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Revue de L'infirmiere Jan 2019Anorexia and bulimia are part of eating disorders which are defined in the diagnostic and statistical manual as mental health disorders. Screening tools exist and there...
Anorexia and bulimia are part of eating disorders which are defined in the diagnostic and statistical manual as mental health disorders. Screening tools exist and there are different types of treatment which are generally multi-disciplinary. The nurse, as well as the family or immediate circle, are essential players in the care. Specialist units and the development of research are improving the understanding, treatment and support of these complex disorders.
Topics: Anorexia Nervosa; Bulimia Nervosa; Diagnostic and Statistical Manual of Mental Disorders; Humans
PubMed: 30910110
DOI: 10.1016/j.revinf.2018.11.002 -
Current Opinion in Psychiatry Nov 2020Our aim is to give an overview of the recent literature on psychological treatment for young adults and adults with anorexia nervosa and to discuss the implications of... (Review)
Review
PURPOSE OF REVIEW
Our aim is to give an overview of the recent literature on psychological treatment for young adults and adults with anorexia nervosa and to discuss the implications of the findings for clinical practice.
RECENT FINDINGS
Three systematic reviews and meta-analyses have recently been published on psychological treatments for anorexia nervosa. Treatment outcomes are still modest and mainly focus on weight outcome, although outcomes for eating disorder disease and quality of life have also been reported. Adhering to a treatment protocol might lead to faster and better results.
SUMMARY
For children and adolescents with anorexia nervosa, the major guidelines recommend a family-based treatment. The treatments of choice for young adults and adults with anorexia nervosa are the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), Cognitive Behaviour Therapy-Enhanced (CBT-E) and Specialist Supportive Clinical Management (SSCM), but none of these treatments seem to be superior. In search of other ways to improve outcome, shared decision making may be a way to help patients become more involved in their treatment, enhance their motivation and consequently improve the outcome.
Topics: Adult; Anorexia Nervosa; Feeding Behavior; Humans; Psychotherapy; Quality of Life; Treatment Outcome
PubMed: 32796187
DOI: 10.1097/YCO.0000000000000642 -
Eating and Weight Disorders : EWD Apr 2022The comorbidity between anorexia nervosa (AN) and bipolar disorders (BD) among subjects with AN is a matter of some debate, regarding its existence, its impact on the...
BACKGROUND
The comorbidity between anorexia nervosa (AN) and bipolar disorders (BD) among subjects with AN is a matter of some debate, regarding its existence, its impact on the clinical manifestations of AN and the nature of the relationship between these disorders. Our aims were: (1) to evaluate the prevalence of BD among patients with severe AN; and (2) to determine whether people with a history of BD present particular clinical AN characteristics in comparison to people with a comorbid major depressive disorder or with any mood disorder comorbidity.
METHODS
177 AN subjects were surveyed to assess their nutritional state, dietary symptomatology, psychiatric comorbidities, treatments received and associated response. The diagnosis of BD relied on DSM-5 criteria, using the short-CIDI. The discriminant features of patients with AN and suspected BD were identified, comparing them to the characteristics of AN patients without any mood disorder and AN patients suffering from major depressive disorder.
RESULTS
Among AN subjects, 11.3% were suspected to have BD. In comparison with the two other groups, these patients had more severe clinical profiles in terms of duration of AN (6.7 years, p = 0.020), nutritional state (p max = 0.031), levels of anxious, depressive and dietary symptoms, lifetime comorbidity with anxious disorders, quality-of-life (p = 0.001) and treatment (antidepressant and mood stabilizers, (p = 0.029)).
LIMITATIONS
The participants were hospitalized in a tertiary center with severe AN. The diagnosis of BD requires evaluation using a more precise diagnostic instrument CONCLUSION: These results underline the importance of systematic early detection of BD and mood disorders among individuals with severe AN, to provide optimum treatment.
LEVEL OF EVIDENCE
III: Evidence obtained from a cross-sectional study.
Topics: Anorexia Nervosa; Bipolar Disorder; Comorbidity; Cross-Sectional Studies; Depressive Disorder, Major; Humans; Prevalence
PubMed: 34142355
DOI: 10.1007/s40519-021-01215-3 -
General Dentistry 2017Eating disorders have captured the attention of medical and dental professionals as well as the public for decades and continue to raise concern today. The literature... (Review)
Review
Eating disorders have captured the attention of medical and dental professionals as well as the public for decades and continue to raise concern today. The literature devoted to anorexia and bulimia highlights myriad psychological, systemic, and dental health complications. Dental practitioners are in a unique position to discover early manifestations of these disorders. The present article reviews anorexia and bulimia, summarizing telltale behavioral traits, systemic manifestations, and dental features to facilitate recognition and enable accurate diagnosis.
