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1.
Georgian Med News ; (306): 46-51, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33130645

RESUMO

Generalized parodontal diseases (GPD) consistently occupy one of the leading places in the structure of dental diseases. Early diagnosis of the initial degree of generalized parodontitis (GP) is an effective way of secondary prevention. This is due to the complexity of understanding the etio-pathogenetic mechanisms of the development generalized parodontal diseases (GPD) and the high association of them with a number of diseases of the internal organs and systems with common points of contact between interdependence and mutual influence, in particular with anorexia nervosa (AN). The aim of this research was to develop a protocol for the treatment of GP in patients with AN. The object - 60 patients (mean age 26±3.8 years), with a diagnosis of GP, I-II degree, chronic, and AN, restrictive, which by simple randomization were divided into three groups (randomized by sex, age of patients, underlying and comorbidy diagnosis) to study the clinical effectiveness of our proposed method. Clinical, radiological, hygienic, immunological, biochemical, psychological and statistical methods were used. Conclusions. Thus, as a result of the proposed treatment protocol, the largest number of satisfactory treatment results was observed in group III patients (85.0±8.0%) with the inclusion of drugs that affect the pathogenetic mechanisms of the disease, including normalization of local immunity, markers of decline oxidative-antioxidant stress, radiological data of normalization of bone tissue of the alveolar process, a tendency to reduce microbial and tissue sensitization.


Assuntos
Anorexia Nervosa , Periodontite , Adulto , Anorexia Nervosa/complicações , Anorexia Nervosa/terapia , Protocolos Clínicos , Humanos , Periodontite/complicações , Projetos de Pesquisa , Resultado do Tratamento , Adulto Jovem
2.
Medicine (Baltimore) ; 99(35): e21739, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871893

RESUMO

RATIONALE: Anorexia nervosa (AN) is a serious eating disorder associated with a distorted body image. Hypercholesterolemia has been found in patients with AN but the mechanism of hyperlipidemia in AN remains little known. Ascites in patients with AN has been attributed to hypoalbuminemia and liver diseases, but massive ascites without the aforementioned etiologies has never been reported in AN. PATIENT CONCERNS: An 11-year-old girl was admitted for exclusion of organic underlying diseases due to severe body weight loss (18% within 3 weeks), poor appetite, and hypercholesterolemia (274 mg/dL). She complained of heartburn sensation, nausea, vomiting, constipation, and postprandial dull abdominal pain with fullness. DIAGNOSES: The patient's condition met with all 3 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for diagnosing AN. On admission, her total cholesterol level was 337 mg/dL and hypocomplementemia (C3 55.5 mg/dL) was also found. Abdominal sonography and computed tomography scans showed massive ascites. However, neither proteinuria nor hypoalbuminemia was found. Upper gastroduodenal endoscopy showed chronic superficial gastritis and colonoscopy revealed negative findings. Ascites obtained by paracentesis demonstrated a transudate without bacterial infection, tuberculosis, or pancreatitis. Exploratory laparoscopy showed nonpurulent ascites. However, biopsies from the small intestine, mesentery, and liver showed chronic inflammation and fibrosis. INTERVENTIONS: The intensive nutritional therapy by increasing total energy intake stepwise with a combination of high-energy formula and her favorite foods. OUTCOMES: Her hypercholesterolemia, hypocomplementemia, and massive ascites resolved after her weight was restored. She developed binge eating with continuous weight gain after discharge. Her weight significantly increased to an obese level (body mass index [BMI] 25.9 kg/m) after loss to follow-up for 4 years until she returned to our emergency room due to suicide attempt. CONCLUSION: Diagnostic crossover between subtypes in anorexia nervosa might be a potential risk factor for illness severity and poor prognosis. AN can manifest as massive ascites with normal albumin concentrations that could possibly be due to chronic inflammation of the intestinal serosa, mesentery, and peritoneal surface of the liver.


