Omega-3 as an adjuvant in the treatment eating and psychological symptoms in patients with anorexia nervosa: a systematic review and meta-analyses.

BACKGROUND: This study was carried out to assess the effects of omega-3 supplementation as an adjunct treatment for eating and psychological symptoms in patients with anorexia nervosa. METHODS: We conducted a systematic review of the literature using the terms 'anorexia nervosa' AND 'Fatty Acids, Omega-3'. Five randomised controlled trials with a total of 144 participants, published between 2003 and 2022, were included. RESULTS: The effects of supplementation of omega-3 on anxiety were standardised mean difference (SMD) 0.79, 95% confidence interval (CI) -0.08 to 1.66; p = 0.08; I² = 3%; two studies, 33 participants; moderate quality of evidence. For depression, the supplementation of omega-3 was SMD: 0.22, 95% CI: -0.50 to 0.93; p = 0.18; I² = 45%; two studies, 33 participants; moderate quality of evidence. For obsessive-compulsive disorder, the supplementation of omega-3 was SMD: -0.22, 95% CI: -0.70 to 2.25; p = 0.36; I² = 0%; three studies, 32 participants; low quality of evidence. CONCLUSION: This research showed that regardless of dose, time or, if associated with other components, the use of omega-3 supplementations as an adjuvant treatment showed no evidence of effect in eating and psychological symptoms in patients with anorexia nervosa.

Efficacy and safety of antipsychotics and antidepressants in the treatment of anorexia nervosa: a systematic review.

INTRODUCTION: The recommendations of the current guidelines are based on low quality evidence. Periodic updating is required, taking recent evidence into consideration. OBJECTIVE: To synthesise the best available clinical evidence on the efficacy and safety of second-generation antidepressants and antipsychotics in patients with anorexia nervosa. METHODS: Systematic review (CRD42020150577). We searched PubMed, SCOPUS, Ovid(Cochrane), EMBASE and LILACS for randomised clinical trials performed in patients with anorexia nervosa that evaluated the use of second-generation antipsychotics or oral antidepressants, at any dose and for any length of time, in outpatient and/or hospital treatment, taking weight (body mass index), psychopathological entities and safety as results. RESULTS: Five studies were included, with four assessed as having a high risk of bias. The evidence indicates that patients receiving treatment with olanzapine or fluoxetine tend to stay in treatment programmes for longer. Olanzapine showed favourable results (one study) in terms of weight gain, but did not show the same results in psychopathology, where the evidence is contradictory. CONCLUSIONS: In accordance with previous reviews, our work allows us to conclude that there is contradictory information on the efficacy of psychotropic drugs in the treatment of anorexia nervosa. Future work should focus on developing clinical trials of high methodological quality.

Avaliação da procura pelos serviços de saúde e tratamento farmacológico de pacientes com anorexia e bulimia nervosa / Evaluation of the search for health services and pharmacological treatment of patients with anorexia and bulimia nervosa / Evaluación de la búsqueda por los servicios de salud y tratamiento farmacológico de pacientes con anorexia y bulimia nerviosa

Introdução: Os transtornos alimentares são caracterizados como distúrbios do comportamento alimentar, associados ao desequilíbrio nos pensamentos, ações e atitudes dos indivíduos resultando em prejuízos à saúde do indivíduo. Estas condições são cada vez mais comuns na sociedade atual e têm ganhado crescente atenção da comunidade científica. Objetivo: Analisar a procura pelo atendimento e farmacoterapia em mulheres com anorexia e bulimia nervosa atendidas em uma faculdade de medicina em 2018. Material e método: Realizou-se análise documental dos prontuários médicos. A procura pelo atendimento foi considerada não-espontânea quando a paciente foi encaminhada pela unidade de urgência/emergência ou compareceu acompanhada por responsável legal sem admitir necessidade de tratamento. Resultados: Identificou-se 14 pacientes, com idade média de 31,21 anos. 43% apresentaram procura não-espontânea pelo atendimento, sendo 83% destas encaminhadas por unidades de urgência/emergência. Foram prescritos 21 medicamentos diferentes, sendo a maioria antidepressivos. 52% dos fármacos prescritos não são disponibilizados pelo Sistema Único de Saúde. 29% dos pacientes apresentavam polifarmácia, 43% automedicação e 57% pensamento de morte. Houve associação entre o pensamento de morte e uso de 4 ou mais medicamentos. Conclusão: Uma parcela considerável das pacientes teve procura não-espontânea pelo atendimento. Os fármacos prescritos foram principalmente antidepressivos e a maioria não é disponibilizado no Sistema Único de Saúde, evidenciando a onerosidade econômica e social do tratamento(AU)

