-
Cadernos de Saude Publica 2023This study sought to synthesize and reinterpret findings from primary qualitative studies on the experience of health professionals in caring for people with anorexia...
This study sought to synthesize and reinterpret findings from primary qualitative studies on the experience of health professionals in caring for people with anorexia nervosa and bulimia nervosa. We conducted a systematic review of the literature with the SPIDER search strategy assessing six databases. A meta-synthesis was performed with data from qualitative studies. Two independent reviewers screened and assessed the articles, extracted data from the articles and elaborated thematic synthesis. Nineteen articles met the inclusion/exclusion criteria. The meta-synthesis revealed three descriptive themes: Going outside the comfort zone: hard relational experiences of health professionals in providing care for people with anorexia nervosa and bulimia nervosa; Reflecting on treatment: relevance of discussion, communication, and flexibility in health professionals' work with anorexia nervosa and bulimia nervosa; and Dealing with ambivalences: experiences of health professionals with family members of people with anorexia nervosa and bulimia nervosa. We elaborated two analytical themes: Making work with eating disorders palatable: malleability necessary for health professionals in bonding with people with anorexia and bulimia nervosa and their families; and Leaving the professional comfort zone: transition from multi to interdisciplinary. Thus, mental health professionals who work with people diagnosed with anorexia and bulimia nervosa cope with hard emotional experiences that makes them feel out of their comfort zone, requiring flexibility to benefit a good therapeutic alliance, but there are still difficulties in promoting interdisciplinarity.
Topics: Humans; Anorexia Nervosa; Bulimia Nervosa; Anorexia; Brazil; Feeding and Eating Disorders
PubMed: 37585904
DOI: 10.1590/0102-311XEN223122 -
Journal of Eating Disorders Jul 2023Inclusion of underrepresented racial and ethnic groups in eating disorder (ED) research is a critical unmet need, but evidence-based recruitment strategies are lacking....
OBJECTIVE
Inclusion of underrepresented racial and ethnic groups in eating disorder (ED) research is a critical unmet need, but evidence-based recruitment strategies are lacking. We sought to determine whether methods we had implemented to increase recruitment of underrepresented racial and ethnic groups were successful in improving racial and ethnic diversity in a clinical trial in women with anorexia nervosa.
METHOD
We implemented new strategies for recruitment of underrepresented racial and ethnic groups in a clinical trial on bone health in women with anorexia nervosa, including leveraging social media, liberalizing language on advertisements to be more inclusive of women who are as yet undiagnosed with the disorder or feel stigmatized by its name, translating advertisements to Spanish, and engaging community health centers. We compared participants' race and ethnicity in this clinical trial versus two similar prior clinical trials.
RESULTS
The percent of non-White and Hispanic participants who have signed a consent form in our ongoing clinical trial (2021-2023) is higher versus two previous clinical trials on bone health in women with anorexia nervosa (2011-2019) with similar inclusion/exclusion criteria and endpoints [non-White: 11/38 (28.9%) vs. 11/188 (5.9%), Hispanic: 6/38 (15.8%) vs. 5/188 (2.7%), p ≤ 0.006]. There was no change in the percent of Black participants [0/38 (0%) vs. 1/188 (0.5%), p = 1.0].
DISCUSSION
Viewing clinical research recruitment through a diversity, equity, and inclusion lens can improve racial and ethnic diversity in ED research. Further research recruitment strategies are needed to be more inclusive of Black populations.