Topics: Anorexia Nervosa; Bulimia Nervosa; Humans; Mouth Diseases; Oral Health; Tooth Diseases; Tooth Erosion
PubMed: 28682280
DOI: No ID Found -
The International Journal of Eating... Nov 2023Food-cue-reactivity entails neural and experiential responses to the sight and smell of attractive foods. Negative emotions can modulate such cue-reactivity and this...
OBJECTIVE
Food-cue-reactivity entails neural and experiential responses to the sight and smell of attractive foods. Negative emotions can modulate such cue-reactivity and this might be central to the balance between restrictive versus bulimic symptomatology in Anorexia Nervosa (AN) and Bulimia Nervosa (BN).
METHOD
Pleasantness ratings and electrocortical responses to food images were measured in patients with AN (n = 35), BN (n = 32) and matched healthy controls (HC, n = 35) in a neutral state and after idiosyncratic negative emotion induction while electroencephalography (EEG) was recorded. The EEG data were analyzed using a mass testing approach.
RESULTS
Individuals with AN showed reduced pleasantness for foods compared to objects alongside elevated widespread occipito-central food-object discrimination between 170 and 535 ms, indicative of strong neural cue-reactivity. Food-object discrimination was further increased in the negative emotional condition between 690 and 1200 ms over centroparietal regions. Neither of these effects was seen in individuals with BN.
DISCUSSION
Emotion modulated food-cue-reactivity in AN might reflect a decreased appetitive response in negative mood. Such specific (emotion-)regulatory strategies require more theoretical work and clinical attention. The absence of any marked effects in BN suggests that emotional cue-reactivity might be less prominent in this group or quite specific to certain emotional contexts or food types.
PUBLIC SIGNIFICANCE
Negative affectivity is a risk factor for the development of eating disorders and individuals with eating disorders experience problems with emotion regulation. To better understand the effects of negative emotions, the present study investigated how they affected neural correlates of food perception in anorexia nervosa and bulimia nervosa.
Topics: Humans; Anorexia Nervosa; Bulimia Nervosa; Cues; Emotions; Electroencephalography
PubMed: 37565581
DOI: 10.1002/eat.24028 -
British Journal of Hospital Medicine... May 2016Anorexia nervosa is a psychiatric disorder with potential life-threatening medical sequelae. This article reviews the principal medical complications associated with... (Review)
Review
Anorexia nervosa is a psychiatric disorder with potential life-threatening medical sequelae. This article reviews the principal medical complications associated with anorexia nervosa, highlights associated diagnostic pitfalls and emphasizes the importance of a multidisciplinary approach to management.
Topics: Anorexia Nervosa; Humans; Interdisciplinary Communication; Patient Care Team
PubMed: 27166107
DOI: 10.12968/hmed.2016.77.5.287 -
European Eating Disorders Review : the... Sep 2022Cognitive characteristics common to autistic individuals are often seen in adults with anorexia nervosa (AN), raising the question of whether autistic people and people... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Cognitive characteristics common to autistic individuals are often seen in adults with anorexia nervosa (AN), raising the question of whether autistic people and people with AN may share an endophenotype. We need to examine autistic characteristics during the early stages of AN to accurately parse true symptom co-occurrence from behavioural alterations due to prolonged illness.
METHODS
We conducted a post-hoc analysis examining autistic characteristics in 59 youth with AN. Adolescents and parents participating in a randomised-clinical trial for AN completed questionnaires probing autistic characteristics at baseline and treatment end. We categorised participants as above or below cut-offs of clinical indicators of autism using the Autism Probability Index (API) and the Autism Spectrum Quotient-10.
RESULTS
Rates of high autistic characteristics ranged between 0% and 36% depending on the instrument used and how the data was obtained (i.e., by informant report or self-report). Paternal report of autistic characteristics differed across treatment completers versus non completers and maternal report indicated lower weight gain for those with elevated characteristics.
CONCLUSIONS
Low rates of autism and fluctuations in autistic features during treatment underscore the importance of longitudinal examinations of autistic characteristics in adolescents with AN. Future studies need to replicate findings in a larger adolescent sample.
