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International Journal of Environmental... Feb 2022Anorexia Nervosa (AN) patients exhibit distorted body representation. The purpose of this study was to explore studies that analyze virtual reality (VR) applications,... (Review)
Review
Anorexia Nervosa (AN) patients exhibit distorted body representation. The purpose of this study was to explore studies that analyze virtual reality (VR) applications, related to body image issues, to propose a new tool in this field. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Scopus, and Web of Science databases were explored; the review included 25 studies. Research has increased over the last five years. The selected studies, clinical observational studies ( = 16), mostly concerning patients' population with AN ( = 14) or eating disorders (EDs) diagnosis, presented multiple designs, populations involved, and procedures. Some of these studies included healthy control groups ( = 7). Studies on community sample populations were also selected if oriented toward clinical applications ( = 9). The VR technologies in the examined period (about 20 years) have evolved significantly, going from very complex and bulky systems, requiring very powerful computers, to agile systems. The advent of low-cost VR devices has given a big boost to research works. Moreover, the operational proposal that emerges from this work supports the use of biofeedback techniques aimed at evaluating the results of therapeutic interventions in the treatment of adolescent patients diagnosed with AN.
Topics: Adolescent; Anorexia Nervosa; Biofeedback, Psychology; Body Image; Feeding and Eating Disorders; Humans; Virtual Reality
PubMed: 35270226
DOI: 10.3390/ijerph19052533 -
Psychiatria Danubina Oct 2023The aim of this systematic review is to critically summarize current literature concerning ethical and legal issues related compulsory treatment (CT) in patients with...
BACKGROUND
The aim of this systematic review is to critically summarize current literature concerning ethical and legal issues related compulsory treatment (CT) in patients with anorexia nervosa (AN).
SUBJECTS AND METHODS
Relevant articles were identified following the PRISMA guidelines after performing title/abstract screening and full text screening. We built the search string using the following terms: "coercion", "compulsory/involuntary treatment", "eating disorders", "anorexia nervosa", "mental capacity", "ethical/legal issues". Research was conducted on original articles published from any time until June 2023.
RESULTS
Out of 302 articles retrieved, seven were included for the analysis, including five studies on mental health practitioners, and two on hospital records. The results show that mental health practitioners a) favor the use of CT, but the support is weaker in AN vs other psychiatric conditions (i.e., schizophrenia or depression); b) support of mental capacity is controversial and some variability was found between different categories of psychiatrists; in particular, both ED-treating and CT experienced mental health practitioners support higher use of CT and lack of capacity of AN patients vs. general psychiatrists; c) use of CT is more supported in the early vs. chronic AN, when chances of success are lower. The analysis of hospital records identified 1) comorbidities, previous admissions and current health risk as CT predictors in 96 Australian patients; 2) family conflicts association with longer hospitalizations in 70 UK patients.
CONCLUSION
CT is usually intended for patients with AN at the onset of disease, mainly to prevent risk of death and self-injury. However, there is some variability in the attitude to perform CT among psychiatrists working in different setting, also related to the concept of mental capacity. There are also cross-national variabilities regarding CT. We can conclude that forcing patients to treatment is a conceivable option, but the balance between protection respect for patient's autonomy should be evaluated on individual bases.
Topics: Humans; Anorexia Nervosa; Coercion; Australia; Feeding and Eating Disorders; Involuntary Treatment
PubMed: 37800229
DOI: No ID Found -
Eating and Weight Disorders : EWD Apr 2024Eating disorder recovery is a poorly defined concept, with large variations among researchers' definitions. Weight maintenance is a key aspect of recovery that remains... (Review)
Review
PURPOSE
Eating disorder recovery is a poorly defined concept, with large variations among researchers' definitions. Weight maintenance is a key aspect of recovery that remains relatively underexplored in the literature. Understanding the role of weight maintenance may help guide the development of treatments. This paper aims to address this by (1) investigating the factors predicting long-term weight maintenance in anorexia nervosa (AN) patients; (2) exploring differences in predictive factors between adolescent and adult populations; and (3) exploring how weight maintenance is conceptualised in the literature.