PubMed: 37454157
DOI: 10.1186/s40337-023-00844-6 -
Folia Medica Cracoviensia Oct 2023Eating disorders are a heterogeneous group of diseases affecting mainly young people in developed countries. Among them, anorexia nervosa (AN) is the one with the... (Review)
Review
Eating disorders are a heterogeneous group of diseases affecting mainly young people in developed countries. Among them, anorexia nervosa (AN) is the one with the highest mortality, up to five times higher compared to healthy individuals. The etiology of this medical condition is complex and still un- certain. However, disturbances of the autonomic nervous system (ANS) and increased lipolysis resulting in a decrease of the adipose tissue volume are common findings among AN patients. Since ANS is directly connected to adipocyte tissue, thus significantly affecting the body's metabolic homeostasis, we suspect that this relationship may be a potential pathophysiological underpinning for the development of AN. In this narrative review, we have analyzed scientific reports on ANS activity in AN considering different phases of the disease in humans as well as animal models. Due to the different effects of the disease itself on the ANS as well as specific variations within animal models, the common feature seems to be dysregulation of its function without the identification of one universal pattern. Nonetheless, higher norepinephrine concentrations have been reported in adipocyte tissue, suggesting local dominance of the sym- pathetic nervous system. Further studies should explore in depth the modulation of sympathetic in adipose tissue factor and help answer key questions that arise during this brief narrative review.
Topics: Animals; Humans; Adolescent; Anorexia Nervosa; Autonomic Nervous System; Adipose Tissue; Norepinephrine; Heart Rate
PubMed: 38310530
DOI: 10.24425/fmc.2023.147215 -
The International Journal of Eating... Mar 2024This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive-behavioral therapy (CBT-E) in patients aged between 12 and 18 years...
OBJECTIVE
This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive-behavioral therapy (CBT-E) in patients aged between 12 and 18 years with anorexia nervosa with a duration of illness <3 versus ≥3 years.
METHODS
One hundred and fifty-nine consecutively treated patients (n = 122 with illness duration <3 years and n = 37 ≥ 3 years) were enrolled in a 20-week intensive CBT-E program. All patients underwent assessment at admission, end of treatment (EOT), and 20-week follow-up. The following measures were used: body mass index (BMI)-for-age percentile and percentage of expected body weight (EBW), Eating Disorder Examination Questionnaire, Brief Symptom Inventory, and Clinical Impairment Assessment.
RESULTS
Approximately 81% of eligible patients began the program, with over 80% successfully completing it. Patients with a longer or shorter duration of illness did not show significantly different treatment outcomes. In detail, BMI-for-age percentile and percentage of EBW outcomes were significantly improved from baseline to EOT, remaining stable until 20-week follow-up in both groups. Similarly, in both groups, scores for eating disorder psychopathology, general psychopathology, and clinical impairment decreased significantly at EOT and remained stable from EOT to follow-up. Furthermore, a substantial percentage of adolescents in both groups achieved a good BMI outcome at EOT and 20-week follow-up, with approximately 60% maintaining a full response at the latter time point.
DISCUSSION
These findings suggest that intensive CBT-E appears to be an effective treatment for severely ill adolescent patients with anorexia nervosa, regardless of whether the duration of illness is shorter or longer than 3 years.
PUBLIC SIGNIFICANCE
Existing treatment outcome studies in adolescents, whether randomized controlled trials or longitudinal investigations, typically involve patients with less than 3 years of illness, while data on the treatment outcomes for adolescents with anorexia nervosa with an illness duration of 3 years or over is very limited. Our findings suggest that adolescents with anorexia nervosa, irrespective of the duration of their illness, can derive similar benefits from intensively CBT-E.
PubMed: 38482877
DOI: 10.1002/eat.24196 -
The International Journal of Eating... Apr 2024In this special issue, international researchers investigate how atypical anorexia nervosa (atypical AN) differs from anorexia nervosa (AN) and other eating disorders...
In this special issue, international researchers investigate how atypical anorexia nervosa (atypical AN) differs from anorexia nervosa (AN) and other eating disorders with respect to demographics, psychological and physiological morbidity, as well as treatment course and outcome. Manuscripts in this special issue report that atypical AN is associated with substantial medical and psychological morbidity, and the majority of studies find few differences between atypical AN and AN. While much remains to be learned about the long-term course and treatment response of individuals with atypical AN to psychological and pharmacological interventions, the evidence supports conceptualization of atypical AN as part of a spectrum-based restrictive eating disorder. These findings together with the potentially stigmatizing use of the term "atypical" suggest it may be time to revise the existing definition of atypical AN.
