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The Lancet. Psychiatry Dec 2015Anorexia nervosa is an important cause of physical and psychosocial morbidity. Recent years have brought advances in understanding of the underlying psychobiology that... (Review)
Review
Anorexia nervosa is an important cause of physical and psychosocial morbidity. Recent years have brought advances in understanding of the underlying psychobiology that contributes to illness onset and maintenance. Genetic factors influence risk, psychosocial and interpersonal factors can trigger onset, and changes in neural networks can sustain the illness. Substantial advances in treatment, particularly for adolescent patients with anorexia nervosa, point to the benefits of specialised family-based interventions. Adults with anorexia nervosa too have a realistic chance of achieving recovery or at least substantial improvement, but no specific approach has shown clear superiority, suggesting a combination of re-nourishment and anorexia nervosa-specific psychotherapy is most effective. To successfully fight this enigmatic illness, we have to enhance understanding of the underlying biological and psychosocial mechanisms, improve strategies for prevention and early intervention, and better target our treatments through improved understanding of specific disease mechanisms.
Topics: Anorexia Nervosa; Humans; Psychotherapy; Randomized Controlled Trials as Topic
PubMed: 26514083
DOI: 10.1016/S2215-0366(15)00356-9 -
Postgraduate Medical Journal Dec 1995The aetiology, assessment and treatment of anorexia nervosa are reviewed in the light of the classical accounts of Morton, Lasègue and Gull. The core symptoms are... (Review)
Review
The aetiology, assessment and treatment of anorexia nervosa are reviewed in the light of the classical accounts of Morton, Lasègue and Gull. The core symptoms are deliberate weight loss, disturbed body image and amenorrhoea, and complications may include cardiac failure, electrolyte disturbances, hypothermia and osteoporosis. Common clinical findings are described. Disturbed brain serotonin activity is implicated in the aetiology of anorexia nervosa, but there is little support for the use of pharmacological treatments. Psychological theories of aetiology are discussed with reference to Bruch, Crisp, Palazzoli and Minuchin: the common theme is the reaction of the patient and her family to the physical and social changes of puberty. Individual and/or family psychotherapy is seen as central to the treatment of anorexia nervosa, and the relevant clinical research is reviewed. The roles of general practitioners, general psychiatrists and eating disorder specialists are discussed in the light of recent consensus treatment guidelines.
Topics: Adolescent; Adult; Anorexia Nervosa; Family Health; Female; Humans; Psychotherapy
PubMed: 8552532
DOI: 10.1136/pgmj.71.842.712 -
Current Problems in Pediatric and... Apr 2017Anorexia nervosa has the highest mortality rate among all psychiatric illnesses, as it can result in significant psychopathology along with life-threatening medical... (Review)
Review
Anorexia nervosa has the highest mortality rate among all psychiatric illnesses, as it can result in significant psychopathology along with life-threatening medical complications. Atypical anorexia nervosa is a new variant described in the latest DSM edition, which has much in common with anorexia nervosa and also can result in significant morbidity and mortality. The evolution of the criteria for these illnesses is reviewed, and the two are compared and contrasted in this article. Important labs to monitor for in those with these illnesses, along with an emphasis on the monitoring of vital signs and weight, are reviewed here. The necessity for close psychiatric monitoring of safety concerns, including suicidal thoughts, is also stressed. The etiology and the treatment of these illnesses are reviewed from a biopsychosocial approach; and lastly, the prognosis of these illnesses is discussed.
Topics: Anorexia Nervosa; Comorbidity; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Humans; Mental Disorders; Prevalence; Risk Factors
PubMed: 28532965
DOI: 10.1016/j.cppeds.2017.02.003 -
The American Journal of Medicine Jan 2016Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical... (Review)
Review
Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders.
Topics: Anorexia Nervosa; Bulimia Nervosa; Comorbidity; Humans
PubMed: 26169883
DOI: 10.1016/j.amjmed.2015.06.031 -
Nursing Oct 2019Anorexia nervosa (AN) is an eating disorder that is difficult to treat, and relapse is common. This article addresses management strategies and nursing interventions for... (Review)
Review
Anorexia nervosa (AN) is an eating disorder that is difficult to treat, and relapse is common. This article addresses management strategies and nursing interventions for adolescents diagnosed with AN.
Topics: Adolescent; Anorexia Nervosa; Comorbidity; Humans; Mental Disorders; Nursing Diagnosis; Risk Factors
PubMed: 31568077
DOI: 10.1097/01.NURSE.0000580640.43071.15 -
BMJ (Clinical Research Ed.) Apr 2007
Review
Topics: Adolescent; Anorexia Nervosa; Female; Humans; Psychotherapy; Risk Assessment; Risk Factors; Weight Gain
PubMed: 17463461
DOI: 10.1136/bmj.39171.616840.BE -
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 -
The Psychiatric Clinics of North America Mar 2019Recent advances in the understanding of aetiologic elements underlying anorexia nervosa have provided valuable insights and are transforming the way this illness is... (Review)
Review
Recent advances in the understanding of aetiologic elements underlying anorexia nervosa have provided valuable insights and are transforming the way this illness is treated. The aim of this article is to consider how neuropsychological understanding and new research can be used to develop a more individualized and personalized approach in the management of this serious illness.
Topics: Anorexia Nervosa; Humans; Precision Medicine; Social Isolation; Starvation
PubMed: 30704633
DOI: 10.1016/j.psc.2018.10.010 -
Archives of Disease in Childhood Oct 2011Clinical confidence and coordinated multidisciplinary care can influence the course of anorexia nervosa in children and adolescents. Sicker and younger patients with... (Review)
Review
Clinical confidence and coordinated multidisciplinary care can influence the course of anorexia nervosa in children and adolescents. Sicker and younger patients with anorexia nervosa often present first to a paediatrician, requiring early recognition and appropriate management. Paediatric knowledge and skills are also needed to manage the impact of eating disorders on growth and development. This review provides practical guidance on the management of anorexia nervosa for paediatricians, in the areas of assessment, acute management and re-feeding, and long-term monitoring. In the absence of a strong evidence base for some of these recommendations, local protocols based on best practice guidelines can reduce anxiety, increase cooperation and reduce risk.
Topics: Adolescent; Anorexia Nervosa; Child; Developmental Disabilities; Diagnosis, Differential; Feeding Methods; Female; Growth Disorders; Humans; Male; Nutrition Assessment; Patient Care Team
PubMed: 20930014
DOI: 10.1136/adc.2009.177394 -
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