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Psychiatria Polska Aug 2020Anorexia nervosa constitutes amajor challenge to medical practitioners, especially clinicians, due to a high rate of chronicity and a very serious risk of relapse. One... (Review)
Review
Anorexia nervosa constitutes amajor challenge to medical practitioners, especially clinicians, due to a high rate of chronicity and a very serious risk of relapse. One of the underlying causes of this state of affairs is the ego-syntonicity of the disorder, which differentiates it from similar conditions, and which is responsible for the patient's denial and lack of motivation for treatment (resulting in frequent instances of therapy refusal or drop-out). The paper outlines different approaches to defining chronic anorexia nervosa. Thisform of anorexia and its therapeutic implications are discussed through the lens of clinicians and other medical professionals. Furthermore, the patients'experiences of chronic anorexia nervosa are described. The dilemmas concerning palliative care for this group of patients are addressed and treatment options and relapse prevention strategies are recommended, with a focus on the latest developments in this respect. The paper is concluded with an optimistic report of complete recovery from this diagnosis, including an analysis of the factors underlying the positive therapeutic outcome.
Topics: Anorexia Nervosa; Cognitive Behavioral Therapy; Disease Progression; Humans; Patient Education as Topic; Patient Selection; Psychotherapy
PubMed: 33386730
DOI: 10.12740/PP/OnlineFirst/118601 -
Anales de Pediatria Sep 2023Nutritional status assessment in anorexia nervosa (AN) includes the evaluation and monitoring of body composition throughout the treatment period. The gold standard for...
INTRODUCTION
Nutritional status assessment in anorexia nervosa (AN) includes the evaluation and monitoring of body composition throughout the treatment period. The gold standard for the study of body composition is dual-energy X-ray absorptiometry (DEXA), although electrical bioimpedance (BIA) is a more accessible, cheaper and faster method that does not involve exposure to radiation.
MATERIAL AND METHODS
We recruited 33 female adolescents with AN (age, 11.7-16.3 years) by consecutive sampling. We collected data on clinical, anthropometric and laboratory variables. Patients were assessed with BIA and DEXA at inclusion in the study and at the end of the study, with a mean duration of follow-up of 1 year, during the nutritional rehabilitation phase.
RESULTS
There was significant improvement in nutritional status, reflected by the body composition obtained by anthropometric measurements and BIA. The phase angle increased significantly during the follow-up. Greater weight loss was associated with the presence of secondary amenorrhoea and decreased bone mineral density in the spine.
CONCLUSIONS
Electrical BIA is a useful tool for assessment and monitoring of nutritional status in paediatric patients with AN. Dual-energy X-ray absorptiometry continues to be essential to assess bone mineral density. The role of hormones such as leptin remains to be elucidated.
Topics: Humans; Female; Adolescent; Child; Nutritional Status; Body Mass Index; Anorexia Nervosa; Body Composition; Bone Density
PubMed: 37563070
DOI: 10.1016/j.anpede.2023.06.015 -
BMC Psychiatry Aug 2023Severe and enduring anorexia nervosa (SE-AN) is amongst the most impairing of all mental illnesses. Collective uncertainties about SE-AN nosology impacts treatment... (Review)
Review
BACKGROUND
Severe and enduring anorexia nervosa (SE-AN) is amongst the most impairing of all mental illnesses. Collective uncertainties about SE-AN nosology impacts treatment refinement. Qualitative research, particularly lived experience literature, can contribute to a process of revision and enrichment of understanding the SE-AN experience and further develop treatment interventions. Poor outcomes to date, as evidenced in clinical trials and mortality for people with SE-AN (1 in 20) demonstrate the need for research that informs conceptualisations and novel treatment directions. This interpretative, meta-ethnographic meta-synthesis aimed to bridge this gap.
METHODS
A systematic search for qualitative studies that explored the AN experiences of people with a duration of greater than 3 years was undertaken. These studies included those that encompassed phenomenology, treatment experiences and recovery.
