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PubMed1993

Anesthesia considerations for anorexia nervosa and bulimia nervosa.

Anorexia nervosa and bulimia are appearing with increasing frequency in preadolescents and adolescents. Eating disorders lead to significant physical changes related to starvation and/or purging. These patients should be specifically questioned about taking laxatives, diuretics, or amphetamines to lose weight. Subclinical abnormalities, coupled with the patient's denial, emphasize the need for careful physical examination and laboratory assessment. Preexisting electrolyte, cardiovascular, and thermoregulatory alterations must be recognized so that an appropriate anesthesia plan can follow.

Anesthesia↗
PubMed2000

Establishing guidelines for pharmacotherapy trials in bulimia nervosa and anorexia nervosa.

OBJECTIVE: This paper addresses the lack of a standard protocol for pharmacotherapy trials for patients with bulimia nervosa (BN) and anorexia nervosa (AN). METHOD: Twenty-two surveys were sent to established researchers in the field of eating disorders to elicit their opinions regarding medication trials, including baseline laboratory tests, the optimal length/frequency of medication management sessions, and the information that should or should not be included in these sessions. RESULTS: Sixteen of 22 researchers completed and returned the survey. Their answers are the basis of the data presented. DISCUSSION: We propose a battery of screening laboratory tests for both conditions. We suggest 30-45-min initial medication management sessions in both AN and BN trials with 15-min follow-ups to be held weekly for AN subjects, and weekly for 2 weeks, then biweekly for 2 weeks, then monthly, for BN subjects. We also recommend that published trials should include explicit details of medication management.

Anorexia Nervosa↗
PubMedDate not supplied

[Epidemiology of anorexia nervosa. Prevalence of anorexia nervosa in female adolescents from the districts of Lisboa and Setubal].

UNLABELLED: Prevalence studies of anorexia nervosa (AN) have shown differences depending of the country and method applied. The partial syndrome is being emphasized. There has been no epidemiological study done on AN in the Portuguese population of continental Portugal. Our objectives were: 1) to study the prevalence of AN in Portuguese populations; 2) to study the presence of partial syndrome and of body image disturbance; 3) to calculate the number of girls dieting; 4) to correlate with other variables. A population of 2,398 girls ranging 10 to 21 years old, from 30 State secondary schools in the Lisbon and Setubal districts were studied. A questionnaire was answered with questions allowing assessment of all DSM IIIR criteria for AN. RESULTS: Prevalence of AN--0.37%, partial syndrome--12.6%, body image disturbance without weight loss--7%, wish to decrease weight in normal or low weight girls--38%, overweight--15.3%, the peak of age for AN was 15 years, the most prevalent socio-economic class for AN was 2 (scale 1 (higher) to 5). School performance was worse with AN and the age menarche was sooner.

Adolescent↗
PubMed1985

Long-term outcome of 151 cases of anorexia nervosa. The Copenhagen Anorexia Nervosa Follow-Up Study.

One hundred and fifty-one patients (140 females - 11 males) with anorexia nervosa (AN) from three departments (child psychiatry, psychiatry, and internal medicine) were re-examined 4-22 years (average 12.5 years) after their first contact with the Rigshospital in Copenhagen. During the years 1960-76 the number of referrals was on the increase, and relatively more patients were treated in the psychiatric departments at the end than at the beginning of the period. Mean age was 16.6 years at onset, 19.0 years at primary contact. Mean weight loss was 32%. Mean duration of treatment was 12 months. Differences between the three departments concern especially age, sex, and duration of treatment. Mean age at follow-up was 31.0 years (range 16-63 years) for surviving probands. Follow-up information originated from semi-structured personal interviews (in 80% of surviving probands) together with register data on all probands, supplemented by extensive hospital data. Nine patients (6%), including six who committed suicide, died on the average 7.3 years after primary contact (average age 27.1 years). The mortality rate was 0.5% per year. At follow-up one fourth of the surviving probands had AN and one fourth suffered from other psychiatric disorders, while one half were free from mental illness. There were no significant differences in outcome between the three departments. As a whole, the group experienced a social decline. It is concluded that a substantial part of this group of AN patients had a poor prognosis with a tendency towards chronicity, despite relatively long and intensive treatment, but, on the other hand, about one half of the probands seemed to be healthy and well functioning.

