Form Of Anorexia Nervosa Research Articles

2019 – Case report: comorbidity of malignant forms of anorexia nervosa and narcissistic personality disorder

Anorexia nervosa is a psychiatric disorder with a prevalence of circa five percent in young women population, with an increased tendency of frequent occurrence over the past twenty years. Although the diagnosis is relatively simple and straightforward, the treatment of these patients is often time-consuming and challenging for clinicians, as the occurrence of malignant and persistent forms of the condition is becoming ever more common. Resistant clinical diagnoses usually arise through comorbidity with other psychiatric disorders. Counted among them, first of all, are personality disorders. A.N. is treated by means of using various groups of psychopharmacological drugs in combination with psychotherapeutic treatment, with intention to establish a favorable therapeutic relationship and stability of the patient. Psychotherapeutic part of the treatment gains in importance when the condition occurs in comorbidity with personality disorders. Supportive treatment measures, namely aggressive rehydration, caloric values compensation via probes and and catheters are often an integral part of the treatment, and become particularly important when faced with treating malignant forms of the condition. Presented case will show that the malignant forms of Anorexia Nervosa can only be understood through insight into the psychological foundations of personality and frequently accompanying disorders on Axis II (DSM-IV). The female patient in question displays a base borderline personality structure with dominant narcissistic tendencies which prompted the development of a malignant form of the condition and thus made the treatment significantly more difficult. Only early intervention with emphasis on the psychotherapy treatment can ensure a better long-term prognosis in such cases.

Growth hormone level at admission and its evolution during refeeding are predictive of short-term outcome in restrictive anorexia nervosa

The growth hormone (GH)–insulin-like growth factor-1 (IGF-1) axis is dramatically altered in patients with anorexia nervosa (AN). The aim of the present study was to investigate whether GH and IGF-1 could be predictors of outcome in patients with a restrictive form of AN. Blood levels of GH, IGF-1, adipocytokines, ghrelin, insulin, glucose, and sex and thyroid hormones were measured in eleven women inpatients with AN and in ten healthy women controls. Three stages were compared during refeeding: admission (T0), when BMI reached 16 kg/m2 (T1) and at discharge when BMI reached 17.5 kg/m2 (T2). Clinical status was assessed 6 months after discharge from hospital (T3), and remission was defined by the maintenance of a BMI > or = 17.5 kg/m2. AN patients in remission (AN-R; n 6) had significantly higher GH levels at admission than those who relapsed (AN-NR; n 5) (P < 0.05). During refeeding (delta = T2 - T0), the AN-R group differed from the AN-NR group only by both GH level decrease (P < 0.05) and BMI increase (P < 0.05). In multiple regression analysis, delta GH was associated negatively and significantly and delta leptin and delta body fat mass levels were associated positively and significantly with BMI at T3 and explained 88% of its variability (r2 0.88, P < 0.05). The present study suggests that a low GH level at admission and the absence of its decrease after weight recovery could predict short-term relapse in women suffering from a restrictive form of AN.

Specific adipocytokines profiles in patients with hyperactive and/or binge/purge form of anorexia nervosa

The aim of our study was to determine whether eating behaviors and/or physical activity level may explain contradicting results in adipocytokines levels in anorexia nervosa (AN). Fasting levels of circulating adipocytokines (adiponectin, resistin and leptin), insulin, glucose, C-reactive protein, cytokines (tumor necrosis factor-alpha and interleukin (IL)-1beta), body composition and resting energy expenditure were measured in 24 women AN patients and 14 women controls. These parameters were compared according to AN subtypes: 15 patients with restrictive (R-AN) form versus 9 patients with binge/purge (BP-AN) form; 15 patients with hyperactive (H-AN) form versus 9 patients with nonhyperactive (NH-AN) form. BP-AN patients had significantly higher serum adiponectin levels compared with R-AN patients (P<0.05), and H-AN patients had higher serum leptin and lower serum resistin levels compared with NH-AN patients (P<0.05 for both). Our study shows specific adipocytokines profiles depending on the subtype of AN: restrictive versus binge/purge and hyperactive versus Nonhyperactive forms. We suggest that these biological signatures could interfere with the outcome of the disease.

