Taste reactivity deficit in anorexia nervosa.

AIM: Anorexia nervosa is a complex psychiatric disorder posing a rapidly increasing burden on modern societies. Our purpose was to clarify perceptual-motivational aspects of gustatory disturbances in the disease. METHODS: A taste reactivity test, with the use of all five primary qualities in two concentrations, was performed in restrictive-type anorexic patients, and their hedonic evaluations were compared to those of age-matched healthy control subjects. RESULTS: The patients gave significantly lower pleasantness scores for pleasant taste stimuli compared with controls. The differences were the greatest for the lower concentration sucrose, umami and sodium chloride. Ratings given for the aversive taste stimuli were similar in both experimental groups. CONCLUSION: Our findings contribute to a better understanding of complex symptoms of anorexia nervosa, and may also help to develop more effective cognitive-behavioral therapies.

[Artistic creativity in the light of Jungian analytical psychology]. / A muvészi alkotás a Jungi analitikus pszichológia megközelítésében.

C.G. Jung's analytical psychology points at important issues in the psychological understanding of creativity. The theories of the Collective Unconscious and the Archetypes contributed to important discoveries in the interpretation of artistic creativity. Jung was concerned to show the relevance of Analytical Psychology to the understanding of European Modernism. Our paper deals with a short Jungian interpretation of Csontvary's art, too.

[The role of gene-environment interaction in the development of eating disorders]. / A gén-környezet interakció szerepe az evészavarok kialakulásában.

The biological research predominant in the last decades have not brought a solution in the discovery of risk factors contributing to the development of eating disorders, and elaborating a more effective therapy. The large amount of molecular genetic studies, however, by showing the various genetic vulnerability, contributed significantly to recognizing a more specific effect of the environmental factors. The authors evaluate the genetic studies of eating disorders and present environmental factors having a role in the development of eating disorders. They report about recently published data of gene-environment interaction and conclude from the data clinically applicable consequences.

[Dreams and imaginations in the therapy of eating disordered patients]. / Almok és imaginációk az evészavaros betegek terápiájában.

Recently the integrative approach has been applied in the treatment of eating disorders with multicausal origin. In order to achieve long-term therapeutic effect, the psychodynamic interpretation is often needed and favoured as a part of the personal, multimodal therapeutic strategy. The present paper focuses on body image distortion as one of the most decisive and least influenceable symptom of the disorder. The symptom is interpreted along the body image distortion-body boundaries-self boundaries-autonomy line. With illustrative therapy details of dreams, imaginations, the authors aim to demonstrate the therapeutic use of dynamically oriented therapy and dynamically oriented hypnotherapy.

[Dreams and imaginations in the therapy of eating disordered patients.]

Recently the integrative approach has been applied in the treatment of eating disorders with multicausal origin. In order to achieve long-term therapeutic effect, the psychodynamic interpretation is often needed and favoured as a part of the personal, multimodal therapeutic strategy. The present paper focuses on body image distortion as one of the most decisive and least influenceable symptom of the disorder. The symptom is interpreted along the body image distortion-body boundaries-self boundaries-autonomy line. With illustrative therapy details of dreams, imaginations, the authors aim to demonstrate the therapeutic use of dynamically oriented therapy and dynamically oriented hypnotherapy.

[Genetic markers and personality traits in eating disorders--preliminary results]. / Genetikai és személyiségfaktorok vizsgálata evészavarokban.

INTRODUCTION: The multidimensional approach of the ethiopathogenesis of eating disorders include the genetic, biologic, psychosocial effects, and premorbid personality markers. AIM/METHOD: To determine the potential relation between genetic and personality trate and state factors, and also to investigate the connection of clinical symptoms and diagnostic subgroups. The serotonin transporter gene (VNTR) polymorphism was investigated by polymerase chain reaction (PCR) technology, the personality factors were determined by the Temperament and Character Inventory (TCI) inventory. RESULTS: Among patients with bulimia nervosa (BN) the short allele of serotonin transporter gene was more frequent than in anorexia nervosa (78% vs. 67%), and in both groups it was more common than in the general population (43%). Patients with anorexia nervosa (AN) have higher scores in the scale of harm avoidance (61,2 vs. 51.4), but in bulimia nervosa the novelty seeking (54.5 vs. 44.2) and the reward dependence factors (53.2 vs. 46.5) were more significant. In the self-directedness (BN: 42.7; AN: 44.3) and the cooperativeness scales (BN: 51.2; AN: 44.6) both groups show lower scores, which could implicate personality disorder in the background of the eating disorders. Anorexic patients with the 10 allele show similar personality factors like patients with bulimia nervosa, while with the 12 allele (homozygotes), their factors were more likely the factors of patients with classic anorexic symptoms. CONCLUSION: Our data strength the role of specific personality factors in the background of the symptoms of eating disorders. Among patients with bulimia nervosa the 10 allele were more frequent, which could indicate the role of the serotonin system in developing eating disorders. Two subgroups were differentiated among patients with anorexia nervosa in relation with personality factors; the factors of patients with the 12 allele homozygotes were similar to the classical factors of anorexia nervosa, while patients with the 10 allele were like bulimic patients. Our results could improve our knowledge with newer aspects concerning the etiology of eating disorders, that might be used in broadening our preventive and therapeutic facilities in the future.

