Abstract Anorexia Nervosa Research Articles

EPA-0058 – Delusional disorder in a man with anorexia nervosa: a case-report

Anorexia nervosa (AN) is a syndrome characterized by three essential criteria. The first is a self-induced starvation, the second is a relentless drive for thinness or a morbid fear of fatness and the third is the presence of medical signs and symptoms resulting from starvation. The most common ages of onset of anorexia nervosa are the mid teens. It occurs 10 to 20 times more often in females than males and it seems to be more frequent in developed countries. In some patients concerns about weight reaches delusional proportions. This subpopulation of patients warrants further study since patients with more delusional beliefs may have a form of AN that is more refractory to treatment. In this report a rare case of Anorexia nervosa is presented in which the patient is a 29 year old male with poor socioeconomic background from a developing country who subsequently experienced a distinct onset of delusional disorder. After four weeks delusional disorder and Anorexia Nervosa resolved due to treatment by atypical antipsychotics (Risperidone).

Is there epigenetics in anorexia nervosa?

Anorexia Nervosa (AN) is a young-onset psychiatric illness, for which the etiology remains unknown and presents a high heritability. Thus, the genetic component is estimated to be 70%. To identify the vulnerability genes to AN, different approaches of molecular genetic are performed, including linkage analysis, the candidate gene association study and, the Genome-Wide Association Study (GWAS). Some polymorphisms of candidate genes, such as the BDNF gene that encodes for the brain-derived neurotrophic factor, were found associated with AN in several studies. In addition to the DNA polymorphisms, there are several other changes around the DNA information, like methylation or the histone modifications, named epigenetic, that modulate the transcription of genes. Thus, first descendents after the Dutch famine in the Second World War have showed a higher risk of impaired glucose tolerance in adulthood. And women exposed to famine in utero presented DNA methylation differences but without link of cause or consequence between famine event and epigenetic changes. To date, only few events of methylation in specific candidate genes have been investigated in AN. Thus, an hypermethylation of the DRD2 gene's promoter was found associated with a downregulation of this gene expression in AN compared to healthy control women (HCW), using leucocytes. While a hypermethylation of the DAT1 promoter was observed correlated with an upregulation of this gene expression. Another study has showed no difference of the methylation level of the Proopiomelanocortin (POMC) promoter between the goups of HCW, underweight AN (acAN) and weight-recovered AN (recAN). But, the expression of POMC was significantly higher in acAN compared to recAN and HCW, and correlated with the leptin levels. These studies suggest that both the etiology and the pathologic consequences of AN could be derived by epigenetic factors, such as the methylation.

Is deep brain stimulation a treatment option for anorexia nervosa?

Anorexia nervosa (AN) is a severe psychiatric disorder with high rates of morbidity, comorbidity and mortality, which in a subset of patients (21%) takes on a chronic course. Since an evidence based treatment for AN is scarce, it is crucial to investigate new treatment options, preferably focused on influencing the underlying neurobiological mechanisms of AN. The objective of the present paper was to review the evidence for possible neurobiological correlates of AN, and to hypothesize about potential targets for Deep brain stimulation (DBS) as a treatment for chronic, therapy-refractory AN. One avenue for exploring new treatment options based on the neurobiological correlates of AN, is the search for symptomatologic and neurobiologic parallels between AN and other compulsivity- or reward-related disorders. As in other compulsive disorders, the fronto-striatal circuitry, in particular the insula, the ventral striatum (VS) and the prefrontal, orbitofrontal, temporal, parietal and anterior cingulate cortices, are likely to be implicated in the neuropathogenesis of AN. In this paper we will review the few available cases in which DBS has been performed in patients with AN (either as primary diagnosis or as comorbid condition). Given the overlap in symptomatology and neurocircuitry between reward-related disorders such as obsessive compulsive disorder (OCD) and AN, and the established efficacy of accumbal DBS in OCD, we hypothesize that DBS of the nucleus accumbens (NAc) and other areas associated with reward, e.g. the anterior cingulated cortex (ACC), might be an effective treatment for patients with chronic, treatment refractory AN, providing not only weight restoration, but also significant and sustained improvement in AN core symptoms and associated comorbidities and complications. Possible targets for DBS in AN are the ACC, the ventral anterior limb of the capsula interna (vALIC) and the VS. We suggest conducting larger efficacy studies that also explore the functional effects of DBS in AN.

