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PubMed2004

New concepts in anorexia nervosa.

Anorexia nervosa (AN), a psychosomatic disorder, has serious negative effects on multiple organs and systems of the human body. A large number of endocrine and metabolic anomalies have been described, including amenorrhea/oligomenorrhea, delayed puberty, hypothyroidism, hypercortisolism, and alterations in the growth hormone (GH) axis and bone metabolism. The role of different peptides, including ghrelin, leptin, neuropeptide Y and serotonin, in the regulation of appetite is discussed. In addition, isolated hypogonadotropic hypogonadism that occurs in these patients is analyzed in detail, as well as the abnormalities in the growth hormone axis. Alterations in bone mineral density, bone markers and the degree of osteopenia in these patients, depending on the age at which amenorrhea began and its duration, are also discussed. Finally, our current understanding of the possible benefits of treatment with estrogens and progestogens is also analyzed.

Anorexia Nervosa↗

PubMed1992

Perceived-competence deficit in anorexia nervosa.

Anorexia nervosa patients are portrayed as competent and accomplished and yet they feel ineffective and diffident. The assessment of this aspect of their self-esteem presents methodological problems. The Interests and Abilities Questionnaire was designed to measure interests and perceived abilities in typical adolescent activities. The disparity between interests and perceived abilities--perceived-competence deficit (PCD)--was hypothesized to be characteristic of anorexics. Three groups of females, aged 14 to 24, were studied: 13 anorexic inpatients, 13 psychiatric inpatients without an eating disorder but of similar severity of illness, and 48 nonclinical subjects. Similar to the nonclinical controls, anorexics were interested in a variety of activities; similar to control patients, anorexics rated their abilities lower than nonclinical subjects. In PCD, anorexics scored significantly higher than both control groups; this difference was not related to level of depression.

Achievement↗

PubMed2003

An existentialist approach to anorexia nervosa.

Anorexia nervosa is an attempt of the self to refuse itself and devise an other self, with dissolution of the link between the self and the body. Although anorectics are often described as academically capable and attractive, in the author's experience they were preoccupied with superficial issues, their drive came not from the seductive promise of intellectual stimuli, but from negative expectations that needs cannot be met, driving one to rise above/outside of needs to "not need." The new self, incorporeal and totally controlled, in its controlling part, is at times perceived as a separate it controlling the mind. The new self, that so much wanted to be in control, is out of control by being under the orders of the it; supposedly not greedy, it has found new object of greediness in weight loss. The anorectic's feeling of "superiority" has relevant therapeutic implications.

Anorexia Nervosa↗

PubMed1992

[The therapeutic challenge of anorexia nervosa].

Anorexia nervosa represents a typical paradox of adolescence. This paradox drives the adolescent to refuse what he fears he would need too much: this need seems threatening because it would make him dependent on the object of satisfaction which seems alienating to him. Thus, he becomes alienated to his refusal, which worsens the underlying need and increases the refusal. The life of the anorectic is centered on a passion for food and fear of bulimia. In fact, food focuses a greater "appetite" for recognition and to be the centre of attention. Beyond, and with, curing of the symptom, the treatment, by means of the weight contract, tends to resolve this paradox in which the anorectic tries to enclose us. To take up the challenge, the treatment must create the conditions for the emergence of pleasure in desiring what they need, without anxiety about their autonomy.

Adolescent↗

PubMedDate not supplied

Cognitive functioning, weight change and therapy in anorexia nervosa.

Anorexia nervosa is associated with impairments in cognitive function which have been hypothesized to be fundamentally attentional in nature. The current study investigated whether therapy and weight gain affect these impairments. A group of anorexics (N = 12) completed a battery of cognitive performance tasks and self-report measures of psychopathology on three occasions, over the course of 12 weeks of in-patient treatment. A non-clinical control population (N = 17) completed the same measures. The anorexics improved on all measures of psychopathology and affective state as a result of therapy. Anorexics displayed poorer recall, reaction times, and motor speed than the control subjects. Although there was a gain in weight over the course of therapy, there was no corresponding improvement in cognitive performance. Impaired task performance in anorexics was not directly related to their psychopathology or affective state.

Adolescent↗

PubMed1975

Treatment of anorexia nervosa.

