Anorexia nervosa and depression in a 5-year-old girl: Treatment with focused family play therapy and medication.

OBJECTIVE: The current case presentation examines the treatment and recovery of a 5-year-old girl diagnosed with comorbid anorexia nervosa and major depressive disorder. Researchers have shown that children as young as 3-years-old may be dissatisfied with their bodies and have concerns about their weight. This case presentation of a 5-year-old child demonstrates that the age range defining early onset of eating disorders can span into early childhood, which requires treatment tailored to the developmental level of these young children. METHOD: A new method "focused family play therapy" was applied. It goes beyond free play or structured play therapy, in that the therapist involves the parents in the play and not only models the situation which creates the child's fears, but also shows through dolls how to be brave and overcome the fears. RESULTS: The current case report demonstrates how the combination of refeeding the child during family meals, participating in focused family play therapy to help the child overcome her fears of eating, and prescribing sertraline to treat her depression was an effective treatment for both the anorexia nervosa and depression. DISCUSSION: This technique may be effective with children ranging in age from 3 to 6 years.

Failure to thrive in toddlers with lack of interest in eating and food and their cognitive development during later childhood.

Background: Experiencing Failure to Thrive or malnutrition in early years has been associated with children later displaying low Intelligence Quotient (IQ). The current study's aim was to examine whether Failure to Thrive in Toddlers with Lack of Interest in Eating and Food, a subtype of Avoidant/Restrictive Food Intake Disorder as defined by DSM-5, which has also previously been identified as Infantile Anorexia (IA), was associated with poor cognitive development outcomes during later childhood. Methods: The IQs and growth parameter of 30 children (53% female) previously diagnosed and treated for IA at 12 to 42 months of age, were reevaluated at a mean age of 10.0 years (SD = 2.1 years) and compared to 30 matched control children. Children's growth was assessed using Z-scores and their cognitive development was measured using the Wechsler Intelligence Scale for Children-4th Edition. Results: None of the growth parameters were significantly related to IQ. Further, IQ scores of children previously diagnosed with IA and control children were not significantly different. However, the education level of children's fathers had a significantly positive effect on IQ. Conclusions: Our study highlights the disjunction between growth parameters and IQ within our sample. Overall, our findings suggest that the primary target of intervention for these children should be the parent-child conflict around the feeding relationship, rather than a focus on the child's weight itself. Finally, our results confirm the relevance to include fathers in the intervention of these children.

Insight into the self-association of key enzymes from pathogenic species.

Self-association of protein monomers to higher-order oligomers plays an important role in a plethora of biological phenomena. The classical biophysical technique of analytical ultracentrifugation is a key method used to measure protein oligomerisation. Recent advances in sedimentation data analysis have enabled the effects of diffusion to be deconvoluted from sample heterogeneity, permitting the direct identification of oligomeric species in self-associating systems. Two such systems are described and reviewed in this study. First, we examine the enzyme dihydrodipicolinate synthase (DHDPS), which crystallises as a tetramer. Wild-type DHDPS plays a critical role in lysine biosynthesis in microbes and is therefore an important antibiotic target. To confirm the state of association of DHDPS in solution, we employed sedimentation velocity and sedimentation equilibrium studies in an analytical ultracentrifuge to show that DHDPS exists in a slow dimer-tetramer equilibrium with a dissociation constant of 76 nM. Second, we review works describing the hexamerisation of GDP-mannose pyrophosphorylase (GDP-MP), an enzyme that plays a critical role in mannose metabolism in Leishmania species. Although the structure of the GDP-MP hexamer has not yet been determined, we describe a three-dimensional model of the hexamer based largely on homology with the uridyltransferase enzyme, Glmu. GDP-MP is a novel drug target for the treatment of leishmaniasis, a devastating parasitic disease that infects more than 12 million people worldwide. Given that both GDP-MP and DHDPS are only active in their oligomeric states, we propose that inhibition of the self-association of critical enzymes in disease is an emerging paradigm for therapeutic intervention.