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1.
Mymensingh Med J ; 31(1): 258-262, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34999712

RESUMO

The 2012 Junior Management of Really Sick Patients with Anorexia Nervosa (MaRSiPAN) guidelines recommends daily blood testing during the initial 5 days of children admitted for inpatient re-feeding. The aim of this study was to determine the clinical utility of this and whether blood tests could be minimised. Single centre retrospective study of children admitted for inpatient treatment of anorexia nervosa (January 2018 - August 2020) was done in a general paediatric ward. Weight, body mass index and re-feeding blood biochemistry were recorded. There were 37 patients, all females, aged between 11-17 years. Weight ranged from 21.4-61.75 Kg. Phosphate levels were 0.6-1.6 mmol/L; mean value 1.22 mmol/L. Over the 5 days of daily testing, mean and median values of all blood results remained within reference ranges. No biochemical indication of re-feeding syndrome was evident and resulted in no change of management. There is limited utility in daily blood testing for patients for the initial 5 days.


Assuntos
Anorexia Nervosa , Adolescente , Anorexia Nervosa/terapia , Índice de Massa Corporal , Criança , Feminino , Hospitalização , Humanos , Pacientes Internados , Estudos Retrospectivos
2.
Am J Case Rep ; 23: e933759, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34972814

RESUMO

BACKGROUND Schizophrenia and anorexia nervosa are challenging mental disorders. In cases in which the cognitive-affective drivers eliciting abnormal eating behaviors strongly influence diagnostic accuracy and treatment planning, it is important to be extremely thorough in differentiating between the phenomenology of delusions, obsessions, and overvalued ideas. CASE REPORT Here we present an unusual relationship between anorexia nervosa and schizophrenia and also an update on diagnosing them according to the new ICD-11 classification system. The case illustrates a 44-year-old Romanian woman who had met the criteria for eating disorder from the age of 15 to 22 years, subsequently developed a psychotic break, and ultimately had schizophrenia from the age of 22 to 44 years (present time). This case report focuses on the dual diagnosis of a psychotic disorder and an eating disorder, with discussions based on the literature available on the topic. CONCLUSIONS Schizophrenia can be considered a disabling mental disorder, but in association with a diagnosis of anorexia nervosa, the patient usually requires immediate admission and medical care in a coordinated and sustained manner. Symptoms of anorexia nervosa might manifest in the active phase of psychosis, precede psychosis, or, less commonly, manifest during the residual phase of the illness. Nevertheless, when these 2 disorders are combined, we can assume that the treatment plan is even more difficult to handle, requiring a multi-disciplinary team. Therefore, to provide adequate clinical care, a proper diagnosis must be made. The complex nature of the interrelationship between psychotic disorders and eating disorders requires further research.


Assuntos
Anorexia Nervosa , Esquizofrenia , Adolescente , Adulto , Anorexia , Anorexia Nervosa/complicações , Anorexia Nervosa/diagnóstico , Delusões , Feminino , Humanos , Classificação Internacional de Doenças , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Adulto Jovem
3.
Appetite ; 168: 105745, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34634375

RESUMO

Food choice and its underlying processes is understudied in bulimia nervosa (BN) and anorexia nervosa (AN). Thus, we examined cognitive processes during food choice through mouse tracing in AN (n = 36) and BN (n = 27) undergoing inpatient treatment. Both patient groups and matched healthy controls (HC, n = 59) made 153 binary food choices before rating all foods on their liking and calorie density. Choice outcomes and corresponding mouse movements were modelled as a function of inpatient treatment stage in our analyses. Compared to patients with BN and HC, those with AN showed a clear calorie avoidance on most trials. Yet, mouse paths in AN patients early in treatment, revealed a late direction reversal ('change of mind', CoM) on high-calorie choices. AN patients later in treatment, by contrast, showed fewer CoM alongside more choices for - and liking of - high-calorie foods. Patients with BN showed more CoM trials during low-calorie choices and low-calorie choices were more frequent in patients later in treatment. Thus, relative to patients early in treatment, patients who are later in treatment show less of the overall group pattern of consistently choosing low-calorie food (AN) or high-calorie food (BN). Less cognitive regulation (fewer CoM trials) went along with higher liking for high-calorie foods in AN. These cross-sectional differences between AN early and late in treatment might reflect the formation of healthier habits. In addition, clear patient group differences suggest more specific treatment strategies.