Assuntos
Anorexia Nervosa/complicações , Anorexia Nervosa/diagnóstico , Ascite/etiologia , Hipercolesterolemia/etiologia , Adolescente , Anorexia Nervosa/sangue , Anorexia Nervosa/psicologia , Transtorno da Compulsão Alimentar/etiologia , Criança , Complemento C3/metabolismo , Feminino , Humanos , Perda de Peso
3.
PLoS One ; 15(7): e0235346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667951

RESUMO

Several studies have recently suggested that an abnormal processing of respiratory interoceptive and nociceptive (painful) stimuli may contribute to eating disorder (ED) pathophysiology. Mood and anxiety disorders (MA) are also characterized by abnormal respiratory symptoms, and show substantial comorbidity with ED. However, no studies have examined both respiratory and pain processing simultaneously within ED and MA. The present study systematically evaluated responses to perturbations of respiratory and nociceptive signals across the levels of physiology, behavior, and symptom report in a transdiagnostic ED sample (n = 51) that was individually matched to MA individuals (n = 51) and healthy comparisons (HC; n = 51). Participants underwent an inspiratory breath-holding challenge as a probe of respiratory interoception and a cold pressor challenge as a probe of pain processing. We expected both clinical groups to report greater stress and fear in response to respiratory and nociceptive perturbation than HCs, in the absence of differential physiological and behavioral responses. During breath-holding, both the ED and MA groups reported significantly more stress, feelings of suffocation, and suffocation fear than HC, with the ED group reporting the most severe symptoms. Moreover, anxiety sensitivity was related to suffocation fear only in the ED group. The heightened affective responses in the current study occurred in the absence of group differences in behavioral (breath hold duration, cold pressor duration) and physiological (end-tidal carbon dioxide, end-tidal oxygen, heart rate, skin conductance) responses. Against our expectations, there were no group differences in the response to cold pain stimulation. A matched-subgroup analysis focusing on individuals with anorexia nervosa (n = 30) produced similar results. These findings underscore the presence of abnormal respiratory interoception in MA and suggest that hyperreactivity to respiratory signals may be a potentially overlooked clinical feature of ED.


Assuntos
Anorexia Nervosa/fisiopatologia , Transtornos de Ansiedade/fisiopatologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Dor Nociceptiva/fisiopatologia , Adolescente , Adulto , Afeto/fisiologia , Anorexia Nervosa/complicações , Anorexia Nervosa/epidemiologia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/epidemiologia , Asfixia/fisiopatologia , Asfixia/terapia , Comorbidade , Medo/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Masculino , Transtornos do Humor/complicações , Transtornos do Humor/epidemiologia , Transtornos do Humor/fisiopatologia , Dor Nociceptiva/complicações , Dor Nociceptiva/epidemiologia , Dor/complicações , Dor/epidemiologia , Dor/fisiopatologia , Sistema Respiratório/fisiopatologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-32491142

RESUMO

Oral problems are common in patients diagnosed with Eating Disorders (ED) and still require better elucidation. We aimed to analyze the prevalence of oral Candida spp in individuals with ED. The sample of the study was comprised of 30 women with purgative habits and 15 without purgative habits. Samples of the oral cavity were collected by sterile cotton swab rubbed on soft tissues and teeth. Yeasts were isolated on Sabouraud dextrose agar. Yeasts were isolated from the oral cavity of 53% of the patients yielding 75 yeast isolates; of these, 43 were identified by conventional mycological methods: C. parapsilosis (n=19), C. glabrata (n=16), Rhodotorula sp (n= 6), C. famata (n=2). The remaining 32 isolates were presumptively identified as C. albicans or C. dubliniensis and required mass spectrometry for the final differentiation: 28 isolates were confirmed as C. albicans and four as C. dubliniensis. Among the control group, only four subjects (26.7%) were found to harbor C. albicans. The four C. dubliniensis isolates were from two patients, one that was only colonized and the other, with severe ED, was diagnosed with an oral candidiasis as demonstrated by the presence of pseudohyphae on the direct mycological exam from different sites. The increased rate of isolation of non-albicans species, such as C. glabrata, C. parapsilosis, and C. dubliniensis in the oral cavity from ED patients with nutritional deficiency may suggest that purgative habits of these patients can lead to changes in normal flora and predispose to oral candidiasis.