Adolescent↗
PubMed2000

CSF oxytocin and vasopressin levels after recovery from bulimia nervosa and anorexia nervosa, bulimic subtype.

BACKGROUND: When ill, people with eating disorders have disturbances of the neuropeptides vasopressin and oxytocin. METHODS: To avoid the confounding effects of the ill state, we studied women who were recovered (more than 1 year, normal weight, and regular menstrual cycles, no bingeing or purging) from bulimia nervosa (rBN) or binge eating/purging-type anorexia nervosa (rAN-BN), and matched healthy control women. RESULTS: Vasopressin was elevated in rAN-BN and showed a trend towards elevation in rBN. In rBN, elevated cerebrospinal fluid vasopressin may be related to having a lifetime history of major depression. In comparison, cerebrospinal fluid oxytocin was normal in recovered subjects, but elevated levels in some rBN might be related to birth control pill use. CONCLUSIONS: These data confirm and extend the possibility that elevated cerebrospinal fluid vasopressin may be related to the pathophysiology of eating disorders, and/or a lifetime history of major depression.

Adult↗
PubMed2005

Eating Disorders Examination versus Eating Disorders Examination-Questionnaire in adolescents with full and partial-syndrome bulimia nervosa and anorexia nervosa.

OBJECTIVE: The current study compared the Eating Disorders Examination (EDE) and the Eating Disorders Examination-Questionnaire (EDE-Q) in adolescents with eating disorders. METHOD: Adolescents (N = 70) with bulimia nervosa (BN; n = 21), partial-syndrome BN (PBN; n = 25), and anorexia nervosa (AN; n = 24) were assessed with the EDE and EDE-Q. RESULTS: Moderate to high correlations were found on all four subscales within and between diagnostic groups. The discrepancy between the EDE and EDE-Q was significantly greater in BN relative to PBN and AN for the Eating Concern subscale. Objective binge episode (OBE) frequency in BN and subjective binge episode (SBE) frequency in BN and PBN were higher with the EDE compared with the EDE-Q. Self-induced vomiting was highly correlated between the two measures. DISCUSSION: Adolescents with BN, PBN, and AN exhibited strong correspondence between the EDE interview and questionnaire formats. However, this consistency was not as pronounced for BN as it was for PBN and AN. The current study lends preliminary credibility to the use of the EDE-Q in adolescent eating disorder samples.

Adolescent↗
PubMed1993

Separation-individuation difficulties and the distinction between bulimia nervosa and anorexia nervosa in college women.

This study investigated whether patterns of late adolescent separation-individuation from parents, as measured by the Psychological Separation Inventory (PSI), are different for anorexic-like and bulimic-like young women in college. It was hypothesized that anorexic-like women would display a pattern of underseparation from both mother and father. Bulimic-like women were expected to show a pattern of underseparation on the conflictual dimension of the PSI but overseparation on the other dimensions. A total of 198 college women completed the PSI, the Eating Disorder Inventory, and a DSM-III-R symptom checklist. Using that checklist, 19 women were classified as bulimic-like (BUN), 8 as like restricting anorexics (RAN), 11 as showing a pattern resembling both bulimia and restricting anorexia (BULAN), 109 as showing limited bulimic or anorexic behaviors (SOME), and 25 as having no eating disorder symptoms (NED). Results indicated some support for the hypotheses. BUN women were overseparated in terms of attitudinal independence from both parents and underseparated in that they experienced more guilt and conflict concerning separation than did the SOME or NED women. The anorexic-like women reported considerable guilt and conflict about separation and tended to be underseparated in general. The results point to the potential value of separation-individuation issues in the distinction between restricting anorexia nervosa and bulimia nervosa.

Adult↗
PubMed1998

[Anorexia nervosa and "anorexia athletica"].

Available evidence supports the assumption that stressors in vulnerable adolescence potentially lead to restrictive dieting and imbalances of serotonergic metabolic particularly in females. In conjunction with idealized body images and developmentally characteristic bodily perceptions prone to distortion pathogenetic mechanisms of eating disorders are released. The entities of eating disorders are dimensionally viewed as points of continua a functions and categorized according to ICD-10 or DSM-IV, respectively. Data of our studies on grammar school students, ballet dancers and anorexia nervosa patients emphasize the necessity to differentiate different types of body shape by using the metric index. Facing this background a distinction of "anorexia athletica" appears unreasonable.

