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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
8.
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
9.
Eat Behav ; 34: 101298, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31176948

RESUMO

Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are highly comorbid. However, little research has examined which specific cognitive-behavioral aspects (e.g., checking, obsessing) of OCD are most relevant in those with AN. Furthermore, there is no research examining aspects of OCD in Atypical AN. The current two studies (N = 139 and N = 115 individuals diagnosed with AN/Atypical AN) examined a) which aspects of OCD were most related to AN symptomatology and b) if there were differences in OCD between individuals diagnosed with AN vs Atypical AN. We found that obsessing was most related to AN symptoms. We also found that there were no substantial significant differences between AN and Atypical AN. These findings add to the literature suggesting minimal differences between AN and Atypical AN, specifically regarding OCD symptomatology. These findings clarify that obsessions (rather than compulsions) may be the specific aspect of OCD most warranting treatment intervention in AN and Atypical AN.


Assuntos
Anorexia Nervosa/psicologia , Comportamento Obsessivo/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Adolescente , Adulto , Anorexia Nervosa/complicações , Anorexia Nervosa/diagnóstico , Comorbidade , Comportamento Compulsivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/complicações , Transtorno Obsessivo-Compulsivo/diagnóstico , Escalas de Graduação Psiquiátrica , Psicometria , Adulto Jovem
10.
JAMA Netw Open ; 2(6): e195313, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31173122

RESUMO

Importance: Anorexia nervosa is recognized as an important cause of morbidity in young people. However, the risk of cancer in people with anorexia nervosa remains uncertain. Objective: To evaluate the association of anorexia nervosa with the risk of developing or dying of cancer. Data Sources: MEDLINE, Scopus, Embase, and Web of Science from database inception to January 9, 2019. Study Selection: Published observational studies in humans examining the risk of cancer in people with anorexia nervosa compared with the general population or those without anorexia nervosa. Studies needed to report incidence or mortality rate ratios (RRs). Data Extraction and Synthesis: Screening, data extraction, and methodological quality assessment were performed by at least 2 researchers independently. A random-effects model was used to synthesize individual studies. Heterogeneity (I2) was assessed and 95% prediction intervals (PIs) were calculated. Main Outcomes and Measures: All cancer incidence and cancer mortality associated with anorexia nervosa. Secondary outcomes were site-specific cancer incidence and mortality. Results: Seven cohort studies published in 10 articles (42 602 participants with anorexia nervosa) were included. Anorexia nervosa was not associated with risk of developing any cancer (4 studies in women; RR, 0.97; 95% CI, 0.89-1.06; P = .53; I2, 0%; 95% PI, 0.80-1.18; moderate confidence). Anorexia nervosa was associated with decreased breast cancer incidence (5 studies in women; RR, 0.60; 95% CI, 0.50-0.80; P < .001; I2, 0%; 95% PI, 0.44-0.83; high confidence). Conversely, anorexia nervosa was associated with increased risk of developing lung cancer (3 studies in women; RR, 1.50; 95% CI, 1.06-2.12; P = .001; I2, 0%; 95% PI, 0.19-16.46; low confidence) and esophageal cancer (2 studies in women; RR, 6.10; 95% CI, 2.30-16.18; P < .001; I2, 0%; low confidence). Conclusions and Relevance: Among people with anorexia nervosa, risk of developing cancer did not differ compared with the general population, but a significantly reduced risk of breast cancer was observed. Understanding the mechanisms underlying these associations could have important preventive potential.


