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1.
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
2.
Medicine (Baltimore) ; 99(29): e20826, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702825

RESUMO

RATIONALE: The typical clinical presentations of patients with primary aldosteronism (PA) include generalized weakness, fatigue, high blood pressure, and potassium deficiency. However, normotensive PA is rare. Therefore, an atypical presentation of normal blood pressure is a challenge for the diagnosis and treatment of PA. PATIENT CONCERNS: A 43-year-old, thin, and tall woman (body mass index, 18.6 kg/m) with generalized weakness for 1 day presented to our emergency department, where hypokalemia was a significant finding. The initial diagnosis was anorexia nervosa with the evidence of renal potassium wasting with low urinary sodium and chloride levels, metabolic alkalosis, normal blood pressure, and low body mass index. However, neither vomiting features nor other specific induced vomiting features were noted. DIAGNOSES: The laboratory examination revealed high plasma aldosterone level, low plasma renin activity, and extremely high aldosterone-to-renin ratio indicating the diagnosis of PA, confirmed via adrenal computed tomography. INTERVENTIONS: Surgical adrenalectomy was performed. Pathological diagnosis was a benign cortical adenoma. OUTCOMES: Patient's serum potassium level and hormonal status became normalized after surgical removal of adrenal adenoma. She fully recovered without any further sequelae. LESSONS: It is too early to rule out PA based on the presence of normal blood pressure in a patient with metabolic alkalosis and renal wasting hypokalemia. Moreover, PA should be considered in a normotensive patient with an unknown hypokalemic etiology to avoid delayed diagnosis and treatment.


Assuntos
Anorexia Nervosa/diagnóstico , Hiperaldosteronismo/diagnóstico por imagem , Hipopotassemia/diagnóstico , Adenoma/cirurgia , Adrenalectomia/métodos , Adulto , Aldosterona/sangue , Alcalose/etiologia , Anorexia Nervosa/psicologia , Pressão Sanguínea/fisiologia , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/patologia , Hiperaldosteronismo/cirurgia , Hipopotassemia/etiologia , Debilidade Muscular/etiologia , Renina/sangue , Sódio/urina , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
PLoS One ; 15(3): e0229742, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32126134

RESUMO

This study examined whether adolescents with anorexia nervosa (AN) are more sensitive to punishment and less sensitive to reward than a non-eating disorder comparison group. Both self-report and performance measures were used to index reward and punishment sensitivity. Participants were adolescents with AN (n = 69) and an individually matched comparison group with healthy weight (n = 69). They completed the Behavioral Inhibition Scale/Behavioral Activation Scale and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire to index self-reported reward and punishment sensitivity, and performed the Spatial Orientation Task to index attention to cues signaling reward and punishment. There was extremely strong evidence (BF10 > 100), that adolescents with AN reported higher sensitivity to punishment than adolescents without an eating disorder. However, adolescents with AN did not differ from the comparison group on self-reported reward sensitivity, and attention to cues signaling reward or punishment. Adolescents with AN clearly show heightened punishment sensitivity, yet this was not paralleled by a heightened proneness to detect signals of punishment. An important next step would be to examine whether punishment sensitivity is a reliable risk factor for the development or maintenance of AN.


Assuntos
Comportamento do Adolescente/psicologia , Anorexia Nervosa/psicologia , Sinais (Psicologia) , Punição/psicologia , Recompensa , Adolescente , Atenção , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Psicometria/estatística & dados numéricos , Fatores de Risco , Autorrelato/estatística & dados numéricos , Adulto Jovem
5.
Medicine (Baltimore) ; 99(9): e19300, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118747

