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Internal Medicine Journal Jan 2020This article presents current diagnostic conceptualisations of eating disorders, including new disorders such as binge eating disorder (BED) and avoidant/restrictive...
This article presents current diagnostic conceptualisations of eating disorders, including new disorders such as binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID). This is followed by contemporary findings in the epidemiology of eating disorders, their broad sociodemographic distribution and the increases in community prevalence. Advances and the current status of evidence-based treatment and outcomes for the main eating disorders, anorexia nervosa, bulimia nervosa and BED are discussed with focus on first-line psychological therapies. Deficits in knowledge and directions for further research are highlighted, particularly with regard to treatments for BED and ARFID, how to improve treatment engagement and the management of osteopenia.
Topics: Anorexia Nervosa; Avoidant Restrictive Food Intake Disorder; Binge-Eating Disorder; Bone Diseases, Metabolic; Bulimia Nervosa; Drug Therapy; Feeding and Eating Disorders; Humans; Prevalence; Psychotherapy; Refeeding Syndrome
PubMed: 31943622
DOI: 10.1111/imj.14691 -
British Journal of Hospital Medicine... Jun 2020Anorexia nervosa is an eating disorder with peak onset in adolescence, which carries the highest mortality rate of all psychiatric illnesses. It is commonly comorbid... (Review)
Review
Anorexia nervosa is an eating disorder with peak onset in adolescence, which carries the highest mortality rate of all psychiatric illnesses. It is commonly comorbid with other physical and mental health problems, yet training on management of people with eating disorders and working knowledge of clinicians working with underweight adolescents is inconsistent. This review of anorexia nervosa in adolescents provides an overview of the presentation, aetiology and treatment of this disorder, with a particular focus on the assessment and management of physical health risks, including refeeding syndrome.
Topics: Adolescent; Anorexia Nervosa; Arrhythmias, Cardiac; Body Mass Index; Bradycardia; Dehydration; Early Diagnosis; Early Medical Intervention; Humans; Hypothermia; Incidence; Prognosis; Refeeding Syndrome; United Kingdom; Water-Electrolyte Imbalance
PubMed: 32589532
DOI: 10.12968/hmed.2020.0099 -
Current Opinion in Psychiatry Nov 2021To review the recent literature on the epidemiology of anorexia nervosa and bulimia nervosa in terms of incidence, prevalence and mortality. (Review)
Review
PURPOSE OF REVIEW
To review the recent literature on the epidemiology of anorexia nervosa and bulimia nervosa in terms of incidence, prevalence and mortality.
RECENT FINDINGS
Although the overall incidence rate of anorexia nervosa is considerably stable over the past decades, the incidence among younger persons (aged <15 years) has increased. It is unclear whether this reflects earlier detection or earlier age of onset. Nevertheless, it has implications for future research into risk factors and for prevention programs. For bulimia nervosa, there has been a decline in overall incidence rate over time. The lifetime prevalence rates of anorexia nervosa might be up to 4% among females and 0.3% among males. Regarding bulimia nervosa, up to 3% of females and more than 1% of males suffer from this disorder during their lifetime. While epidemiological studies in the past mainly focused on young females from Western countries, anorexia nervosa and bulimia nervosa are reported worldwide among males and females from all ages. Both eating disorders may carry a five or more times increased mortality risk.
SUMMARY
Anorexia nervosa and bulimia nervosa occur worldwide among females and males of all age groups and are associated with an increased mortality risk.
Topics: Anorexia Nervosa; Bulimia Nervosa; Feeding and Eating Disorders; Female; Humans; Incidence; Male; Prevalence
PubMed: 34419970
DOI: 10.1097/YCO.0000000000000739 -
Medicina Clinica Jan 2024Anorexia nervosa and bulimia nervosa are eating disorders associated with life-threatening multisystemic medical complications. This narrative review aimed to present... (Review)
Review
Anorexia nervosa and bulimia nervosa are eating disorders associated with life-threatening multisystemic medical complications. This narrative review aimed to present the medical complications most related to these disorders. In anorexia nervosa, many of them are linked to malnutrition and underweight, usually reversible with renutrition and weight restoration, although refeeding can also be linked to some medical complications. Purging behaviors observed in the anorexia nervosa binge-purging subtype and bulimia nervosa have been mainly related to hydrolectrolyte and acid-base disturbances, in addition to local complications. Thus, an early identification and therapeutic intervention of these disorders is considered crucial. Integral medical monitoring should be ensured to prevent potential serious complications from the early stages, with the involvement of physicians, psychologists, nutritionists, and other specialists in a multidisciplinary approach according to the patient's needs.
