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PubMed1991

Current perspectives on drug therapies for anorexia nervosa and bulimia nervosa.

Anorexia nervosa and bulimia nervosa are eating disorders that strike a significant number of adolescent and young adult women and carry a significant morbidity and mortality. Over the last 30 years, virtually every class of psychiatric drug as well as atypical agents have been tested in the management of these vexing and often chronic disorders. For anorexia nervosa, there is in 1991 little if any role for pharmacotherapy. Drugs used to promote food intake and weight gain, such as cyproheptadine, amitriptyline, clonidine and opiate antagonists, have provided disappointing results. For bulimia nervosa, double-blind placebo-controlled clinical trials have confirmed an antibulimic effect for tricyclic antidepressants, such as imipramine and desipramine. Monoamine oxidase inhibitors, while having a significant antibulimic effect, require careful adherence to a dietary regimen which may limit patient compliance. Newer antidepressants such as trazodone, amfebutamone and fluoxetine may prove useful if further study substantiates preliminary beneficial results. Other agents such as anticonvulsants, benzodiazepines, lithium, fenfluramine and opiate antagonists also require additional study, indicating that the optimal integration of pharmacotherapies with other treatments awaits further research.

Adolescent↗
PubMed2005

Depression, anxiety, and obsessionality in long-term recovered patients with adolescent-onset anorexia nervosa.

Anorexia nervosa (AN) is frequently associated with symptoms of depression, anxiety, and obsessive-compulsive behavior which also develop secondary to semistarvation. It is less certain if these symptoms persist after recovery. A few studies have already reported on high prevalence rates of anxious, depressive, and obsessive features in long-term recovered patients with AN, but several of these so called "long-term" recovered patients had only maintained weight restoration for six to twelve months. The aim of this study was to determine whether depressive, anxious, and obsessive-compulsive symptoms persist in truly long-term recovered patients (BMI 20.3+/-2.5 kg/m(2)) who no longer had any eating disorder symptoms (including weight phobia) for at least 3 years. Seventeen subjects of an AN sample (n=39) previously described in a 10-year follow-up met our strict criteria of at least 3 years of complete recovery of AN. In comparison to 39 age-, sex-, and occupation-matched healthy subjects without a history of psychiatric or eating disorder, long-term recovered patients had higher levels of depressive (p=0.002), anxious (p=0.006), and obsessive-compulsive (p=0.015) features but did not differ with regard to psychiatric morbidity and psychosocial adaptation. In conclusion, depressive, anxious, and obsessive-compulsive symptoms may be personality traits in subjects with former adolescent anorexia nervosa.

Adolescent↗
PubMed2004

Cytokine mRNA expression patterns in the disease course of female adolescents with anorexia nervosa.

Anorexia nervosa (AN) is a serious eating disorder characterized by extreme weight loss and abnormalities of the neuroendocrine and immune systems. Cytokines have been discussed to be involved in the pathomechanisms underlying cachexia. Therefore our study aimed at examining the mRNA expression pattern of tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), interleukin-6 (IL-6) and interleukin-10 (IL-10) in whole blood of 11 female AN patients and 10 age and sex matched normal weight control subjects using a sensitive quantitative polymerase chain reaction (PCR) method. We found a significant increase in TNF-alpha and IL-6 mRNA expression in anorectic patients at admission (mean BMI 14.8 +/- 1.3) when compared to controls. During follow-up, the expression of TNF-alpha mRNA remained significantly higher in formerly anorectic patients (mean BMI 18.7 +/- 0.5) while IL-6 mRNA expression decreased. We interpret our results as suggesting that TNF-alpha may contribute to metabolic abnormalities in anorexia nervosa even after goal BMI is achieved.

Acute Disease↗
PubMed2001

Pericardial effusions in anorexia nervosa.

Anorexia nervosa is an eating disorder that may be accompanied by cardiac symptoms of varying severity. So far disturbances like arrhythmias, mitral valve prolapse and loss of cardial ventricle mass have been described. Other somatic complications consist of electrolyte and acid-base imbalances, which in turn influence cardiac function. Between 1990 and 1999 we observed ten case reports from inpatient anorexic female adolescents, who developed pericardial effusions in the course of their illness. The diagnosis and course was revealed by echocardiography. No signs of heart failure could be noticed. In eight patients pericardial effusion remitted completely or partly by a concurrent increase in weight. A distinct pathophysiology for the development of pericardial effusion could not be revealed, but a correlation to restoration of weight seems to exist. Our report suggests that pericardial effusions are more frequent cardiac complications in anorexia nervosa than previously known. In most cases the clinical significance is doubtful.