METHODS
We conducted a systematic review following PRISMA guidelines to address our research questions. Five databases were searched and filtered according to our exclusion criteria.
RESULTS
From the search, 1059 studies were yielded, and 13 studies were included for review. A range of weight, biological and psychological factors were found to predict weight maintenance among these papers. BMI at admission and discharge from inpatient treatment was the most common predictor among the papers. Few studies investigated biological factors and mixed evidence was found for psychological factors. We found no observable differences between adult and adolescent populations. Finally, weight maintenance was defined and measured differently across studies.
CONCLUSION
This review's findings can help contribute to a well-rounded understanding of weight maintenance, and ultimately, of recovery. This can help support clinicians in tailoring interventions to improve long-term outcomes in AN. Future research should aim to replicate studies to better understand the relationship between the factors identified and weight maintenance.
LEVEL I
Systematic review.
Topics: Adult; Adolescent; Humans; Anorexia Nervosa; Body Weight Maintenance; Weight Loss; Feeding and Eating Disorders; Hospitalization
PubMed: 38582784
DOI: 10.1007/s40519-024-01649-5 -
Translational Behavioral Medicine Jun 2023Evaluating the presence of behavior change techniques (BCTs) in mHealth apps could be used to better understand what "active ingredients" contribute to outcomes. Despite...
Evaluating the presence of behavior change techniques (BCTs) in mHealth apps could be used to better understand what "active ingredients" contribute to outcomes. Despite the early onset of Anorexia Nervosa (AN) and the increasing use of mobile apps to seek mental healthcare among young people, BCTs underpinning mHealth apps targeting AN have never been systematically examined. This review systematically identified and analyzed BCTs underpinning apps targeted at reducing AN in young people in an attempt to understand their active components. Apps were searched and screened in Apple Store and Google Play. Six apps that met the inclusion criteria and were coded by trained researchers against the BCT Taxonomy V1. Overall, 22 of 93 possible BCTs were identified. The most common were "Information about health consequences," "Social support (unspecified)," and "Information about antecedents". Identified BCTs suggested potential overlaps with traditional clinical treatments for AN, such as cognitive behavioral therapy and family-based therapy. Further investigation is required to evaluate the apps' usability and effectiveness.
Topics: Humans; Adolescent; Anorexia Nervosa; Behavior Therapy; Mobile Applications; Delivery of Health Care; Telemedicine
PubMed: 36753537
DOI: 10.1093/tbm/ibad003 -
International Journal of Environmental... May 2020: Anorexia nervosa (AN) among the general population is a rare but often fatal illness. Objective: To summarize the incidence of AN using a systematic review and... (Meta-Analysis)
Meta-Analysis
: Anorexia nervosa (AN) among the general population is a rare but often fatal illness. Objective: To summarize the incidence of AN using a systematic review and meta-analysis. : Four online databases (PubMed, Scopus, WoS and Embase) were consulted. The review was conducted according to with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was limited to women. The methodological quality of the studies was assessed by the Newcastle-Ottawa Scale (NOS). : A total of 31 articles were included in the study. The incidence rate of AN ranged from 0.5 to 318.0 cases per 100,000 women-years. The incidence in studies based on outpatient healthcare services (OHS) was higher than those based on hospital admissions (HA) (8.8 95% CI: 7.83-9.80 vs. 5.0 95% CI: 4.87-5.05). In young women, the incidence in OHS was higher than HA (63.7, 95% CI 61.21-66.12 vs. 8.1 95% CI 7.60-8.53). The linear trend in the incidence of AN was increasing in all ages of women and young women, both in studies with hospital admission records, and in those based on outpatient healthcare services. : The incidence of AN depends on the methodology, the type of population and the diagnostic criteria used.
Topics: Ambulatory Care; Anorexia Nervosa; Feeding and Eating Disorders; Female; Hospitalization; Humans; Incidence; Pregnancy
PubMed: 32481615
DOI: 10.3390/ijerph17113824 -
Frontiers in Neuroscience 2021Autonomic nervous system (ANS) dysfunction has been suggested to contribute to the high prevalence of cardiovascular complications in individuals with anorexia nervosa...