Topics: Humans; Bulimia Nervosa; Anorexia; Anorexia Nervosa; Feeding and Eating Disorders; Malnutrition
PubMed: 37598049
DOI: 10.1016/j.medcli.2023.07.028 -
Nutrients Apr 2021Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an... (Review)
Review
Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.
Topics: Adolescent; Adolescent Health Services; Ambulatory Care; Anorexia Nervosa; Body Mass Index; Caregivers; Critical Care; Health Policy; Home Care Services, Hospital-Based; Hospitalization; Humans; Nutritional Support; Parents; Psychotherapy; Quality of Health Care; Stakeholder Participation; Treatment Outcome
PubMed: 33924294
DOI: 10.3390/nu13041265 -
Psychiatria Polska Oct 2019Refeeding syndrome (RS) is one of the serious complications during treatment of anorexia nervosa. It includes hormonal and metabolic changes that occur during the... (Review)
Review
Refeeding syndrome (RS) is one of the serious complications during treatment of anorexia nervosa. It includes hormonal and metabolic changes that occur during the process of refeeding in chronically malnourished patient when nutrition is introduced in an excessive and improper amount. RS manifests in water-electrolyte imbalances, including hypophosphatemia (the mostimportant diagnosticmarker), hypokalemia, hyponatremia, hypomagnesaemia, fluid retention, vitamin deficiency and metabolic acidosis. It applies to either oral and parenteral supplementation. In the treatment of malnourished patients with anorexia nervosa, it is essential to establish an initial caloric amount that will stimulate weight gain from the beginning of treatment, increase its effectiveness while minimizing the risk of RS. Recent research suggests that the current recommendations may be too stringent in this respect and require further updating. Awareness of the risks associated with RS, including significant mortality, appears to be currently insufficient also among physicians. There is a need for far more specialized multidisciplinary centers for patients with anorexia nervosa and also appropriate algorithms and standards of care for that population. The aim of this paper is to systematize the current knowledge about RS and RS prevention, to increase awareness of its occurrence and present the results of the latest research on safe resupplementation of patients suffering from anorexia nervosa.
Topics: Anorexia Nervosa; Feeding Methods; Humans; Refeeding Syndrome; Water-Electrolyte Balance; Weight Gain
PubMed: 31955189
DOI: 10.12740/PP/OnlineFirst/90275 -
Cleveland Clinic Journal of Medicine Jun 2020Anorexia nervosa is a mental illness characterized by self-starvation, marked weight loss, and malnutrition. As the illness worsens, numerous medical complications... (Review)
Review
Anorexia nervosa is a mental illness characterized by self-starvation, marked weight loss, and malnutrition. As the illness worsens, numerous medical complications develop throughout the body. Some of these resolve with effective nutritional rehabilitation and weight gain, whereas others can lead to permanent damage.
Topics: Anorexia Nervosa; Bone Diseases, Metabolic; Brain Diseases, Metabolic; Cardiomyopathies; Early Medical Intervention; Humans; Lung Diseases; Prognosis
PubMed: 32487556
DOI: 10.3949/ccjm.87a.19084 -
Nutrients Aug 2019Knowledge of anorexia nervosa (AN) in childhood is scarce. This review gives a state-of-the-art overview on the definition, classification, epidemiology and etiology of... (Review)
Review
Knowledge of anorexia nervosa (AN) in childhood is scarce. This review gives a state-of-the-art overview on the definition, classification, epidemiology and etiology of this serious disorder. The typical features of childhood AN in comparison to adolescent AN and avoidant restrictive eating disorder (ARFID) are described. Other important issues discussed in this article are somatic and psychiatric comorbidity, differential diagnoses and medical and psychological assessment of young patients with AN. Special problems in the medical and psychological treatment of AN in children are listed, although very few studies have investigated age-specific treatment strategies. The physical and mental outcomes of childhood AN appear to be worse than those of adolescent AN, although the causes for these outcomes are unclear. There is an urgent need for ongoing intensive research to reduce the consequences of this debilitating disorder of childhood and to help patients recover.