Introduction: Eating disorders are characterized as disorders of eating behavior, associated with imbalance in the thoughts, actions and attitudes of individuals resulting in harm to the health of the individual. These conditions are increasingly common in today's society and have gained increasing attention from the scientific community. Objective: To analyze the search for health services and pharmacotherapy in women with anorexia and bulimia nervosa attended at a medical school in 2018. Material and method: Documental analysis of medical records was performed. The search for care was considered non-spontaneous when the patient was referred by the emergency unit or accompanied by a legal guardian without admitting need for treatment. Results: We identified 14 patients with a mean age of 31.21 years. 43% showed non-spontaneous search for care, which 83% were referred by emergency units. 21 different drugs were prescribed, most of them antidepressants. 52% of the drugs prescribed are not available from Brazilian Unified Health System. 29% of the patients presented polypharmacy, 43% self-medication and 57% thought death. There was an association between the thought of death and the use of 4 or more medications. Conclusion: A considerable number of patients had non-spontaneous search for care. The drugs prescribed were mainly antidepressants and most are not available in the Brazilian Unified Health System , evidencing the economic and social onerosity of the treatment(AU)

Introducción: Los trastornos alimentarios se caracterizan como disturbios del comportamiento alimentario, asociados al desequilibrio en los pensamientos, acciones y actitudes de los individuos resultando en perjuicios a la salud del individuo. Estas condiciones son cada vez más comunes en la sociedad actual y han ganado creciente atención de la comunidad científica. Objetivo: Analizar búsqueda de atención médica y farmacoterapia en mujeres con anorexia y bulimia nerviosa atendidas en una Facultad de medicina en 2018. Material y método: se realizó análisis documental de registros médicos. La búsqueda de atención médica fue considerada no espontánea cuando la paciente fue remitida por urgencia/emergencia o acompañada por responsable legal sin admitir necesidad de tratamiento. Resultados: se identificaron 14 pacientes, edad media de 31,21 años. 43% presentaron búsqueda no espontánea, 83% de estas remitidas por unidades de urgencia/emergencia. Fueron prescritos 21 medicamentos diferentes, la mayoría antidepresivos. 52% de medicamentos prescritos no son proporcionados por el Sistema Único de Salud Brasileño. 29% de los pacientes presentan polifarmacia, 43% automedicación y 57% pensamiento de muerte. Hubo asociación entre pensamiento de muerte y uso de 4 o más medicamentos. Conclusión: Parte considerable de los pacientes tuvo búsqueda no espontánea de atención médica. Los medicamentos prescritos fueron principalmente antidepresivos, la mayoría no disponible en el Sistema Único de Salud Brasileño, evidenciando la onerosidad económica y social del tratamiento(AU)

Do cannabinoids constitute a therapeutic alternative for anorexia nervosa? / ¿Constituyen los cannabinoides una alternativa terapéutica en anorexia nerviosa?

INTRODUCTION: Cannabinoids have been postulated as an alternative for anorexia nervosa. However, their actual clinical efficacy and safety are still discussed. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews including two primary studies, both corresponding to randomized trials. We concluded cannabinoids might not increase weight or improve symptoms in anorexia nervosa, and are probably associated to frequent adverse effects.

INTRODUCCIÓN: Se ha planteado que la estimulación del apetito con cannabinoides podría constituir una alternativa terapéutica en anorexia nerviosa. Sin embargo, su utilidad clínica y seguridad genera controversia. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES:: Identificamos cuatro revisiones sistemáticas que en conjunto incluyen dos estudios primarios, ambos correspondientes a ensayos aleatorizados. Concluimos que los cannabinoides podrían no aumentar el peso ni mejorar la sintomatología en la anorexia nerviosa, y se asocian a efectos adversos frecuentes.

