Rapid amelioration of anorexia nervosa in a male adolescent during metreleptin treatment including recovery from hypogonadotropic hypogonadism.

With this case report we support our medical hypothesis that metreleptin treatment ameliorates starvation related emotional, cognitive and behavioral symptomatology of anorexia nervosa (AN) and show for the first time strong effects in a male patient with AN. A 15.9 year old adolescent with severe AN of eight-month duration was treated off-label with metreleptin. Hyperactivity was assessed with accelerometry. Visual analogue scales (VAS), validated self- and clinician rating scales and lab results tracked changes from baseline to end of the 24-day dosing period and a five-month follow-up. Substantial improvements of mood and eating disorder related cognitions and hyperactivity set in after two days of treatment. During dosing, sub-physiological testosterone and TT3 levels normalized; clinically libido reemerged. Weight did not increase substantially during the dosing period. During follow-up target weight was attained; mood did not deteriorate; hyperactivity ceased. The results substantiate the strong effects seen in female cases and underscore the need for a double-blind placebo-controlled trial to confirm the observed strong, multiple and rapid onset beneficial effects of metreleptin in AN.

Death Anxiety and Depression in Amyotrophic Lateral Sclerosis Patients and Their Primary Caregivers.

Background: Given the lethal severity of amyotrophic lateral sclerosis (ALS), the aim of this study was to illuminate the coherence of depression and death anxiety in both ALS patients and caregivers and in how far patients and caregivers are influenced by the mindset of their respective counterpart. Methods: 30 couples of patients (mean age 60.57; 13 women, 17 men) and primary caregivers (mean age 57.33; 16 women, 14 men) were included into the study. Death anxiety was assessed using the newly developed BOFRETTA scale, depression via Beck Depression Inventory, anxiety by means of State Trait Anxiety Inventory and caregivers' exertion using the Caregiver Strain Index. Patients' impairment was assessed with the ALS functional rating scale. Results: We found that while death anxiety was related to depression in both patients and caregivers, death anxiety was related to anxiety only in patients. Caregiver strain correlated with both caregiver's depression and anxiety. Moreover, patients' and caregivers' depression, anxiety and death anxiety correlated to the ones of their counterpart. Conclusion: These results suggest that despite little depressive symptoms in ALS patients the fatal prognosis of the disease takes into account, depression and death anxiety influence each other and might be addressed together in pharmacological and especially psychotherapeutic interventions to the benefit of the patient. Medical professionals should not forget to offer sufficient support to caregivers tending patients affected by depression and death anxiety as they are likely to mirror their patient's feelings.