Assuntos
Anorexia Nervosa , Bulimia Nervosa , Anorexia Nervosa/terapia , Bulimia Nervosa/terapia , Estudos Transversais , Preferências Alimentares , Humanos , Pacientes Internados
4.
Appetite ; 168: 105666, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34461195

RESUMO

OBJECTIVE: Anhedonia, which in part involves the lack of pleasure in consuming palatable food, is a long-lasting symptom observed in patients both when acutely ill and when long term recovered from Anorexia Nervosa. The neurocircuitry underlying this phenomenon is not well understood. Here we use the preclinical activity-based anorexia (ABA) model in adolescent female rats to assess the impact of excessive exercise, limited food intake and acute weight loss, on adolescent female rat orofacial responding to intraoral sucrose, as measured by the taste reactivity test (TRT). Animals were identified as either prone or resistant to this paradigm based on a weight loss criterion. Measures of food intake, running wheel activity, taste reactivity and medial prefrontal cortex astrocyte expression were compared across groups. METHODS: Adolescent female rats implanted with an intraoral catheter were given a TRT using 1 M (M) sucrose at baseline, max weight loss (25% weight loss from start of ABA or 7 full days on the paradigm) or 10 days recovered from the ABA paradigm. Animals were sacrificed after the final TRT and astrocyte density was measured via immunohistochemistry. RESULTS: Animals resistant to the ABA paradigm ran less than prone animals during the ABA period. Additionally, we found that resistant animals displayed more cumulative 'liking' responses to sucrose compared to prone animals at maximum weight loss. Finally, we found prone animals 10-days recovered from ABA had reduced medial prefrontal cortex astrocyte density compared to levels in resistant animals. DISCUSSION: Rats presented with the physiological challenge of the ABA paradigm either adapt their behavior to stabilize their body weight (i.e. resistant), or rapidly lose weight (i.e. prone). Furthermore, we found that prone animals have reduced orofacial responding to 1 M sucrose at maximum weight loss compared to responses in resistant animals, and this anhedonia-like behavior may be a result of reduced astrocyte density that affects cortical function.


Assuntos
Anorexia Nervosa , Anorexia , Animais , Astrócitos , Modelos Animais de Doenças , Feminino , Humanos , Ratos , Perda de Peso
5.
Nutrients ; 13(12)2021 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-34959952

RESUMO

Anorexia nervosa (AN) is characterised by disrupted and restrictive eating patterns. Recent investigations and meta-analyses have found altered concentrations of inflammatory markers in people with current AN. We aimed to assess nutrient intake in participants with current or recovered AN, as compared to healthy individuals, and explore group differences in dietary inflammatory potential as a possible explanation for the observed alterations in inflammatory markers. We recruited participants with current AN (n = 51), those recovered from AN (n = 23), and healthy controls (n = 49). We used the Food Frequency Questionnaire (FFQ), to calculate a Dietary Inflammatory Index (DII®) score and collected blood samples to measure serum concentrations of inflammatory markers. In current AN participants, we found lower intake of cholesterol, compared to HCs, and lower consumption of zinc and protein, compared to HC and recovered AN participants. A one-way ANOVA revealed no significant group differences in DII score. Multivariable regression analyses showed that DII scores were significantly associated with tumour necrosis factor (TNF)-α concentrations in our current AN sample. Our findings on nutrient intake are partially consistent with previous research. The lack of group differences in DII score, perhaps suggests that diet is not a key contributor to altered inflammatory marker concentrations in current and recovered AN. Future research would benefit from including larger samples and using multiple 24-h dietary recalls to assess dietary intake.


Assuntos
Anorexia Nervosa/metabolismo , Anorexia Nervosa/fisiopatologia , Ingestão de Alimentos/fisiologia , Mediadores da Inflamação/sangue , Fenômenos Fisiológicos da Nutrição/fisiologia , Adolescente , Adulto , Anorexia Nervosa/diagnóstico , Biomarcadores/sangue , Comportamento Alimentar/fisiologia , Feminino , Humanos , Inflamação , Inquéritos e Questionários , Fator de Necrose Tumoral alfa/sangue , Adulto Jovem
6.
Nutrients ; 13(12)2021 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-34959979