Anorexia nervosa is a well-known syndrome occurring predominantly in adolescent girls, and characterised by amenorrhoea and gross weight loss due to self-induced restriction of food intake. The prognosis is poor but full recovery does occur as illustrated by long-term follow-up of 22 unselected patients, eight of whom have recovered to date. A definite treatment programme is recommended as likely to improve the prognosis. This consists of hospital admission for restoration of normal weight, combined with family intervention and continuing long-term individual psychotherapy. The hospital regime for weight restoration involves bed rest, refeeding by experienced nursing staff, and a situation where the patient has no opportuinty for avoiding weight gain but receives constant reassurance. Under these conditions restoration of full normal weight is achieved, as illustrated by 14 admissions to hospital with only one failure to acheive target weight.

Acute Disease↗

PubMed2006

Set shifting deficit in anorexia nervosa.

Anorexia nervosa (AN) is a severe mental illness characterized in part by rigid thinking and ritualized behaviors involving eating and weight. Cognitive rigidity may play a role in the perpetuation of symptoms, and may provide information as to important brain-based abnormalities. Neuropsychological studies of patients with AN have shown cognitive dysfunction, but few have focused on cognitive flexibility. This study assessed set shifting in patients with AN, as a measure of cognitive flexibility. In this study, 15 patients with AN were compared with 11 healthy controls using a neuropsychological battery including the Wisconsin Card Sort Test (WCST). While patients with AN did not differ from controls on 5 measures of neuropsychological function, they made significantly more perseverative errors on the WCST, indicating a problem in set shifting. This finding suggests that patients with AN have a specific neurocognitive abnormality that may play a role in the development and persistence of this disorder.

Adult↗

PubMed2006

Personality pathology among individuals with a lifetime history of anorexia nervosa.

Anorexia nervosa (AN) appears to be associated with certain personality features. The degree to which personality pathology persists after the acute phase of illness is unclear. This study aimed to investigate personality pathology in a large sample (n = 153) of women with histories of AN using the Dimensional Assessment of Personality Pathology (DAPP) and to evaluate the persistence of pathological personality features by comparing women with acute (n = 83) and remitted AN (n = 55). Women with AN demonstrated high levels of emotional dysregulation, social inhibition and compulsivity relative to age-matched healthy women (n = 124). Identity problems, intimacy problems and schizotypal features were highlighted as important. The same 14 pathological personality dimensions were significantly elevated in both ill and remitted participants, though remitted individuals' scores were reduced on 4 of the subscales. These results indicate that pathological personality features in AN are persistent traits, although some features may become exaggerated in the acute phase.

Acute Disease↗

PubMed1977

Oral complications in anorexia nervosa.

Anorexia nervosa (AN), a psychosomatic disease mainly affecting young women, is characterized by conscious starvation, periods of excessive carbohydrate intake and often deliberate vomiting. Medical history, dental examination, and saliva tests of 39 patients aged 14 to 42 years, having suffered from AN for periods of 1 to 20 years, showed dental caries, due to excessive carbohydrate consumption, in all subjects, often in a rampant form. In patients with a history of intense vomiting (27 cases) severe lingual-occlusal erosion (perimylolysis) was nearly always present. Buccal erosion, mainly due to high consumption of acid fruits and drinks to relieve thirst caused by dehydration, was more frequent in vomiting than in non-vomiting patients. Subnormal values of saliva properties, owing to dehydration or xerostomia-inducing medication, were present in the majority of cases; the lowest values occurred in those vomiting. The association AN - vomiting - perimylolysis is discussed, as well as prophylactic and therapeutic measures. A medical, psychiatric, and dental survey of AN is presented.

Adolescent↗

PubMedDate not supplied

[Anorexia nervosa].

Anorexia nervosa is a very serious and potentially lethal eating disorder. It is characterized by distorted body picture, obsession with thinness, and loss of body weight exceeding 15% of expected ideal body weight. The incidence of this disorder is increased and the earlier the diagnosis and therapy start, the better is the prognosis. Etiology is unknown, but biological, social and psychological factors are assumed. The clinical picture is characterized by loss of body weight, amenorrhea, opstipation, sensitivity to cold, dry skin, exhaustion and obsession with the fear of becoming fat. Some laboratory findings are deranged, especially electrolyte balance. Hormonal derangement is also found. Diagnosis is made according to ICD 10, or DSM IV diagnostic criteria. In differential diagnosis, distinction has to be made from many somatic and some psychiatric disorders. Generally, somatic complications indicate the treatment, first in hospital and later on the outpatient basis. In the treatment, special attention should be paid to simultaneous application of pharmacotherapy and psychotherapy in order to ensure better prognosis, which is usually poor.