Autonomic nervous system (ANS) dysfunction has been suggested to contribute to the high prevalence of cardiovascular complications in individuals with anorexia nervosa (AN), yet has not been thoroughly investigated. The current review aimed to synthesize the evidence of basal ANS function in individuals with a current diagnosis of AN and those with a previous diagnosis who had achieved weight restoration, as compared to controls. A systematic review of nine databases was conducted and studies that were published in a peer-review journal, in English, that included at least one assessment of ANS function in individuals with a current or previous diagnosis of AN were selected. Forty-six studies were included with a total of 811 participants with a current diagnosis of AN and 123 participants with a previous diagnosis of AN. ANS function was assessed through heart rate variability ( = 27), orthostatic challenge, blood pressure variability or baroreflex sensitivity ( = 11), adrenergic activity ( = 14), skin conductance level ( = 4), and pupillometry ( = 1). Individuals with AN demonstrated increased parasympathetic activity and decreased sympathetic activity, suggestive of autonomic dysregulation. Following weight restoration, autonomic function trended toward, or was equivalent to, control levels. Autonomic dysregulation is indicated through a range of assessments in individuals with AN. Future investigations should utilize a variety of assessments together in order to conclusively establish the nature of autonomic dysfunction in AN, and following extended weight restoration. Moreover, investigation into the co-occurrence of ANS function and cardiovascular risk is required.
PubMed: 34262430
DOI: 10.3389/fnins.2021.682208 -
Journal of Eating Disorders Apr 2023This review investigates the relationship between weight and risk of medical instability (specifically bradycardia, hypotension, hypothermia, and hypophosphatemia) in... (Review)
Review
This review investigates the relationship between weight and risk of medical instability (specifically bradycardia, hypotension, hypothermia, and hypophosphatemia) in adolescents with typical and atypical anorexia nervosa. Atypical anorexia nervosa, listed as an example under the DSM-5 category of Other Specified Feeding and Eating Disorders (OSFED), describes patients who are not clinically underweight but otherwise meet criteria for anorexia nervosa. There is a lack of empirical evidence exploring medical complications in adolescents presenting with atypical anorexia nervosa. The small number of studies that do exist in this area indicate that medical instability exists across a range of weights, with weight loss being associated with increased medical risk, independent of underweight. The aim of this review was to collate and analyse results from available studies and identify indicators of medical risk in these two groups of adolescents with restrictive eating disorders. Studies were identified by systematic electronic search of medical databases, including PubMed and EMBASE. All studies investigated the relationship between weight and medical instability and included adolescents diagnosed with anorexia nervosa or atypical anorexia nervosa. One randomised controlled trial, five cohort studies and three chart reviews were included, with a total sample size of 2331 participants. Between 29 and 42% of participants presented with medical instability requiring hospitalisation, in the absence of underweight. Underweight adolescents were significantly more likely to have lower blood pressures (p < 0.0001) and bradycardia was significantly associated with greater weight loss (p < 0.05). There were no statistically significant associations found between degree of underweight and heart rate, temperature, or rate of weight loss (p = 0.31, p = 0.46 and p = 0.16, respectively). Adolescents that were less than 70% median body mass index were significantly more likely to have hypophosphatemia (p < 0.05). The findings of this review support the hypothesis that medical instability can occur across a range of weights in adolescent eating disorders, with rapid weight loss being an important indicator of increasing medical risk. Results were limited by the small number of existing studies that contained data for statistical analysis. Rapid weight loss should be considered as an important indicator of medical instability in adolescents presenting with both typical and atypical anorexia nervosa.
PubMed: 37024943
DOI: 10.1186/s40337-023-00779-y -
Eating and Weight Disorders : EWD May 2021The aims of this systematic review and meta-analysis are to provide a summary of the current literature concerning compulsory treatments in patients with eating... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The aims of this systematic review and meta-analysis are to provide a summary of the current literature concerning compulsory treatments in patients with eating disorders (ED) and to understand whether compulsorily and involuntarily treated patients differ in terms of baseline characteristics and treatment outcomes.