RESULTS
36 papers, comprising 382 voices of SE-AN experiences informed the meta-ethnographic findings. Four higher order constructs were generated through a synthesis of themes and participant extracts cited in the extracted papers: (1) Vulnerable sense of self (2) Intra-psychic processes (3) Global impoverishment (4) Inter-psychic temporal processes. Running across these meta-themes were three cross cutting themes (i) Treatment: help versus harm, (ii) Shifts in control (iii) Hope versus hopelessness. These meta-themes were integrated into conceptualisations of SE-AN that was experienced as a recursive process of existential self-in-relation to other and the anorexia nervosa trap.
CONCLUSIONS
The alternative conceptualisation of SE-AN proposed in this paper poses a challenge to current conceptualisations of AN and calls for treatments to engage with the complex intra and inter-psychic processes of the SE-AN, more fully. In doing so, clinicians and researchers are asked to continue to be bold in testing novel ideas that may challenge our own rigidity and attachment to dominant paradigms to best serve the individual person with SE-AN. The 'global impoverishment of self', found in this synthesis of AN experiences, should inform proposed diagnostic criteria for SE-AN.
Topics: Humans; Affect; Anorexia Nervosa; Anthropology, Cultural; Concept Formation; Qualitative Research
PubMed: 37596588
DOI: 10.1186/s12888-023-05098-9 -
Deutsches Arzteblatt International Mar 2024Anorexia nervosa (AN) is a serious disease with a lifetime prevalence of up to 3.6% in women and 0.3% in men. Abnormally low weight and the associated starvation partly... (Review)
Review
BACKGROUND
Anorexia nervosa (AN) is a serious disease with a lifetime prevalence of up to 3.6% in women and 0.3% in men. Abnormally low weight and the associated starvation partly account for its somatic and mental manifestations.
METHODS
This review is based on publications retrieved by a selective search concerning AN in childhood and adolescence.
RESULTS
The peak age of onset of AN is 15.5 years. The frequency of inpatient treatment for AN rose by 40% during the COVID pandemic, indicating the importance of environmental factors; the heritability of AN is estimated at 0.5. The ICD-11 sets the threshold for AN-associated underweight at the fifth percentile for age of the body mass index, as long as the remaining diagnostic criteria are met. The main goal of the multiprofessional treatment of AN is the return to normal body weight, which is a central prerequisite for regaining somatic and mental health. The mean duration of AN is 3.4 years, and approximately twothirds of patients recover from the disease over the long term.
CONCLUSION
Marked weight loss in childhood and adolescence can trigger AN in the presence of a predisposition to this disease. Patients and their families should receive psychoeducation regarding the symptoms of starvation and their overlap with those of AN. Important objectives are to shorten the duration of the illness, minimize mortality and the risk of chronic illness, and to identify pharmacological approaches to treatment.
Topics: Humans; Anorexia Nervosa; Adolescent; Child; Female; Male; COVID-19
PubMed: 38170843
DOI: 10.3238/arztebl.m2023.0248 -
Nutricion Hospitalaria Nov 2023Anorexia nervosa (AN) is a psychiatric disease with a high prevalence and comorbidities, characterized by a low response rate to treatment. It is considered as a...
Anorexia nervosa (AN) is a psychiatric disease with a high prevalence and comorbidities, characterized by a low response rate to treatment. It is considered as a multifactorial disease. In recent years, the focus has been placed on the presence of intestinal dysbiosis and its possible involvement as a causal factor as well as an alternative treatment. The objective of this work has been to review the current state of knowledge of alterations in the intestinal microbiota identified in patients with AN and the possibility of using probiotics as a therapeutic alternative. Significant changes in the diversity of species associated with weight loss have been described that could favor the perpetuation of the disorder, and that would explain many of the nutritional, gastrointestinal, psychological, and cognitive alterations present in these patients. The use of probiotics, still little studied in patients with AN, sheds some light on this matter to improve the treatment response, always hand in hand with conventional treatments.