Indexing psychopathology throughout family-based treatment for adolescent anorexia nervosa: are we on track?

Anorexia nervosa (AN) is amongst the most severe of all psychiatric illnesses, demonstrating an average duration of 7 years and mortality rates of up to 20% in adults (Steinhausen, 2002). As such, ...

Family cognitive remediation therapy for anorexia nervosa

Anorexia nervosa (AN) in childhood and adolescence has a poor prognosis. It is possible that this may in part be due to the fact that cognitive weaknesses that appear to be risk factors for its development and maintenance are not being targeted in treatment. Through its focus on these deficits, cognitive remediation therapy (CRT) has been shown to be a promising intervention for AN. Furthermore, family interventions are widely recommended for this patient population, but to date no studies have reported the use of CRT in a family setting. This paper presents a case series in which family-based CRT was a significant component of the management. It was well received by patients and their families and previously treatment resistant patients became more engaged with the entire treatment process. In addition, all patients receiving family-based CRT went on to make progress towards recovery. These initial clinical observations suggest family-based CRT is likely to be a useful addition to treatment for child and adolescent AN and justifies formal evaluation.

Tyrosine supplementation as an adjunct treatment in anorexia nervosa – a noradrenergic repletion hypothesis

Anorexia nervosa (AN) is accompanied by an increased frequency of pre-morbid anxiety. Anxiety disorders are associated with increased brain activity of catecholamines, especially noradrenaline. It has been hypothesized that noradrenergic dysregulation may be a major factor in the causation of AN. In this article, we explore this hypothesis and how it might account for the reduction of anxiety found in starvation, the increase in anxiety found with re-feeding, and thus the reinforcement of anxiety by re-feeding. We propose that alleviation of this dysregulation through the noradrenaline precursor (tyrosine) supplementation, leading to saturation of supply, may alleviate some of the pathological changes found in AN. We consider how the hypothesis might be investigated. The success of tyrosine supplementation would have important implications from theoretical, research and clinical perspectives.

Altération de la qualité de vie dans l’anorexie mentale et amélioration sous traitement : validation d’un nouveau questionnaire, le QUAVIAM

Anorexia nervosa (AN) is a chronic and often severe eating disorder, which could have a serious impact on various life domains. AN may lead to physical, mental, behavioural and socioprofessional impairment. Thus, one could expect a poor quality of life (QoL) in AN patients. QoL is certainly a key factor to provide quantitative measurement of treatment efficacy that will facilitate clinical decision-making and treatment planning. Despite that QoL was rarely prospectively analyzed in AN patients, one could conclude that AN patients showed reduced QoL, as compared to normal controls and other psychiatric-disordered patients. It seems that mental health components of QoL are more impaired than the physical ones in AN patients, who showed a modest impact in the physical domain. Thus, our aim was to analyse the QoL using a new, French, questionnaire, the QUAVIAM (qualité de vie dans l'anorexie mentale). After a bibliography research (including EDE, EDI, SF-36, QOL.ED), the choice of 12 themes, regrouped in six scores, was made by three eating disorder specialists and two recovered patients. For each score, 10 to 15 questions were written by the experts, and then corrections and validation were made by the five experts and 21 patients. After this, we prospectively determined the reproducibility (3 days interval), the specificity, and the sensitivity for short-term change in patients exhibiting an "active" AN (n=54, mean age: 31 ± 9 yrs, mean BMI: 14.1 ± 2.8 kg/m(2), AN duration: 2.6 ± 1.9 yrs), and again after cognitive behavioral therapy (CBT). We also analyzed the QUAVIAM score and subscores in 48 recovering patients and in 56 subjects without eating disorder. The QUAVIAM final version (61 questions) was collected in 76 patients and the 56 healthy controls matched for sex and age. Its reproducibility was 91% (intra-questionnaire) and 94% (inter-questionnaire), its specificity 98% (versus controls; P<0.0001) and its sensitivity 99%. The QUAVIAM global score of the AN patients was more impaired (389 ± 87) than that of the recovering patients (157 ± 82) and the normal controls (89 ± 49; P<0.0001). Each of the six subscores was higher (more altered) in active AN than in recovering AN patients and in normal subjects: the somatic, the psychological, the hedonic, the socioprofessional, the affective and the TCA-related ones (P<0.001 for each comparison). The QUAVIAM global score and its subscores were significantly improved (decreased) by the 3-month CBT: 385 ± 25 before and 189 ± 30 after CBT (P<0.0001). The changes were observed for all the subscales (P<0.0001). The somatic subscore did not decrease less than the other subscores. Thus, the present study permits proposing the QUAVIAM for analysis of physical, mental, behavioural and socioprofessional impairment or improvements in AN patients.