RESUMO

To characterize the fractional amplitude of low-frequency fluctuation (fALFF) in drug-naïve first-episode female patients with anorexia nervosa (AN) using resting-state functional magnetic resonance imaging (rs-fMRI).Whole brain rs-fMRI data were collected from 7 drug-naïve first-episode female patients with DSM-5 AN and 14 age-matched healthy female controls. fALFF values were calculated and compared between the two groups using a two-sample t test. Correlation analysis between the fALFF values in the entire brain and body mass index (BMI) was performed.Compared with the healthy controls, increased fALFF values were observed in the AN patients in their right hippocampus and left superior frontal gyrus, while decreased fALFF values were observed in their left rectus and left middle occipital gyrus. Moreover, low BMI was significantly associated with decreased fALFF in the left inferior frontal gyrus but increased fALFF in the left calcarine. In particular, the z-standardized fALFF (zfALFF) value of the left rectus was positive associated with BMI.Our findings suggest that spontaneous brain activity in the frontal region, hippocampus and rectus, characterized by fALFF values, was altered in drug-naïve, first-episode female patients with AN.


Assuntos
Anorexia Nervosa/tratamento farmacológico , Imagem por Ressonância Magnética/normas , Adolescente , Adulto , Anorexia Nervosa/fisiopatologia , Anorexia Nervosa/psicologia , China , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/estatística & dados numéricos , Lobo Occipital/anormalidades , Lobo Occipital/anatomia & histologia , Córtex Pré-Frontal/anormalidades , Córtex Pré-Frontal/anatomia & histologia
6.
Nervenarzt ; 91(5): 411-416, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32076755

RESUMO

Even with guideline-conform treatment in specialized outpatient clinics and intensive treatment programs, some patients suffering from severe and enduring anorexia nervosa do not achieve a satisfying level of mental health and quality of life. As this patient group is associated with a high mortality, a palliative stage of anorexia nervosa is postulated. In these cases, treatment decisions should factor in not only a prolongation of life but also quality of life, especially when compulsory treatment is considered. In doubtful cases, a palliative care physician and the clinical ethics committee should be consulted.


Assuntos
Anorexia Nervosa , Cuidados Paliativos , Anorexia Nervosa/psicologia , Anorexia Nervosa/terapia , Humanos , Cuidados Paliativos/ética , Qualidade de Vida , Encaminhamento e Consulta
7.
Psychiatry Res ; 284: 112768, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31931274

RESUMO

Anorexia nervosa (AN) is a multifactorial illness. Although several studies have determined which factors could predispose AN, few studies have determined which factors could precipitate it. What is more, it has been suggested that having experienced stressful life events (SLE) could be related to the onset of AN. The aim of this study was to explore specific psychosocial and familial correlates and the impact of SLE in the onset of AN. Following a case-control design, 40 adolescents diagnosed with AN were matched to three control groups, 40 healthy adolescents, 40 adolescents with affective disorders, 40 adolescents with asthma and their families by sex, age and socioeconomic status. Diagnostic interviews K-DSADS and questionnaires were used. The results empathised that no specific predisposing correlates were found for AN. Similarly, the increase of the amount of SLE prior to the onset is an overall characteristic for psychiatric disorders, which in AN it is only specifically related to psychological correlates, but no to cortisol. In terms of specific SLE, those related to interpersonal problems were frequent at the onset of AN. The results highlight the consequences of SLEs in the emotional well-being of the AN adolescents, that could be specific for this psychopathology.


Assuntos
Anorexia Nervosa/psicologia , Relações Familiares/psicologia , Relações Interpessoais , Acontecimentos que Mudam a Vida , Estresse Psicológico/psicologia , Adolescente , Adulto , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/epidemiologia , Estudos de Casos e Controles , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Inquéritos e Questionários
8.
Int J Eat Disord ; 53(1): 3-19, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31506978

