Is Anorexia Truly a Contemporary Disease?

BACKGROUND: Anorexia nervosa (AN) is reported to be on the rise. However, instances of fasting have been noted since antiquity. Can modern diagnoses be applied to circumstances very different from our own? Is there a continuum of symptoms whose meanings have evolved over centuries, or is AN a recent development? SUBJECTS AND METHODS: A literature review was conducted. Twelve articles were found to be pertinent to the study, including several by Jacques Maître, who also published a book on the subject that was utilized. RESULTS: Few instances of fasting and no deaths from AN are reported in Western antiquity. With the advent of Christianity, prolonged fasting appears in the West. From the 12thcentury onwards, food deprivation becomes significant in women's spiritual lives, reaching a peak in inedia until the Renaissance. In 1873, Lasègue and Gull published a medical description of AN. Thereafter, AN fluctuated between being a distinct pathology and a symptom of another syndrome. Long considered a hysterical symptom, Freud initiated a shift toward sexual causality. In 1914, hypophyseal atrophy was considered a cause but was later forgotten. World War II did not produce instances of AN; food refusal has meaning only when food is abundant. During times of imposed famine, women's roles in food management and corpulence are valorized. In the 1960s, attention shifted to body image and an inability to cope with pubertal changes. Today, Russell describes a change in patient profiles with increased fear of weight gain and reduced fear of sexualization. CONCLUSION: Two opposing theses emerge. On one hand, it is argued that mystical fasts and AN cannot be linked and that AN is a recent disorder. Modern society subjects us to greater social pressures, forcing women to deny their biological roles in pursuit of thinness. On the other hand, AN is considered the heir to mystical fasting, as part of women's attempts to escape societal roles. Hagiographic descriptions and psychoanalytic studies that highlight the unconscious dynamics between mother-daughter relationships and pubertal difficulties support this view.

Microbiota Diversity and Inflammation as a New Target to Improve Mood: Probiotic Use in Depressive Disorder.

BACKGROUND: There is a lot of evidence for a bidirectional communication between the gut and brain. Dysbiosis and increase intestinal permeability may lead to a systemic low-grade inflammatory response or various neuroactive bacterial metabolite may cross gut barrier. Pro-inflammatory cytokines or bacterial metabolites such as short-chain fatty acid (SCFA) are known to pass through blood brain barrier and altered neurotransmitter metabolism or increase production of neurotoxic pathways. In this review we hypothesized that restoring the gut microbiota ecosystem could improve mental disorders. We reviewed literature for human evidence proving clinical relevance of probiotics intake in mental disorders. SUBJECTS AND METHODS: We searched literature with keywords "depression" or "major depressive disorder" and "probiotic". We selected randomized control trial and we considered having both outcomes concerning impact on depressive symptoms but also on inflammation biomarkers, microbiota composition, cerebral nervous system or cognition. RESULTS: Seven out of fourteen randomized control trial reported significant improvement on depressive symptoms in patients taking probiotics. Besides improvement in depressive symptoms, we found decrease in inflammatory markers such as IL-6, decrease in serum kynurenine level, changes in microbiota diversity and abundance of species correlated to depressive disorder and higher cognitive performance. CONCLUSIONS: Probiotic seems to be secure and more effective on depression when used in supplement to usual antidepressant and in mild to moderate depression. We highlighted positive impact on vulnerability factors prevent further worsening. Probiotics could have anti-inflammatory effect acting on inflammatory markers well known to have a role on pathogenesis of depression. A strong correlation between neuroactive metabolites and a relative abundance of microbiota bacterial species underlined importance to consider the gut-brain axis in mental disorders.

COVID, the Main Cause of Mysery of Teenager? Retrospective Study of Hospitalizations of 15-25 in Psychosomatics (2018-2022).

BACKGROUND: Since the outbreak of COVID-19, there has been an apparent increase in the utilization of mental health services and psychiatric disorders among youth. However, there is little data on youth mental health prior to the pandemic. Some authors suggest that the increase in the use of psychiatric care started before. Are we facing a recent phenomenon initiated by the pandemic that will disappear with it, or did it highlight an older issue? Have the profiles of the young people and the care provided changed since the pandemic? SUBJECTS AND METHODS: Retrospective study of the hospitalization records of patients aged 15 to 25. The inclusion period extends from January 1, 2018, to December 31, 2022. RESULTS: There was an increase in the number of young people hospitalized from September 2020 to February 2021, suggesting a delayed effect of Covid's impact. 44% of young people were hospitalized through emergency services, number that has increased. There has been an increase in prior psychiatric care and hospitalizations among patients hospitalized since the beginning of the pandemic. 49% attribute their condition to family issues. Upon discharge, many patients were on medication, but there has been no significant change in prescriptions since the pandemic began. The majority of patients were referred to their primary care physician, psychologist, and psychiatrist, which has not changed since the pandemic began. CONCLUSIONS: Apart from the increase in hospitalizations, the rest of the practices within the institution has remained unchanged, suggesting that there are few differences in issues brought by patients since the start of the pandemic. Difficulties related to the family environment remain the primary reason for hospitalization requests. We do not have clear evidence of a worsening situation, which tends to support the hypothesis that COVID-19 has been a catalyst for a pre-existing state.

Alcohol Use Disorder in a University General Hospital: a Four-Year Observational Study of Liaison Psychiatry.

