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Psychiatry Research Apr 2016Age at onset (AAO) of eating disorders has classically been described in adolescence. We analyzed data from 806 subjects with anorexia nervosa (AN) or bulimia nervosa...
Age at onset (AAO) of eating disorders has classically been described in adolescence. We analyzed data from 806 subjects with anorexia nervosa (AN) or bulimia nervosa (BN) and performed a normal distribution admixture analysis to determine their AAO. No significant differences were found concerning the AAO functions of AN and BN subjects. Both groups had a mean AAO of about 18 years. Most of the subjects with AN (75.3%) and BN (83.3%) belonged to the early onset group. The definition of AAO for ED may be crucial for planning treatment modalities, with specific consideration of their clinical history and course.
Topics: Adolescent; Adult; Age of Onset; Anorexia Nervosa; Bulimia Nervosa; Feeding and Eating Disorders; Female; Humans; Male; Young Adult
PubMed: 27086237
DOI: 10.1016/j.psychres.2016.02.048 -
Nutrients Aug 2019Anorexia nervosa (AN) is an eating disorder often occurring in adolescence. AN has one of the highest mortality rates amongst psychiatric illnesses and is associated...
Anorexia nervosa (AN) is an eating disorder often occurring in adolescence. AN has one of the highest mortality rates amongst psychiatric illnesses and is associated with medical complications and high risk for psychiatric comorbidities, persisting after treatment. Remission rates range from 23% to 33%. Moreover, weight recovery does not necessarily reflect cognitive recovery. This issue is of particular interest in adolescence, characterized by progressive changes in brain structure and functional circuitries, and fast cognitive development. We reviewed existing literature on fMRI studies in adolescents diagnosed with AN, following PRISMA guidelines. Eligible studies had to: (1) be written in English; (2) include only adolescent participants; and (3) use block-design fMRI. We propose a pathogenic model based on normal and AN-related neural and cognitive maturation during adolescence. We propose that underweight and delayed puberty-caused by genetic, environmental, and neurobehavioral factors-can affect brain and cognitive development and lead to impaired cognitive flexibility, which in turn sustains the perpetuation of aberrant behaviors in a vicious cycle. Moreover, greater punishment sensitivity causes a shift toward punishment-based learning, leading to greater anxiety and ultimately to excessive reappraisal over emotions. Treatments combining physiological and neurobehavioral rationales must be adopted to improve outcomes and prevent relapses.
Topics: Adolescent; Adolescent Behavior; Adolescent Development; Age Factors; Anorexia Nervosa; Brain; Cognition; Cognition Disorders; Feeding Behavior; Female; Humans; Magnetic Resonance Imaging; Mental Health; Puberty, Delayed; Recovery of Function; Risk Factors; Sex Factors; Treatment Outcome
PubMed: 31443192
DOI: 10.3390/nu11081907 -
Emergency Medicine Clinics of North... Feb 2024Anorexia nervosa (AN) and bulimia nervosa (BN) are easily missed in the emergency department, because patients may present with either low, normal, or increased BMI.... (Review)
Review
Anorexia nervosa (AN) and bulimia nervosa (BN) are easily missed in the emergency department, because patients may present with either low, normal, or increased BMI. Careful examination for signs of purging and excessive use of laxatives and promotility agents is important. Careful examination for and documentation of dental erosions, posterior oropharyngeal bruising, Russel's sign, and salivary and parotid gland inflammation are clues to the purging behavior. Treatment for AN should include cognitive behavioral therapy with concomitant efforts to treat any psychiatric comorbidities, whereas BN and BED have been successfully treated with fluoxetine and lisdexamfetamine, respectively.
Topics: Humans; Feeding and Eating Disorders; Bulimia Nervosa; Anorexia Nervosa; Comorbidity
PubMed: 37977748
DOI: 10.1016/j.emc.2023.06.024 -
JAMA Network Open Jan 2024Observational studies have associated anorexia nervosa with circadian rhythms and sleep traits. However, the direction of causality and the extent of confounding by...
IMPORTANCE
Observational studies have associated anorexia nervosa with circadian rhythms and sleep traits. However, the direction of causality and the extent of confounding by psychosocial comorbidities in these associations are unknown.
OBJECTIVES
To investigate the association between anorexia nervosa and circadian and sleep traits through mendelian randomization and to test the associations between a polygenic risk score (PRS) for anorexia nervosa and sleep disorders in a clinical biobank.
DESIGN, SETTING, AND PARTICIPANTS
This genetic association study used bidirectional 2-sample mendelian randomization with summary-level genetic associations between anorexia nervosa (from the Psychiatric Genomics Consortium) and chronotype and sleep traits (primarily from the UK Biobank). The inverse-variance weighted method, in addition to other sensitivity approaches, was used. From the clinical Mass General Brigham (MGB) Biobank (n = 47 082), a PRS for anorexia nervosa was calculated for each patient and associations were tested with prevalent sleep disorders derived from electronic health records. Patients were of European ancestry. All analyses were performed between February and August 2023.