RESUMO

OBJECTIVE: To critically appraise papers reporting on moderators and mediators of recommended psychological treatments for anorexia nervosa (AN) and bulimia nervosa (BN) in adolescents. METHOD: A systematic search of databases was conducted including PsycINFO, Embase, MEDLINE, AMED, CINAHL, and the Cochrane Library. Studies were included where a randomized controlled trial (RCT) compared therapies for AN or BN and reported on moderators or mediators of treatment effect. Twenty-one eligible papers were included, all based on data from eight RCTs. RESULTS: Family therapies were dominant in the literature. Individual or separated treatment appeared superior for families with more difficult relationships, whereas conjoint family treatment appeared to be superior where good family relationships were reported. Where there was greater eating disorder psychopathology in AN, including eating disorder-related obsessions and compulsions, the response was better to a family approach than to individual therapies. There was some evidence that a family treatment was superior for those engaging in purging behaviors in BN. Measures of family relationships, parental self-efficacy, and early change emerged as possible mediators; however, the quality of evidence was mixed and the findings, in some cases, arguably circular. Moderator and mediator analyses were underpowered in all studies, with multiple, and post-hoc, analyses being run, and a broad range of outcome measures used. DISCUSSION: This review recommends that emerging findings are explored further in adequately powered trials of the different recommended therapies, with a move toward focusing on effect sizes. A consensus on acceptable definitions of outcome, including remission and recovery, would benefit future research.


Assuntos
Anorexia Nervosa/terapia , Bulimia Nervosa/terapia , Psicoterapia/métodos , Adolescente , Anorexia Nervosa/psicologia , Bulimia Nervosa/psicologia , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
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
10.
Clin Child Psychol Psychiatry ; 25(1): 5-15, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31328537

RESUMO

Parents are often the first to detect the initial signs of anorexia nervosa (AN) and take necessary measures to ensure that their children receive appropriate treatment. The evaluation of AN in adolescence is complicated by taking into account the tendency to minimize and deny the symptoms by adolescents, and the difficulty of parents in detecting the main symptoms. We compared the adolescent and parent scores on measures of disordered eating at initial presentation. The sample consisted of 62 adolescents diagnosed with AN, who attended an eating disorder children's unit. Adolescents completed the Eating Attitudes Test (EAT-40) and their parents the Anorectic Behavior Observation Scale (ABOS). The questionnaire data were collected as part of the routine clinical practice and were obtained from clinical notes. The findings indicate no significant correlations between the EAT-40 and ABOS scores, or between AN subtypes according to parent observation of symptoms. There were significant differences between parents, with mothers reporting higher scores than fathers. This study highlights the importance of psychoeducation for parents on the early signs of AN, in order to improve recognition and diagnosis at initial assessment of their adolescent children in the early phases.


Assuntos
Anorexia Nervosa/psicologia , Comportamento Alimentar/psicologia , Pais/psicologia , Adolescente , Atitude , Feminino , Humanos , Masculino , Relações Pais-Filho , Inquéritos e Questionários
11.
Clin Child Psychol Psychiatry ; 25(1): 16-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31648525

RESUMO

BACKGROUND: Therapeutic alliance is one of the most important aspects of treatment of adolescents with anorexia nervosa. Little is known about the facilitators and obstacles of its process in this situation. We aimed to explore the experience of therapeutic alliance in inpatient treatment among adolescents with anorexia nervosa, their parents and their psychiatrists. METHODS: This qualitative study, using semi-structured interviews, took place in France. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. RESULTS: Forty-one participants were included, 15 teenaged girls, 18 parents and 8 psychiatrists. Analysis showed two themes: (1) what facilitates an alliance in treatment - with four facilitators: (a) human qualities, (b) an active role in the treatment, (c) taking time and (d) taking care of the entire family and (2) what impedes an alliance in treatment with four obstacles: (a) being too close or too distant, (b) focusing on weight, (c) control and constraints and (d) psychiatrization. CONCLUSION: Collaborative work between paediatricians and psychiatrists could facilitate therapeutic alliance with parents. Definition of therapeutic alliance in this situation should be enlarged to include the adolescent-parent relationship. It is necessary to construct specific items to integrate these specific aspects to existing scales.