Topics: Humans; Anorexia Nervosa; Microbiota; Brain; Gastrointestinal Microbiome; Gastrointestinal Tract
PubMed: 37929904
DOI: 10.20960/nh.04955 -
CNS Drugs Feb 2023Anorexia nervosa is a disorder associated with serious adverse health outcomes, for which there is currently considerable treatment ineffectiveness. Characterised by... (Review)
Review
Anorexia nervosa is a disorder associated with serious adverse health outcomes, for which there is currently considerable treatment ineffectiveness. Characterised by restrictive eating behaviours, distorted body image perceptions and excessive physical activity, there is growing recognition anorexia nervosa is associated with underlying dysfunction in excitatory and inhibitory neurometabolite metabolism and signalling. This narrative review critically explores the role of N-methyl-D-aspartate receptor-mediated excitatory and inhibitory neurometabolite dysfunction in anorexia nervosa and its associated biomarkers. The existing magnetic resonance spectroscopy literature in anorexia nervosa is reviewed and we outline the brain region-specific neurometabolite changes that have been reported and their connection to anorexia nervosa psychopathology. Considering the proposed role of dysfunctional neurotransmission in anorexia nervosa, the potential utility of zinc supplementation and sub-anaesthetic doses of ketamine in normalising this is discussed with reference to previous research in anorexia nervosa and other neuropsychiatric conditions. The rationale for future research to investigate the combined use of low-dose ketamine and zinc supplementation to potentially extend the therapeutic benefits in anorexia nervosa is subsequently explored and promising biological markers for assessing and potentially predicting treatment response are outlined.
Topics: Humans; Anorexia Nervosa; Receptors, N-Methyl-D-Aspartate; Ketamine; Zinc; Brain
PubMed: 36681939
DOI: 10.1007/s40263-022-00984-4 -
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 -
Irish Journal of Psychological Medicine Sep 2020Management of the high rates of medical and psychiatric complications, including self-harm and suicide, associated with anorexia nervosa requires regular clinical... (Review)
Review
Management of the high rates of medical and psychiatric complications, including self-harm and suicide, associated with anorexia nervosa requires regular clinical review. However, during the current pandemic, face-to-face clinical assessments carry the risk of infection and transmission in this vulnerable cohort already compromised by low weight and lowered immunity. This paper describes how one service has had to adapt usual care during the COVID-19 pandemic without contributing excessively to carer burden or compromising patient safety.
Topics: Anorexia Nervosa; Betacoronavirus; COVID-19; Caregivers; Coronavirus Infections; Cost of Illness; Humans; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32434615
DOI: 10.1017/ipm.2020.60 -
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 -
Mediators of Inflammation 2021In patients with anorexia nervosa (AN), decreased intracellular (ICW), extracellular (ECW), and total body water (TBW) as well as changes in serum cytokine...
In patients with anorexia nervosa (AN), decreased intracellular (ICW), extracellular (ECW), and total body water (TBW) as well as changes in serum cytokine concentrations have been reported. In this exploratory study, we measured body composition and serum cytokine levels in patients with AN ( = 27) and healthy controls (HCs; = 13). Eating disorder symptom severity was assessed using the Eating Disorder Examination-Questionnaire (EDE-Q). Body composition was determined by bioimpedance analysis (BIA) which provided information on ICW, ECW, and TBW. Following blood collection, 27 cytokines and chemokines were quantified using multiplex ELISA-based technology: Eotaxin, Eotaxin-3, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon- (IFN-) , interleukin- (IL-) 1, IL-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12/IL-23p40, IL-12p70, IL-13, IL-15, IL-16, IL-17A, interferon -induced protein- (IP-) 10, macrophage inflammatory protein- (MIP-) 1, MIP-1, monocyte chemoattractant protein- (MCP-) 1, MCP-4, thymus and activation-regulated chemokine (TARC), TNF-, and TNF-. ICW, ECW, and TBW volumes were significantly lower in patients with AN than in HCs. In the whole sample, GM-CSF, MCP-4, and IL-4 were positively, whereas IFN-, IL-6, and IL-10 were negatively associated with all three parameters of body water. In AN participants, we found a statistically significant negative correlation of IL-10 with ICW, ECW, and TBW. Our results suggest an interaction between body water and the cytokine system. Underlying mechanisms are unclear but may involve a loss of water from the gut, kidneys, or skin due to AN-associated inflammatory processes.
Topics: Adult; Anorexia Nervosa; Body Composition; Body Water; Chemokines; Cytokines; Female; Humans; Interleukin-10
PubMed: 33867858
DOI: 10.1155/2021/8811051