Anorexia Nervosa Patients Research Articles

Assessment of trabecular bone score using updated TBSTT in anorexia nervosa-The AN-BO study.

Anorexia Nervosa (AN) is characterized by a distortion of body image, very low body weight, malnutrition and hormonal dysregulations, resulting in reduced bone mineral density (BMD) and impaired bone microarchitecture. The updated Trabecular Bone Score (TBS) algorithm accounts for soft tissue thickness (TBSTT) instead of BMI (TBSBMI). The aim of the study was to assess both TBS algorithms in adult AN patients compared to normal-weight controls(CTRL). This retrospective cross-sectional study investigated 34 adult female anorexia nervosa (AN) patients and 26 healthy normal-weighted age- and sex-matched controls (CTRL). Bone texture analysis was assessed by TBSTT and TBSBMI (TBS iNsight® V4.0 and V3.1), bone mineral density (BMD; lumbar spine LS, femoral neck, total hip) and body composition by DXA (GE Lunar iDXATM). Laboratory analyses included bone turnover markers (CTX; P1NP; sclerostin). Data analysis was performed using parametric (t-test) or non-parametric test (Mann-Whitney-U-Test) depending on normality, one-way ANCOVA and correlation analysis (Perason's or Spearman's). AN patients (BMI 14.7(1.6)) and CTRL (BMI 22.4(4.0)) were of comparable age (22.8(7.1) vs.25.0(4.0)years, p = 0.145). TBSTT(1.319±0.09 vs.1.502±0.07, p<0.001) and TBSBMI(1.317±0.10 vs.1.548±0.09, p<0.001) were significantly lower in AN patients compared to CTRL. Soft tissue thickness was lower in AN (p<0.001). Within the CTRL group, but not in AN, TBSTT and TBSBMI were significantly different (p<0.001). BMD was lower at all sites in AN patients (p<0.001 for all), being lowest at LS. Bone Mineral Content, Lean Body mass and Fat Mass were lower in AN (p<0.001). AN patients had lower P1NP (p = 0.05), but higher CTX (p = 0.001) and sclerostin (p = 0.003) levels. Adult AN patients have lower TBSTT and TBSBMI, reduced BMD and an uncoupling of bone turnover. In AN both TBS algorithms show similar reduced trabecular bone microarchitecture. The observed difference of TBSTT and TBSBMI in CTRL with normal body composition highlight the importance of the new algorithm.

Eye movement desensitization and reprocessing (EMDR) therapy for the treatment of eating disorders: A systematic review of the literature

AbstractEye movement desensitization and reprocessing (EMDR) has demonstrated promise as a treatment for eating disorders (ED). The present study aimed to systematically evaluate the current evidence regarding the use of EMDR therapy in the treatment of EDs, ED symptomatology and body image concerns. Included articles were original studies that described the use of EMDR therapy in the treatment of EDs, published in the English language in a peer‐review journal. The search was conducted using four electronic databases: PsycINFO, MedLine, Embase, and Web of Science. Two independent reviewers conducted screening, selection, risk of bias assessment and data extraction. Of the initial search of 109 potential studies, eight met inclusion criteria, including six case studies, one quasi‐experimental study, and one randomised control trial (RCT). The RCT indicated that including an EMDR component did not have benefits over standard treatment for core ED symptoms, whereas the quasi‐experimental study demonstrated some benefits for inclusion of EMDR as a treatment adjunct for anorexia nervosa patients. Case studies indicated some promising outcomes for patients with various presentations. Despite EMDR being an available treatment for several decades now, there is limited clinical evidence regarding its efficacy in the treatment of EDs. These findings highlight a critical need for more clinical research in this area to ensure clinical practice is guided and supported by evidence‐based outcomes.

Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa

BackgroundAnxiety is a core characteristic of anorexia nervosa and a potential target of exposure therapy, which requires a profound understanding of the patients’ fears in order to be successful. The knowledge about fears in anorexia nervosa that should be targeted during exposure therapy can be enriched by laboratory research to the precise emotional and behavioral responses of anorexia nervosa patients when they are exposed to disorder relevant fear stimuli.MethodsIn the laboratory, patients with anorexia nervosa (n = 15) and healthy controls (n = 51) were exposed to 1. their own body weight and a 10% higher body weight on the scale, 2. a standardized lab breakfast, and 3. five virtual bodies with different BMIs ranging from extreme underweight to lower healthy weight. The participants emotional (anxiety, disgust, satisfaction, acceptance) and behavioral responses (calorie consumption) were assessed. Patients with anorexia nervosa but not the healthy controls then received an intensive exposure treatment (~ 30 individual exposure sessions) targeting their individual fears, next to standard care. After the exposure treatment, it was investigated whether the patients’ responses to the laboratory tasks changed.ResultsAcross all tasks, the patients reported more anxiety than healthy controls. The patients also consumed less calories during the breakfast and accepted the different body weights on the scale less than healthy controls. During the virtual body exposure, the patients’ emotional responses did not differ per avatar but they reacted more negatively towards avatars with healthier weights than did healthy controls. After the exposure treatment, the patients reported less fears and they consumed more calories while their BMIs had increased. They were also more accepting of healthier weights.ConclusionsExposure to food-, body- and weight-related stimuli in the laboratory induces emotional reactions in patients with anorexia nervosa that are informative for the identification of exposure therapy treatment targets. In addition, exposure therapy targeting individual fears in patients with anorexia nervosa led to symptom reduction and is a promising intervention for the treatment of anorectic fears, though more research is needed to optimize its efficacy.

Changes in the Firmicutes to Bacteriodetes ratio in the gut microbiome in individuals with anorexia nervosa following inpatient treatment: A systematic review and a case series.

Anorexia nervosa has the highest mortality rate among psychiatric illnesses. Current treatments remain ineffective for a large fraction of patients. This may be due to unclear mechanisms behind its development and maintenance. Studies exploring the role of the gut microbiome have revealed inconsistent evidence of dysbiosis. This article aims to investigate changes in the gut microbiome, particularly, mean differences in the Firmicutes to Bacteroidetes ratio, in adolescent and adult individuals with anorexia nervosa following inpatient treatment. Longitudinal studies investigating gut microbiome composition in inpatient populations of anorexia nervosa before and after treatment were systematically reviewed. Additionally, gut microbiome compositions were characterized in three acute anorexia nervosa inpatients early after admission and after 4-12weeks of treatment. Review results indicated an increase in the Firmicutes to Bacteroidetes ratio in individuals with anorexia nervosa after treatment. These however did not match values of their healthy counterparts. In the case-series samples, the reverse occurred with samples taken 4weeks after treatment. In the patient who provided an extra sample 12weeks after treatment, similar results to the studies included in the review were observed. Furthermore, Firmicutes to Bacteroidetes ratio values in the case-series samples were notably higher in the two patients who had chronic anorexia nervosa. Differences in methodologies, small sample sizes, and insufficient data limited the generalizability of the outcomes of the reviewed studies. Results suggest a potentially unique microbiome signature in individuals with chronic anorexia nervosa, which may explain different outcomes in this group of patients.

Autistic traits and perspective taking in youths with anorexia nervosa: an exploratory clinical and eye tracking study

BackgroundDespite their apparent dissimilarity, Anorexia Nervosa (AN) and Autism Spectrum Disorder (ASD) share many features, especially in terms of social and emotional difficulties. In recent years, empathic abilities in AN have been frequently assessed using self-report measures. Otherwise, the director task (DT) has been used to investigate the ability to take the visual perspective of another individual in a communicative context, using eye-tracking technology. The aim of the current study was to test the presence of autism-relevant features in AN, through: (i) comparing self-reported autistic traits and empathic abilities in a group of young inpatients with AN and age/gender matched healthy controls (HC); (ii) comparing performance on the director paradigm.MethodsThe participants were females in the age-range between 11 and 18 years: 24 with AN and 23 HC. Autistic traits, empathic abilities, and severity of the eating disorder were respectively measured using: the Autism Quotient (AQ), the Interpersonal Reactivity Index (IRI), and the Eating Disorder Inventory-3 (EDI-3). Both groups performed a computerized task in which a director instructed them to move objects placed on a set of shelves using a mouse, while their eye gaze was tracked. A total of 36 shelf configurations, divided into three categories (with dimensional distractor – with spatial distractor – control), were created.ResultsSubjects with AN showed higher autistic traits than HC. Eye-tracking data revealed that subjects with AN took longer to decide which object to select and where to move it, both in distractor-trials and in control-trials. In the AN group, we found a significant negative correlation between the total score of the AQ and the number of fixations to the irrelevant object in the dimensional control condition -in which the subjects were asked to focus on dimensional aspects of the object (large-small)-.ConclusionsAutistic traits were over-represented in a group of young inpatients with AN. Through the use of eye-tracking technology, this exploratory study documented some differences between AN inpatients and HC in their online processes during the perspective taking tasks, which could be considered a target of tailored intervention. A larger sample of patients is needed to confirm these preliminary findings.