Adolescent↗
PubMed2000

Bone size and volumetric density in women with anorexia nervosa receiving estrogen replacement therapy and in women recovered from anorexia nervosa.

Anorexia nervosa is associated with bone loss during adulthood, but may also delay skeletal growth and mineral accrual during growth. We asked the following questions. 1) Is anorexia nervosa associated with reduced bone size and reduced volumetric bone mineral density (vBMD)? 2) Is estrogen replacement therapy (ERT) or recovery from anorexia nervosa associated with normal bone size and vBMD? Using dual-energy x-ray absorptiometry, we measured bone size and vBMD of the third lumbar vertebra and femoral neck in a cross-sectional study of 161 female patients: 77 with untreated anorexia nervosa, 58 with anorexia nervosa receiving ERT, 26 recovered from anorexia nervosa, and 205 healthy age-matched controls. Results were expressed as the SD or z-score (mean +/- SEM). Deficits in vertebral body and femoral neck width in untreated women were -1.0 +/- 0.1 and -0.3 +/- 0.1 SD (P < 0.001 and P < 0.05, respectively). Deficits in bone width were less in the ERT-treated women than in untreated women at the vertebral body (-0.6 +/- 0.1 SD; P < 0.001), but not at the femoral neck (-0.4 +/- 0.2 SD; P < 0.05). There were no significant deficits in vertebral body and femoral neck width in recovered women (both -0.3 +/- 0.2 SD; P = NS). In untreated women, vertebral and femoral neck vBMD were -1.6 +/- 0.1 and -1.1 +/- 0.1 SD, respectively (both P < 0.001), less severely reduced in ERT-treated women (-1.2 +/- 0.2 and -0.6 +/- 0.2 SD, respectively; both P < 0.001), and least reduced in recovered women (-0.6 +/- 0.1 and -0.5 +/- 0.2 SD; P < 0.01 and P < 0.05, respectively). After adjusting for differences in fat and lean mass, vertebral body and femoral neck width were no longer reduced in untreated, ERT-treated, and recovered women. Adjustment for body composition had little effect on group difference in vBMD. Bone fragility in anorexia nervosa is due to reduced bone size and reduced vBMD. Although causality cannot be inferred in cross-sectional studies, the data are consistent with the view that malnutrition may contribute to reduced bone size, whereas estrogen deficiency may reduce vBMD. The use of ERT early in disease is a reasonable component of management if the chance of recovery appears remote.

Absorptiometry, Photon↗
PubMed1985

The discriminative value of psychological characteristics in anorexia nervosa. Clinical and psychometric comparison between anorexia nervosa patients, ballet dancers and controls.

The present controlled study examined anorexic and psychological characteristics of female ballet dancers, who by career choice must focus on thinness, and anorexia nervosa patients. Anorexia nervosa (AN) patients, female ballet (BA) students as well as asymptomatic female controls (AF) were compared with respect to the psychological characteristics: the Drive to Achieve, the Motive to Avoid Failure (Negative Fear of Failure) and the Motive to Achieve (Positive Fear of Failure). The results confirmed previous empirical and clinical findings that the AN group and the BA group can be differentiated from a control group with respect to a heightened Drive to Achieve. However, the Drive to Achieve of AN patients was found to originate in an avoidance of failure (the Negative Fear of Failure), while in BA students this drive was found to stem from a motive to achieve (the Positive Fear of Failure). The findings underline the importance of an evaluation of psychological characteristics in subjects with anorexic symptoms.

Achievement↗
PubMed1995

Anorexia nervosa: directions for future research. Study Group on Anorexia Nervosa.