Topics: Adolescent; Anorexia Nervosa; Child; Humans; Treatment Outcome
PubMed: 31426409
DOI: 10.3390/nu11081932 -
Canadian Family Physician Medecin de... Jun 2023To address screening, diagnosis, and treatment of adolescents with anorexia nervosa and atypical anorexia nervosa in primary care. (Review)
Review
OBJECTIVE
To address screening, diagnosis, and treatment of adolescents with anorexia nervosa and atypical anorexia nervosa in primary care.
SOURCES OF INFORMATION
A literature search was conducted in PubMed using the subject headings , and . Applicable articles were reviewed, with key recommendations summarized. Most evidence is level I.
MAIN MESSAGE
Recent studies suggest that the global COVID-19 pandemic contributed to an increase in the incidence of eating disorders, particularly among teenagers. This has resulted in increasing responsibility for primary care providers regarding the assessment, diagnosis, and management of these disorders. Moreover, primary care providers are in ideal positions to identify adolescents at risk of eating disorders. Early intervention is of utmost importance for avoiding long-term health consequences. High rates of atypical anorexia nervosa indicate a need for providers to have awareness of weight biases and stigmas. Treatment primarily involves a combination of renourishment and psychotherapy, generally through family-based therapy, with pharmacotherapy playing a lesser role.
CONCLUSION
Anorexia nervosa and atypical anorexia nervosa are serious, potentially life-threatening illnesses that are best addressed through early detection and treatment. Family physicians are in an optimal position to screen for, diagnose, and treat these illnesses.
Topics: Adolescent; Humans; Anorexia Nervosa; Pandemics; COVID-19; Psychotherapy; Physicians, Family
PubMed: 37315981
DOI: 10.46747/cfp.6906387 -
The British Journal of Psychiatry : the... Feb 2020Little is known about the long-term outcome of anorexia nervosa.
BACKGROUND
Little is known about the long-term outcome of anorexia nervosa.
AIMS
To study the 30-year outcome of adolescent-onset anorexia nervosa.
METHOD
All 4291 individuals born in 1970 and attending eighth grade in 1985 in Gothenburg, Sweden were screened for anorexia nervosa. A total of 24 individuals (age cohort for anorexia nervosa) were pooled with 27 individuals with anorexia nervosa (identified through community screening) who were born in 1969 and 1971-1974. The 51 individuals with anorexia nervosa and 51 school- and gender-matched controls were followed prospectively and examined at mean ages of 16, 21, 24, 32 and 44. Psychiatric disorders, health-related quality of life and general outcome were assessed.
RESULTS
At the 30-year follow-up 96% of participants agreed to participate. There was no mortality. Of the participants, 19% had an eating disorder diagnosis (6% anorexia nervosa, 2% binge-eating disorder, 11% other specified feeding or eating disorder); 38% had other psychiatric diagnoses; and 64% had full eating disorder symptom recovery, i.e. free of all eating disorder criteria for 6 consecutive months. During the elapsed 30 years, participants had an eating disorder for 10 years, on average, and 23% did not receive psychiatric treatment. Good outcome was predicted by later age at onset among individuals with adolescent-onset anorexia nervosa and premorbid perfectionism.
CONCLUSIONS
This long-term follow-up study reflects the course of adolescent-onset anorexia nervosa and has shown a favourable outcome regarding mortality and full symptom recovery. However, one in five had a chronic eating disorder.
Topics: Adolescent; Adult; Anorexia Nervosa; Chronic Disease; Comorbidity; Female; Follow-Up Studies; Humans; Male; Quality of Life; Sweden; Time Factors; Treatment Outcome; Young Adult
PubMed: 31113504
DOI: 10.1192/bjp.2019.113