Stimulant medications in the management of bulimia nervosa and anorexia nervosa in patients with and without comorbid attention deficit hyperactivity disorder: A systematic review.

People with attentional problems are at increased risk of eating disorders. This paper aimed to systematically review and synthesize the existing evidence on stimulant medication in the management of patients with bulimia nervosa (BN) or anorexia nervosa (AN) with or without comorbid attention deficit hyperactivity disorder (ADHD). A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A protocol for the review was registered with Open Science Framework (OSF) Registry and critical appraisal of the literature was conducted using Joanna Briggs Institute (JBI) Critical Appraisal Tools. Thirteen articles met inclusion criteria including two quasi-experimental studies, one randomized controlled trial, four case series, and six case reports. 26 cases were included from studies and 32 from case series/reports. Only two cases from a single case report had a diagnosis of AN, while the remainder had BN. Stimulants included methylamphetamine, lisdexamfetamine, methylphenidate, dextroamphetamine sulphate and mixed amphetamine salt. In nearly all cases of BN there were reported reductions in eating disorder symptoms. The rates of adverse effects were high and included weight loss, decreased appetite, tachycardia, dry mouth, fatigue, insomnia, restlessness, nausea, bruxism, headache, palpitations, blood pressure changes, irritability, anxiety, depressed mood, and diaphoresis. There is currently insufficient evidence to support the use of stimulant medications to treat symptoms of BN or AN. The authors recommend considering screening patients with BN for ADHD.

WAY-208466, a 5-HT6 receptor agonist, increases food motivation in primates: A behavioural and PET imaging study opening perspectives in eating disorders

The 5-HT6 receptor (5-HT6R) is highly expressed in the anterior striatum, a region involved in food-intake and anxiety-related behaviours that shows abnormal activity in anorexia nervosa (AN) patients. Indeed, 5-HT6R antagonists decrease food motivation across species. Rodent studies have shown the acute anxiolytic properties of WAY-208466, a selective 5-HT6R agonist. Thus, we hypothesized that this agent could increase food motivation and decrease anxiety-related behaviours by impacting cortico-striatal circuits. We administered acute (0.1 mg/kg) and subchronic (0.03 and 0.1 mg/kg) intramuscular injections to four macaques performing a food-choice task and expressing spontaneous behaviours. We used PET imaging with the [18F]2FNQ1P specific tracer to determine 5-HT6R occupancy in several regions that could be linked with the induced behavioural changes. Acute and subchronic activation of 5-HT6R transmission led to a reversible increase in food motivation. WAY-208466 also decreased anxiety-like behaviours when given acutely but not subchronically. However, in the subchronic protocol, the higher dose led to increased activity characterized by movements and object-related behaviour expression. PET imaging revealed that these behavioural changes could be sustained by cortico-striatal circuits involved in food intake. These findings demonstrate that this 5-HT6R agonist subchronic treatment successfully increases food motivation but does not fully achieve the expected anxiolytic effect in monkeys. It suggests that targeting 5-HT6Rs may be a promising approach for treating the restrictive subtype of AN, which, unlike anxiety, has not been shown to benefit from treatment with selective serotonin reuptake inhibitors.