[Leptin and glucose metabolism in eating disorders]. / A leptin és glukóz metabolizmus evészavarokban.

AIM: Leptin, which was discovered only a decade ago, is a peptide that informs hypothalamic areas about the energy balance of the body. New research findings, has suggested a possible role of leptin in eating disorders as well. Few data are available about the relationship between leptin, insulin and glucose metabolism in the pathomechanism of eating disorders. The authors were searching for answers to these relationships in their investigations. METHODS: The study groups included 56 patients with eating disorders and 22 healthy subjects served as controls. The diagnosis was based on DSM-IV criteria. For measuring leptin, insulin and C-peptide serum concentrations a radioimmunoassay method was applied, and serum glucose concentrations were detected by spectrofluorimetry. Detailed statistical analysis of the results was carried out. RESULTS: A correlation between BMI and serum leptin concentration could be proved only in anorectic patients. In contrast to former findings, there was no correlation between BMI and leptin concentration in the bulimia group, and the leptin concentrations were significantly higher in bulimic patients than in the control group. During the glucose tolerance test, leptin levels showed a significant decrease in the anorexia group. CONCLUSION: The results raise the possibility of a direct effect of central regulatory mechanisms of food intake in the pathomechanism of anorexia nervosa.

Use of antipsychotics in the management of schizophrenia during pregnancy.

The rapid development of pharmacotherapy has resulted in a growing clinical importance for the treatment of the increasing number of women with schizophrenia during pregnancy. An evolving database on reproductive health safety factors for women with schizophrenia has begun to be of assistance in optimising clinical benefits for women with childbearing potential. Given the prevalence of antipsychotic use during pregnancy in women with schizophrenia, it is important for the clinician to have a prepared approach to the administration of these agents. In general, the use of psychotropic medication during pregnancy is indicated when risk to the fetus from exposure to this medication is outweighed by the risks of untreated psychiatric illness in the mother. The preponderance of evidence from registries to large health surveys indicate that treatment with antipsychotic medication confers either no or a small nonspecific risk for organ malformations. According to the relevant literature published on the safety of antipsychotic medication during pregnancy, the findings are encouraging; however, the currently available data are very limited. Until there are more controlled prospective data on the impact of drugs on fetal and later development, the clinician will continue to work in a state of potential uncertainty, weighing partially estimated risks against managing individual clinical problems. The aim for the clinician should be to provide the best information available regarding the scope of possible risks associated with the treatment of schizophrenia during pregnancy. On the basis of the available data, generalisation is impossible and recommendations should be made on a drug-by-drug basis. The risks and benefits must always be carefully weighed for each patient on an individual basis. Only a woman who is well enough to acknowledge her pregnancy and her mental illness can effectively weigh the relative and partially unknown risks of treatment with antipsychotic medication against the highly probable risks of illness exacerbation if untreated.

Urinary steroid metabolites and 11beta-hydroxysteroid dehydrogenase activity in patients with unipolar recurrent major depression.