Assuntos
Anorexia Nervosa/complicações , Neoplasias/mortalidade , Adulto , Idoso , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/etiologia , Distribuição por Sexo , Adulto Jovem
11.
Int J Eat Disord ; 52(6): 752-756, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31038775

RESUMO

Anorexia nervosa (AN) has been associated with a multitude of hypothalamic pituitary abnormalities, although it is unknown which aberrations reflect disease causation and which are the consequences of severe malnutrition. Among these endocrinopathies, hypothalamic-posterior pituitary aberrations have been described, including disorders of osmoregulation. We report the case of an adolescent female with a history of severe AN, restricting subtype, treated aggressively with multiple hospitalizations. During hospitalization for severe weakness and lethargy, her course of medical stabilization was complicated by significant polyuria, ultimately diagnosed as central diabetes insipidus (DI). This is the first reported case, to our knowledge, of a severely malnourished adolescent with AN-restricting subtype developing central DI during the refeeding process for medical stabilization, thus adding to the small body of existing literature on disordered osmoregulation in this patient population. This case report raises the question as to whether the frequency of central DI during refeeding is greater than that previously recognized. Additional research should focus on how neuroendocrine dysregulation of water balance might impact the clinical course of AN and its treatment.


Assuntos
Anorexia Nervosa/complicações , Diabetes Insípido Neurogênico/diagnóstico , Adolescente , Feminino , Humanos
12.
Eat Weight Disord ; 24(5): 963-967, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31054131

RESUMO

PURPOSE: Premorbid obesity is an identified risk factor for eating disorder (ED) development among adolescent males. However, pervasive gender- and weight-related biases about ED inhibit timely diagnosis and treatment among this demographic. This study examined the psychological and medical characteristics of three adolescent males with premorbid obesity who were not diagnosed with atypical anorexia nervosa (AAN) until medical sequelae of malnutrition warranted emergent hospitalization. Factors associated with diagnostic delays among these cases were identified to facilitate increased awareness of this at-risk demographic. METHODS: Retrospective chart review was conducted on three adolescent males (aged 12-17) with AAN and premorbid obesity who were medically hospitalized for 13-24 days (M = 20.3, SD = 9.7). Demographic variables, psychological characteristics, and physical data were extracted. RESULTS: Each case presented at normal or overweight BMI status (M = 22.7 kg/m2, SD = 3.2) following a significant loss of weight ranging from 19 to 42% of total body mass (M = 31.7%, SD = 9.5) over 5-12 months (M = 8.3, SD = 2.9). Plausible factors associated with diagnostic delays included initial weight loss recommendations by a medical provider, with little support or oversight; limited insight that symptoms were problematic; social reinforcement of dieting behaviors; low prevalence of psychiatric comorbidity; parental obesity; and parental history of bariatric surgery. CONCLUSIONS: These cases elucidate the importance of close follow-up of youth with obesity who are encouraged to lose weight. Further education about AAN among males with premorbid obesity is crucial for timely diagnosis and intervention.


Assuntos
Anorexia Nervosa/complicações , Obesidade/complicações , Adolescente , Índice de Massa Corporal , Criança , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
13.
BMJ Case Rep ; 12(5)2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31129642

RESUMO

Non-occlusive mesenteric ischaemia (NOMI) is a life-threatening condition that requires emergent intervention and anorexia nervosa is a chronic eating disorder that requires careful medical and nutritional management. A 54-year-old woman with a history of anorexia nervosa and undergoing chronic haemodialysis developed abdominal pain and called an ambulance. On arrival, she was in shock and abdominal examination was consistent with diffuse peritonitis. Computed tomography scan suggested ischaemia from the distal ileum to the ascending colon. Emergency laparotomy revealed NOMI from the distal ileum to the transverse colon. The treatment strategy included staged operations and careful medical management to optimise nutritional support and electrolyte management with survival of the patient. NOMI and anorexia nervosa are both difficult to manage. Meticulous interdisciplinary management can result in a good outcome.


Assuntos
Colo/cirurgia , Íleo/cirurgia , Isquemia Mesentérica/cirurgia , Dor Abdominal/etiologia , Anorexia Nervosa/complicações , Anorexia Nervosa/terapia , Antibacterianos/uso terapêutico , Colo/patologia , Feminino , Humanos , Íleo/patologia , Isquemia Mesentérica/complicações , Isquemia Mesentérica/tratamento farmacológico , Pessoa de Meia-Idade , Apoio Nutricional
15.
Psychiatr Clin North Am ; 42(2): 263-274, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31046928

RESUMO

Anorexia nervosa and bulimia nervosa are mental illnesses with associated complications affecting all body systems with arguably the highest mortality of all mental health disorders. A comprehensive medical evaluation is an essential first step in the treatment of anorexia nervosa and bulimia nervosa. Weight restoration and cessation of purging behaviors are often essential components in the management of medical complications of these illnesses.