Unveiling the devastations of streptococcus sanguinis infective endocarditis masquerading as iron deficiency anaemia: a case report

Abstract Background Iron deficiency is the leading cause of anaemia worldwide and frequently observed in adolescent women, particularly those with eating disorders like anorexia nervosa. Consequently, clinicians may overlook iron deficiency anaemia, potentially missing a more serious diagnosis. Case summary A 19-year-old woman was referred to the hospital by her general practitioner due to worsening symptomatic iron deficiency anaemia, despite treatment with oral iron supplementation. Her blood cultures consistently grew Streptococcus sanguinis, and an echocardiogram revealed vegetations on the mitral and tricuspid valves, confirming the diagnosis of infective endocarditis. Several systemic complications of varying acuity were identified, including a ruptured left common iliac artery aneurysm with active haemorrhage into the left psoas muscle, enlarging cerebral, hepatic, and right common femoral artery aneurysms, splenic infarction with abscess formation, and an infected left psoas muscle hematoma. Multimodal imaging and collaboration within the multidisciplinary endocarditis team were crucial for coordinating further evaluation and managing the complex array of peripheral lesions in infective endocarditis. The patient was discharged with a good clinical outcome after 81 days. Discussions This case highlights the risks of overlooking iron deficiency anaemia in adolescent women with anorexia nervosa and the serious consequences of untreated complicated infective endocarditis. It emphasises the need for thorough investigation of anorexia nervosa patients for infections due to their reduced clinical response, to ensure early diagnosis and treatment.

Neuropsychiatric considerations in treating anorexia nervosa patients with osteopathic manipulative medicine: a narrative review.

Osteopathic manipulative medicine (OMM) has a growing recognition in serving as an effective treatment topromote adaptation and homeostasis of the body by addressing musculoskeletal, neural, vascular, and lymphatic structures to promote self-healing and regulation. OMM can treat the musculoskeletal tension and sympathetic hyperactivity resulting from the increased cortisol response and hypersensitivity found in varying psychiatric illnesses, including anorexia nervosa (AN). This paper addresses the considerations necessary for treating AN patients with OMM, emphasizing the need to evaluate their abnormal high-level neuronal processing of sensory information, including differences in touch perception compared to the general population. Current literature was gathered utilizing a combination of the following keywords: anorexia nervosa, perception of touch, and osteopathic manipulative medicine/treatment. No literature was found addressing the effects of OMM on treating AN patients. Eight studies addressed the change in perception of touch found in AN patients. Results of the literature review reveal that the perceptions of touch in AN patients are distorted and can lead to reduced perceived pleasantness encountered in social interactions and touch. Specific changes have been found in C-tactile (CT) afferents responsible for the positive effects of touch, thus influencing emotional regulation. The significance of addressing this topic is to provide insight into the pathophysiological processes of AN and to inform physicians of unconventional stimuli that may exacerbate AN symptoms and behaviors. Further study is required to elucidate the role and mechanism of OMM in patients with AN and whether manual therapy could worsen pathological behavior and thinking patterns seen in AN patients. Such studies could include, but are not limited to, examining biological factors such as cortisol levels in AN patients receiving OMM and collecting data about AN patients' thinking patterns and behavior during OMM treatment.

No Evidence for Cross-Sectional or Longitudinal Associations between Cognitive Flexibility Performances and Nutritional Status in a Cohort of Inpatients with Anorexia Nervosa.

According to the Cognitive-Interpersonal model of anorexia nervosa (AN), the combined influence of cognitive and socio-emotional difficulties would constitute vulnerability and maintaining factors. Poor cognitive flexibility is one of the endophenotypic candidates (i.e., a trait marker) of the disorder, but few studies have examined its association with illness symptom variations, notably weight status. The study aimed to evaluate the relationships between cognitive flexibility performances and nutritional status indices (BMI; body composition) at different times of the disorder. Cross-sectional and longitudinal associations between cognitive flexibility (TAP 2.1) and nutritional status indices, along with anxious and depressive (HAD) and eating disorder (EDE-Q) symptomatology were investigated using univariate and multivariate analyses in a cohort of AN inpatients evaluated at hospital admission (N = 167) and discharge (N = 94). We found no or negligible associations between nutritional status and HAD or EDE-Q scores or cognitive flexibility performances, either cross-sectionally or longitudinally. Cognitive performances did not significantly differ between the AN subtypes. In agreement with the Cognitive-Interpersonal model of AN, cognitive flexibility is independent of nutritional status, as well as the AN subtype. It is also independent of the levels of anxious, depressive, or ED symptomatology. A new therapeutic approach targeting cognitive flexibility and intolerance to change could benefit severely emaciated people with AN, regardless of disease subtype and level of dysphoria.