TRIAL REGISTRATION
ClinicalTrails.gov Identifier NCT03928028.
Topics: Adolescent; Adult; Anorexia Nervosa; Autism Spectrum Disorder; Autistic Disorder; Humans; Self Report; Surveys and Questionnaires
PubMed: 35780511
DOI: 10.1002/erv.2937 -
Internal and Emergency Medicine Oct 2014Anorexia nervosa (AN) is an eating disorder in which a distorted self-perception of body image and an excessive fear of gaining weight result in extreme restrictions in... (Review)
Review
Anorexia nervosa (AN) is an eating disorder in which a distorted self-perception of body image and an excessive fear of gaining weight result in extreme restrictions in eating habits. AN may be divided into two types: a "binge-eating/purging type" during which the individual regularly engages in overeating and then purging behavior, and a "restricting type", in which she does not. AN is a serious medical problem in young people in Western societies. It is widely reported that patients with AN exhibit an enhanced mortality rate as compared with age-matched healthy subjects, which has been mainly ascribed to cardiac complications. At least one-third of all deaths in patients with anorexia nervosa are estimated to be due to cardiac causes, mainly sudden death. Cardiovascular complications of AN can be present in up to 80% of cases, and among them alterations in cardiac electrical activity, structure and hemodynamics have been reported as causes of morbidity and mortality. The objective of this brief review is to summarize current knowledge on the main cardiovascular complications of AN, their underlying mechanisms and the possible therapeutic approaches.
Topics: Anorexia Nervosa; Cardiovascular Diseases; Humans
PubMed: 25056404
DOI: 10.1007/s11739-014-1107-2 -
The British Journal of Psychiatry : the... Sep 2021Anorexia nervosa affects most organ systems, with 80% suffering from cardiovascular complications. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Anorexia nervosa affects most organ systems, with 80% suffering from cardiovascular complications.
AIMS
To define echocardiographic abnormalities in anorexia nervosa through systematic review and meta-analysis.
METHOD
Two reviewers independently assessed eligibility of publications from Medline, EMBASE and Cochrane Database of Systematic Reviews registries. Studies were included if anorexia nervosa was the primary eating disorder and the main clinical association in described cardiac abnormalities. Data was extracted in duplicate and quality-assessed with a modified Newcastle-Ottawa scale. For continuous outcomes we calculated mean and standardised mean difference (SMD), and corresponding 95% confidence interval. For dichotomous outcomes we calculated proportion and corresponding 95% confidence interval. For qualitative data we summarised the studies.
RESULTS
We identified 23 eligible studies totalling 960 patients, with a mean age of 17 years and mean body mass index of 15.2 kg/m2. Fourteen studies (469 participants) reported data suitable for meta-analysis. Cardiac abnormalities seen in anorexia nervosa compared with healthy controls were reduced left ventricular mass (SMD 1.82, 95% CI 1.32-2.31, P < 0.001), reduced cardiac output (SMD 1.92, 95% CI 1.38-2.45, P < 0.001), increased E/A ratio (SMD -1.10, 95% CI -1.67 to -0.54, P < 0.001), and increased incidence of pericardial effusions (25% of patients, P < 0.01, 95% CI 17-34%, I2 = 80%). Trends toward improvement were seen with weight restoration.
CONCLUSIONS
Patients with anorexia nervosa have structural and functional cardiac changes, identifiable with echocardiography. Further work should determine whether echocardiography can help stratify severity and guide safe patient location, management and effectiveness of nutritional rehabilitation.
Topics: Adolescent; Anorexia Nervosa; Body Mass Index; Echocardiography; Feeding and Eating Disorders; Humans; Incidence
PubMed: 32026793
DOI: 10.1192/bjp.2020.1 -
Eating and Weight Disorders : EWD Dec 2015Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Many of the deaths are attributable to medical complications which arise as the malnutrition... (Review)
Review
Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Many of the deaths are attributable to medical complications which arise as the malnutrition and weight loss worsens. Every body system may be adversely affected by anorexia nervosa. Yet, remarkably, most of the medical complications of anorexia nervosa are treatable and reversible with optimal medical care, as part of a multidisciplinary team who are often involved in the care of these patients. Herein, we will describe the medical complications of anorexia nervosa and their treatments.
Topics: Anorexia Nervosa; Humans
PubMed: 26138740
DOI: 10.1007/s40519-015-0202-3