EXPOSURES
Genetic instruments for anorexia nervosa, chronotype, daytime napping, daytime sleepiness, insomnia, and sleep duration.
MAIN OUTCOMES AND MEASURES
Chronotype, sleep traits, risk of anorexia nervosa, and sleep disorders derived from a clinical biobank.
RESULTS
The anorexia nervosa genome-wide association study included 16 992 cases (87.7%-97.4% female) and 55 525 controls (49.6%-63.4% female). Genetic liability for anorexia nervosa was associated with a more morning chronotype (β = 0.039; 95% CI, 0.006-0.072), and conversely, genetic liability for morning chronotype was associated with increased risk of anorexia nervosa (β = 0.178; 95% CI, 0.042-0.315). Associations were robust in sensitivity and secondary analyses. Genetic liability for insomnia was associated with increased risk of anorexia nervosa (β = 0.369; 95% CI, 0.073-0.666); however, sensitivity analyses indicated bias due to horizontal pleiotropy. The MGB Biobank analysis included 47 082 participants with a mean (SD) age of 60.4 (17.0) years and 25 318 (53.8%) were female. A PRS for anorexia nervosa was associated with organic or persistent insomnia in the MGB Biobank (odds ratio, 1.10; 95% CI, 1.03-1.17). No associations were evident for anorexia nervosa with other sleep traits.
CONCLUSIONS AND RELEVANCE
The results of this study suggest that in contrast to other metabo-psychiatric diseases, anorexia nervosa is a morningness eating disorder and further corroborate findings implicating insomnia in anorexia nervosa. Future studies in diverse populations and with subtypes of anorexia nervosa are warranted.
Topics: Female; Humans; Male; Middle Aged; Anorexia Nervosa; Circadian Rhythm; Genetic Risk Score; Genome-Wide Association Study; Sleep; Sleep Initiation and Maintenance Disorders; Adult; Aged
PubMed: 38175645
DOI: 10.1001/jamanetworkopen.2023.50358 -
Acta Clinica Croatica Sep 2018- The purpose of the present study was to examine the association among the risk of eating disorder (ED), psychological adjustment, empathy, attachment style and...
- The purpose of the present study was to examine the association among the risk of eating disorder (ED), psychological adjustment, empathy, attachment style and thin-ideal internalization among adolescents with anorexia nervosa (AN), as compared to a healthy control (HC) group. The Questionnaire of General Data, the Eating Disorders Inventory-3 (EDI-3), the Questionnaire of Sociocultural Attitudes Towards Appearance-3 (SATAQ-3), the Experiences in Close Relationships-Revised (ECR-R) and the Basic Empathy Scale (BES) were administered to 35 female adolescents with AN and 35 HC adolescents. Eating disorder risk was found to be highest in AN females with higher levels of general psychological maladjustment (GPMC), followed by HC females with higher thin-ideal internalization. In the AN group, attachment style and thin-ideal internalization in combination with GPMC were not indicated as significant predictors of eating disorder risk. Study data provide support to conceptualizations of EDs that emphasize the role of general psychological maladjustment in the development of EDs.
Topics: Adolescent; Anorexia Nervosa; Body Image; Croatia; Emotional Adjustment; Empathy; Feeding and Eating Disorders; Female; Humans; Risk Assessment; Risk Factors; Surveys and Questionnaires
PubMed: 31168171
DOI: 10.20471/acc.2018.57.03.01 -
British Journal of Hospital Medicine... Dec 2021Acute pancreatitis is a condition whereby erroneous activation of trypsin and zymogen results in pancreatic autodigestion. There are many aetiologies, with alcohol...
Acute pancreatitis is a condition whereby erroneous activation of trypsin and zymogen results in pancreatic autodigestion. There are many aetiologies, with alcohol intake and gallstones being the most common. Anorexia nervosa is an eating disorder in which patients' reduced food intake and psychological aversion of weight gain can result in low body weight and malnourishment. The link between pancreatitis and anorexia nervosa is not well understood; this article explores the theorised pathophysiology connecting the two conditions, as well as the optimal management of patients when the conditions co-exist based on current literature. A literature search was performed using MEDLINE, EMBASE and CINAHL databases for all journal articles on the topic of presentations of acute or chronic pancreatitis in adults with anorexia nervosa. The literature proposes various links between anorexia nervosa and pancreatitis. It is theorised that pancreatitis may arise as a result of malnourishment itself or secondary to the refeeding process. Some explanations focus on the histopathological changes to the pancreas that malnourishment induces, while others focus on the enzymatic changes and oxidative damage that arise in the malnourished state. More mechanical mechanisms such as gastric dilatation, gastrointestinal ileus and compartmental fluid shift during refeeding have also been proposed as explanations for the link between the conditions. Some medications used in the management of anorexia nervosa have also been linked to pancreatitis.
