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Soins; La Revue de Reference Infirmiere Dec 2023As a complex pathology, anorexia nervosa interacts with the psychological challenges of pregnancy, and raises questions about how to support the women concerned. As part...
As a complex pathology, anorexia nervosa interacts with the psychological challenges of pregnancy, and raises questions about how to support the women concerned. As part of a multidisciplinary approach, support groups are particularly important, offering both individual and social support. Child-parent drop-in centers can also provide a supportive space for the psychological work of parenting.
Topics: Pregnancy; Humans; Female; Anorexia Nervosa; Self-Help Groups
PubMed: 38070980
DOI: 10.1016/j.soin.2023.10.009 -
Trends in Molecular Medicine Apr 2024In anorexia nervosa (AN), measurable biological parameters can inform the process of treating patients. Such biomarkers include established laboratory parameters as well... (Review)
Review
In anorexia nervosa (AN), measurable biological parameters can inform the process of treating patients. Such biomarkers include established laboratory parameters as well as a range of potential future biomarkers, including genetic, metabolomic, microbiomic, endocrine, immunological, hematological, electrophysiological, and neuroimaging parameters. In this opinion article we discuss how these biomarkers can support diagnosic and therapeutic processes at specific steps during the AN treatment cycle, that is, the diagnosis, diagnostic specification, risk management, choice of therapy, therapy monitoring, and treatment review. History-taking, physical and neuropsychological examination, clinical observation, and judgment about treatment success by the patient, their carers, and members of the multidisciplinary team are essential to interpret laboratory and imaging data appropriately and to assess the full clinical picture.
Topics: Humans; Anorexia Nervosa; Treatment Outcome
PubMed: 38331700
DOI: 10.1016/j.molmed.2024.01.002 -
Primary Care Mar 2023Eating disorders are mental health disorders with complicating medical, psychiatric, and nutritional comorbidities. Common eating disorder diagnoses include anorexia... (Review)
Review
Eating disorders are mental health disorders with complicating medical, psychiatric, and nutritional comorbidities. Common eating disorder diagnoses include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, and other specified feeding or eating disorder. Unspecified feeding or eating disorder is most applicable in brief acute care settings. Eating disorders occur across age, gender, racial, ethnic, and socioeconomic variables. Effective assessment, intervention, and collaborative treatment are needed to decrease risk factors and increase opportunities for recovery.
Topics: Humans; Feeding and Eating Disorders; Anorexia Nervosa; Bulimia Nervosa; Binge-Eating Disorder; Primary Health Care
PubMed: 36822720
DOI: 10.1016/j.pop.2022.10.012 -
The International Journal of Eating... Jul 2023To review the recent literature on the proposed entity of "terminal anorexia nervosa." (Review)
Review
OBJECTIVE
To review the recent literature on the proposed entity of "terminal anorexia nervosa."
METHOD
Review of recent literature on the concept of "terminal AN" as well as past and supporting work.
RESULTS
The cases and proposed definitions are reviewed, as is the growing literature on this topic. Problems exist with predicting outcomes and thus, determining futility, as well as about capacity for decision-making.
DISCUSSION
To make decisions about treatment futility, the existing database for predicting AN course and treatment response must expand greatly. In addition, while decisional capacity is central to the debate, its determination may be unusually complex in this situation. The gaps identified point to extensive needs for future research, but they also indicate that the concept of "terminal AN" cannot be defined at present and should not be used.
PUBLIC SIGNIFICANCE
Anorexia nervosa is challenging to treat, and it often lasts for years. There is debate about whether palliative care or medical aid in dying should be considered. Identifying who has a terminal case of AN is important for this question, but we have limited ability to predict a given individual's outcome at present, and there are concerns about the ability of those with AN to make treatment decisions. This means the concept of "terminal AN" should not currently be used.
Topics: Humans; Anorexia Nervosa; Palliative Care
PubMed: 37057340
DOI: 10.1002/eat.23957 -
International Journal of Environmental... Dec 2022(1) Background: Body image is being defined as the picture of our own body in our mind with its size and shape, and with a perceptive and attitudinal evaluation of this...
(1) Background: Body image is being defined as the picture of our own body in our mind with its size and shape, and with a perceptive and attitudinal evaluation of this body. It appears to be a complex clinical construct predisposing an individual to developing and maintaining anorexia nervosa (AN), as well as having considerable impact on prolonging the duration of this illness and its relapse risk. The aim of the research work was to assess whether the symptomatology of eating disorders, level of depression, and mental pain are associated with body image, and examine the influence of a distorted body image as well as eating disorders and depression symptoms on mental pain in AN; (2) Methods: A total of 36 women diagnosed with AN and 69 healthy controls (HC) participated in this study. All participants completed a battery of the following scales: EAT-26, BSQ-34, BIDQ, BDD-YBOCS, CESDR, and the Mental Pain Scale; (3) Results: Results show statistically significantly greater body image disturbances and higher level of depression and mental pain intensity in the AN compared to the HC group. Regression analysis indicates a greater impact of distorted body image, eating disorders, and depression symptoms on mental pain in AN; (4) Conclusions: As assumed, distorted body image and mental pain are central components of AN that should be especially emphasized in the therapeutical process of treating AN. Future research should focus on the etiopathogenesis of distorted body image in relation to the chronicity of mental pain and depression in AN, and address these outcomes in clinical practice to minimize suicide risk in this high-risk group of patients.