Assuntos
Anorexia Nervosa/complicações , Bulimia Nervosa/complicações , Candidíase Bucal/complicações , Boca/microbiologia , Adulto , Candida/classificação , Candida/isolamento & purificação , Estudos de Casos e Controles , Feminino , Humanos , Espectrometria de Massas , Pessoa de Meia-Idade , Fenótipo
7.
Ann R Coll Surg Engl ; 102(8): 560-565, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32326720

RESUMO

Necrotising enterocolitis (NEC) is a rare cause of the acute abdomen in adults and carries one of the highest mortality rates in gastroenterology. However, its rarity confines research to small case reports. Both its pathogenesis and aetiology remain enigmatic in adult patients, proving timely diagnosis and management a challenge. This paper reports on one case of NEC in an adult patient with underlying anorexia nervosa, following a seven-day period of starvation. She underwent emergency laparotomy for resection of necrotic bowel and subsequently made a good recovery. To date, there have only been eight reports linking NEC with anorexia nervosa. We review our patient in the context of plausible mechanisms hypothesised in these cases. Successful management depends on prompt diagnosis, resuscitation and surgical intervention.


Assuntos
Anorexia Nervosa/complicações , Enterocolite Necrosante , Abdome/diagnóstico por imagem , Abdome/cirurgia , Adolescente , Adulto , Enterocolite Necrosante/diagnóstico , Enterocolite Necrosante/etiologia , Enterocolite Necrosante/patologia , Enterocolite Necrosante/cirurgia , Feminino , Humanos , Adulto Jovem
8.
Int J Eat Disord ; 53(4): 508-512, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32141642

RESUMO

Gastrointestinal (GI) symptoms are common in anorexia nervosa (AN), can predate illness onset, complicate renourishment, and persist after recovery. We explore how, through processes of aversive visceral conditioning, early GI pain and discomfort may increase vulnerability to AN in some individuals. Processes include enhanced preoccupation with the gut resulting from aversive visceral memories and disruptions in the typical acquisition of self-attunement when children learn to map and interpret interoceptive sensations and develop adaptive actions. We question whether a fear of weight gain, in some cases, may be an epiphenomenon of the recapitulation of actual or perceived GI symptoms that is especially relevant during puberty, especially in girls. This conceptualization has immediate clinical implications and offers ideas for future research. We propose that GI discomfort associated with renourishment may reignite prior aversive visceral experiences. We encourage development of a formulation that organizes the individual's current experience of the body with respect to these prior aversive experiences. Our conceptualization underscores the importance of assessment of GI experiences in individuals with AN; the examination of dietary strategies that minimize GI symptoms and enhance renourishment efficacy; and strategies that attempt to alter this aversive visceral conditioning by mapping sensations to meanings and adaptive actions.


Assuntos
Dor Abdominal/diagnóstico , Anorexia Nervosa/complicações , Saliva/metabolismo , Adolescente , Criança , Feminino , Humanos , Masculino , Saliva/citologia
9.
Pediatr. aten. prim ; 22(85): e13-e19, ene.-mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193435

RESUMO

INTRODUCCIÓN: el objetivo del estudio es describir los hallazgos electrocardiográficos y ecocardiográficos en mujeres adolescentes con anorexia nerviosa y correlacionarlos con parámetros clínicos. PACIENTES Y MÉTODOS: estudio observacional, retrospectivo, de casos y controles. Se estudiaron 98 mujeres adolescentes ingresadas en un hospital terciario por anorexia nerviosa restrictiva (ANR) durante los últimos 15 años, en las que se realizó valoración electrocardiográfica y ecocardiográfica al ingreso. RESULTADOS: la edad media fue similar en ambos grupos (14,6 ± 2,0 frente a 14,7 ± 2,0 años). Las pacientes con ANR presentaban menor frecuencia cardiaca (57 ± 12 frente a 72 ± 13 lpm), voltajes más bajos (rV5 = 1,1 ± 0,5 frente a 1,6 ± 0,4 mV) y menor masa ventricular izquierda (65,7 ± 14,8 frente a 90 ± 15,3 g/m2) que las pacientes controles. No se encontraron diferencias en la medición del QTc. En las pacientes con ANR, la bradicardia no se correlacionó con el peso (r = -0,20; p = 0,05), ni con el índice de masa corporal (IMC) (r = 0,02; p = 0,22) al ingreso. El grosor del septo interventricular y la masa del ventrículo izquierdo fueron significativamente menores en los pacientes con ANR (5,7 mm frente a 6,8 mm, p <0,001; 65,7 frente a 90 g/m2; p <0,001). La masa ventricular izquierda se correlacionó de forma significativa con el IMC (r = 0,21; p <0,001) y con la frecuencia cardiaca (FC) (r = -0,225; p <0,001). CONCLUSIONES: las alteraciones cardiacas fueron más prevalentes en pacientes con ANR. La bradicardia, los trastornos de la repolarización ventricular y la disminución de la masa cardiaca fueron los más frecuentemente identificados