A Quantum Psychopathological Account of Anorexia Nervosa

Anorexia Nervosa (AN) is a mental disorder characterised by a refusal to maintain body weight at or above 85% of the minimally normal weight for age and height, an intense fear of gaining weight and a disturbance in the way in which one’s body is perceived such that the sufferer is often unable to see that s/he is underweight. Contemporary psychodynamic, feminist and neuropsychological accounts of AN present only partial and sometimes conflicting accounts of this disorder. A quantum psychopathological account of AN might therefore enrich our understanding of this disorder by providing links between the social and the neural explanations for AN while at the same time adding substantially to their depth. In this vein, this paper follows and builds on the recent work of Donald Mender, who has suggested that Quantum Paradigms of Psychopathology (QPP) might be preferable to the currently prevalent biopsychosocial model of mental illness, and who has more specifically suggested that quantum theories of mind might offer a way to render psychoanalytical accounts of mental illness scientifically falsifiable. The first part of this paper will provide a brief yet thorough account of the psychodynamic, feminist and neuropsychological accounts of AN; the second will provide an in-depth overview of four contemporary quantum theories of mind; and the third will consider how these theories might be useful in our understanding of AN, examining specifically their impact on neuropsychology, their impact on psychotherapy and finally the possibility of developing a Quantum Object Relations (QOR) account of AN, based on Mender’s suggestion that “sociable” bosons might account for the impact of internalised ‘objects’ on a patient’s mental health, as identified in the psychoanalytic literature. NeuroQuantology | March 2013 | Volume 11 | Issue 1| Page 63-82

A Review of Anorexia and Bulimia Nervosa for the Forensic Pathologist

Anorexia nervosa (AN) and, to a much lesser extent, bulimia nervosa (BN) are psychiatric illnesses that carry the highest mortality rates compared to other psychiatric illnesses. They tend to be chronic disorders with many acute fair-ups that have profound negative impact on the body as a whole. Many medical complications can arise acutely and chronically following excessive dieting, purging, over exercising, abuse of medications such as diuretics and laxatives or any combination of these. In contrast to the profound effects eating disorders can have, the postmortem findings and testing can be subtle to nonexistent and may be overshadowed by trauma (in the case of suicides), natural disease (in the case of diabetes and alcoholism) and postmortem shifts (in electrolyte testing and toxicology). A full understanding of how eating disorders affect the body in the acute, chronic, and refeeding stages is needed to properly certify these deaths.

1966 – A wrong body: a neuroscience perspective on the etiology of anorexia nervosa

Anorexia nervosa (AN) patients have a disturbance in the way in which one's body is experienced and perceived: they evaluate negatively their own body and body parts and deny the seriousness of their current low body weight. It is controversial whether these symptoms are secondary to dysfunctions in the neuronal processes related to appetite and emotionality or reflect a primary disturbance in the way the body is experienced and remembered. Our spatial experience is organized around two different reference frames - egocentric (body as reference of first-person experience) and allocentric (body as object in the physical world) - that influence each other during the interaction between long- and short-term memory processes in spatial cognition. Neuroimaging studies on AN patients showed several structural and functional alterations in frame and memory-related bodyimage-processing brain circuits. Particularly, both structural and functional studies showed alterations of the precuneus and the inferior parietal lobe. These alterations may be related to the etiology of the body image distortion: individuals with AN are locked to an allocentric ( observer view ) negative memory of the body that is no more updated by contrasting egocentric representations driven by perception.