Topics: Acute Disease; Adult; Anorexia Nervosa; Feeding and Eating Disorders; Humans; Malnutrition; Pancreatitis
PubMed: 34983221
DOI: 10.12968/hmed.2021.0429 -
Psychiatry and Clinical Neurosciences Sep 2019Anorexia nervosa (AN) has one of the highest mortality rates of any psychiatric disorder. Treatments are often ineffective and relapse is common. Most research... (Review)
Review
Anorexia nervosa (AN) has one of the highest mortality rates of any psychiatric disorder. Treatments are often ineffective and relapse is common. Most research attempting to understand the underlying causes and maintenance factors of AN has focused on environmental contributions, yet there is much to be explored in terms of biological risk and maintenance factors. In this paper, we focus primarily on AN research related to genetics and the complex microbial community in the gut (intestinal microbiota), and how these impact our conceptualization of this disorder. Emerging research identifying significant negative genetic correlations between AN and obesity suggests that the conditions may represent 'metabolic bookends'. The identification of underlying biological mechanisms may provide both insight into extreme weight dysregulation on both ends of the spectrum and new possible points of entry for AN treatment. Additionally, the reported microbial imbalance (dysbiosis) in the gut microbiota in AN patients, potentially due to a nutrient- and energy-deprived gut environment, implies alterations in functional and metabolic capacity of the gut microbiome. The extent to which AN and obesity can also be considered to be 'microbiome bookends' requires further investigation. Finally, we discuss ongoing and future AN projects exploring the interplay between host genomics, the environment, and cumulative microbial genomes (microbiome) as well as interventions at the microbial and gut level.
Topics: Anorexia Nervosa; Dysbiosis; Gastrointestinal Microbiome; Gene-Environment Interaction; Humans; Obesity; Satiety Response
PubMed: 31056797
DOI: 10.1111/pcn.12857 -
The American Journal of Medicine Jun 2021
Topics: Acute Disease; Anorexia Nervosa; Humans; Inflammation; Nutritional Status; Prospective Studies; Serum Albumin
PubMed: 34049636
DOI: 10.1016/j.amjmed.2020.08.023 -
Annales D'endocrinologie Jun 2022Anorexia nervosa is a psychiatric disorder that mainly affects women (sex ratio 1/10) and for which the prognosis remains poor (10% of deaths and high risk of...
Anorexia nervosa is a psychiatric disorder that mainly affects women (sex ratio 1/10) and for which the prognosis remains poor (10% of deaths and high risk of chronicity). This disorder is associated with a risk of infertility explained by different physiopathological pathways. Thus, the clinical and subclinical forms of this disease may be over-represented in populations of women using medically assisted reproduction technologies. This raises the question of a narcissistic investment of the pregnancy, with a desire for pregnancy for what it brings to the woman. However, this recourse to mechanized care to access motherhood leads to questions for these women for whom access to femininity and sexuality may have been hindered. Furthermore, suffering from eating disorders might have a significant impact upon pregnancy, birth, and the offspring's well-being with psychiatric, obstetric, pediatric, child psychiatric and developmental morbidities. Thus, several specific aspects must be considered by medical professionals when women with anorexia nervosa either intend to undergo fertility treatment or become pregnant. It is important to promote the training of nursing and medical staff to the specific clinic of anorexia nervosa and the development and implementation of multidisciplinary teams to ensure follow-up of these women from the beginning of their treatment until the sixth month postpartum.
Topics: Anorexia Nervosa; Child; Feeding and Eating Disorders; Female; Fertility; Humans; Pregnancy; Reproduction
PubMed: 35461887
DOI: 10.1016/j.ando.2022.04.012 -
The Psychiatric Clinics of North America Mar 2019Growing interest exists in the association of gut bacteria with diseases, such as diabetes, obesity, inflammatory bowel disease, and psychiatric disorders. Gut... (Review)
Review
Growing interest exists in the association of gut bacteria with diseases, such as diabetes, obesity, inflammatory bowel disease, and psychiatric disorders. Gut microbiota influence the fermentation of nutrients, body-weight regulation, gut permeability, hormones, inflammation, immunology, and behavior (gut-brain axis). Regarding anorexia nervosa (AN), altered microbial diversity and taxa abundance were found and associated with depressive, anxious, and eating disorder symptoms. Potential mechanisms involve increased gut permeability, low-grade inflammation, autoantibodies, and reduced brain cell neogenesis and learning. Gut microbiome is strongly influenced by refeeding practices. Microbiota-modulating strategies like nutritional interventions or psychobiotics application could become relevant additions to AN treatment.
Topics: Anorexia Nervosa; Gastrointestinal Microbiome; Humans
PubMed: 30704642
DOI: 10.1016/j.psc.2018.10.004