Anorexia Nervosa↗

PubMed2004

A pilot open case series of ethyl-EPA supplementation in the treatment of anorexia nervosa.

Anorexia nervosa (AN) carries the highest risk of morbidity and mortality amongst psychiatric disorders. The efficacy of current treatment approaches is limited. Despite the fat-phobic nature of the disease, poly-unsaturated fatty acids (PUFAs) have not received much research attention. Patients who consume western diet, which is rich in n-6 PUFAs and trans-fatty acids, are likely to develop severe n-3 PUFA deficiency during self-induced starvation. Re-feeding programmes do not take into consideration n-3 EFA intake, possibly leading to further n-3 PUFA deficiency during weight restoration, and this might contribute to the maintenance of the disorder. To test this hypothesis, we carried out a systematic case series of E-EPA supplementation in the treatment of AN. Seven young patients received 1g/day E-EPA in addition to standard treatment, and were followed up for 3 months. Three of them recovered and four improved. Randomised controlled trials are warranted to examine the effectiveness of E-EPA in AN further.

Adolescent↗

PubMed2001

Starving the brain: structural abnormalities and cognitive impairment in adolescents with anorexia nervosa.

Anorexia nervosa (AN) is one of the most common chronic illnesses afflicting adolescent girls and is associated severe medical complications. The structural abnormalities found in the brain of adolescents with AN are among the earliest and most striking physical consequences. In the past, it had been assumed that the brain abnormalities found in patients with AN reverse with weight-recovery. Recent evidence has shown that not all of these changes are completely reversible with weight recovery. To date, very little is known about the functional significance of these brain abnormalities. Several studies have shown that cognitive dysfunction is also a common feature of AN. Although current evidence suggests that there may be some degree of improvement in cognition with weight-recovery, it is unclear whether cognition recovers fully or equally across all neuropsychological domains. Furthermore, it remains unknown whether the reported functional consequences are associated with these structural brain changes. This article will review the current literature on structural brain abnormalities and cognitive dysfunction in adolescents with AN.

Anorexia Nervosa↗

PubMed2003

Brain structure and function in adolescents with anorexia nervosa.

Anorexia nervosa (AN) commonly arises during adolescence and is associated with significant medical morbidity. Abnormalities in brain structure and function are among the most common, early, and concerning physical consequences. Advances in neuroimaging technology have played an important role in delineating the structural and functional changes found in patients with AN. Studies using computed tomography and magnetic resonance imaging have demonstrated changes in brain structure in the low-weight stages of AN. In addition, functional neuroimaging techniques have demonstrated altered brain metabolism. Debate continues as to whether these brain abnormalities are fully reversible with weight restoration. Neuropsychological research has demonstrated that cognitive dysfunction is also a common feature of AN. Multiple studies have indicated deficits in various neuropsychological domains. Whether the reported cognitive deficits are reversible with weight gain remains unknown. To date, some preliminary evidence suggests that reported cognitive deficits in patients with AN may be associated with structural brain abnormalities. This chapter reviews the current literature about neuroimaging studies and cognitive function in adolescents with AN, discusses the possible underlying mechanisms causing these changes, and explores the possible association between them.

Adolescent↗

PubMed2004

Neuropsychological investigation of decision-making in anorexia nervosa.

Anorexia nervosa (AN) could be considered a form of obsessive-compulsive disorder in which an impairment of the cognitive domain related to decision-making was found. We explored this function in AN patients, as well as possible differences between restricting type and binge/purge type, with the aim of examining the hypothesis that AN is part of the obsessive-compulsive spectrum. Decision-making was assessed in 59 inpatients with AN and 82 control subjects using the Gambling task, which simulates real-life decision-making by assessing the ability to balance immediate rewards against long-term negative consequences. We confirmed the supposed deficit of decision-making in AN. However, restricting and binge eating/purge subtypes showed different patterns of decision-making impairment. Poor performance on the Gambling task is not a mere consequence of starvation and does not appear to be related to illness severity. The decision-making deficiency that some AN patients show is linked to those individual features that contribute to the phenomenological expression of the disorder.

Adult↗

PubMed1998

Proton magnetic resonance spectroscopy in acute, juvenile anorexia nervosa.