INTRODUCTION: the aim of the study was to describe the electrocardiographic and echocardiographic findings in female adolescents with anorexia nervosa and to assess their correlation with clinical variables. PATIENTS AND METHODS: we conducted a retrospective observational case-control study. The analysis included 98 female adolescents admitted to a tertiary hospital due to anorexia nervosa over the last 15 years, all of who underwent an electrocardiographic and echocardiographic evaluation. RESULTS: the mean age was similar in both groups: 14.6 ± 2.0 years in cases vs. 14.7 ± 2.0 years in controls. Patients with anorexia had significantly lower heart rates (57 ± 12 vs. 72 ± 13 bpm), a smaller R-wave in V5 (1.1 ± 0.5 vs 1.6 ± 0.4 mV) and a lesser left ventricular mass (65.7 ± 14.8 vs 90 ± 15.3 g/m2) compared to controls. We found no differences in the QTc interval. In patients with anorexia, the presence of bradycardia was not correlated to weight (r = -0.20, p = 0.05) or body mass index (r = 0.02, p = 0.22) at admission. We found that the left ventricular mass was significantly correlated to the body mass index (r = 0.21, p <0.001,) and the heart rate (r = -0.225, p <0.001). CONCLUSIONS: cardiac abnormalities were more prevalent in patients with anorexia nervosa. Bradycardia, changes in ventricular repolarization, and a lesser left ventricular mass were the most frequent abnormalities in our sample


Assuntos
Humanos , Feminino , Adolescente , Anorexia Nervosa/complicações , Eletrocardiografia/estatística & dados numéricos , Ecocardiografia/estatística & dados numéricos , Bradicardia/epidemiologia , Disfunção Ventricular Esquerda/epidemiologia , Anorexia Nervosa/epidemiologia , Estudos Retrospectivos , Estudos de Casos e Controles , Pesos e Medidas Corporais/estatística & dados numéricos
10.
J Cardiovasc Electrophysiol ; 31(2): 432-439, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31917489

RESUMO

BACKGROUND: Anorexia nervosa (AN) is associated with autonomic dysfunction and carries a high risk of sudden death, putatively attributed to ventricular tachyarrhythmias. To date, long-term cardiac monitoring has not been performed to confirm this speculation. METHODS AND RESULTS: We assessed the safety and acceptability of an insertable cardiac monitor (ICM) in patients with severe AN with markedly reduced body mass index (BMI), and investigated heart rate (HR) and rhythm before and after weight restoration. Autonomic function was assessed as HR response to a standardized activity protocol at baseline and four additional visits over 360 days. The Florida Patient Acceptance Survey (FPAS) was used to measure ICM acceptability. During a mean follow-up of 10 months, no ICM-related complications occurred and ICM was well-accepted by the 11 study participants (nine women, aged 19-59 years, baseline BMI = 12.7 ± 1.6 kg/m2 ). Both resting and peak HR increased with weight restoration and were directly associated with BMI (both P < .001). No ventricular tachyarrhythmias occurred during the study period, but two participants (18%) experienced eight sinus pauses (3.0-7.0 seconds) and three runs of supraventricular tachycardia. CONCLUSIONS: Long-term cardiac rhythm monitoring with an ICM is feasible, safe, and acceptable in patients with severe AN. Autonomic dysfunction in AN results in not only profound resting bradycardia, but also some degree of chronotropic incompetence, both of which improve with weight restoration. Clinically significant bradyarrhythmias are more common than ventricular tachyarrhythmias in AN, and may represent a competing underlying mechanism for the high risk of sudden death in this population.