Temporal Relationships of Emotional Avoidance in a Patient with Anorexia Nervosa—A Time Series Analysis

Anorexia nervosa (AN) is a serious eating disorder marked by self-induced underweight. In patients with AN, the avoidance of emotions appears to be a central feature that is reinforced during the acute state of the disorder. This single case study investigated the role of emotional avoidance of a 25-year-old patient with AN during her inpatient treatment. Throughout the course of 96 days, the patient answered questions daily about her emotional avoidance, pro-anorectic beliefs, perfectionism, and further variables on an electronic diary. The patient's daily self-assessment of emotional avoidance was described in terms of mean value, range, and variability for the various treatment phases. Temporal relationships between emotional avoidance and further variables were determined using a time series approach (vector autoregressive (VAR) modelling). Diary data reflect that the patient's ability to tolerate unpleasant emotions appeared to undergo a process of change during inpatient treatment. Results of the time series analysis indicate that the more the patient was able to deal with negative emotions on any one day (t-1), the less she would be socially avoidant, cognitively confined to food and eating, as well as feeling less secure with her AN, and less depressive on the following day (t). The findings show that for this patient emotional avoidance plays a central role in the interacting system of various psychosocial variables. Replication of these results in other patients with AN would support the recommendation to focus more on emotional regulation in the treatment of AN.

Plasma Levels of Neuropeptide Y and Peptide YY in Patients Diagnosed with Anorexia Nervosa and Type 2 Diabetes Morbid Obese Subjects

Anorexia Nervosa (AN) and Obesity are prevalent in modern societies. This study evaluate circulating levels of Neuropeptide Y (NPY) and of Peptide Tyrosine-Tyrosine (PYY) in 60 women: 20 affected by AN (Body Mass Index = BMI 15.74 ± 2.09 kg/m2, age 30.19 ± 10.52 yr), 10 restrictor (BMI 14.89 ± 1.64 kg/m2) and 10 binge-purge subtype (BMI 18.27 ± 0.81 kg/m2); 20 affected by severe Obesity (BMI>40 kg/m2; age 33.56 ± 5.2 yr) with type II diabetes with no therapy, and 20 healthy controls (BMI 22.06 ± 0.93 kg/m2, age 32.44 ± 4.35 yr). NPY is higher in AN than obese and controls (70.17 ± 20.84 vs 25.12 ± 7.26 and 52.20 ± 10.88 pmol/L; p<0.001) and lower in obese than controls (p<0.001). PYY is higher in AN than obese and controls (219.77 ± 83.51 vs 116.42 ± 41.42 and 94.97 ± 12.74 pg/ml; p<0.001), with no differences between obese and controls. In AN, NPY and PYY are quite higher (p=0.059; p=0.06) in restrictor (75.77 ± 20.86 pmol/L; 241.78 ± 84.6 pg/ml) than in binge-purge subtype (53.39 ± 8.72 pmol/L; 153.73 ± 29.45 pg/ml). Increase of NPY despite simultaneous PYY increase in AN might be related to reduced sensitivity to PYY inhibitory effect on NPY production or increased production of NPY from sympathetic peripheral nervous system, a finding evident mainly in restrictor AN. In obese PYY is close to controls suggesting a reduced intestinal production of this peptide because of the stimulus of continuous overfeeding, whereas the reduced NPY production could be explained by increased levels of insulin and leptin. Reduced NPY levels suggest that in these obese the overfeeding is not dependent on increased hungry signal, but on inadequate satiety signal.

Drive for Leanness, Anorexia Nervosa, and Overactivity: The Missing Link

Anorexia nervosa (AN) is a psychiatric condition characterized by deliberate reduction of body weight. Some patients with AN exhibit overactivity that can worsen their state of malnutrition. Employing an evolutionary psychiatry line of inquiry, we propose that rigidity of thinking and overactivity are behavioral phenotypic changes in AN patients that are normal to tree-dwelling mammals, such as monkeys. Such behavior can lead to good functioning as ballet dancers and athletes but lead to certain disadvantages in other areas of modern life. The overactivity in AN, though under conscious control may be neurobehavioral and driven subconsciously by disordered cerebral neuropsychopharmacology.