RESUMO

Impulsive and compulsive behaviors have both been observed in individuals with obesity. The co-occurrence of obesity and type 2 diabetes (T2D) is more strongly associated with impulsivity, although there are no conclusive results yet. A multidimensional assessment of impulsivity and compulsivity was conducted in individuals with obesity in the absence or presence of T2D, compared with healthy, normal-weight individuals, with highly impulsive patients (gambling disorders), and with highly compulsive patients (anorexia nervosa). Decision making and novelty seeking were used to measure impulsivity, and cognitive flexibility and harm avoidance were used for compulsivity. For impulsivity, patients with obesity and T2D showed poorer decision-making ability compared with healthy individuals. For compulsivity, individuals with only obesity presented less cognitive flexibility and high harm avoidance; these dimensions were not associated with obesity with T2D. This study contributes to the knowledge of the mechanisms associated with diabetes and its association with impulsive-compulsive behaviors, confirming the hypothesis that patients with obesity and T2D would be characterized by higher levels of impulsivity.


Assuntos
Comportamento Compulsivo/psicologia , Diabetes Mellitus Tipo 2/psicologia , Comportamento Impulsivo , Obesidade/psicologia , Adulto , Anorexia Nervosa/complicações , Anorexia Nervosa/psicologia , Aprendizagem da Esquiva , Estudos de Casos e Controles , Cognição , Comportamento Compulsivo/complicações , Estudos Transversais , Tomada de Decisões , Diabetes Mellitus Tipo 2/complicações , Feminino , Jogo de Azar/complicações , Jogo de Azar/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Psicometria , Autorrelato
7.
Nutrients ; 13(12)2021 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-34959997

RESUMO

Individuals with anorexia nervosa (AN) often suffer psychological and gastrointestinal problems consistent with a dysregulated gut microbial community. Psychobiotics have been postulated to modify microbiota and improve mental well-being and gut symptoms, but there is currently a lack of evidence for such approaches in AN. The aim of this study was to use an in vitro colonic model to evaluate the impact of dietary restrictions associated with AN on the intestinal ecosystem and to assess the impact of pre and probiotic intervention. Bacteriology was quantified using flow cytometry combined with fluorescence in situ hybridisation and metabolic end products (including neurotransmitters) by gas chromatography and liquid chromatography mass spectrometry Consistent with previous research, the nutritional changes significantly reduced total microbiota and metabolites compared with healthy conditions. Pre and probiotic supplementation on restricted conditions enhanced the microbial community and modulated metabolic activity to resemble that of a healthy diet. The model system indicates that nutritional changes associated with AN can impact the microbial community, and that these changes can, at least in part, be restored through the use of pre and probiotic interventions.


Assuntos
Anorexia Nervosa/dietoterapia , Anorexia Nervosa/microbiologia , Microbiota , Prebióticos/administração & dosagem , Probióticos/administração & dosagem , Adulto , Dieta/métodos , Fezes/microbiologia , Feminino , Cromatografia Gasosa-Espectrometria de Massas/métodos , Microbioma Gastrointestinal , Humanos , Saccharomyces boulardii
8.
Soins Psychiatr ; 42(337): 16-19, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34895689

RESUMO

An innovative structure, the referral centre for eating disorders of the Paris Psychiatry and Neurosciences Hospital Group provides initial access to care for anorexia and bulimia through a holistic and multidisciplinary assessment of the patient. The health professionals aim to accompany the patient towards the management of his disorders but also in the recognition of the latter. This is a crucial issue in compliance and acceptance of care.


Assuntos
Anorexia Nervosa , Bulimia Nervosa , Bulimia , Acesso aos Serviços de Saúde , Humanos , Encaminhamento e Consulta
9.
Harefuah ; 160(12): 814-817, 2021 Dec.
Artigo em Hebraico | MEDLINE | ID: mdl-34957718

RESUMO

INTRODUCTION: Hypernatremic dehydration is an uncommon condition, whose main treatment is fluid administration. In cases of extreme hypernatremia, that treatment paradoxically poses a real danger to the patient's morbidity and mortality. In very rare cases, restrictive type anorexia nervosa causes extreme dehydration that can result in elevated sodium levels. In this case study we present a teenage girl who suffers from restrictive anorexia nervosa and was admitted to the pediatric intensive care unit (PICU) with an acute confusional state, with extremely severe hypernatremia up to 203 mEq/L, combined with hyperglycemia up to 700 mg/dL. Under hypotonic electrolyte solution treatment, a gradual sodium level decrease of 8 mEq/L per day was achieved with complete normalization of sodium without any neurological damage. Moreover, glucose levels were normalized rapidly and spontaneously without additional treatment with insulin.