Assuntos
Anorexia Nervosa/complicações , Arritmias Cardíacas/diagnóstico , Sistema Nervoso Autônomo/fisiopatologia , Frequência Cardíaca , Coração/inervação , Telemetria , Potenciais de Ação , Adulto , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/fisiopatologia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Composição Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Telemetria/instrumentação , Fatores de Tempo , Adulto Jovem
11.
Eur Eat Disord Rev ; 28(2): 122-140, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31845471

RESUMO

OBJECTIVE: A growing body of empirical literature indicates altered taste perception in individuals with anorexia nervosa (AN). However, it remains unknown whether the observed impairments in the neural processing of taste stimuli represent etiopathogenetic factors of AN or whether they are a secondary consequence of malnutrition. METHOD: In the current systematic review, scientific studies were identified using the MEDLINE, PsycINFO, and Scopus databases. A supplemental search was performed by searches through reference lists of the relevant publications and via Google Scholar. RESULTS: On the basis of the searches conducted, 16 publications were identified and included in this literature review. The results of those studies point to disturbances in the structure and functioning of brain regions involved in taste processing in AN. CONCLUSIONS: The findings of the reviewed studies suggest that altered reward, interoceptive, and cognitive-emotional processing may contribute to abnormal taste processing in AN.


Assuntos
Anorexia Nervosa/complicações , Encéfalo/fisiopatologia , Disgeusia/fisiopatologia , Paladar/fisiologia , Adulto , Anorexia Nervosa/psicologia , Feminino , Humanos , Adulto Jovem
12.
Clin Child Psychol Psychiatry ; 25(1): 33-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30764636

RESUMO

OBJECTIVE: To assess the outcome of adolescents with anorexia nervosa (AN) about 20 years after first treatment. METHODS: Sixty-two women diagnosed with AN during adolescence were invited to participate. Of these 62 patients, 38 agreed to participate and were assessed with a battery of questionnaires and interviews. A control group of 30 women of similar age was also assessed. RESULTS: Of the patients who completed the full assessment, 13 (34%) presented some degree of eating disorder (ED) at follow-up (10 (26%) met full Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for an ED and 3 (8%) showed partial remission of an ED). The remaining 25 (66%) patients had fully recovered from AN. The duration of untreated illness before admission was significantly associated with an increased risk of a current ED (odds ratio (OR) = 3.334 (1.3-8.7); p = .014). Of the patients who had recovered totally from their ED, 24% showed another psychiatric disorder. This percentage rose to 70% in patients with a current ED. CONCLUSION: Sixty-six percent of adolescents who completed the assessment achieved remission of their AN. Comorbidity was more common in the current ED group. The variable that best predicted complete remission was the number of years without treatment, showing the importance of detection and early intervention.


Assuntos
Anorexia Nervosa/terapia , Transtornos de Ansiedade/complicações , Transtorno Depressivo/complicações , Adolescente , Adulto , Idade de Início , Anorexia Nervosa/complicações , Anorexia Nervosa/psicologia , Feminino , Seguimentos , Humanos , Inquéritos e Questionários , Adulto Jovem
13.
J Abnorm Psychol ; 128(8): 806-812, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31657595

RESUMO

Individuals with anorexia nervosa (AN) often present inflexible behaviors and rigid thinking styles, which may contribute to disorder maintenance. Studies of set shifting have documented impairments in AN, but results have varied across samples. Moreover, the hypothesis that deficient set shifting may constitute an endophenotype rests largely on observations made with neuropsychological tests with limited ability to isolate component cognitive control processes. The current behavioral study used a task switching paradigm with a demonstrated ability to fractionate the hierarchical organization underlying task- and response-set shifting in 22 weight-recovered women with a history of AN (recAN) relative to 22 age-matched healthy controls. Whereas recAN performed generally more accurately than healthy controls, they also responded more slowly. Despite slower performance, however, recAN error rates did not exhibit the characteristic improvement in task switching on trials with a concurrent response switch-an interaction thought to index efficient action sequencing and the hierarchical control of behavior. These results were not mediated by comorbid symptoms, but no relationships with clinical measures were detected. Inefficient set shifting in AN may be related to a general tendency to sustain a high level of cognitive control (as evident here in a robust speed-accuracy trade-off), which interferes with context-sensitive regulation of processing priorities (as evident here in an atypical interaction between task and response switching). Although scarring effects cannot be excluded and the generalizability of our findings needs to be tested, the current observations in recAN provide novel evidence that altered set shifting may be a trait marker of the disorder. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Anorexia Nervosa/complicações , Anorexia Nervosa/psicologia , Transtornos Cognitivos/complicações , Transtornos Cognitivos/psicologia , Adolescente , Adulto , Feminino , Humanos , Testes Neuropsicológicos/estatística & dados numéricos , Adulto Jovem
14.
Praxis (Bern 1994) ; 108(14): 899-904, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31662110