Assuntos
Anorexia Nervosa/terapia , Terapia Familiar , Relações Pais-Filho , Psiquiatria , Aliança Terapêutica , Adolescente , Adulto , Anorexia Nervosa/psicologia , Feminino , Humanos , Masculino , Pesquisa Qualitativa
12.
BMC Psychol ; 7(1): 72, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727151

RESUMO

BACKGROUND: For some young persons diagnosed with anorexia nervosa, treatment will inevitably involve phases where hospitalization is required. Inspired by the encouraging evidence-base for outpatient family-based treatment for adolescent anorexia nervosa, clinicians and program developers have started to incorporate outpatient family-based treatment principles into higher levels of care. During family-based inpatient treatment, collaborative efforts are largely directed toward the parents of the adolescent. Consequently, the therapeutic focus on the young person is more of an indirect one. With this study we aimed to understand how young persons with lived experience from a family-based inpatient treatment setting, where the adolescents were admitted together with their parents, viewed therapeutic aspects related to staff-patient collaboration and staff-related behaviors. METHODS: Thirty-seven semi-structured interviews of former adolescent inpatients were conducted. Participants' post-treatment reflections were inductively analyzed by applying a thematic analytic framework. RESULTS: Based upon user perspectives from a treatment setting highly influenced by a family therapeutic approach, findings revealed that former inpatients prefer tailored treatment and a collaborative approach. Eight subthemes constituting two main themes emerged: 1) There are no ready-made solutions. Staff should facilitate collaboration by tailoring treatment toward the young person's perspectives, and 2) Emphasizing skills that matter. Staff should display a non-judgmental stance, educate patients, stimulate motivation, enable activities and prevent iatrogenic effects during the stay. CONCLUSIONS: This study adds valuable user perspectives to the ongoing work with adapting family-based frameworks into higher levels of care. Clinicians could benefit from viewing their practice from the standpoint of the young person's post-treatment reflections. From their unique perspectives as having lived experience and hence, "insider knowledge" with a specific treatment situation, clinicians are reminded of the importance of being mindful on the young persons' views.


Assuntos
Anorexia Nervosa/terapia , Atenção Plena , Relações Profissional-Paciente , Autocontrole/psicologia , Adolescente , Adulto , Anorexia Nervosa/psicologia , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Motivação , Pesquisa Qualitativa , Comportamento Social
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.
Presse Med ; 48(10): 1065-1071, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31653538

RESUMO

Othorexia Nevrosa is defined as an obsessive though regarding healthy food consumption, food properties and cooking tools. Orthorexia Nevrosa is not mentioned in the psychiatric nosography and is not considered as a disorder. While no formal diagnostic criteria currently exist, screening tools have been developed to explore characteristics of Orthorexia Nevrosa. While Orthorexia Nevrosa has specific characteristics, an overlapping exists with Eating Disorders (ED) and Obsessive Compulsive Disorder (OCD) symptoms.


Assuntos
Utensílios de Alimentação e Culinária , Comportamento Alimentar/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Ingredientes de Alimentos/análise , Transtorno Obsessivo-Compulsivo/psicologia , Anorexia Nervosa/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/prevenção & controle , Manipulação de Alimentos , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/prevenção & controle , Fatores de Risco
15.
Int J Eat Disord ; 52(11): 1316-1321, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31584714

RESUMO

OBJECTIVE: Models of anorexia nervosa (AN) posit that set-shifting deficits may contribute to behavioral inflexibility and extreme dietary restriction. Findings from neurocognitive studies of set-shifting in AN have been somewhat mixed, perhaps due to the use of tasks that cannot distinguish shifting from other processes (i.e., learning). To more precisely characterize cognitive flexibility and selectively assess this process independent of rule learning and feedback sensitivity, we examined task-switching ability in AN. METHOD: Women ill with AN, subthreshold AN or atypical AN (IAN; n = 40), women remitted from AN (RAN; n = 24), and age-matched healthy control women (n = 42) completed a computerized cued color-shape task-switching paradigm. Groups were compared on mix costs (reflecting global cognitive control) and switch costs (reflecting transient cognitive control). RESULTS: Although mix costs were equivalent across groups, switch costs were more pronounced in the IAN group, as indicated by a group-by-trial type interaction for reaction times on stay and switch trials. DISCUSSION: Findings indicate that IAN, but not RAN, have difficulty flexibly switching between cognitive task sets, and suggest that prior findings of set-shifting deficits in AN may reflect difficulty with cognitive flexibility independent of learning deficits. As such, task-switching may represent a promising adjunctive treatment target.