Quality of Life and Clinical Impairment in Spanish Adolescent Anorexia Nervosa Patients.

Eating disorders have serious physical, mental and social consequences that can affect the quality of life of the sufferer. This study aimed to evaluate the relationship between the severity of ED-related psychopathology and clinical impairment in adolescents with anorexia nervosa (AN) as well as their perception of health-related quality of life. Eighty-six Spanish young women with AN completed a set of questionnaires assessing eating disorder pathology, clinical impairment, and quality of life. The set included the following instruments: the Eating Disorder Examination Questionnaire, Clinical Impairment Assessment, Short Form-12 Item Health Survey, and the Eating Disorder-Specific Heath-Related Quality of Life instrument. Descriptive and regression analyses were applied to identify associations between variables. Higher scores on clinical impairment domains were associated with greater impairment of mental and physical health. Moreover, clinical impairment domains and concerns due to ED were related to a lower quality of life. In conclusion, adolescents with AN have a poor quality of life. Moreover, the findings suggest that the clinical features of impairment may serve as severity indicators of quality of life.

Psychological understanding of Anorexia nervosa gained from combined clinical care

Introduction Anorexia nervosa (AN) is a debilitating illness with rapidly increasing incidence. The longer it lasts the more difficult is to cure. Although in the majority of the cases the main treatment is psychotherapy severe cases require inpatient admission for life saving support. The presentation expounds the combined therapeutic approach that anorexia nervosa patients of Semmelweis University Psychiatry and Psychotherapy Department provided with.Currently the backbone of psychotherapy for AN is cognitive behavioral therapy (CBT), schema therapy and katathym imaginative psychotherapy (KIP) combined with psychodrama.ObjectivesOne of the aims of our research is to identify the most relevant focus of psychotherapy by identification of specific personality traits in patients with AN, who will be compared with healthy controls. Furthermore, two subgroups of patients will be compared with each other: the milder version of AN (BMI above 16) with the more severe form of AN who are required inpatient admission.MethodsWomen with AN (age:18-45) have been compared to age-matched controls on MINI and SCID-5-AMPD interview variables and on the scales of online questionnaires, such as EDI-I., MZQ, DIS-Q, SCL-90, PHQ-9, STAI, CTQ and YPI.Results Clinical care highlighted important underlying psychological causes such as inadequate mirroring, absence of the father, or on the contrary, overly intimate relationship with the father, and relentless inner voice as a consequence of unintegrated inner aspects.The SCID-5-AMPD pointed out affected areas of personality such as Identity, Self-directedness, Negative affectivity, Intimacy, Alienation. Importantly, neither trauma scales (measured by CTQ), nor dissociation (measured by DIS-Q) differed significantly between patients and healthy controls.Conclusions Planning psychotherapy could benefit from the identified foci. Anti-depressive medication must be considered in order to improve outcome of inpatient admission. The CTQ probably does not measure the subtle but chronic inadequacy of attachment and mirroring that apparently are typical in AN. The reliable identification of the typical dissociative inner voice that often seen in anorexia nervosa may need another questionnaire apart from DIS-Q.The research is supported by bilateral science and technology (S&amp;T) cooperation project 2019-2.1.11-TÉT-2020-00242Disclosure of InterestNone Declared

Short-chain fatty acids in plasma and feces: An optimized and validated LC-QqQ-MS method applied to study anorexia nervosa

Short-chain fatty acids (SCFAs) are organic saturated monocarboxylic acids with fewer than six carbon atoms. Their recently described relevance in health and disease has brought to the table the need for a convenient method for their analysis. The current research presents an optimized and validated LC-QqQ-MS method for the absolute quantification of SCFAs in plasma and feces. This method has proven to be accurate and precise in a wide range of concentrations (0.2 – 200 µM). It has been applied to more than 500 samples showing good precision, reproducibility, and linearity results. The method was applied to study samples from anorexia nervosa (AN) patients and matched healthy controls (HC). The results showed significant differences in the concentration of plasmatic and fecal SCFAs between both groups whose implications in AN are yet to be determined. Nonetheless, these findings denote important alterations in the SCFAs homeostasis in AN which can be linked to the metabolic alterations and the intestinal dysbiosis already characterized in the disease. More research is still required to identify the function of these metabolites in the pathophysiology of AN, but the present work provides a reliable methodology and valuable information to continue delving into the potential role of the microbiota as a therapeutic target via the gut-brain axis.