Assuntos
Anorexia Nervosa/complicações , Bulimia Nervosa/complicações , Anorexia Nervosa/mortalidade , Bulimia Nervosa/mortalidade , Humanos , Desnutrição , Perda de Peso
16.
Nutrients ; 11(4)2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30959831

RESUMO

INTRODUCTION: Anorexia nervosa (AN) is a complex psychiatric disorder, which can lead to specific somatic complications. Undernutrition is a major diagnostic criteria of AN and it can be associated with several micronutrients deficiencies. OBJECTIVES: This study aimed to determinate the prevalence of micronutrients deficiencies and to compare the differences between the two subtypes of AN (restricting type (AN-R) and binge-eating/purging type (AN-BP)). METHODS: We report a large retrospective, monocentric study of patients that were hospitalized in a highly specialized AN inpatient unit between January 2011 and August 2017 for severe malnutrition treatment in the context of anorexia nervosa. RESULTS: Three hundred and seventy-four patients were included, at inclusion, with a mean Body Mass Index (BMI) of 12.5 ± 1.7 kg/m². Zinc had the highest deficiency prevalence 64.3%, followed by vitamin D (54.2%), copper (37.1%), selenium (20.5%), vitamin B1 (15%), vitamin B12 (4.7%), and vitamin B9 (8.9%). Patients with AN-BP type had longer disease duration history, were older, and had a lower left ventricular ejection fraction (LVEF) (p < 0.001, p = 0.029, p = 0.009) when compared with AN-R type patients who, instead, had significantly higher Alanine Aminotransferase (ALT) and Brain Natriuretic Peptide (BNP) levels (p < 0.001, p < 0.021). In the AN-BP subgroup, as compared to AN-R, lower selenium (p < 0.001) and vitamin B12 plasma concentration (p < 0.036) was observed, whereas lower copper plasma concentration was observed in patients with AN-R type (p < 0.022). No significant differences were observed for zinc, vitamin B9, vitamin D, and vitamin B1 concentrations between the two types of AN patients. CONCLUSION: Severely malnourished AN patients have many micronutrient deficiencies. Micronutrients status must be monitored and supplemented to prevent deficiency related complications and to improve nutritional status. Prospective studies are needed to explore the symptoms and consequences of each deficiency, which can aggravate the prognosis during recovery.


Assuntos
Anorexia Nervosa/complicações , Desnutrição/complicações , Micronutrientes/deficiência , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
17.
Ugeskr Laeger ; 181(12)2019 Mar 18.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30931885

RESUMO

This is a case report of a 51-year-old woman with bilateral stress fractures of the pelvic rami and a history of anorexia nervosa (AN). AN is a psychiatric condition of low weight caused by restricted food intake, impaired body image and an exaggerated fear of gaining weight in addition to compensating behaviour such as excessive physical activity. Among patients with AN, reduced bone density is common, and a higher risk of fractures is present. Stress fractures should be suspected in patients, who have AN and experience pain from the musculoskeletal system without a history of trauma.


Assuntos
Anorexia Nervosa , Fraturas de Estresse , Anorexia Nervosa/complicações , Feminino , Fraturas de Estresse/etiologia , Humanos , Pessoa de Meia-Idade , Dor
18.
Nutrients ; 11(3)2019 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-30832404

RESUMO

Multiple studies on the dynamics of inflammatory cytokines in patients with anorexia nervosa (AN) have been published, although results are not consistent among reports. Thus the pathophysiologic roles of these cytokines are not clear. We performed an exploratory analysis that included (1) comparisons of plasma interleukin-18 (IL-18) concentrations between patients with AN (n = 21) and healthy controls (n = 39), and (2) correlations between body mass index (BMI) and IL-18 concentrations in both groups, exploring the relationship between malnourishment and IL-18. Plasma IL-18 levels were significantly decreased in patients with AN compared with controls. Plasma IL-18 levels correlated to BMI in controls, but not in patients with AN. These results suggest that a decline in plasma IL-18 levels in patients with AN is not only due to malnourishment, but other pathophysiologic changes as well. IL-18 has a role in the brain's reaction to sadness and chronic stress. Therefore, decreased levels of IL-18 may commonly occur in patients with chronic AN.


