Eating Disorders and Psychofarmachology: Rethink the Treatment of Eating Disorders.

The pharmacological approach to eating disorders (ED) is effective in a few conditions, and to date, no treatment has shown certain efficacy in treating patients with this disorder. Furthermore, attempts to regulate hunger and satiety through modulation pharmacological effects of neurotransmitters and neuropeptides have shown only short-term benefit. However, in light of the serious impact of DCA on patients and the scarcity of non-pharmacological therapeutic approaches, research in this area should not be abandoned, also because new generation "molecules" become increasingly available. Many studies looked at efficacy of antipsychotics, Tryciclics, SSRI, mood stabilizers in the treatment of ED. Gabaergic circuit, the opioid one are extremely involved in the neurohormonal mechanisms of regulation of dietary behaviors and that molecules that influence these circuits could be used in the pharmacological treatment of ED as already happens in the case of Naltrexone, gabapentine or gabaergic drugs.

Trans-auricular Vagus Nerve Stimulation in the Treatment of Recovered Patients Affected by Eating and Feeding Disorders and Their Comorbidities.

INTRODUCTION: Eating and feeding disorders (EFD's) represent the psychiatric pathology with the highest mortality rate and one of the major disorders with the highest psychiatric and clinical comorbidity. The vagus nerve represents one of the main components of the sympathetic and parasympathetic nervous system and is involved in important neurophysiological functions. Previous studies have shown that vagal nerve stimulation is effective in the treatment of resistant major depression, epilepsy and anxiety disorders. In EFD's there are a spectrum of symptoms which with Transcutaneous auricular Vagus Nerve Stimulation (Ta-VNS) therapy could have a therapeutic efficacy. SUBJECTS AND METHODS: Sample subjects is composed by 15 female subjects aged 18-51. Admitted to a psychiatry community having diagnosed in according to DSM-5: anorexia nervosa (AN) (N=9), bulimia nervosa (BN) (N=5), binge eating disorder (BED) (N=1). Psychiatric comorbidities: bipolar disorder type 1 (N=4), bipolar disorder type 2 (N=6), border line disorder (N=5). The protocol included 9 weeks of Ta-VNS stimulation at a frequency of 1.5-3.5 mA for 4 hours per day. The variables detected in four different times (t0, t1, t2, t3, t4) are the following: Heart Rate Variability (HRV), Hamilton Depression Rating Scale (HAMD-HDRS-17), Body Mass Index (BMI), Beck Anxiety Index (BAI). RESULTS: Data analysis showed statistically significant differences between recording times (p>0.05) in HAM-D (t0=18.28±5.31; t4=9.14±7.15), in BAI (t0=24.7±10.99; t4=13.8±7.0) the reported values show how during (T0-T4) the treatment there are a decay of the degree in the depressive state, in the state of anxiety and an improvement in the value of BMI. In particular, the BMI in the AN-BN sub-sample had a minimum gain of 5% and a maximum of 11%. The analysis of H.R.V. did not show a significant changes among subjects thus confirming the discordance of the activity of the sympathetic and parasympathetic nervous system in EFD's. CONCLUSIONS: Although the sample does not possess a relevant value to determine long-term efficacy of Ta-VNS or on a larger number of patients, this study reports how the application of neuro-stimulation in EFD's may become an ADD-ON in therapeutic approach. Indeed, substantial improvements are highlighted in the results and confirmed hypotheses proposed by the study.

Depression and Immunity: the HCV model.

Available research shows that only some individuals will develop a specific psychiatric disorder in the presence of the same life events. Different regulation scales are used to define the events that can be considered as stressful and to value their psychological burden. A personal illness, especially if chronic, is certainly an event characterized by great emotional and psychological impact. Moreover, symptoms such as mood changes and anxiety, which are commonly observed in patients affected by HCV, can be related to the awareness of suffering from a chronic progressive disease and to the past or current substance abuse. It is well known that the assumption of interferon α (IFN α) is associated with the onset of depressive symptoms, similar to those observed in major depression, in fact, from 30% to 50% of patients receiving IFN develop depression during treatment.Many data in literature show the very important role of pro-inflammatory cytokines in the onset of the Depression.

Short- and long-term effects of Covid-19 pandemic on health care system for individuals with eating disorders.

Introduction: The Covid-19 pandemic and its consequences have negatively impacted the incidence of EDs, determining a substantial burden on patients, caregivers and healthcare systems world-wide. This literature review aims to investigate the short- and long-term effects of the pandemic on care provider systems, exploring the possibility of "rethinking" ED care programs. Methods: Records were systematically (following the PRISMA guidelines) identified through PubMed, Google Scholar and Scopus searching. Results: The Covid-19 pandemic led to an abrupt and substantial increase in pediatric and adolescent ED visits and hospital admissions. Despite a decline in the second-year post-onset, absolute visit volumes remained elevated relative to pre-pandemic levels. Barriers to access specialist ED care have emerged, including socio-economic status and a lack of public outpatient services. Consequently, this situation has prompted healthcare providers to explore innovative bridge plans and multidisciplinary telehealth solutions to face such challenges. Discussion: Challenges in insurance shifts, treatment disruptions and discharge planning underscore the need for comprehensive strategies in ED care. Overall, our findings highlight the importance of adopting multidisciplinary approaches, implementing location-specific plans, and integrating telehealth to effectively address the evolving challenges posed by the pandemic and enhance the efficiency of ED specialist care programs.

A disconnection between nutritional status (in terms of body mass index and phase angle) and psychopathology in anorexia nervosa.

The aim of our study was to investigate the relationship between nutritional status (body mass index and phase angle) and psychological symptoms at admission and discharge in a residential population of anorexic patients. We also aimed to determine the evolution of the above psychological symptoms and nutrition rehabilitation from admission to discharge. Thirty-six consecutive patients were included. The evaluation was performed using the following measures at admission and discharge: body mass index, phase angle, Eating Disorders Inventory-3, Multiphasic Personality Inventory-2 and Body Uneasiness. Admission and discharge nutritional status were not correlated with psychometric scores respectively at admission and at discharge. In addition, neither the improvement in the scores on the psychometric scales between admission and discharge was correlated to body mass index, phase angle improvement. For the group as a whole there were significant improvements from admission to discharge in nutritional status, Multiphasic Personality Inventory-2-Depression, Body Uneasiness-Global Score Index and in all the composites of Eating Disorders Inventory-3. Our data showed a disconnection between nutritional status and eating disorders psychopathology and/or psychiatric comorbidities.