Adolescent↗
PubMed2007

[Compulsory treatment in anorexia nervosa].

Anorexia nervosa is a psychiatric disorder with a very high mortality rate. If the eating disorder reaches life-threatening severity, for example through a body mass index lower than 13 kg/m (2), the possibility of compulsory treatment has to be considered. However, civil commitment of patients and forced feeding against their will may reduce self confidence and self esteem. This impedes the important goal of motivating patients to undergo psychotherapy. Furthermore, compulsory treatment is regarded as a contravention of the patient's physical inviolability as enshrined in the German Constitution. Up to now only a few studies about the use of guardianship legislation for anorexia nervosa have been published. The present paper reviews psychiatric literature and significant judgements of German courts on this topic. It finishes by examining clinical issues on forced feeding and possible consequences for psychotherapy.

Anorexia Nervosa↗
PubMed1989

Adoption and identity: a case of anorexia nervosa.

Anorexia nervosa, as a retreat from and subsequent avoidance of intolerable maturational turmoil, can provide a vivid insight, especially as body weight is restored to normal within treatment, into the sexual and identity conflicts that have previously characterized the adolescence of the individual. When the adolescent has been adopted into the family then the challenge of developing biological (genetic) identity is especially great to the individual and his adoptive parents. A rare case of anorexia nervosa in a male adoptee is presented against this background. Our patient's dependent and smothering bond with his adoptive mother, which was loving but highly conditional, left him with no room for negotiation when it was threatened by his emerging sexual and other impulsivity and new assertiveness. Understanding and treatment of such cases can also help to shed light on the particular challenges that face many adoptive parents when their adopted children experience the thrust of puberty and enter adolescence.

Adoption↗
PubMed1998

From malnutrition to refeeding during anorexia nervosa.

Anorexia nervosa is one of the most common forms of malnutrition observed in Western society in individuals without physical diseases, with an average risk of mortality of 20% in a younger population aged between 15 and 25 years. It is characterised by an initial dramatic decrease in food intake that leads to profound depletion in muscle and fat mass. During the course of the disease, the resting energy expenditure decreases proportionally to the loss of lean body mass with a decrease in thyroid hormone secretion. The metabolic adaptation during anorexia nervosa is similar to that observed during starvation with a relative sparing of protein stores. After an initial weight loss, the total energy expenditure is similar to that in normal individuals, with a decrease in resting energy expenditure and an increased energy-related physical activity. At the end stage of wasting, however, physical activity dramatically decreases as well as energy intake. This metabolic adaptation of semi-starvation is impaired during refeeding with an increase in the thermic effect of food and a high risk of refeeding syndrome with severe hypophosphatemia.

Anorexia Nervosa↗
PubMed2003

The human genetics of anorexia nervosa.

Anorexia nervosa is a severe eating disorder characterised by restricted eating, the relentless pursuit of thinness and obsessive fears of being fat. The involved risk factors are probably numerous, but the existence of a genetic vulnerability has been proposed for decades. The heritability in the broad sense is computed on the basis of aggregation studies, treated twin samples and twin studies from the general population. Many difficulties make this heritability estimation problematic, but the convergence of the results (from family studies and two types of twin studies) gives the most convincing evidence in favour of a major role of genetics in the vulnerability to anorexia nervosa, with a heritability around 70%. Regarding the analysis of candidate genes, the most frequently studied is the 5-HT(2A) gene, with positive and negative results. We thus propose a meta-analysis showing that a large heterogeneity between samples exists, but the main effect of the -1438A allele persists even when extracting this contaminating effect (p=0.003). Furthermore, the absence of significant correlation between odds ratio and time after first publication of each sample, and size of each sample, is in accordance with the fact that the A allele is a risk factor. In order to explain the high heterogeneity between the nine studies yet performed, an alternative explanation such as a "modifying the phenotype" effect is proposed.

Anorexia Nervosa↗
PubMed1989

Bulimia nervosa and anorexia nervosa.

Anorexia and bulimia nervosa are aetiologically distinct diseases with different treatments. Though it was described more recently, bulimia nervosa occurs more commonly. Accurate diagnosis and early treatment should reduce the mortality of both conditions.

Anorexia Nervosa↗
PubMedDate not supplied

[Role of leptin in anorexia nervosa].

