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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 -
Canadian Family Physician Medecin de... Jun 2023To address screening, diagnosis, and treatment of adolescents with anorexia nervosa and atypical anorexia nervosa in primary care. (Review)
Review
OBJECTIVE
To address screening, diagnosis, and treatment of adolescents with anorexia nervosa and atypical anorexia nervosa in primary care.
SOURCES OF INFORMATION
A literature search was conducted in PubMed using the subject headings , and . Applicable articles were reviewed, with key recommendations summarized. Most evidence is level I.
MAIN MESSAGE
Recent studies suggest that the global COVID-19 pandemic contributed to an increase in the incidence of eating disorders, particularly among teenagers. This has resulted in increasing responsibility for primary care providers regarding the assessment, diagnosis, and management of these disorders. Moreover, primary care providers are in ideal positions to identify adolescents at risk of eating disorders. Early intervention is of utmost importance for avoiding long-term health consequences. High rates of atypical anorexia nervosa indicate a need for providers to have awareness of weight biases and stigmas. Treatment primarily involves a combination of renourishment and psychotherapy, generally through family-based therapy, with pharmacotherapy playing a lesser role.
CONCLUSION
Anorexia nervosa and atypical anorexia nervosa are serious, potentially life-threatening illnesses that are best addressed through early detection and treatment. Family physicians are in an optimal position to screen for, diagnose, and treat these illnesses.
Topics: Adolescent; Humans; Anorexia Nervosa; Pandemics; COVID-19; Psychotherapy; Physicians, Family
PubMed: 37315981
DOI: 10.46747/cfp.6906387 -
The Psychiatric Clinics of North America Mar 2019Recent advances in the understanding of aetiologic elements underlying anorexia nervosa have provided valuable insights and are transforming the way this illness is... (Review)
Review
Recent advances in the understanding of aetiologic elements underlying anorexia nervosa have provided valuable insights and are transforming the way this illness is treated. The aim of this article is to consider how neuropsychological understanding and new research can be used to develop a more individualized and personalized approach in the management of this serious illness.
Topics: Anorexia Nervosa; Humans; Precision Medicine; Social Isolation; Starvation
PubMed: 30704633
DOI: 10.1016/j.psc.2018.10.010 -
Digestive Diseases and Sciences Nov 2017Anorexia nervosa (AN) has the highest mortality rate of all psychiatric illnesses due to the widespread organ dysfunction caused by the underlying severe malnutrition.... (Review)
Review
Anorexia nervosa (AN) has the highest mortality rate of all psychiatric illnesses due to the widespread organ dysfunction caused by the underlying severe malnutrition. Starvation causes hepatocyte injury and death leading to a rise in aminotransferases. Malnutrition-induced hepatitis is common among individuals with AN especially as body mass index decreases. Acute liver failure associated with coagulopathy and encephalopathy can rarely occur. Liver enzymes may also less commonly increase as part of the refeeding process due to hepatic steatosis and can be distinguished from starvation hepatitis by the finding of a fatty liver on ultrasonography. Individuals with AN and starvation-induced hepatitis are at increased risk of hypoglycemia due to depleted glycogen stores and impaired gluconeogenesis. Gastroenterology and hepatology consultations are often requested when patients with AN and signs of hepatitis are hospitalized. It should be noted that additional laboratory testing, imaging, or liver biopsy all have low diagnostic yield, are costly, and potentially invasive, therefore, not generally recommended for diagnostic purposes. While the hepatitis of AN can reach severe levels, a supervised increase in caloric intake and a return to a healthy body weight often quickly lead to normalization of elevated aminotransferases caused by starvation.
Topics: Anorexia Nervosa; Energy Intake; Humans; Liver; Liver Diseases; Liver Function Tests; Nutrition Assessment; Nutritional Status; Predictive Value of Tests; Prevalence; Recovery of Function; Risk Factors; Treatment Outcome
PubMed: 28932925
DOI: 10.1007/s10620-017-4766-9 -
The International Journal of Eating... Apr 2023A description of atypical anorexia nervosa (atypical AN) was provided in DSM-5 in 2013 and a sizable literature has since developed describing the clinical features of... (Review)
Review
OBJECTIVE
A description of atypical anorexia nervosa (atypical AN) was provided in DSM-5 in 2013 and a sizable literature has since developed describing the clinical features of individuals with atypical AN and comparing them to those of individuals with anorexia nervosa (AN) and those of healthy individuals. The purpose of this study was to conduct a systematic review of this literature.