Anorexia nervosa is usually associated with a shrinkage of the brain that is at least partially reversible with weight gain. The pathogenesis of this brain abnormality is unclear. The purpose of this study was to investigate potential alterations in localized proton magnetic resonance (1H MR) spectra of anorectic patients immediately after an interval of excessive weight loss. Twelve patients and seventeen control subjects were examined. Water suppressed 1H MR spectra were recorded from two voxels placed in the thalamus and in the parieto-occipital white matter. The spectra of ten patients could be evaluated. Comparing patients and control subjects, significantly higher signal intensity ratios of choline containing compounds (Cho) relative to total creatine (Cr) as well as significantly lower ratios of N-acetyl-aspartate (NAA) relative to Cho were found in the white matter region. We hypothesize that these results indicate an abnormal starvation, associated membrane turnover, which predominantly takes place in the white matter. No evidence for neuronal degeneration was found in the thalamus or in the white matter region.

Adolescent↗

PubMed1993

Vascular responses to angiotensin II in anorexia nervosa.

Anorexia nervosa (AN) patients have a tendency to develop renin-angiotensin-aldosterone (RAA) abnormalities caused by abnormal behaviors expressed over long periods of time. Short-term dietary sodium intake is a known modulator of blood pressure response to infused angiotensin II (A II) in normal subjects. Therefore AN patients and normal gender-matched and age-matched controls were studied for vascular responses to exogenous A II. Untreated AN patients needed significantly greater quantities of exogenous A II to raise diastolic blood pressure (DBP) to over 20 mmHg for 30 min compared with controls (12.1 +/- 0.47 versus 7.6 +/- 0.69 ng/kg/min, p < 0.01). The amount of A II required to raise DBP to over 20 mmHg in AN patients in tests before and after completion of treatment (4.2 +/- 0.33 months later) was significantly different (12.1 +/- 0.47 versus 8.1 +/- 0.25 ng/kg/min, p < 0.01). There was no significant difference between AN patients following treatment and controls. Our results indicate that it requires long time before decreased A II responsiveness caused by chronic sodium depletion normalizes in AN patients.

Adolescent↗

PubMed1991

Influence of naloxone infusion on prolactin and growth hormone response to growth hormone-releasing hormone in anorexia nervosa.

Anorexia nervosa (AN) is frequently associated with anomalies of growth hormone (GH) and prolactin (PRL) secretion. We studied the GH and PRL responses to GHRH1-44 (50 micrograms IV) and the effect of a naloxone infusion (1.6 mg/hr), started 1 hr before GHRH administration, on this response in 12 female patients with AN, aged 15-30 yr, and in seven normal women, aged 19-27 yr, during the follicular phase as controls. In AN, GHRH induced an increase in GH levels similar to that observed in normal subjects. A significant inhibition of the GH response to GHRH was observed during naloxone infusion, similar to the inhibition in normal female subjects during the follicular phase. PRL levels showed a significant increment after GHRH alone and a slight, nonsignificant, PRL increment after GHRH during naloxone infusion in AN patients. In contrast a slight PRL decrease was observed after GHRH, both before and during naloxone infusion, in the normal subjects. Our study demonstrates that endogenous opioids play a role in influencing PRL secretion in patients with AN different from their role in normal subjects.

Adolescent↗

PubMed1993

Serum insulin-like growth factor-I concentrations in the recovery of patients with anorexia nervosa.

Anorexia nervosa (AN) can result in extreme malnutrition, and these patients frequently require inordinately large amounts of calories to gain weight during refeeding therapy. Insulin-like growth factor-I (IGF-I) is a polypeptide that mediates many of the anabolic effects of growth hormone. Low levels of IGF-I have been associated with malnutrition and can cause poor weight gain. To clarify the potential relationship of IGF-I to weight gain, serial serum IGF-I, retinol-binding protein and prealbumin levels were measured at admission, 2 weeks and 4 weeks, in 14 consecutive consenting patients admitted for treatment of AN. Baseline IGF-I levels were lower in the patients compared to age-matched controls (mean 20.8 +/- 2.5 vs 32.9 +/- 2.9 nmol/L, p < 0.01). In patients with no weight gain, IGF-I levels were static. There was a stepwise increment in the IGF-I values related to weight gain. Retinol-binding protein and prealbumin, proteins commonly used to assess nutritional status, did not demonstrate important correlations with weight gain. Further studies are required to determine whether or not initial low IGF-I levels impede weight gain in AN patients and whether treatment with IGF-I (possibly in combination with growth hormone) may be of benefit in this disease process.

Adolescent↗