Assuntos
Anorexia Nervosa/psicologia , Função Executiva/fisiologia , Testes Neuropsicológicos/normas , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
16.
Int J Eat Disord ; 52(11): 1229-1236, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31486125

RESUMO

OBJECTIVE: This study examined the distinctiveness of specific constructs of body-image disturbance in patients with anorexia nervosa (AN) and bulimia nervosa (BN). We compared weight/shape dissatisfaction, weight/shape overvaluation, weight/shape preoccupation, and fear of weight gain in patients with AN and BN and examined how each specific body-image construct relates to clinical measures within and between AN and BN. METHOD: A clinical sample of 490 treatment-seeking patients diagnosed with DSM-5 AN (N = 310) or BN (N = 180) by clinicians using structured interviews in Portugal completed the Eating Disorder Examination-Questionnaire to assess body image and eating-disorder (ED) psychopathology. RESULTS: Both within and between AN and BN, the four body-image constructs varied in their strengths of association among themselves, with ED psychopathology, and body mass index (BMI). Analyses revealed considerable variability in variance accounted for in clinical measures by body-image constructs. Body-image constructs predicted significant, albeit small, variance in BMI within BN (dissatisfaction, preoccupation significant) but not within AN. Body-image constructs predicted significant, albeit small, variance in the frequencies of binge eating and purging in AN (with preoccupation significant for both and fear for purging) but not within BN. Body-image constructs predicted significant variance in ED psychopathology (large amounts of variance for Eating Concern and Restraint) within both AN and BN (with overvaluation, preoccupation, and fear significant). CONCLUSION: Clinical manifestations of body-image disturbances are complex and show important differences across AN and BN. Understanding distinctions and differential salience of different body-image constructs across different EDs can inform refinement of specific case conceptualization.


Assuntos
Anorexia Nervosa/psicologia , Imagem Corporal/psicologia , Bulimia Nervosa/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Anorexia Nervosa/diagnóstico , Bulimia Nervosa/diagnóstico , Humanos
17.
Eat Weight Disord ; 24(5): 825-834, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31473987

RESUMO

PURPOSE: Emotional functions may play an important role in anorexia nervosa (AN). The onset of the disorder generally occurs during adolescence, which is a critical period of emotional development. However, most studies that evaluated emotional functions in AN were conducted in adult patients. The aim of this study was to evaluate emotion regulation, emotion recognition, and empathy skills in adolescent girls with AN by controlling for the effects of depression and anxiety symptoms, childhood traumatic experiences, and attachment security on emotional functions. METHODS: Thirty-two adolescent girls with AN and 32 healthy counterparts completed the Difficulties in Emotion Regulation Scale, the Reading the Mind in the Eyes Test, Toronto Alexithymia Scale-20, and the Child and Adolescent KA-SI Empathic Tendency Scale-Adolescent Form. RESULTS: The results revealed that adolescents with AN were found to have more difficulties in emotion regulation, higher alexithymic tendencies, and lower empathy skills compared with the control group. However, emotion recognition was not found to be significantly different between the two groups. These results were the same when controlling for the effects of depression and anxiety symptoms, childhood traumatic experiences, and attachment security except for empathy skills. Alexithymia and depressive symptoms were significantly related to emotion regulation difficulties in adolescents with AN. CONCLUSIONS: Considering the results, it seems that emotion regulation and alexithymia may play a crucial role in the development and maintenance of AN. Accordingly, it is necessary to focus on the improvement of these skills during the treatment of AN. Furthermore, interventions promoting these skills during adolescence may be preventive. LEVEL OF EVIDENCE: Level III, case-control study.