Topics: Humans; Anorexia Nervosa; Feeding and Eating Disorders
PubMed: 38390637
DOI: 10.1002/eat.24174 -
Hormones (Athens, Greece) Mar 2024Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a regulator of low-density-lipoprotein cholesterol (LDL-C), a major risk factor for cardiovascular (CV) disease.... (Observational Study)
Observational Study
AIM
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a regulator of low-density-lipoprotein cholesterol (LDL-C), a major risk factor for cardiovascular (CV) disease. Since the hormone leptin has been suggested as having a role in CV risk regulation, possibly by modulating LDL receptor expression through the PCSK9 pathway, nutritional status may represent a potential regulator. Thus, evaluation of PCSK9 levels in human eating disorders appears to be of interest. In this report, we evaluate the lipoprotein profile, PCSK9, and leptin levels in subjects affected by anorexia nervosa (AN) to improve our understanding of the metabolic alterations in this disease.
METHODS AND RESULTS
We designed a case-control observational study, enrolling 20 anorexic adolescent females and 20 adolescent females without AN as the control group, age- and sex-matched. Subjects affected by AN showed lower BMI, total cholesterol, and LDL-C in comparison to the control group, with lipoprotein levels in the normal range. Furthermore, adolescent girls with AN show significantly higher PCSK9 (+24%, p < 0.005) and lower leptin levels (-43%, p < 0.01), compared to the control group.
CONCLUSIONS
The findings of increased levels of PCSK9 and reduced leptin levels among AN subjects warrant further research in order to unravel the role of the liver and adipose tissue in the management of PCSK9/LDL metabolism in adolescents affected by AN.
Topics: Female; Adolescent; Humans; Proprotein Convertase 9; Cholesterol, LDL; Leptin; Proprotein Convertases; Serine Endopeptidases; Anorexia Nervosa
PubMed: 37999906
DOI: 10.1007/s42000-023-00504-z -
Journal of Eating Disorders Oct 2023In the course of the COVID-19 pandemic, a steady increase in adolescent anorexia nervosa admissions has been observed. Contributing factors may have been uncontrollable...
BACKGROUND
In the course of the COVID-19 pandemic, a steady increase in adolescent anorexia nervosa admissions has been observed. Contributing factors may have been uncontrollable changes in school attendance due to lockdowns and social restrictions. However, patients' reports on the impact of these factors have not been assessed in detail as of yet. Furthermore, alexithymia, the difficulty to identify and describe one's own emotions, has increased during the pandemic and is known to be heightened in eating disorders. Thus, it may have contributed to symptom severity in anorexia nervosa during the pandemic.
METHODS
The present study examined pandemic-related changes in social media use, body satisfaction, and perceived loss of control and their impact on depressive, anxious, and eating disorder symptomatology in a sample of adolescent girls with anorexia nervosa (n = 29) and healthy controls (n = 23). Additionally, the influence of current alexithymia as a cross-diagnostic risk factor was assessed. Adolescents answered questionnaires once shortly after admission to inpatient, outpatient, or daycare treatment.
RESULTS
An increase in perceived loss of control during the pandemic and heightened alexithymia explained a significant portion of variance in present depressive symptomatology, which in turn contributed to eating disorder symptomatology.
CONCLUSIONS
These relationships emphasize alexithymia and perceived loss of control as valuable constructs for early screenings and interventions.
PubMed: 37828587
DOI: 10.1186/s40337-023-00905-w -
Journal of Psychiatric Research Nov 2023Anorexia nervosa (AN) is a psychiatric disorder with a tenuous longitudinal course marked by a high risk of relapse. Previous studies suggest that aberrant threat...