BACKGROUND: Alcohol use disorder is insufficiently treated because it is poorly detected. Improved screening in general hospitals is a major issue in treatment organisation. SUBJECT AND METHOD: Through a retrospective exploratory study based on a review of medical records over four years (2016-19) before the COVID pandemic, we recorded the number of liaison psychiatric referrals for alcohol use disorder and identified two indicators: follow-up care implemented and survival at three years. RESULTS: Subject to the limitations of a retrospective review of medical records, we observed that 136 of 859 referrals concerned an alcohol use disorder. At three years, 25% (34 patients) had died. The causes of death were analysed, which revealed that 65% were directly attributable to alcohol consumption. Ongoing follow-up care was documented for only 17% (15 patients) of the 136 referred patients. Twelve patients who were followed up (80%) were in remission at one year. CONCLUSION: Although the results showed the efficacy of psychiatric follow-up care, the low recruitment of patients receiving regular follow-up care confirmed the problem of access to treatment. Our results support the need for screening and earlier intervention in general hospitals by raising awareness and training all doctors, but also by reflecting on new methods of liaison psychiatry treatment.

Pregnancy Outcomes After Kidney Transplantation and Long-Term Evolution of Children: A Single Center Experience.

BACKGROUND: Pregnancies in women who underwent kidney transplants are at high risk compared with the general population. METHODS: In this study, we aimed to retrospectively assess the obstetrical complications, delivery outcomes, and impact of pregnancy on kidney allograft function in a single-center cohort of kidney transplant recipients (KTRs). We provide data regarding the long-term evolution of children. RESULTS: Thirty-two KTRs underwent a total of 57 pregnancies between 1994 and 2010. Fourteen pregnancies (24 %) did not survive caused by miscarriages (n = 9), stillborn (n = 1), ectopic pregnancies (n = 2), and medical abortion (n = 2). Live birth occurred in 76% of pregnancies. Delivery was by cesarean in 66%. The mean gestational age was 30.45 ± 11.3 weeks and 65% of newborns were premature. A low birth weight <2500g was noted in 46%. Obstetric complications were de novo hypertension in 4%, pre-eclampsia in 9%, and gestational diabetes in 2%. The 5- and 10-year post-delivery death-censored graft loss rates were 3.1% and 12.5%, respectively. Data on 21 children were collected via a self-questionnaire. After a median follow-up time of 17 years, they appeared in good medical and psychological health. None of them suffered from chronic disease (especially uronephrological condition) or was taking chronic medication. CONCLUSIONS: Long-term evolution of children born to women who underwent kidney transplants seems favorable. Pregnancies in KTRs are successful in two-thirds of cases but are at increased risk of prematurity, delivery by cesarean, and low birth weight.

Real or Virtual Relationships: Does It Matter to Teens?

BACKGROUND: Social networks are taking over teenagers' lives and altering the way they relate to others. They are creating their own and changing culture. Which is a cause for concern for adults, who do not understand it. Moreover, usage peaks at a pivotal time in life: adolescence. Therefore it seems important to understand these new habits, and the reasons why social networks are such an important part of the life of adolescents. Furthermore, we looked into the question if virtual relationships have an impact on real-life relationships, and vice versa. SUBJECTS AND METHODS: This literature review examined studies published between 2008 and September 2019. Twenty-five articles were selected from PubMed, Scopus, PsychINFO and Cochrane databases. RESULTS: Above all, teenagers are motivated to use social networks because they can develop an identity based on an idealized profile. This profile must be at least as good as those of their peers, in order to obtain the latter's approval. This is notably the case in a context where changes to the family structure give a greater weight to the opinion of peers. Young people are driven to seek refuge on the Internet by a lack of family support, and parents who are less emotionally present. This effect could be limited by encouraging communication between teenagers and their parents. Finally, romantic relationships are impacted by the availability of pornography. Viewing pornography is increasingly seen as a normal stage of development and is linked to poorer attachment to peers and family. CONCLUSIONS: The Internet seems to support a gradual detachment from family life and a move towards greater inclusion in the peer group. This is all the more evident in a context where family structures are changing.

Management of adult patients with anorexia nervosa: a literature review.

BACKGROUND: Anorexia is a frequent pathology; not only does it cause major changes in patients' quality of life, but also the mortality rate is high. This mortality mainly affects young people. However, care remains controversial. The aim of this literature review is, therefore, to review current guidelines. SUBJECTS AND METHODS: A review of the literature published between 2006 and 2017, from articles contained in the Cochrane, PubMed, Scopus and PsychINFO databases. Keywords were 'anorexia nervosa', 'adults' and 'management'. RESULTS: Patient management must be multidisciplinary and prioritise weight gain. For this to happen, outpatient monitoring must include a gradual normalisation of eating habits. This always involves psychotherapy and sometimes prescription medication. However, no specific therapy or psychotropic drug has demonstrated statistical superiority in the management of anorexic patients. Cognitive behavioural therapy remains the most effective therapy in preventing relapse, and family therapies for the treatment of young patients who are still living with their families of origin. Hospitalization is sometimes necessary and must then include gradual and closely monitored refeeding to avoid the potentially fatal refeeding syndrome. CONCLUSIONS: The management of anorexic patients is complex but always involves reaching a normal weight. The best prognosis is found in young patients with the least chronic disease.