Anorexia nervosa: estudo de caso com uma abordagem de sucesso

A anorexia nervosa (AN) é doença grave de etiologia multifatorial, que envolve predisposição genética, fatores socioculturais, vulnerabilidades biológicas e também psicológicas. Caracteriza-se por séria restrição alimentar auto-imposta, com conseqüências orgânicas e psíquicas graves, e alta taxa de mortalidade. O objetivo deste artigo é descrever um caso de AN, tratado em grupo psicoterápico, heterogêneo, de adolescentes, sem focar no comportamento anoréxico. Analisaram-se as implicações da doença nos aspectos familiar, social, na escolaridade e na sexualidade da paciente. O método terapêutico empregado, em grupo heterogêneo, sem focar no comportamento anoréxico, mostrou-se eficaz tanto na aderência ao tratamento quanto na evolução do caso.

Impaired bone health in anorexia nervosa

Anorexia nervosa (AN), a condition of malnutrition, has a multitude of effects, including low bone mineral density (BMD). Much has been discovered over the last couple of decades regarding the extent and pathophysiology of low BMD in AN, including the role of gonadal steroids, neuroendocrine hormones and appetite-regulating peptides. The effects of AN on bone are particularly concerning in adolescents, who are in the process of accruing peak bone mass, and decreased rates of bone-mass accrual in these critical years are predictive of poor bone health in later life. Although dual-energy x-ray absorptiometry continues to be the standard technique for monitoring BMD, newer techniques such as quantitative computed tomography and calcaneal ultrasound are being explored. Weight and menses recovery continue to be the most effective treatment for improving BMD in AN. Further research is needed to translate the pathophysiology being unraveled into clinical applications for improving BMD in AN.

Whole-Body Dual-Energy X-Ray Absorptiometry Comes of Age: Bone Structural Measures and Their Physiological Determinants in Anorexia Nervosa

Anorexia nervosa (AN) warrants study by all endocrinologists for a variety of reasons, not the least being the devastating endocrine and structural effects of this disorder of appetite on its unfortunate victims. This is all the more poignant because those of us with more normal satiety regulation lack comprehension of the disorder. If the impact and epidemiology of AN in Westernized societies is not sufficient reason for a detailedunderstandingoftheeffectsofthedisorder,thenitsroleas a physiological model for adolescent and early adulthood starvation the world over should interest both humanitarians and physiologists, involving as it does the regulation of growth and fuel metabolism. In this great tapestry, it could be argued that the skeletal impact of the disorder is of low importance. There are two reasons why this argument is invalid. The first is that the skeleton accuratelyreflectsthephysiologicaleffectsofthediseasewritten in its shape, size, and function, and second, the majority who survive the ravages of the adolescent phase of the disorder are oftenleftwithapermanentlydamagedskeletonasaresultoflack of attainment of their genetically programmed optimal peak bone mass with consequent increased fracture risk (1). Anatomy of Skeletal Growth It is a truism to state that our shape is determined by our bone structure. The huge variety of shape and size of our species, evident to us all every day, is a result of the huge variation in skeletal structure determined in part during the few short years ofouradolescentgrowthspurt.Assessmentofadolescentgrowth bythemeasurementofheightisapartofthephysicalassessment ofteenagersandisausefulpointertoavarietyofdisordersofthe activityofthephyses,thedeterminantsofheight.However,bone enlargement is determined not only by an increase in length but alsobyanincreaseinwidthanddepth,togetherwithanincrease in the bone within the bone. Cohort studies show that peak height velocity occurs 2–3 yr before menarche and peak bone mineral accretion in the 2 yr around menarche (2, 3). Eight percent of adult height and 22% of adult total-body bone mineral are gained in the 2 yr surrounding peak height velocity (4). Because peak bone mineral accretion occurred 1 yr later than peak heightvelocity,thereisadecreaseinsize-correctedbonemineral density(BMD;thebonewithinthebone)beforemenarche(3,5), reflecting a disassociation between linear skeletal growth and bone mineral accretion during the rapid lengthening of bones occurring at this time. Careful examination of the femoral neck site confirms that the periosteal expansion reaches its maximum about 2 yr after the attainment of peak height (6). This latter growth cannot be assessed by physical examinationbutratherneedsanimagingtechniquebestsuppliedbydual