RESUMO

Endocrine Consequences of Anorexia Nervosa Abstract. Anorexia nervosa is a perilous disease of unknown etiology that causes a variety of endocrine effects. Characteristic for anorexia nervosa are a reduced food intake and thus significant underweight, as well as the fear of gaining weight. Often sufferers also have a distorted self-perception, the urge to move and amenorrhea. AN is difficult to treat and often has a chronic course, and is associated with an increased mortality risk. The endocrinological changes occur in several endocrine axes, their extent is related to the degree of malnutrition. Low leptin levels, due to the underweight, signal a potentially dangerous lack of energy to the brain. There is a cascade of neuroendocrine adaptive responses to help the organism to survive. The effects of starvation are extensive, affecting the pituitary gland, thyroid gland, as well as the adrenal glands, gonads and bones. In positive cases, most dysfunctions are reversible; the compromised bone stability recovers only slowly.


Assuntos
Anorexia Nervosa , Doenças do Sistema Endócrino , Hipófise , Glândula Tireoide , Anorexia Nervosa/complicações , Doenças do Sistema Endócrino/etiologia , Feminino , Humanos , Leptina , Hipófise/fisiopatologia , Glândula Tireoide/fisiopatologia
15.
Nursing ; 49(10): 24-30, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31568077

RESUMO

Anorexia nervosa (AN) is an eating disorder that is difficult to treat, and relapse is common. This article addresses management strategies and nursing interventions for adolescents diagnosed with AN.


Assuntos
Anorexia Nervosa/enfermagem , Adolescente , Anorexia Nervosa/complicações , Anorexia Nervosa/epidemiologia , Anorexia Nervosa/fisiopatologia , Comorbidade , Humanos , Transtornos Mentais/epidemiologia , Diagnóstico de Enfermagem , Fatores de Risco
16.
Eat Disord ; 27(5): 471-481, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31524091

RESUMO

Osteoporosis is a common and very serious complication of anorexia nervosa. It affects these patients, both males and females, at very young ages. This loss of bone mineral density begins quickly, soon after the onset of the eating disorder. It is one of the rare medical complications of anorexia nervosa which may result in irreparable harm, even if there is successful nutritional rehabilitation and weight restoration. Nevertheless, notwithstanding its high importance, there is a paucity of evidence-based medicine to guide the optimal approach to diagnosis, prevention, and treatment. This paper attempts to inform clinicians taking care of these patients about a reasonable and measured approach to this problem, while the field awaits more definitive medical literature.


Assuntos
Anorexia Nervosa/complicações , Densidade Óssea/fisiologia , Educação Continuada , Osteoporose/terapia , Adolescente , Adulto , Fatores Etários , Anorexia Nervosa/terapia , Feminino , Humanos , Masculino
17.
Psychiatr Danub ; 31(Suppl 3): 497-502, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488779

RESUMO

BACKGROUND: A link between abnormalities in circadian rhythms and the development of eating disorders was extensively hypothesized, mainly in consideration of the influence of the circadian clock on eating behavior. The present review is aimed at summarizing the evidence about biological rhythms disruptions in eating disorders, possibly clarifying their impact on the psychopathological profile of such patients. METHODS: Electronic database MEDLINE/PubMed/Index Medicus was systematically searched for original articles examining the prevalence of circadian rhythms disruptions in eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder). RESULTS: Studies included in the review confirmed the hypothesis of a high prevalence of circadian disruptions in eating disorders. The analyzed research mainly focused on sleep-wake cycle, rest-activity abnormalities and hormonal secretion, whilst literature about other circadian rhythms was scanty. Altered biological rhythms presented higher association with specific psychopathological features, but such relationship was assessed in few studies. CONCLUSIONS: Circadian rhythms disruptions were confirmed to be relevant aspects in the context of eating disorders. Further research is needed in order to clarify the role of biological rhythms in such illnesses, in the attempt to address adjunctive treatment strategies with the possible focus of circadian abnormalities.