Assuntos
Anorexia Nervosa/psicologia , Regulação Emocional/fisiologia , Emoções/fisiologia , Empatia/fisiologia , Reconhecimento Facial/fisiologia , Adolescente , Ansiedade/psicologia , Estudos de Casos e Controles , Criança , Depressão/psicologia , Expressão Facial , Feminino , Humanos , Percepção Social , Inquéritos e Questionários , Teoria da Mente/fisiologia
19.
Nutrients ; 11(9)2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31540208

RESUMO

Anorexia nervosa (AN) is a psychiatric disorder affected by psychological, environmental, and biological factors. Individuals with AN avoid high-fat, high-calorie diets and have shown abnormal metabolism of fatty acids (FAs), which are essential for brain and cognitive/neuropsychiatric health. To clarify the relationship between FAs and AN, fasting and postprandial plasma FAs in AN patients and age-matched control women were analyzed via mass-spectrometry. Clinical phenotypes were assessed using Becker Anxiety Inventory and Becker Depression Inventory. AN patients and controls exhibited different FA signatures at both fasting and postprandial timepoints. Lauric acid, eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and alpha-linoleic acid (ALA) were higher in AN than in controls (lauric acid: 15,081.6 ± 14,970.2 vs. 8257.4 ± 4740.2 pmol/mL; ALA at fasting: 2217.7 ± 1587.6 vs. 1087.9 ± 821.2 pmol/mL; ALA at postprandial: 1830.9 ± 1115.6 vs. 1159.4 ± 664.7 pmol/mL. EPA: 33,788.3 ± 17,487.5 vs. 22,860.6 ± 12,642.4 pmol/mL; DPA: 32,664.8 ± 16,215.0 vs. 20,969.0 ± 12,350.0 pmol/mL. FDR-adjusted p-values < 0.05). Food intake and AN status modified the correlations of FAs with body mass index (BMI), depression, and anxiety. Desaturases SCD-18 and D6D showed lower activities in AN compared to controls. Altered FA signature, specifically correlations between elevated n-3 FAs and worsened symptoms, illustrate metabolic underpinnings in AN. Future studies should investigate the mechanisms by which FA dysregulation, specifically elevated n-3 FAs, affects AN risk and outcome.


Assuntos
Anorexia Nervosa/sangue , Ingestão de Alimentos/fisiologia , Ácidos Graxos/sangue , Adulto , Anorexia Nervosa/psicologia , Ansiedade/sangue , Depressão/sangue , Ácido Eicosapentaenoico/sangue , Jejum , Ácidos Graxos Dessaturases , Elongases de Ácidos Graxos , Ácidos Graxos Ômega-3/sangue , Ácidos Graxos Ômega-6/sangue , Ácidos Graxos Insaturados/sangue , Feminino , Humanos , Período Pós-Prandial
20.
Psychiatry Res ; 281: 112561, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31521839

RESUMO

Clinical and cognitive factors associated with clinical insight regarding both baseline level and its time-related changes, in outpatients treated for anorexia nervosa. The 193 participants were recruited at 13 French centers specializing in eating disorders (FFAB network) and assessed for insight (SAI-ED), body mass index (BMI), eating disorder severity, symptoms of depression and anxiety, emotional state, silhouette, and functionality; two cognitive tests were also administered. The 137 patients were then re-assessed 18 weeks later. Minimum and ideal subjective BMI and premorbid intelligence were associated with poor baseline insight. Contrary to nearly all other clinical factors, the level of insight revealed no improvement after four months of care. Only the higher value of the minimum lifetime BMI was significantly predictive of increased insight. More positive emotions (PANAS), less symptoms of depression and anxiety (HADS scores), and fewer syndromes (HADS above threshold) were the only factors that covaried with the changes in the level of insight. In conclusion, poor insight has little time variability, contrary to nearly all clinical and cognitive factors. As increased insight is mainly accompanied by improvements in the emotional domain, the latter could represent potential targets for patients with lack of awareness about their eating disorder.


Assuntos
Anorexia Nervosa/psicologia , Índice de Massa Corporal , Cognição , Emoções , Adulto , Anorexia Nervosa/fisiopatologia , Anorexia Nervosa/terapia , Ansiedade/psicologia , Depressão/psicologia , Feminino , Humanos , Masculino , Pacientes Ambulatoriais/psicologia
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