METHOD
A systematic review following PRISMA guidelines was conducted of studies published since 2013 that compared the clinical characteristics of individuals with atypical AN to those of individuals with AN and/or healthy controls. Meta-analyses were conducted when similar measures were reported in three or more studies.
RESULTS
Twenty-four publications met criteria for inclusion. Their results indicated that the level of eating disorder-specific psychopathology is significantly higher among individuals with atypical AN than among controls and as high or higher as among individuals with AN while levels of non-eating disorder psychopathology are similar. Individuals with atypical AN experience many of the physiological complications associated with AN, but some complications appear less frequent.
DISCUSSION
The psychological symptoms and physiological complications of individuals with atypical AN are generally similar to those of individuals with AN, although there may be differences in the frequency of some physical complications. Little information is available on the course, outcome, and treatment response of individuals with atypical AN. In addition, full diagnostic criteria for atypical AN have not been developed, and the nosological relationship of atypical AN to established eating disorders such as bulimia nervosa is unclear.
PUBLIC SIGNIFICANCE
Atypical anorexia nervosa as described in the DSM-5 identifies individuals with many of the psychological characteristics of typical anorexia nervosa who, despite significant weight loss, are not underweight. The current systematic review found that the psychological symptoms and physiological characteristics of individuals with atypical AN are generally similar to those of individuals with AN, although there may be differences in the frequency of some physical complications.
Topics: Humans; Anorexia Nervosa; Feeding and Eating Disorders; Bulimia Nervosa; Weight Loss; Thinness; Psychopathology
PubMed: 36508318
DOI: 10.1002/eat.23856 -
American Family Physician Jan 2015Eating disorders are life-threatening conditions that are challenging to address; however, the primary care setting provides an important opportunity for critical...
Eating disorders are life-threatening conditions that are challenging to address; however, the primary care setting provides an important opportunity for critical medical and psychosocial intervention. The recently published Diagnostic and Statistical Manual of Mental Disorders, 5th ed., includes updated diagnostic criteria for anorexia nervosa (e.g., elimination of amenorrhea as a diagnostic criterion) and for bulimia nervosa (e.g., criterion for frequency of binge episodes decreased to an average of once per week). In addition to the role of environmental triggers and societal expectations of body size and shape, research has suggested that genes and discrete biochemical signals contribute to the development of eating disorders. Anorexia nervosa and bulimia nervosa occur most often in adolescent females and are often accompanied by depression and other comorbid psychiatric disorders. For low-weight patients with anorexia nervosa, virtually all physiologic systems are affected, ranging from hypotension and osteopenia to life-threatening arrhythmias, often requiring emergent assessment and hospitalization for metabolic stabilization. In patients with frequent purging or laxative abuse, the presence of electrolyte abnormalities requires prompt intervention. Family-based treatment is helpful for adolescents with anorexia nervosa, whereas short-term psychotherapy, such as cognitive behavior therapy, is effective for most patients with bulimia nervosa. The use of psychotropic medications is limited for anorexia nervosa, whereas treatment studies have shown a benefit of antidepressant medications for patients with bulimia nervosa. Treatment is most effective when it includes a multidisciplinary, teambased approach.
Topics: Adolescent; Adult; Anorexia Nervosa; Body Mass Index; Bulimia Nervosa; Depression; Diagnostic and Statistical Manual of Mental Disorders; Disease Management; Family Practice; Female; Hospitalization; Humans; Male; Mass Screening; Practice Guidelines as Topic; Psychotherapy; Social Environment; Social Support; Symptom Assessment
PubMed: 25591200
DOI: No ID Found -
The British Journal of Psychiatry : the... Feb 2020Little is known about the long-term outcome of anorexia nervosa.
BACKGROUND
Little is known about the long-term outcome of anorexia nervosa.
AIMS
To study the 30-year outcome of adolescent-onset anorexia nervosa.