Assuntos
Transtornos Cronobiológicos/complicações , Transtornos Cronobiológicos/fisiopatologia , Ritmo Circadiano , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Anorexia Nervosa/complicações , Anorexia Nervosa/fisiopatologia , Transtorno da Compulsão Alimentar/complicações , Transtorno da Compulsão Alimentar/fisiopatologia , Bulimia Nervosa/complicações , Bulimia Nervosa/fisiopatologia , Humanos , Psicopatologia
18.
BMJ Case Rep ; 12(9)2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31558490

RESUMO

We report the case of a patient with anorexia nervosa accompanied by acute subdural haematoma following a fall. A 34-year-old Japanese woman had serious medical complications and brain atrophy. After careful nutritional treatment, her laboratory test results improved and brain atrophy was reversed, and we prevented to perform surgery. However, unexpected prominent oedema of her lower legs and pleural effusion occurred. After receiving treatment for these symptoms, she eventually returned to her former occupation and started following a normal diet. Very few cases of anorexia nervosa accompanied by intracranial haemorrhage have been reported. Coagulation disorder and brain atrophy are supposed to be the primary causes of haematoma formation in the present case. Intracranial haemorrhage likely occurs in patients with anorexia nervosa despite minor head trauma. Because anorexia nervosa is not rare and the age of such patients is advancing, knowledge regarding this disorder would be useful for neurosurgeons.


Assuntos
Anorexia Nervosa/complicações , Anorexia Nervosa/dietoterapia , Hematoma Subdural Agudo/etiologia , Adulto , Feminino , Hematoma Subdural Agudo/diagnóstico por imagem , Humanos , Tomógrafos Computadorizados
20.
Medicine (Baltimore) ; 98(29): e16499, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335717

RESUMO

RATIONALE: Anorexia nervosa is a chronic psychiatric disease defined by severe weight loss, due to fear of obesity, and self-imposed semi-starvation. Of the many complications following anorexia nervosa, low bone mineral density (BMD) is a significant risk factor for fractures. Anorexia nervosa is associated with higher risk of incident fracture in females across all age groups, and in males >40 years old. Sites at highest risk of fracture include the hip/femur and pelvis in females, and vertebrae in males with anorexia nervosa. PATIENT CONCERNS: A 29-year-old woman known to have suffered from anorexia nervosa 15 years ago visited the emergency department due to right hip pain after falling while getting out of a taxi. During the period of anorexia nervosa, she had a body mass index (BMI) of 14.06 kg/m (weight, 36 kg; height, 1.60 m) and suffered from amenorrhea. At the time of presentation, she had a BMI of 19.53 kg/m (weight, 50 kg; height, 1.60 m) and had regular menstrual periods, indicating clinical recovery from anorexia nervosa. DIAGNOSES: Plain radiography, computed tomography, and bone scintigraphy revealed AO 31-A2.2 type right hip proximal femur intertrochanteric fracture. The BMD showed a T score of -3.9 in the hip and -3.6 at the lumbar level, indicating severe osteoporosis. INTERVENTIONS: Osteosynthesis was performed with proximal femoral nail antirotation (PFNA) and wiring. OUTCOMES: There were no specific symptoms, such as trauma or infection, during postoperative rehabilitation and postoperative management, and she was discharged after 2 weeks. After 1 year of follow-up at our outpatient clinic, she had no complications. LESSONS: Here, we describe an unusual case of unilateral femoral intertrochanteric fracture that occurred after clinical recovery from anorexia nervosa. This case indicated that the risk of fracture remains even after recovery of BMI. We propose that women who have clinically recovered from anorexia nervosa should be advised to undergo annual osteodensitometric analyses after consulting with specialists in other areas (psychiatry, endocrinology, eating disorders).


Assuntos
Acidentes por Quedas , Anorexia Nervosa/complicações , Fraturas do Quadril/etiologia , Osteoporose/complicações , Adulto , Índice de Massa Corporal , Pinos Ortopédicos , Fios Ortopédicos , Feminino , Fixação Interna de Fraturas/métodos , Fraturas do Quadril/cirurgia , Humanos , Osteoporose/etiologia , Fatores de Tempo
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