Assuntos
Anorexia Nervosa , Hipernatremia , Adolescente , Anorexia Nervosa/complicações , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/terapia , Criança , Desidratação/diagnóstico , Desidratação/etiologia , Desidratação/terapia , Feminino , Humanos , Hipernatremia/diagnóstico , Hipernatremia/etiologia , Hipernatremia/terapia , Sódio
10.
Nutrients ; 13(12)2021 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-34959800

RESUMO

Anorexia nervosa (AN) is a mental disorder characterized by an intense fear of weight gain that affects mainly young women. It courses with a negative body image leading to altered eating behaviors that have devastating physical, metabolic, and psychological consequences for the patients. Although its origin is postulated to be multifactorial, the etiology of AN remains unknown, and this increases the likelihood of chronification and relapsing. Thus, expanding the available knowledge on the pathophysiology of AN is of enormous interest. Metabolomics is proposed as a powerful tool for the elucidation of disease mechanisms and to provide new insights into the diagnosis, treatment, and prognosis of AN. A review of the literature related to studies of AN patients by employing metabolomic strategies to characterize the main alterations associated with the metabolic phenotype of AN during the last 10 years is described. The most common metabolic alterations are derived from chronic starvation, including amino acid, lipid, and carbohydrate disturbances. Nonetheless, recent findings have shifted the attention to gut-microbiota metabolites as possible factors contributing to AN development, progression, and maintenance. We have identified the areas of ongoing research in AN and propose further perspectives to improve our knowledge and understanding of this disease.


Assuntos
Anorexia Nervosa/metabolismo , Ingestão de Alimentos/psicologia , Comportamento Alimentar/psicologia , Metabolômica , Anorexia Nervosa/microbiologia , Ingestão de Alimentos/fisiologia , Comportamento Alimentar/fisiologia , Microbioma Gastrointestinal/fisiologia , Humanos , Fenótipo , Inanição/metabolismo
11.
Trials ; 22(1): 839, 2021 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-34819116

RESUMO

BACKGROUND: Anorexia nervosa (AN) mainly affects women (sex ratio 1/10) and most often starts during adolescence. The prognosis of AN remains poor (10% of deaths and high risk of chronicity). Body dissatisfaction, disturbances in recognition and identification of body sensations are some of the key symptoms of AN. However, there is a contrast between this consensual observation of body image disorders in AN, and the relative deficit of specifically targeted body treatments. Our proposal for a body approach specifically dedicated to AN is based on the understanding that posture, breathing, muscle tension and body perception are closely linked to our psychological and emotional state and are therefore disturbed in patients with AN. The purpose of this monocentric randomized controlled trial is to evaluate if a targeted osteopathic protocol treatment for AN in addition to treatment as usual (TAU) is significantly more effective than TAU alone. METHODS: In total, 72 patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups: one receiving the specific osteopathic treatment targeted for AN in addition to the TAU (group A) and the other one, receiving TAU only (group B). The patients in group A will receive 5 30-min osteopathic treatment sessions. Soft specific palpatory techniques on the diaphragm, digestive system and cervical region will be performed. The TAU is defined by the multidisciplinary approach recommended by the French health high authority. The primary outcome is the evaluation of interoceptive sensibility and secondary outcomes include clinical and psychopathology-related symptoms with assessment of somatic dysfunctions' evolution. A qualitative study will also be carried out, applying the Interpretative Phenomenological Analysis method. Patients will be included for a maximum of 14 weeks between the inclusion time and the last evaluation. DISCUSSION: If the results of the study are positive (statistically significant efficacy of this osteopathic treatment protocol), the study will provide arguments in favor of osteopathic sessions as a possible non-invasive additional treatment option in the multidisciplinary care approach for patients with AN. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04666415 , Release Date: December 11, 2020; N° ID-RCB: 2019-A02613-54.