METHOD
All 4291 individuals born in 1970 and attending eighth grade in 1985 in Gothenburg, Sweden were screened for anorexia nervosa. A total of 24 individuals (age cohort for anorexia nervosa) were pooled with 27 individuals with anorexia nervosa (identified through community screening) who were born in 1969 and 1971-1974. The 51 individuals with anorexia nervosa and 51 school- and gender-matched controls were followed prospectively and examined at mean ages of 16, 21, 24, 32 and 44. Psychiatric disorders, health-related quality of life and general outcome were assessed.
RESULTS
At the 30-year follow-up 96% of participants agreed to participate. There was no mortality. Of the participants, 19% had an eating disorder diagnosis (6% anorexia nervosa, 2% binge-eating disorder, 11% other specified feeding or eating disorder); 38% had other psychiatric diagnoses; and 64% had full eating disorder symptom recovery, i.e. free of all eating disorder criteria for 6 consecutive months. During the elapsed 30 years, participants had an eating disorder for 10 years, on average, and 23% did not receive psychiatric treatment. Good outcome was predicted by later age at onset among individuals with adolescent-onset anorexia nervosa and premorbid perfectionism.
CONCLUSIONS
This long-term follow-up study reflects the course of adolescent-onset anorexia nervosa and has shown a favourable outcome regarding mortality and full symptom recovery. However, one in five had a chronic eating disorder.
Topics: Adolescent; Adult; Anorexia Nervosa; Chronic Disease; Comorbidity; Female; Follow-Up Studies; Humans; Male; Quality of Life; Sweden; Time Factors; Treatment Outcome; Young Adult
PubMed: 31113504
DOI: 10.1192/bjp.2019.113 -
Current Psychiatry Reports Jan 2019We review research related to sex differences in eating disorders (EDs) in adolescents. Prior work has explored clinical differences; thus, we examine literature in... (Review)
Review
PURPOSE OF REVIEW
We review research related to sex differences in eating disorders (EDs) in adolescents. Prior work has explored clinical differences; thus, we examine literature in areas identified as playing an etiological or maintenance role in EDs including: genetics, hormones, neurocognitive inefficiencies, and reward circuitry.
RECENT FINDINGS
Sex steroids appear to a play role in the unmasking of genetic risk for development of EDs and puberty may be a heightened period of risk for females. While neurocognitive differences have been well studied in adults with ED, research with adolescents has been less conclusive. Recent work suggests that neural circuitry involved in reward and punishment may play role in development and maintenance of EDs in females. Males are underrepresented in these areas of research. Given known sex differences in healthy adolescents, it is likely there are sex differences in the putative biological etiology/maintenance of EDs. Males should be included in future research.
Topics: Adolescent; Anorexia Nervosa; Bulimia Nervosa; Female; Genetic Predisposition to Disease; Humans; Male; Sex Characteristics
PubMed: 30637488
DOI: 10.1007/s11920-019-0988-1 -
Molecular Genetics & Genomic Medicine Jul 2020Anorexia nervosa is a multifactorial eating disorder that manifests with self-starvation, extreme anxiety, hyperactivity, and amenorrhea. Long-term effects include organ... (Review)
Review
BACKGROUND
Anorexia nervosa is a multifactorial eating disorder that manifests with self-starvation, extreme anxiety, hyperactivity, and amenorrhea. Long-term effects include organ failure, disability, and in extreme cases, even death.
METHODS
Through a literature search, here we summarize what is known about the molecular etiology of anorexia nervosa and propose genetic testing for this condition.
RESULTS
Anorexia nervosa often has a familial background and shows strong heritability. Various genetic studies along with genome-wide association studies have identified several genetic loci involved in molecular pathways that might lead to anorexia.
CONCLUSION
Anorexia nervosa is an eating disorder with a strong genetic component that contributes to its etiology. Various genetic approaches might help in the molecular diagnosis of this disease and in devising novel therapeutic options.
Topics: Animals; Anorexia Nervosa; Genetic Predisposition to Disease; Genetic Testing; Humans; Molecular Targeted Therapy
PubMed: 32368866
DOI: 10.1002/mgg3.1244