Trastorno del comportamiento alimentario de difícil tratamiento. Caso clínico / Eating behavior disorders difficult to treat. A clinical case

La incidencia de los trastornos de la conducta alimentaria (TCA), integrados por la bulimia nerviosa (BN) y la anorexia nerviosa (AN) ha aumentado en los últimos años. Su etiología es multifactorial. Las edades de presentación son cada vez más tempranas, afectando a individuos de ambos sexos. Son trastornos crónicos, que asocian importante morbi-mortalidad y que frecuentemente se presentan con múltiples recaídas. El tratamiento requiere la participación de un equipo multidisciplinario, sin claras evidencias que indiquen la efectividad de diversas estrategias terapéuticas. Se analiza el caso clínico de una adolescente portadora de TCA: AN con componente purgativo. Presentaba varios de los factores de riesgo descriptos para la enfermedad, la forma de presentación fue característica y presentó algunas de las complicaciones más frecuentes. El tratamiento se inició con la paciente hospitalizada, realizando un abordaje multidisciplinario. La respuesta inicial no fue buena, por lo que fue necesario cambiar la estrategia terapéutica. Como objetivo terapéutico principal se planteó el cuidado de la integridad física y mental. Se buscó recuperar el estado nutricional instaurando cambios en la conducta alimentaria.

(N-3) Fatty acids: molecular role and clinical uses in psychiatric disorders.

New discoveries in the field of neurophysiology and neuropharmacology have revealed the role of (n-3) fatty acids in controlling inflammation and protecting neuron cells from oxidative damage, preserving their function. It has also been thought that their psychoactive properties could be beneficial in certain psychiatric illnesses. This article discusses the newest discoveries of the affected activities by these fats in the cerebral cortex and the efforts that have been made to put them in practice in clinical trials in humans. In general, we were able to detect certain discord in the scientific community when designing placebo-based studies (mainly in establishing the appropriate therapeutic dose of (n-3) fatty acids, varying from the recommended dietary dose to an amount that may be 3 or 4 times higher), and in interpreting results. Although many studies have had the validity of their results questioned because of their small sample size, several studies seem to indicate that the (n-3) fatty acids are useful therapeutic tools in treating psychiatric conditions such as major depression, bipolar disorder, and several other disorders. Larger sample size studies are still required to better analyze the treatment potential of these agents.

Anorexia y Bulimia Nerviosa. Aproximación nutricional / Anorexia and Bulimia Nervosa. Nutritional approach

La prevalencia entre los adolescentes, de trastornos de la conducta alimentaria como anorexia nerviosa (AN), bulimia nerviosa (BN) y otro (obesidad, alimentación compulsiva, o no especificados), viene creciendo día a día de modo sostenido y a gran velocidad; y siendo la alimentación una necesidad básica, importante y vital para el crecimiento y desarrollo, debe entenderse que este acto ejerce una conducta poderosa influencia en la estructura y funcionamiento del organismo por lo tanto una conducta alimentaria adecuada hace posible que esto se desarrolle de manera adecuada y óptima. Cada sociedad tiene formas habituales de alimentarse según sus costumbres y características socioculturales y religiosas; cuando un individuo se aparta de los límites racionales presentando características anormales tanto en la calidad como en la cantidad o distribución de las comidas a esto se le llama ôTrastornos en la Conducta Alimentariaõ. El tratamiento de los trastornos en la conducta alimentaria representa todo un desafío de Salud Pública por su alta incidencia, gravedad y evolución clínica prolongada con propensión a la cronicidad y por el grupo etáreo afectado, por lo tanto, es indispensable buscar las herramientas que permitan una detección temprana y una intervención especializada con un equipo multidisciplinario que incluya médico, psicólogo, nutricionista, psiquiatría, de modo que el pronóstico de recuperación sea el mejor posible.