Inpatient admissions and mortality of anorexia nervosa patients according to their preceding psychiatric and somatic diagnoses.

Anorexia nervosa (AN) is associated with increased risk of mortality, but little is known about the risk of inpatient admissions and mortality outcomes in individuals with diagnoses of both AN and other psychiatric and somatic conditions. We aimed to investigate the inpatient admissions and mortality among people with AN and other diagnosed conditions using Danish national registers. This retrospective cohort study included individuals diagnosed with AN in Denmark, born 1977-2010. We identified other mental and somatic conditions in this population. We used Cox proportional hazards regression to estimate the risk of inpatient admission and mortality, focusing on (i) the number of other diagnosed conditions, and (ii) specific combinations of conditions diagnosed prior to the AN diagnosis. Categories of inpatient admissions considered were due to: (i) AN, (ii) any psychiatric disorder, and (iii) any somatic disorder. Additionally, competing risks survival analysis was used to calculate the cumulative incidence of inpatient admission and all-cause mortality over the follow-up period. The study population included 11,489 individuals. The most common conditions individuals had prior to their AN diagnosis were other eating disorders (34.5%) and anxiety disorders (32.7%). During the follow-up, 3184 (27.7%), 4604 (40.1%), and 6636 (57.8%) individuals were admitted for AN, any psychiatric disorder, and any somatic disorder, respectively; and in total 106 (0.9%) died. The risk of all outcomes was highest among those who had received a higher number of other diagnoses. For most combinations, the risks of admission and mortality were increased. Our study presents the prevalence of other conditions in patients with AN in Denmark and elucidates their association with higher rates of inpatient admission and mortality. Our findings highlight the need for comprehensive, multidisciplinary care of patients with AN considering the spectrum of other diagnosed conditions to improve health outcomes.

Comparing Olanzapine with Placebo in Patients with Anorexia Nervosa for Increasing BMI and Weight Gain

Anorexia Nervosa is an eating disorder that can be characterized by having exceptionally low body weight with feeling of disgust to food. Commonly known treatment for Anorexia Nervosa is psychological treatment with methods like CBT and MANTRA, but now with the introduction of pharmacological drugs it is the aim of this review to identify whether olanzapine is effective compared with placebo in increasing BMI and weight gain. What was found is that olanzapine showed great increases in BMI [F (1, 20) =6.64, p=0.018] when compared to placebo, and that it noticeably had decreased depression and anxiety. Additional studies found that olanzapine patients gained weight more rapidly and achieved their BMI targets more quickly than those taking a placebo. On the other hand, a contradictory finding was seen, it was that there was no significant difference between olanzapine and placebo in the matter of weight recovery and psychologic, depressive, and anxious symptoms. What is concluded is that to minimize the rely on pharmacologic therapies until new findings emerge, and to depend mostly on psychotherapies such as CBT and MANTRA for increasing BMI in anorexia nervosa patients.

Case Reports of Binge Eating Patterns in the Recovery Phase of Anorexia Nervosa Patients With and Without Food Addiction.

Food addiction refers to a condition in which individuals exhibit addictive-like behaviors toward food, like those observed in substance abuse. Although still debated, evidence supporting the validity and usefulness of the concept of food addiction is growing. Food addiction is particularly associated with obesity and eating disorders involving binge eating. This study discusses the cases of two adolescent patients who presented with anorexia nervosa. During the recovery phase of anorexia nervosa, binge eating was observed, and the patterns of binge eating significantly differed between patients, with and without food addiction. Therefore, healthcare professionals treating eating disorders should be aware of food addiction and modify their treatment strategies accordingly.