Topics: Humans; Female; Anorexia Nervosa; Body Image; Feeding and Eating Disorders; Pain
PubMed: 36613039
DOI: 10.3390/ijerph20010718 -
Health (London, England : 1997) Mar 2023This autoethnography examines my experience of the diagnosis and treatment of anorexia nervosa. Drawing on memory and personal and medical documents relating to...
This autoethnography examines my experience of the diagnosis and treatment of anorexia nervosa. Drawing on memory and personal and medical documents relating to inpatient admissions in an adult specialist eating disorder unit, I narrate and analyse my experience in terms of my relationship to the diagnosis of anorexia and the constructions of it I encountered. I show how I came to value an identity based on anorexia and how I learned ways of 'doing' the diagnosis in treatment. This involved me valuing medical markers of illness, including signs of poor health, which became crucial to how I performed my diagnosis and retained the diagnostically-informed sense of self that I valued. I suggest that, ultimately, these diagnostic-dynamics, alongside other effects of long-term inpatient treatment such as detachment from 'normal life', prolonged my struggles with self-starvation. The insights from this autoethnography shed light on potential iatrogenic impacts of diagnosis and treatment for anorexia.
Topics: Adult; Humans; Anorexia Nervosa; Anorexia; Feeding and Eating Disorders; Hospitalization; Inpatients
PubMed: 34041954
DOI: 10.1177/13634593211017190 -
Nutrition Research Reviews Dec 2023Anorexia nervosa (AN) is characterised by the restriction of energy intake in relation to energy needs and a significantly lowered body weight than normally expected,... (Review)
Review
Anorexia nervosa (AN) is characterised by the restriction of energy intake in relation to energy needs and a significantly lowered body weight than normally expected, coupled with an intense fear of gaining weight. Treatment of AN is currently based on psychological and refeeding approaches, but their efficacy remains limited since 40% of patients after 10 years of medical care still present symptoms of AN. The intestine hosts a large community of microorganisms, called the "microbiota", which live in symbiosis with the human host. The gut microbiota of a healthy human is dominated by bacteria from two phyla: and, majorly, . However, the proportion in their representation differs on an individual basis and depends on many external factors including medical treatment, geographical location and hereditary, immunological and lifestyle factors. Drastic changes in dietary intake may profoundly impact the composition of the gut microbiota, and the resulting dysbiosis may play a part in the onset and/or maintenance of comorbidities associated with AN, such as gastrointestinal disorders, anxiety and depression, as well as appetite dysregulation. Furthermore, studies have reported the presence of atypical intestinal microbial composition in patients with AN compared with healthy normal-weight controls. This review addresses the current knowledge about the role of the gut microbiota in the pathogenesis and treatment of AN. The review also focuses on the bidirectional interaction between the gastrointestinal tract and the central nervous system (microbiota-gut-brain axis), considering the potential use of the gut microbiota manipulation in the prevention and treatment of AN.
Topics: Humans; Anorexia Nervosa; Microbiota; Gastrointestinal Microbiome; Eating; Appetite
PubMed: 35875979
DOI: 10.1017/S0954422422000130 -
Human Brain Mapping Oct 2021Anorexia nervosa (AN) is a complex psychiatric disorder with poorly understood etiology. Numerous voxel-based morphometry (VBM) and resting-state functional imaging... (Meta-Analysis)
Meta-Analysis Review
Anorexia nervosa (AN) is a complex psychiatric disorder with poorly understood etiology. Numerous voxel-based morphometry (VBM) and resting-state functional imaging studies have provided strong evidence of abnormal brain structure and intrinsic and functional activities in AN, but with inconsistent conclusions. Herein, a whole-brain meta-analysis was conducted on VBM (660 patients with AN, and 740 controls) and resting-state functional imaging (425 patients with AN, and 461 controls) studies that measured differences in the gray matter volume (GMV) and intrinsic functional activity between patients with AN and healthy controls (HCs). Overall, patients with AN displayed decreased GMV in the bilateral median cingulate cortex (extending to the bilateral anterior and posterior cingulate cortex), and left middle occipital gyrus (extending to the left inferior parietal lobe). In resting-state functional imaging studies, patients with AN displayed decreased resting-state functional activity in the bilateral anterior cingulate cortex and bilateral median cingulate cortex, and increased resting-state functional activity in the right parahippocampal gyrus. This multimodal meta-analysis identified reductions of gray matter and functional activity in the anterior and median cingulate in patients with AN, which contributes to further understanding of the pathophysiology of AN.
Topics: Anorexia Nervosa; Cerebral Cortex; Humans; Neuroimaging
PubMed: 34296492
DOI: 10.1002/hbm.25602 -
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