Assuntos
Anorexia Nervosa , Adolescente , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/terapia , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
J Abnorm Psychol ; 130(7): 736-747, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34780229

RESUMO

Anorexia nervosa (AN) is characterized by a relentless pursuit of thinness, despite serious implications for health and social relations. In a previous study wielding the power of computational psychiatry, we found alterations in learning from negative feedback and in neural activity in the posterior medial frontal cortex (pMFC) in young acutely underweight AN patients (acAN). Here we ask whether these abnormalities are merely a state-related consequence of the illness or whether they might constitute a trait marker predisposing individuals to AN. To address this question, we employed the same reinforcement learning paradigm during fMRI with 31 female former AN patients after complete weight-recovery (recAN) and 31 age-matched healthy volunteers (15-28 years). Participants performed a decision task that required adaptation to changing reward contingencies. Data were analyzed within a hierarchical Gaussian filter model, which captures interindividual variability in feedback learning and decision-making under uncertainty. Similar to acute patients, individuals recovered from AN appear to emphasize negative over positive feedback when updating expectations regarding changing reward-punishment contingencies (difference in learning rate between punished and rewarded trials was increased in recAN: p = .006, d = .70. This behavioral pattern was mirrored in hyperactivation of the pMFC following negative feedback (FWE p < .001). Because the previously observed alterations in acANs are also evident after recovery and do not correlate with state variables like weight, altered feedback learning might be a trait marker of AN. The neural underpinnings of these alterations may lie in the pMFC. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Anorexia Nervosa , Lobo Frontal , Reforço Psicológico , Adolescente , Adulto , Anorexia Nervosa/psicologia , Humanos , Punição/psicologia , Recompensa , Adulto Jovem
13.
J Consult Clin Psychol ; 89(10): 805-815, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34807656

RESUMO

Objective: Especially for adult patients with anorexia nervosa (AN), treatment response is generally low to moderate. The present study aimed to evaluate the efficacy of cognitive remediation therapy (CRT) as adjunctive treatment for AN regarding clinical and cognitive outcomes. Method: In this randomized controlled superiority trial, 167 adult and adolescent (≥17 years) patients with AN were randomly allocated (1:1) to 10 weekly sessions of group therapy of either CRT (n = 82) or art therapy (ART; n = 85) as an adjunct to inpatient treatment-as-usual (TAU). Outcomes were assessed at baseline, end-of-treatment (10 weeks), and 6-month follow-up. Change in body mass index (BMI), eating disorder psychopathology, and health-related quality of life (QoL) from baseline to 6-month follow-up served as primary outcomes. Improvements in motivation to change and several indices of set-shifting and central coherence between baseline and end-of-treatment and between baseline and 6-month follow-up served as secondary outcomes. Analysis was by intention to treat. Results: Treatment groups did not differ regarding change in BMI, eating disorder psychopathology, and health-related QoL from baseline to 6-month follow-up. Likewise, groups neither differed regarding improvements in these outcomes between baseline and end-of-treatment nor in motivation to change, set-shifting, and central coherence at any time, except for greater short-term improvements in one measure of set-shifting in the CRT group. Conclusions: CRT as an adjunct to inpatient TAU for AN was not efficacious in improving clinical and cognitive outcomes. The results do not support routine employment of CRT in inpatient treatment for AN. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Anorexia Nervosa , Terapia Cognitivo-Comportamental , Remediação Cognitiva , Adolescente , Adulto , Anorexia Nervosa/terapia , Humanos , Qualidade de Vida , Resultado do Tratamento
14.
Artigo em Inglês | MEDLINE | ID: mdl-34769915

RESUMO

Assessment of body composition is fundamental in diagnosis and treatment of anorexia nervosa (AN). The gold standard dual-energy X-ray absorptiometry (DXA) is expensive and not universally available. Bioelectrical impedance analysis (BIA) is a non-invasive, inexpensive method relative to DXA. We compared DXA and BIA in the assessment of fat-free mass (FFM), fat mass (FM), and body fat percentage (BF%) in women with AN upon admission (ANT1) and discharge (ANT2) from an inpatient specialist unit with a referent healthy control (HC) group. The study population consisted of 31 ANT1, 25 ANT2, and 52 HC women with median age of 21 years. Body composition was measured by DXA and Tanita foot-to-foot BIA. Comparison between the two methods was done using Bland-Altman analysis, Pearson's correlation coefficient, Lin's concordance correlation coefficient, and linear regression. The mean difference (bias) in FM and BF% values obtained by DXA and BIA in ANT1 (FM: +1.01 kg, BF%: +2.26%) and ANT2 (FM: +1.49 kg, BF%: +1.66%) were comparable to HC (FM: -1.32 kg, BF%: -2.29%) although in opposite directions. Less bias was observed in FFM values in ANT1 (-0.46 kg) and ANT2 (-0.86 kg) than in HC (+2.03 kg); however, the limits of agreement between the two methods were wider in ANT1 and ANT2 than in HC for all measurements. No association was observed between age, percentage of total body water, and the time spent on the inpatient specialist unit with the difference in estimates of body composition between DXA and BIA. Comparison of DXA and BIA suggests that DXA should remain the gold standard for measuring body composition; the development of more specific BIA equations is required to improve validity and precision of BIA in patients with AN. Despite ease and cost in both BIA access and operation, the suitability of BIA in a low bodyweight eating disorders population remains questionable.