On September 27-29, 1993, the Study Group on Anorexia Nervosa (AN): Basic Mechanisms, Clinical Approaches and Treatment met in Geneva, Switzerland to discuss recent progress in research on anorexia nervosa, and to identify directions for future studies. Anorexia nervosa is a disorder of unknown etiology, without a specific curative treatment, affecting mostly individuals in adolescence and early adulthood, with significant morbidity and mortality, and having a major impact on psychosocial and vocational development. In anorexia nervosa there are severe disturbances in virtually every endocrine system, such as the hypothalamic-pituitary-adrenal (HPA) axis, the hypothalamic-pituitary-gonadal (HPG) axis, the hypothalamic-pituitary-thyroid (HPT) axis, the growth hormone (GH)/somatomedin C (IGF-1) system, and the central and peripheral arginine vasopressin (AVP) systems. Furthermore, classical neurotransmitter systems, such as the cholinergic noradrenergic, and serotonergic systems, are abnormally regulated in anorexia nervosa. New research data is also emerging on the abnormal regulation of immune function in this disorder. The Study Group concluded that even though several biological systems are abnormally regulated in anorexia nervosa, there is no biological test which is specific enough to make the diagnosis of the disorder. New directions for research in anorexia nervosa are identified and discussed in this report. Finally, the Study Group proposed future meetings to bring together clinical and pre-clinical (pharmacological, biochemical, and molecular) scientists studying topics, such as neuroendocrine function, which are important in the biology of anorexia nervosa.

Anorexia Nervosa↗
PubMed2003

[Leptin levels in female patients with restrictive and purgative types of anorexia nervosa].

BACKGROUND: Anorexia nervosa is an eating disorder with typically chronic course. Two subtypes of anorexia nervosa have been described based on the pattern of eating behavior. Restrictive form of anorexia nervosa is characterized by chronically decreased food intake, while the purgative subtype typically consists of alternating episodes of fasting and overnutrition with factitious vomiting. METHODS AND RESULTS: The aim of this study was to compare anthropometric parameters, serum levels of fat-derived hormone leptin, cholesterol, triacylglycerols and serum leptin/body mass index ratio in patients with restrictive and purgative subtypes of anorexia nervosa respectively. Significantly lower body weight (37.79 +/- 3.93 vs. 49.63 +/- 9.84 kg, p < 0.05), body mass index (13.51 +/- 1.43 vs. 17.75 +/- 2.64 kg/m2, p < 0.05),), body fat percentage (13.28 +/- 2.83 vs. 18.9 +/- 5.65%, p < 0.05), serum leptin (1.117 +/- 0.95 vs. 5.88 +/- 4.7 ng/ml, p < 0.05) and cholesterol levels (4.14 +/- 1.78 vs. 6.31 +/- 1.27 mmol/l, p < 0.05) were found in patient with restrictive relative to purgative subtype of anorexia nervosa. In contrast, no difference in triglyceride levels between both groups was found. Serum leptin levels positively correlated with body mass index and body fat percentage only in patients with purgative subtype of anorexia nervosa (body mass index r = 0.95, p < 0.001, body fat percentage r = 0.64, p < 0.05) but not in those with restrictive subtype. CONCLUSIONS: In conclusion, we demonstrated that serum leptin levels were significantly lower in restrictive relative to purgative subtype of anorexia nervosa. We suggest that this difference is primarily due to distinctions in body fat content.

Adult↗
PubMed1993

Anorexia nervosa "restricters" who purge: implications for subtyping anorexia nervosa.

It has not been clear from earlier studies whether it is binge eating per se or the compensatory behaviors frequently associated with binge eating (i.e., self-induced vomiting and/or laxative abuse) that provide the most relevant marker for subclassifying anorexia nervosa. The current study addressed this question by comparing the clinical and psychological features of three groups of anorexia nervosa patients: "pure restricting" patients who do not binge (by definition) and who also do not purge (AN-R, N = 116); "restricting-purging" patients who engage in purging behavior (AN-RP, N = 74); and anorexia nervosa "bulimics" who binge eat as defined in earlier studies (AN-B, N = 190). While all three groups displayed similar levels of psychological disturbance on many variables, the overall pattern of findings indicates that the AN-RP group displays significantly more psychopathology than the AN-R group and their profile of disturbance is very similar to that observed with the AN-B group. Thus, anorexia nervosa patients who purge, regardless of whether or not they report objective binge episodes, may be meaningfully distinguished from nonpurging patients. These results, combined with the medical risks associated with purging behaviors and the formidable problems associated with the definition of binge eating, support a sub-typing system for anorexia nervosa based on the presence or absence of purging rather than binge eating.

Adult↗
PubMedDate not supplied

Abnormalities of the respiratory function and control of ventilation in patients with anorexia nervosa.