Anorexia and bulimia nervosa are the main psychiatric disorders characterised by abnormal models of feeding and perception of people's personal physical appearance and weight. These symptoms are associated with a severe psychosocial uneasiness that leads to severe medical complications and this, to its turn, has a big impact on morbidity and sick rate of general population. Although researchers have made big improvements in individualising some likely pathogenic mechanisms that include different factors (genetic, neurochemical and sociocultural) and psychological development, the pathogenesis of these kinds of feeding disorders is still unknown. Leptina is a neurochemical factor particularly relevant. It is a 17 KD hormone, produced by adipocytes. At hypothalamic level, it is essential for regulating body weight and body development. Recent studies have identified some factors responsible for the production and the secretion of leptina. They are micro and macronurishing factors, hormones and the sympatic neurotic system that is the most important among them. It plays a very important role for some disorders of feeding behaviour, specifically for the anorexia nervosa, where we notice a reduction of leptina levels strictly correlated to a reduction of the fat component. Since anorexia nervosa is associated to medical, nourishing and psychological components, it involves different areas and needs complete measurement and administration. Therefore the approach to this kind of pathology has necessarily to predict a multidisciplinary administration of patients. The aim of our work has been to point out the possible interactions between leptina and the development and progression of anorexia nervosa, on the basis of recent works and reviews in medical literature.

Anorexia Nervosa↗
PubMed1999

Osteoporosis in anorexia nervosa.

Anorexia nervosa is a disorder characterized by low body weight and amenorrhoea (in females). These features lead to a risk of osteoporosis, a condition in which bone loss leads to weakening of bone structure and increased fracture risk.

Anorexia Nervosa↗
PubMed1987

Anorexia nervosa.

Anorexia nervosa is a complex neuroendocrine-psychiatric illness that affects adolescents; its origins and pathophysiology are still poorly understood. The typical psychologic and physiologic characteristics of the illness are discussed, and the multidisciplinary team approach to diagnosis and management is outlined.

Adolescent↗
PubMed1993

Psychopharmacology in the treatment of anorexia nervosa and bulimia nervosa.

Anorexia nervosa and bulimia nervosa remain enigmatic disorders with poorly understood etiologies. Clinicians continue to find these disorders very challenging to treat. As their underlying pathophysiology is clarified, it is hoped that specific pharmacologic treatments will be developed to alleviate the pain and disability these disorders produce.

Anorexia Nervosa↗
PubMed1985

[Update on anorexia nervosa].

Anorexia nervosa is an adolescent pathology of the present. Its frequency is increasing in the western countries. New data concerning the criteria of diagnosis, the evolution, the prognosis, the psychopathology and the treatment have been drawn of numerous recent studies and are exposed in the paper.

Adolescent↗
PubMed2006

[Coercion in the treatment of anorexia nervosa].

Anorexia nervosa (AN) is a complex disorder of unclear aetiology, nowadays one of the most serious chronic diseases of adolescent girls and young women. Severe weight loss and associated behaviours may endanger anorexic patients' lives. A characteristic for the disorder the reluctance in accepting treatment can lead in such situations to the necessity of involuntary treatment. The authors have presented indications for hospitalization as well as have discussed consequences, short- and longterm effectiveness of coercion measures in therapy of anorexia. The necessity of further investigations on this problem has been stresssed, particulary connected with good prognosis in the involuntary treatment. The lack of one-valued legal bases for involuntary treatment of anorexia in polish legislation has been mentioned as well as the lack of proper medical outposts providing them complex treatment.

Anorexia Nervosa↗
PubMed1979

Psychosocial dynamics in anorexia nervosa.

Anorexia nervosa represents a self-destructive struggle for separate identity, and cultural factors play a part in the present increasing incidence. This paper presents a broad view, which embraces family dynamics and the natural history of the disease, to clarify important issues in its management and prevention. Both family and individual psychotherapy may have a place in the patient's personal rehabilitation.

Adolescent↗
PubMed1984

The diagnostic challenge of anorexia nervosa.

Anorexia nervosa is apparently increasing in incidence and prevalence. Accurate diagnosis may be delayed because of the wide range of presenting complaints and the grossly misleading history. Expenditure of valuable time and resources on fruitless investigations may be avoided if physicians acquire some knowledge of common anorexic behavior patterns. It should be possible to make a confident diagnosis on clinical grounds alone.

Adolescent↗