Assuntos
Anorexia Nervosa , Absorciometria de Fóton , Adulto , Anorexia Nervosa/diagnóstico , Composição Corporal , Índice de Massa Corporal , Impedância Elétrica , Feminino , Humanos , Pacientes Internados , Adulto Jovem
15.
Int J Eat Disord ; 54(11): 1989-1997, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34676907

RESUMO

OBJECTIVE: Stepped-care models of treatment are underexplored in eating disorders. To enhance treatment outcomes, and informed by literature about adaptations to family-based treatment (FBT), we developed an FBT-based stepped-care model for adolescents with anorexia nervosa (AN) that was consistent with family preference (i.e., tailored) and responsive to adolescent needs (i.e., intensity). The aim of this study was to evaluate the effectiveness of this model in terms of remission at end-of-treatment. METHOD: Adolescents (N = 82), aged 12-18 years (M = 15.1, SD = 1.8) and meeting Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria for AN, were assessed at baseline, Weeks 24 and 48. FBT was tailored to family preference and clinical need, with 16-18 sessions by Week 24. This was followed by three FBT booster sessions or an extension of FBT plus booster sessions (Week 48). The primary outcome was defined as weight > 95% of %median body mass index plus within 1 SD of the Eating Disorder Examination (EDE) global score community norms. RESULTS: Remission rates were 45.1% and 52.4% at Weeks 24 and 48, respectively. Commensurable improvements were evident across secondary outcomes (e.g., EDE subscale scores). As a reference point, remission rates compared positively with results from a recent randomized clinical trial from the same center and at the same time points (Week 24:45.1% vs. 32.1% and Week 48:52.4% vs. 30.2%). Controlling for propensity score, no statistically significant differences were observed. DISCUSSION: This stepped-care model, designed to be responsive to the individual needs of adolescents and their families, achieved encouraging rates of remission. This study provides an important signal that supports future clinical trials of stepped-care models for adolescents with AN.


Assuntos
Anorexia Nervosa , Adolescente , Anorexia Nervosa/terapia , Índice de Massa Corporal , Manual Diagnóstico e Estatístico de Transtornos Mentais , Terapia Familiar , Humanos , Resultado do Tratamento
16.
Psychiatr Danub ; 33(Suppl 4): 552-557, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34718280

RESUMO

BACKGROUND: To study the psychosomatic options and dynamics in patients with eating disorders. To conduct a comparative study of psychosomatic characteristics of surveyed patients with eating disorders, taking into account the duration and severity of protein-energy deficiency and levels of catecholamines excretion; to reveal features of mental working capacity, basic mental processes and EEG data at different stages of eating disorders; to develop scientifically based effective methods and means for correcting pathological changes that have arisen as a result of prolonged protein-energy deficiency in eating disorders. METHODS: Catamnestic, statistical, clinico-psychopathological with somatic, psychological and laboratory examination, anthropometry, high-performance liquid chromatography, electroencephalography. Statistical analysis of collected data was processed using the program IBM SPSS Statistics 22, the confidence level p-value is ≤0.001. RESULTS: The long-term consequences of prolonged fasting in 500 women with eating disorders (ED), who applied for help at the RUDN department and were examined in 1987-2013, were studied. The most common somatic complications of prolonged protein-energy deficiency were investigated. In addition to the clinical method and anthropometry, to measure the efficiency of weight gain after prolonged alimentary deficiencies and to treat anorexia nervosa patients the pathopsychological method of "Shabalina's complex decoding" and analysis of catecholamine excretion rates in urine of patients with anorexia at different stages of therapy were used. Improvement of mental performance and general condition of the examined after applying the developed treatment was observed. Scientifically based principles of therapy, allowing to avoid complications of long-term fasting and during weight gain were suggested.