Assuntos
Anorexia Nervosa/sangue , Interleucina-18/sangue , Desnutrição/sangue , Adulto , Anorexia Nervosa/complicações , Anorexia Nervosa/fisiopatologia , Índice de Massa Corporal , Estudos de Casos e Controles , Citocinas/sangue , Feminino , Humanos , Japão , Desnutrição/psicologia , Adulto Jovem
19.
Eat Behav ; 33: 30-33, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30852343

RESUMO

PURPOSE: To examine the potential factor structure of the Eating Disorder Diagnostic Scale (EDDS) in a sample of individuals with bipolar disorder. METHOD: Exploratory common factor analyses were conducted in a sample of 1031 people with bipolar disorder as defined by the Structured Clinical Interview for DSM-IV-TR. RESULTS: Approximately 27% of participants had a comorbid eating disorder. Exploratory factor analysis yielded a 3 factor solution (i.e., shape/weight concerns; binge eating behaviors, compensatory behavior). CONCLUSIONS: The 3-factor solution of the EDDS in a bipolar disorder sample is consistent with major eating disorder symptom domains. Future research is necessary to replicate these findings in eating disorder samples with diverse comorbid psychopathology.


Assuntos
Anorexia Nervosa/psicologia , Transtorno da Compulsão Alimentar/psicologia , Transtorno Bipolar/psicologia , Bulimia Nervosa/psicologia , Comportamento Alimentar/psicologia , Adulto , Anorexia Nervosa/complicações , Anorexia Nervosa/epidemiologia , Transtorno da Compulsão Alimentar/complicações , Transtorno da Compulsão Alimentar/epidemiologia , Transtorno Bipolar/complicações , Bulimia Nervosa/complicações , Bulimia Nervosa/epidemiologia , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicopatologia
20.
Eat Weight Disord ; 24(5): 969-974, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30712218

RESUMO

PURPOSE: Anorexia nervosa is a chronic disease which may result in various complications. In pediatric clinical practice, it is common to observe complications related to progressive cachexia caused by malnutrition; however, cases of severe complications, like electrolyte disorders, which represent a direct threat to life, due to polydipsia, are rarely observed. The purpose of this study is to highlight that excessive drinking is of primary importance in anorexia nervosa patients, as it can result in severe medical complications, including increased risk of death. METHODS: We report the case of a 13-year-old girl with anorexia nervosa, who was referred to hospital with seizures, disorders of consciousness, and cardiorespiratory failure. RESULTS: The unstable condition of the patient was attributed to hyponatremia (119 mmol/l), decreased serum osmolality (248 mmol/kg), and decreased urine osmolality (95 mmol/kg) caused by polydipsia (water intoxication) and persistent vomiting. The presented girl was drinking large amounts of water prior to a weigh-in to falsify her low body weight. CONCLUSIONS: Polydipsia is a common problem reported by patients with eating disorders, but one which rarely leads to serious clinical complications, due to severe hyponatremia. This case underscores the importance of careful evaluation of fluid intake and the need for regular monitoring of serum electrolytes in patients with anorexia nervosa. All clinicians treating patients with such disease, as well as the parents of sick children, should be familiar with this life-threatening condition. LEVEL IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.


Assuntos
Anorexia Nervosa/complicações , Hiponatremia/etiologia , Polidipsia/complicações , Insuficiência Respiratória/etiologia , Convulsões/etiologia , Inconsciência/etiologia , Adolescente , Feminino , Humanos
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