BACKGROUND: The aim of the present study was to obtain comprehensive information on steroid metabolism in depressed patients. METHODS: 24-h urinary steroids were measured by gas chromatography in patients with unipolar recurrent major depression (URMD) compared to controls, and an index of relative activity of the 11beta-hydroxysteroid dehydrogenase (11beta-HSD) enzyme was calculated. RESULTS: The levels of etiocholanolone (E) (p < 0.05), beta-cortolone (beta-CL) (p < 0.01) were significantly decreased, while levels of allo-tetrahydrocorticosterone (aTHB) (p < 0.05) and cortisol (F) (p < 0.01) were elevated in depressed women. The levels of dehydroepiandrosterone (DHEA) (p < 0.01), tetrahydrocorticosterone (THB) (p < 0.01), beta-CL (p < 0.01), and aTHB (p < 0.05) were found significantly decreased in depressed men. The index of 11beta-HSD activity (p < 0.01) was significantly decreased in patients in both sexes. LIMITATIONS: The sample is limited to only urine samples of patient with URMD; the correlation between the severity of depression and F and DHEA was not analyzed. CONCLUSION: Our investigations confirmed that URMD associated with altered steroid metabolism, which shows gender differences, pointing to the different stress sensibility of women. These differences may be the cause as well as the consequence of the major depression (MD).

Urinary steroids in young women with eating disorders.

Urinary steroid components were measured after enzyme hydrolysis and methoxym-silyl derivatization by capillary gas chromatography in young women with eating disorders. Using three internal standards, programmed temperature from 50 to 300 degrees C and flame ionization detection, on ULTRA-1 capillary column the separation of 28 steroid components is possible. Fifteen young women with different eating disorders, i.e. anorexia nervosa, bulimia nervosa and bulimarexia (aged 16-28 years) and 15 healthy women (aged 22-26 years) collected 24-h urine. A significant decrease of dehydroepiandrosterone (p<0.05) and a significant elevation of the stress marker allo-tetrahydrocorticosterone (p<0.05) were observed in the patients with compared to the controls. Among the patients two groups were defined due to a significant difference in the content of the cortisol metabolites compared to each other and to controls (p<0.01). The results confirm the role of dehydroepiandrosterone in eating disorders. The increased level of the stress marker allo-tetrahydrocorticosterone refers to the involvement of stress in these diseases, but the relevance of hormone alteration to the pathophysiology of eating disorders remains to be elucidated. The reason of the differences in cortisol metabolites levels in some patients needs further investigations.

Nonlinear and linear EEG complexity changes caused by gustatory stimuli in anorexia nervosa.

The objective of the present study was to investigate the effects of pleasant and unpleasant gustatory stimuli on nonlinear and linear complexity measures of the EEG in healthy controls and in anorexia nervosa (AN) patients. The subjects were exposed to unpleasant (bitter tea) and pleasant (chocolate) gustatory stimuli for 2 min. Multichannel EEG was recorded and the dimensional complexity (point-correlation dimension) and Omega complexity were calculated from the EEG epochs corresponding to the above taste conditions. In AN patients lower-dimensional complexity was observed in the majority of recording sites than that seen in controls, independent of taste conditions. Higher Omega complexity was seen in control subjects in the left side irrespective of taste effects. No such hemispheric difference was observed in AN. The lower-dimensional complexity seen in AN patients may be caused by long-lasting effects of malnutrition. The lack of a significant Omega complexity change in response to exposure of sweet taste in the left side seen in AN patients may correspond to a decreased sensitivity to such stimuli in these subjects.

Effects of sweet and bitter gustatory stimuli in anorexia nervosa on EEG frequency spectra.

The possible differences in processing gustatory stimuli in anorexic patients compared to healthy control subjects was investigated by electrophysiological methods. The electroencephalogram (EEG) was recorded in outpatients treated with anorexia nervosa (AN) and age-matched controls after exposure to sweet (milk chocolate) and bitter (black tea) taste stimuli. Power spectrum analysis was performed on EEG epochs recorded in the above conditions. Compared to controls a significantly higher percent of theta, and lower percent of alpha1 band power was found in anorexic patients, irrespective of the kind of taste effects and hemispheric side. The pattern of activation caused by sweet and bitter stimuli was found to be different in these two groups, possibly indicating altered gustatory processing mechanisms in AN.

Anorexia nervosa following sexual harassment on the internet: a case report.

BACKGROUND: Sexual abuse may be a risk factor for the development of anorexia nervosa. No information is available on sexual abuse through the Internet and its connection to the development of eating disorders. METHOD: We report on a case of an adolescent female with the diagnosis of anorexia nervosa, whose symptomatology correlated significantly with an incident of sexual harassment experienced via the Internet. RESULTS: A case of on-line harassment suffered without off-line follow-up is reported to have led to a restrictive type of anorexia nervosa, where the symptomatology was connected to a "computer scatology" like persecution of our patient. DISCUSSION: A causal connection of the on-line sexual harassment suffered and development of eating disorder is reported.