BACKGROUND: Anorexia nervosa is a good model to study the effects of malnutrition on the respiratory system, since it excludes the consequences that some chronic diseases can have on the lung. OBJECTIVE: The objective of this study was to assess pulmonary function and alterations in the respiratory system in patients with anorexia nervosa. METHODS: Twenty-two women, 12 with anorexia nervosa and 10 healthy volunteers, were studied. Anthropometric data were gathered for all the participants. In every case, an arterial blood gas test and functional respiratory study, that included spirometry, plethysmography, measure of maximum muscular respiratory pressure and study of the ventilatory pattern at baseline and after hypercapnic stimulation, were performed. RESULTS: No significant differences were found in mean age and height in both groups of patients but there was a difference in body mass index (p < 0.05). In pulmonary function tests, an increase in residual volume (RV), RV/total lung capacity (TLC) ratio and functional residual capacity and a decrease in maximum respiratory pressure were found in patients with anorexia nervosa compared to the control group (p < 0.05). Differences were also found in the ventilatory pattern, with a reduction in minute ventilation and occlusion pressure as well as a decreased response of these parameters to hypercapnic stimulation (p < 0.05) in the patients with anorexia nervosa. CONCLUSION: In patients with anorexia nervosa, a significant elevation in RV, in the RV/TLC ratio and in functional residual capacity and a decrease in the maximum respiratory pressure were noted. In addition, they present an alteration in the central respiratory drive and a response of the respiratory system to hypercapnic stimulation. Although these alterations have no repercussion on the maintenance of gas exchange in baseline conditions, they may have in extreme situations.

Adult↗
PubMedDate not supplied

Anorexia nervosa and "reverse anorexia" among 108 male bodybuilders.

Two disorders of body image encountered in a study of 108 bodybuilders are described. In a study of the psychiatric effects of anabolic steroids, structured interviews were administered to 55 bodybuilders who had used anabolic steroids and 53 non-user controls. Three (2.8%) of the subjects reported a history of anorexia nervosa--a rate far higher than the 0.02% rate typically reported among American men (P < .001). Nine (8.3%) of the subjects, two of whom were former anorexics, described a "reverse anorexia" syndrome, where they believed that they appeared small and weak even though they were actually large and muscular. Reverse anorexic subjects reported that they declined social invitations, refused to be seen at the beach, or wore heavy clothes even in the heat of summer because they feared that they looked too small. All nine reverse anorexia cases occurred among steroid users; none occurred among non-users (P < .003). Four subjects reported that their reverse anorexic symptoms contributed to their decision to start using steroids. Disorders of body image, including both anorexia nervosa and its reverse form, may occur frequently in men who lift weights regularly. Reverse anorexia may precipitate or perpetuate the use of anabolic steroids in some individuals.

Adult↗
PubMed1991

An open trial of fluoxetine in patients with anorexia nervosa.

BACKGROUND: Anorexia nervosa is a disorder of unknown etiology with a high rate of relapse and no known treatment. Because anorexia nervosa shares some similarities with obsessive compulsive disorder, we hypothesized that a serotonin-specific medication might be useful in the treatment of this illness. METHOD: We administered an open trial of fluoxetine to 31 patients with DSM-III-R anorexia nervosa. Most anorexics were started on fluoxetine treatment after inpatient weight restoration and then discharged from the hospital and followed up as outpatients. RESULTS: At the time of follow-up (11 +/- 6 months on fluoxetine), 29 of the 31 patients had maintained their weight at or above 85% average body weight (97% +/- 13% average body weight for the group). We judged response as good in 10, partial in 17, and poor in 4 anorexics as measured by improvements in eating behavior, mood, and obsessional symptoms. Restrictor anorexics responded significantly better than bulimic and/or purging-type anorexics. CONCLUSION: This open trial suggests that fluoxetine may help patients with anorexia nervosa maintain a healthy body weight as outpatients. The reasons for the positive effects of fluoxetine are uncertain, but the agent may help by improving eating behavior and/or reducing obsessionality, depression, and anxiety. It is important to emphasize that this was not a double-blind, placebo-controlled study. Thus we can not be certain of the efficacy of fluoxetine and caution that fluoxetine should not be used as the sole treatment of anorexia nervosa at this time.

Adolescent↗