Aspectos da leptina na anorexia nervosa: possíveis efeitos benéficos no tratamento da hiperatividade / Aspects of leptin in anorexia nervosa: possible beneficial effects on the treatment of hyperactivity

Pesquisas recentes demonstram a relação direta da leptina na regulação do balanço energético e como um dos fatores envolvidos em transtornos alimentares. Com ação no sistema nervoso central, a leptina interfere na ingestão alimentar, no metabolismo da glicose, no peso corporal, na produção de hormônios sexuais e na atividade física. As pesquisas realizadas tanto em seres humanos como em animais demonstram que a queda nos níveis de leptina está relacionada aos sintomas apresentados na anorexia nervosa: a baixa ingestão alimentar, a perda excessiva de peso corporal, a amenorréia e a hiperatividade. Assim, o grau de hipoleptinemia não é apenas uma forte indicação de baixa reserva de tecido adiposo, mas também de severa desordem, sendo que os níveis de leptina podem ser utilizados para avaliar melhor a gravidade da doença. Pesquisas estão sendo realizadas com o objetivo de discutir a possibilidade de utilização da leptina como coadjuvante no tratamento de pacientes com anorexia nervosa para a diminuição da hiperatividade. Acredita-se que o tratamento com leptina associado à medicação e à psicoterapia, poderia ser benéfico em pacientes anoréxicas extremamente ativas, deixando-as mais suscetíveis ao tratamento adicional. Uma realimentação suficiente, a medicação, a psicoterapia e um ambiente acolhedor durante o tratamento com leptina devem ser assegurados. Assim, este artigo tem como objetivo discorrer sobre a leptina e aspectos relacionados à anorexia, e discutir como esta informação pode ser importante na avaliação clínica de pacientes com este transtorno alimentar.

Recent studies have demonstrated a direct relationship between leptin and the regulation of energy balance, and as a factor involved in eating disorders. Acting on the central nervous system, leptin affects food intake, glucose metabolism, body weight, the production of sexual hormones, and physical activity. Studies with humans and animals indicate that low leptin levels are related to symptoms of anorexia nervosa: low food intake, excessive loss of body weight, amenorrhea and hyperactivity. Thus, the degree of hypoleptinemia is not only a strong indication of low reserves of adipose tissue, but also of a severe disorder, and leptin levels can be used to better evaluate the seriousness of the disease. Research has aimed to study the use of leptin in the treatment of patients with AN, and positive results have been obtained in the reduction of hyperactivity. It is possible that leptin treatment associated with medication and psychotherapy can be beneficial for extremely active anorexia nervosa patients, making them more susceptible to further treatment. Adequate food intake, medication, psychotherapy, and a comfortable environment during leptin treatment should be ensured. Thus, this article aims to describe leptin and aspects related to anorexia, and discuss how this information can be important in the clinical evaluation of patients with this eating disorder.

Donepezil (aricept) as a treatment for anorexia nervosa: a very feasible therapeutic possibility.

Anorexia nervosa is a serious, multifactorial disease, characterized by psychiatric and neurological disturbances, which would appear to be similar to the manifestations of dementia. Patients with anorexia nervosa present compromised affectivity, characterized by hypomanic, manic and depressive symptoms, and their cholinergic system is altered with a decrease in the release of acetylcholine. Donepezil is a drug that been proven to be effective in the treatment of dementia, including Alzheimer's; it has been used for affective disorders and its mechanism of action is to inhibit the acetylcholinesterase enzyme to increase acetylcholine. Therefore, donepezil could be effective in treating anorexia nervosa.

Hospitalization of patients with anorexia nervosa: a therapeutic proposal.

Anorexia nervosa is an eating disorder that primarily affects young women and has a high morbidity and mortality rate. Hospitalization effectively overcomes the acute phase, prevents progression to chronicity and promotes lasting changes. Our aim is to establish a prior therapeutic contract and systematize hospitalization in three stages comprising: clinical and nutritional approaches, individual and group psychotherapy, family therapy, occupational therapy, body therapy and pharmacotherapy. Because of the multiple determination of anorexia nervosa and the risk involved, treatment must be carried out by a multidisciplinary team.