Assuntos
Anorexia Nervosa , Transtornos da Alimentação e da Ingestão de Alimentos , Anorexia Nervosa/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Humanos , Inquéritos e Questionários
17.
Nervenarzt ; 92(11): 1203-1213, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34618173

RESUMO

An overview of eating and feeding disorders according to the future criteria of the International Classification of Diseases (ICD-11) is presented, including information on differential diagnosis, epidemiology, etiology, pathogenesis as well as therapy. Binge-eating disorder is new and the most frequent eating disorder. While anorexia nervosa and bulimia nervosa mostly affect women, the gender ratio in binge-eating disorder is more balanced. Concerning etiology, socio-cultural, biological and psychological factors are discussed. Cognitive behavioral psychotherapy is the best-validated treatment for all three eating disorders. According to the German guidelines for treatment (2019), focal psychodynamic psychotherapy is also a treatment option for anorexia nervosa. Evidence for the positive effect of psychopharmacologic drugs in the treatment of anorexia nervosa is still lacking. Fluoxetine has been shown to have a limited effect in the treatment of bulimia nervosa.


Assuntos
Anorexia Nervosa , Terapia Cognitivo-Comportamental , Transtornos da Alimentação e da Ingestão de Alimentos , Psicoterapia Psicodinâmica , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/epidemiologia , Anorexia Nervosa/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Previsões , Humanos
18.
Transl Psychiatry ; 11(1): 532, 2021 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-34657121

RESUMO

Anorexia nervosa (AN) has been associated with altered reward processing. We recently reported greater neural response in secondary visual areas when processing visual food stimuli in acutely underweight AN patients (acAN). In order to examine whether the observed alterations are indicative of acute undernutrition or a potential trait marker of AN, we set out to assess neural responses in acAN and in individuals weight-recovered from AN (recAN). FMRI data were collected from a total of 126 female volunteers, 35 acAN, 33 recAN, and 58 age-matched healthy controls (HC) while they viewed streams of food, social and neutral stimuli. A standard general linear model (GLM) was used to interrogate neural responses to the different stimuli in recAN vs. age-matched HC. Moreover, within-subject multivoxel pattern analyses (MVPA) in the two matched samples (acAN/HC and recAN/HC) were used to estimate neural representation of food vs. neutral, and social vs. neutral stimuli. A multiple regression analysis was conducted to test associations between the accuracy of the neural representation and treatment outcome. The GLM revealed no group differences between recAN and HC. The MVPAs showed greater classification accuracy of food stimuli in the posterior fusiform gyrus in acAN but not recAN. Classification accuracy was associated with better treatment outcome. Our findings suggest that the neural representation of food stimuli is altered in secondary visual areas in acAN and normalizes with weight recovery. Possibly this altered representation reflects attentional engagement motivating food intake, which may promote the recovery process.


Assuntos
Anorexia Nervosa , Anorexia Nervosa/terapia , Córtex Cerebral , Feminino , Alimentos , Humanos , Imageamento por Ressonância Magnética , Magreza , Resultado do Tratamento
19.
Tijdschr Psychiatr ; 63(9): 673-678, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34647306

RESUMO

BACKGROUND: Often anorexia nervosa occurs with other psychiatric comorbidities of which mood disorders are the most frequent. Depressive feelings hamper the chance of a favourable outcome of this persistent disorder. In addition, the underweight makes antidepressants work suboptimal. Electroconvulsive therapy (ECT) offers an important therapeutic value in the treatment of mood disorders. We are investigating whether ECT can be an effective treatment method for patients with anorexia nervosa and major depressive disorder. AIM: Analysis of the literature on the possible effectiveness of electroconvulsive therapy (ECT) in the treatment of major depressive disorder and anorexia nervosa supplemented with a case report. METHOD: Literature study in PubMed, Web of Science and Embase and a case report. RESULTS: 262 published articles were found between 1955 and 2020, 16 were found to be relevant. CONCLUSION: From the literature, clinical recommendations cannot be made binding. No randomized controlled trials have been published on this subject. However, we saw in our case study and in the literature found that clearing the depressive symptoms through electroconvulsive therapy led to an improvement in food and fluid intake. ECT has no effect on their deranged thought pattern.


Assuntos
Anorexia Nervosa , Transtorno Depressivo Maior , Eletroconvulsoterapia , Anorexia Nervosa/complicações , Anorexia Nervosa/terapia , Antidepressivos/uso terapêutico , Depressão , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Resultado do Tratamento
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