Eating disorders: an overview of treatment responses and the potential impact of vulnerability genes and endophenotypes

Anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED) are the three main eating disorders. Antidepressants, antipsychotics, anticonvulsants, prokinetic agents, opiate antagonists, appetite suppressants, tetrahydrocannabinol, cyproheptadine, zinc and ondansetron have been tested, and are frequently associated with psychological treatment. Selective serotonin reuptake inhibitors have a proven efficacy in BN and binge eating disorder. Other treatments, such as atypical antipsychotics in AN, anticonvulsants in BN and BED, and naltrexone and ondansetron in BN, may be promising, but lack the appropriate trials. The development of genetic researches in eating disorders may help the clinician to choose the most appropriate treatment in forthcoming years, using genetic polymorphisms of vulnerability genes, those linked to endophenotypes, or genes implicated in the metabolism of the drug treatment.

Development of acromegaly in a patient with anorexia nervosa: Pathogenetic and diagnostic implications

Anorexia nervosa (AN) is a psychosomatic disorder characterized by an alteration in body image, resulting in eating abnormalities that lead to malnutrition associated with secondary endocrinological disturbances. AN is associated with high levels of GH and low levels of IGF-I, suggestive of a nutritionally acquired lack of GH action or GH resistance and of an unbalanced hypothalamic GH neuroregulation with GHRH prevalence on SS tone. In this clinical report, we describe the development of acromegaly in a patient affected by AN and we discuss pathogenetic and diagnostic implications.

Emerging drugs for eating disorder treatment

Anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) comprise the currently recognised eating disorders. Although distinct diagnostic entities, they share certain forms of comorbid psychopathology, particularly anxiety and mood disorders. BN and BED have been studied most intensively as targets for pharmacotherapy. The list of drugs tested in eating disorders is substantial; however, the number of therapeutic classes of medications tested in these conditions is relatively modest. Antidepressant medications, including tricyclic antidepressants, selective serotonin re-uptake inhibitors, as well as some of the novel antidepressants, have shown evidence of some therapeutic value in both BN and BED. Their efficacy in AN, however, has been disappointing. The pharmacological options for AN are very limited. The number of controlled trials that have been conducted is small, and the research that has been successfully completed has generally failed to demonstrate medication efficacy. Patients with BN typically show reduced binge eating and purging frequency in medication trials, but rarely attain abstinence. In BED, patients often measure the value of their medication therapy by its ability to stimulate weight loss, which is another area on which future pharmacotherapy may improve. Novel pharmacological interventions are needed for each of these conditions. Peptide hormones are increasingly being evaluated for eating disorder treatment, including ghrelin agonists, neuropeptide Y1 and -5 antagonists, orexin receptor antagonists, corticotropin-releasing factor receptor 2 antagonists, histamine 3 antagonists, melanocortin 4 receptor antagonists, β3-adrenoceptor agonists, 5-hydroxytryptamine-2A antagonists and growth hormone agonists. Although these compounds are in early phases of clinical testing for eating disorder treatments, data from these studies will be instructive in the quest for effective pharmacotherapy for these conditions. An overview of the current pharmacotherapy options for eating disorders is presented with a discussion of the emerging potential treatments.

Dying To Be Thin: Attachment to Death in Anorexia Nervosa

Anorexia Nervosa (AN) usually follows a prolonged course accompanied by significant morbidity and high mortality. AN patients have been found to have elevated and attempted suicide rates, with suicide being the second most common cause of death in AN after the complications of the disorder itself. The suicide risk in AN is similar to that in major depression or conduct disorder and linked mainly to longer duration of illness, lower weight, bingeing and purging, impulsivity-related manifestations, comorbid substance abuse, and affective disorder. This paper reviews suicidal tendency and disturbed body image, death and eating disorders, and attachment and death with clinical implications related to AN.