METHODS
Relevant articles were identified following the PRISMA guidelines by searching the following terms: "treatment refusal", "forced feeding", "compulsory/coercive/involuntary/forced treatment/admission", "eating disorders", "feeding and eating disorders", "anorexia nervosa", "bulimia nervosa". Research was restricted to articles concerning humans and published between 1975 and 2020 in English.
RESULTS
Out of 905 articles retrieved, nine were included for the analyses allowing the comparisons between 242 compulsorily and 738 voluntarily treated patients. Mean body mass index (BMI) was slightly lower in patients compelled to treatments. Mean illness duration, BMI at discharge and BMI variation showed no significant differences between the two groups. Average length of hospitalization was 3 weeks longer among compulsory-treated patients, but this did not result in a higher increase in BMI. No significant risk difference on mortality was estimated (three studies).
CONCLUSIONS
Compulsory treatments are usually intended for patients having worse baseline conditions than voluntary ones. Those patients are unlikely to engage in treatments without being compelled but, after the treatments, albeit with longer hospitalisations, they do achieve similar outcomes. Therefore, we can conclude that forcing patients to treatment is a conceivable option.
LEVEL OF EVIDENCE
Level I, systematic review and meta-analysis.
Topics: Anorexia Nervosa; Body Mass Index; Bulimia Nervosa; Feeding and Eating Disorders; Humans; Treatment Outcome
PubMed: 33099675
DOI: 10.1007/s40519-020-01031-1 -
International Journal of Molecular... Dec 2023Among the factors incriminated in the appearance of eating disorders, intestinal microbiota has recently been implicated. Now there is evidence that the composition of... (Review)
Review
Among the factors incriminated in the appearance of eating disorders, intestinal microbiota has recently been implicated. Now there is evidence that the composition of gut microbiota is different in anorexia nervosa. We gathered many surveys on the changes in the profile of gut microbiota in patients with anorexia nervosa. This review comprehensively examines the contemporary experimental evidence concerning the bidirectional communication between gut microbiota and the brain. Drawing from recent breakthroughs in this area of research, we propose that the gut microbiota significantly contributes to the intricate interplay between the body and the brain, thereby contributing to overall healthy homeostasis while concurrently impacting disease risk, including anxiety and mood disorders. Particular attention is devoted to elucidating the structure and functional relevance of the gut microbiota in the context of Anorexia Nervosa.
Topics: Adult; Child; Humans; Anorexia Nervosa; Anxiety; Anxiety Disorders; Feeding and Eating Disorders; Gastrointestinal Microbiome
PubMed: 38203211
DOI: 10.3390/ijms25010041 -
Journal of Eating Disorders 2018A salient feature of anorexia nervosa (AN) is the persistent and severe restriction of food, such that dietary intake is inadequate to maintain a healthy body weight.... (Review)
Review
A salient feature of anorexia nervosa (AN) is the persistent and severe restriction of food, such that dietary intake is inadequate to maintain a healthy body weight. Experimental tasks and paradigms have used illness-relevant stimuli, namely food images, to study the eating-specific neurocognitive mechanisms that promote food avoidance. This systematic review, completed in accordance with PRISMA guidelines, identified and critically evaluated paradigms involving images of food that have been used to study AN. There were 50 eligible studies, published before March 10 2018, identified from Medline and PsychINFO searches, and reference screening. Studies using food image-based paradigms were categorised into three methodologic approaches: neuropsychology, neurophysiology, and functional magnetic resonance imaging (fMRI). Paradigms were reviewed with a focus on how well they address phenomena central to AN. Across tasks, differences between individuals with AN and healthy peers have been identified, with the most consistent findings in the area of reward processing. Measuring task performance alongside actual eating behaviour, and using experimental manipulations to probe causality, may advance understanding of the mechanisms of illness in AN.
PubMed: 30410758
DOI: 10.1186/s40337-018-0217-z