Neuronal activation in the paraventricular thalamus and lateral habenula during activity-based anorexia in mice

Self-starvation in anorexia nervosa patients ultimately progresses into a state of energy deficit and the body responds with homeostatic changes giving rise to many of the core symptoms. To accelerate progress towards effective therapies, we need to better understand the neurobiological underpinnings of this disease. Hence, we sought to identify brain regions of potential importance for anorexia nervosa by exploring neuronal activity in the activity-based anorexia (ABA) mouse model using Fos-TRAP2 technique. Given the function of many nuclei in the dorsal thalamus that centre around the integration of internal stimuli, such as metabolic state, with appropriate behavioural responses, activation of populations in the dorsal thalamus was the main focus. Substantial neuronal activation was found in several dorsal thalamic nuclei of ABA mice. In particular, ABA considerably increased neuronal activity in the paraventricular thalamus (PVT) and the lateral habenula (LHb). In addition, immunohistochemistry revealed that a significant proportion of the activated neurons in PVT and LHb were calretinin neurons, implicated in starvation-induced arousal. These findings position the dorsal thalamus as a region involved in anorexia-induced neuronal activities and as a potential site to further examine in the relation to anorexia nervosa.

Increased GDF15 in a subgroup of anorexia nervosa patients and in anorectic mice

Increased GDF15 in a subgroup of anorexia nervosa patients and in anorectic mice

Suicidal Behavior in Eating Disorders

Many studies have shown that people with eating disorders have higher rates of suicidal ideation, suicide attempts, and completed suicide than the general population. One of the diseases with the highest suicide rate among psychiatric disorders is anorexia nervosa. Some hypotheses have been proposed to explain possible causes of increased suicidal behavior in eating disorders. Some conditions common to eating disorders and suicidal behavior, such as dissatisfaction with the body and interoceptive deficits, have been cited. It has been conclusively shown that psychiatric comorbidity, especially the co-diagnosis of depression, increases the risk of suicide in patients with eating disorders. However, increased suicidal behavior in eating disorders cannot be explained by comorbidity alone. The interpersonal psychological theory of suicide (IPTS), developed by Joiner, aims to understand why people commit suicide and to explain the differences in individual suicidal behavior. Some researchers have thought that the increased suicidal behavior of people with eating disorders, especially anorexia nervosa patients, is expected from the perspective of IPTS. The compensatory behaviors of patients with eating disorders, such as vomiting or chronic restrictive food intake, are painful and challenging actions for the body. It can be considered that repeated encounters with painful and challenging experiences form a habit in the individual and reduce pain avoidance. When viewed from the IPTS perspective, decreased pain avoidance may explain the increased suicide attempts and completed suicides of individuals. Clinicians working with eating disorder patients must conduct regular and comprehensive assessments of suicide. Comorbidities such as major depression, anxiety disorder, and substance-use disorder should not be overlooked in patients with eating disorders and should be taken seriously.

Mental flexibility assessment: A research protocol for patients with Parkinson's Disease and Anorexia Nervosa.

Mental Flexibility oscillates between adaptive variability in behavior and the capacity to restore homeostasis, linked to mental health. It has recently been one of the most investigated abilities in mental and neurological diseases such as Anorexia nervosa and Parkinson's disease, studied for rigidity or cognitive inflexibility. Patients with anorexia nervosa have rigid cognitive processes about food and weight, which leads to restrictive eating and excessive exercise. People who struggle to adapt their cognitive processes and actions to change their diet and exercise habits may have a harder time recovering from the disorder. On the other hand, research suggests that Parkinson's disease patients may have cognitive flexibility impairments that impair their ability to perform daily tasks and adapt to new environments. Although of clinical interest, mental flexibility lacks theoretical liberalization and unified assessment. This study introduces "IntellEGO" a protocol for a new, multidimensional psychometric assessment of flexibility. This assessment evaluates a person's authentic ability to handle daily challenges using cognitive, emotional, and behavioral factors. Since traditional assessments often focus on one domain, we aim to examine flexibility from multiple angles, acknowledging the importance of viewing people as whole beings with mental and physical aspects. The study protocol includes two assessment phases separated by a rehabilitation period. T0, the acute phase upon admission, and T1, the post-rehabilitation phase lasting 15 days for Parkinson's patients and 4 weeks for eating disorder patients, will be assessed. Neuropsychological performance, self-report questionnaires, psychophysiological measures, and neuroendocrine measures will be collected from Anorexia Nervosa and Parkinson's Disease patients during each study phase. The objective of this procedure is to provide clinicians with a comprehensive framework for conducting meticulous assessments of mental flexibility. This framework considers emotional, cognitive, and behavioral factors, and is applicable to various patient populations.