Anorexia nervosa (AN) is a psychiatric disorder with a tenuous longitudinal course marked by a high risk of relapse. Previous studies suggest that aberrant threat perception and reward processing operate in many with AN, and may produce obstacles to treatment engagement; therefore, these could potentially represent predictors for longitudinal clinical outcomes. In this study, anxiety and reward symptoms, behaviors, and neural circuit connectivity were measured in intensively treated AN-restrictive subtype patients (n = 33) and healthy controls (n = 31). Participants underwent an fMRI experiment using a monetary reward task in combination with either overlapping individually tailored anxiety-provoking words or neutral words. Behavioral/psychometric measures consisted of reaction times on the monetary reward task and self-ratings on anxiety symptoms at study entry. We tested multimodal, multivariate models based on neural, behavioral, and psychometric measures of reward and anxiety to predict physiological (Body Mass Index; BMI) and psychological (eating disorder symptom severity) longitudinal outcomes in AN over six months. Our results indicated that higher anxiety symptom psychometric scores significantly predicted BMI reductions at follow-up. Untreated anxiety after intensive treatment could put individuals with AN at heightened risk for weight loss. This represents a potentially modifiable risk factor that could be targeted more aggressively to help reduce the chance of future clinical worsening.
Topics: Humans; Anorexia Nervosa; Reward; Female; Magnetic Resonance Imaging; Adult; Longitudinal Studies; Young Adult; Anxiety; Adolescent; Body Mass Index; Male; Brain
PubMed: 37839390
DOI: 10.1016/j.jpsychires.2023.09.004 -
Metabolism: Clinical and Experimental Mar 2024Anorexia Nervosa (AN) is a severe psychiatric disorder of an unknown etiology with a crude mortality rate of about 5 % per decade, making it one of the deadliest of all...
AIMS/HYPOTHESIS
Anorexia Nervosa (AN) is a severe psychiatric disorder of an unknown etiology with a crude mortality rate of about 5 % per decade, making it one of the deadliest of all psychiatric illnesses. AN is broadly classified into two main subtypes, restricting and binge/purging disorder. Despite extensive research efforts during several decades, the underlying pathophysiology of AN remains poorly understood. In this study, we aimed to identify novel protein biomarkers for AN by performing a proteomics analysis of fasting plasma samples from 78 females with AN (57 restrictive and 21 binge/purge type) and 70 healthy controls.
METHODS
Using state-of-the-art mass spectrometry-based proteomics technology in conjunction with an advanced bioinformatics pipeline, we quantify >500 plasma proteins.
RESULTS
Differential expression analysis and correlation of proteomics data with clinical variables led to identification of a panel of novel protein biomarkers with potential pathophysiological significance for AN. Our findings demonstrate evidence of a humoral immune system response, altered lipid metabolism and potential alteration of plasma cells in AN patients. Additionally, we stratified AN patients based on the quantified proteins and suggest a potential autoimmune nature in the restrictive subtype of AN.
CONCLUSIONS/INTERPRETATION
In summary, on top of biomarkers of AN subtypes, this study provides a comprehensive map of plasma proteins that constitute a resource for further studies of the pathophysiology of AN.
Topics: Female; Humans; Anorexia Nervosa; Proteome; Fasting; Blood Proteins; Biomarkers
PubMed: 38104923
DOI: 10.1016/j.metabol.2023.155760 -
Soins; La Revue de Reference Infirmiere Dec 2023The diagnosis of anorexia nervosa is one of the easiest to make in that it is a positive diagnosis, not a differential diagnosis. It is defined by a few criteria which...
The diagnosis of anorexia nervosa is one of the easiest to make in that it is a positive diagnosis, not a differential diagnosis. It is defined by a few criteria which together become almost pathognomonic: excessive restriction of energy intake combined with an irrational fear of weight and an altered body image. Even if weight is at the heart of the medical team's concerns, it is important to question the pathology in its history, in order to put it in to context, and sometimes to understand the para-logic and its function in the patient's life history. It is necessary to work on emotions and cognitions in addition to behaviour.
Topics: Humans; Body Image; Anorexia Nervosa; Emotions; Fear; Surveys and Questionnaires
PubMed: 38070979
DOI: 10.1016/j.soin.2023.10.008