electrolyte Balance; Weight Gain
PubMed: 31955189
DOI: 10.12740/PP/OnlineFirst/90275 -
Cleveland Clinic Journal of Medicine Jun 2020Anorexia nervosa is a mental illness characterized by self-starvation, marked weight loss, and malnutrition. As the illness worsens, numerous medical complications... (Review)
Review
Anorexia nervosa is a mental illness characterized by self-starvation, marked weight loss, and malnutrition. As the illness worsens, numerous medical complications develop throughout the body. Some of these resolve with effective nutritional rehabilitation and weight gain, whereas others can lead to permanent damage.
Topics: Anorexia Nervosa; Bone Diseases, Metabolic; Brain Diseases, Metabolic; Cardiomyopathies; Early Medical Intervention; Humans; Lung Diseases; Prognosis
PubMed: 32487556
DOI: 10.3949/ccjm.87a.19084 -
Nature Reviews. Disease Primers Nov 2015Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in... (Review)
Review
Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes; however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of 'thinness' and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.
Topics: Adaptation, Physiological; Adolescent; Anorexia Nervosa; Body Image; Humans; Malnutrition
PubMed: 27189821
DOI: 10.1038/nrdp.2015.74