Depresión y trastorno de la alimentación / Depression and eating disorders

Los trastornos de la alimentación coexisten frecuentemente con los trastornos depresivos aún cuando la naturaleza de la asociación es todavía controvertida. Las 3 hipótesis fundamentales plantean que los trastornos de la alimentación son pirmarios y la sintomatología depresiva es una consecuencia de ellos, que a la inversa son fenómenos secundarios a un trastorno primario del humor, o bien que ambos tipos de trastornos comparten una multiplicidad de factores que los determinan a ambos. La alta prevalencia de depresión y suicidio en los pacientes con trastornos de la conducta alimentaria, sumando a la alta frecuencia de depresión en las familias de estos pacientes, son una fuerte evidencia de que ambos podrían ser trastornos relacionados. El estudio de los marcadores biológicos ha demostrado una sorprendente similitud entre depresión y trastornos de alimentación. En ambos se ha encontrado evidencia consistente de hipofunción serotoninérgica central, similar respuesta en el test de supresión de dexametasona y efectividad de la luminoterapia tanto para los síntomas depresivos como para los trastornos de la conducta alimentaria. Otro elemento que sugiere una íntima relación entre ambos trastornos es la efectiva respuesta a antidepresivos tricíclicos, inhibidores de la MAO y serotoninérgicos selectivos en el control de los trastornos de la conducta alimentaria que ha sido ampliamente reportada en la literatura. La idea de que la AN y la BN forman parte de un conjunto de trastornos relacionados con hipofunción serotoninérgica parece ser la mejor explicación de los aspectos biológicos involucrados en la génesis de estos trastornos, aspectos que sin embargo deben ser evaluados en el conjunto de factores psicológicos, biográficos y socioculturales que determinan los problemas de salud mental

Reversibility of cerebral ventricular enlargement in anorexia nervosa, demonstrated by quantitative magnetic resonance imaging.

OBJECTIVE: To determine the reversibility of the loss of brain parenchyma and ventricular enlargement in patients with anorexia nervosa after refeeding. STUDY DESIGN: Quantitative magnetic resonance imaging was performed on three groups of subjects: (1) 12 female adolescents hospitalized with anorexia nervosa, (2) the same 12 patients after nutritional rehabilitation, a mean of 11.1 months later, and (3) 12 healthy age-matched control subjects. Sixty-four contiguous coronal magnetic resonance images, 3.1 mm thick, were obtained. With a computerized morphometry system, lateral and third ventricular volumes were measured by a single observer unaware of the status of the patient. RESULTS: On admission, patients were malnourished and had lost an average of 11.7 kg (body mass index, 14.3 +/- 2.0 kg/m2). After refeeding, they gained an average of 9.7 kg (body mass index, 17.9 +/- 1.5 kg/m2). Total ventricular volume decreased from 17.1 +/- 5.5 cm3 on admission to 12.4 +/- 3.0 cm3 after refeeding (p < 0.01) and returned to the normal range. The degree of enlargement of the third ventricle was greater than that of the lateral ventricles. There was a significant inverse relationship between body mass index and total ventricular volume (r = -0.63; p < 0.05). CONCLUSION: In patients with anorexia nervosa, cerebral ventricular enlargement correlates with the degree of malnutrition and is reversible with weight gain during long-term follow-up.

Disturbances in growth hormone secretion and action in adolescents with anorexia nervosa.

Women in whom anorexia nervosa develops during adolescence have failure of linear growth associated with low levels of insulin-like growth factor I (IGF-1). To investigate the pathophysiology of growth retardation in adolescents with anorexia nervosa, we measured basal growth hormone (GH), growth hormone-binding protein (GHBP), IGF-1, and insulin-like growth factor binding protein-3 (IGFBP-3) in three groups of patients: (1) 28 recently hospitalized female adolescents with anorexia nervosa, (2) 23 of the same patients after partial weight restoration, and (3) 28 healthy control subjects matched for age, sex, and pubertal stage. Fasting GH levels in group 1 did not differ significantly from those in group 3. In contrast, serum GHBP (p < 0.001), IGF-1 (p < 0.001), and IGFBP-3 (p < 0.01) were significantly lower in group 1 than in group 3. Serum GHBP and IGFBP-3 levels were positively correlated with body mass index. Serum GHBP levels were low in patients in all five pubertal stages and even in those shown to have adequate GH secretion. In group 2 (after refeeding) the serum IGF-1 concentration increased significantly and GHBP and IGFBP-3 returned to normal. We conclude that patients with anorexia nervosa have diminished GH action resulting in decreased secretion of IGF-1. The positive correlation with body mass index and the reversibility with refeeding suggest that these changes are secondary to malnutrition. Altered GH function that occurs during the years of active growth can explain the growth retardation seen in anorexia nervosa.