Prescription de l’olanzapine chez l’enfant et l’adolescent

Resume Nous presentons une revue de la litterature parue entre 1996 et 2004 concernant les indications psychiatriques et les effets indesirables de l’olanzapine chez l’enfant et l’adolescent. L’olanzapine s’avere efficace dans la schizophrenie infantile et de l’adolescent, dans les troubles bipolaires, dans l’anorexie mentale avec ideation delirante, dans les troubles envahissants du developpement et dans les troubles du comportement severes, associes ou non a des tics. L’effet indesirable le plus genant est la prise de poids importante, suivi de la sedation, alors que les troubles extrapyramidaux restent legers a moderes. Les enzymes hepatiques, la glycemie, la prolactinemie peuvent etre augmentees. Mais, quel que soit leur interet, la plupart de ces observations restent anecdotiques au regard de la methodologie requise pour des essais cliniques valides, et la necessite de disposer, en pedopsychiatrie, d’etudes menees selon les standards appliques dans les autres disciplines, quelles qu’en soient les difficultes, est soulignee par tous.

Is Anorexia Nervosa a Delusional Disorder? An Assessment of Eating Beliefs in Anorexia Nervosa

Anorexia nervosa (AN) is a serious mental illness, characterized in part by intense and irrational beliefs about shape and weight, including fear of gaining weight. Although these beliefs are considered to be a diagnostic criterion for the illness, they have not been systematically characterized. This study used the Brown Assessment of Beliefs Scale (BABS) to identify the dominant belief that interfered with eating in a sample of underweight patients with AN (N=25). The degree of insight was assessed quantitatively. The majority of participants (68%) spontaneously reported a dominant belief consistent with fear of gaining weight or becoming fat. Twenty percent of patients were categorized as delusional. The total score on the BABS was significantly correlated with the drive-for-thinness subscale of the Eating Disorders Inventory (EDI) (r=0.41, p=0.04), but did not correlate with overall measures of AN severity (body mass index [BMI], duration of illness, lowest BMI, other subscales of the EDI, or total EDI score). These findings highlight the centrality of fear of fat in AN and suggest the possibility that there is a subgroup of patients whose concerns about their 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.

Non-fat-phobic anorexia nervosa in British South Asian adolescents

The current study investigated the clinical features of British South Asian adolescent females presenting with low weight in the absence of organic disease. The authors performed a retrospective case note study of South Asian British female adolescents presenting with weight loss/anorexia nervosa to psychiatric clinics and matched White English peers presenting with low weight. South Asian patients presented more frequently with loss of appetite (p = .01) and less frequently with fat phobia (p = .032) and weight preoccupation (p = .001). South Asians also had significantly more satisfactory relationships with their nuclear family and peers (p = .03). Differing symptom profiles for anorexia nervosa need to be taken into account when assessing patients from different cultures. South Asian adolescents may present with a non-fat-phobic form of anorexia nervosa. This has clinical and epidemiologic implications. Further investigation is warranted to assess the nosologic status of this group.

Serum Adiponectin and Resistin Concentrations in Patients with Restrictive and Binge/Purge Form of Anorexia Nervosa and Bulimia Nervosa

To study the role of adipose tissue-derived hormones in the pathophysiology of eating disorders, circulating levels of adiponectin, resistin, and other hormonal and metabolic parameters were measured in 16 females with the restrictive subtype of anorexia nervosa (R-AN), 10 females with the binge/purge subtype of anorexia nervosa (P-AN), 15 females with bulimia nervosa (BN), and 12 age-matched healthy females (C). Body mass index (BMI), body fat content, and serum leptin levels were severely decreased in R-AN and moderately decreased in P-AN patients, whereas the BN group did not differ from C in these parameters. Serum soluble leptin receptor levels were increased in R-AN and P-AN and unchanged in BN patients. Circulating adiponectin levels were inversely related to BMI and were unchanged in BN patients and increased by 53% in P-AN and by 96% in R-AN relative to C group, respectively. In contrast, resistin levels in malnourished R-AN and P-AN were not different from either C or BN groups and showed no significant relationship to BMI or body fat content. We suggest that increased adiponectin levels reflect decreased body fat content in AN patients. In contrast, circulating resistin levels do not appear to be closely related to the nutritional status.

A critical examination of the amenorrhea and weight criteria for diagnosing anorexia nervosa.

Amenorrhea and weight loss to below 15% of 'healthy' weight are current diagnostic criteria for anorexia nervosa (AN). This study compares females who meet current International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for AN with females who meet the essential psychopathology and significant self-starvation, but lack either amenorrhea or weight loss below 85%. This study retrospectively examined the medical charts of 588 consecutive admissions to an in-patient treatment program. All diagnoses conformed to ICD-10 and DSM-IV. Of 588 admissions, 297 females had some form of AN with 77.4% (230 of 297) meeting current criteria, while 22.6% (67 of 297) with core psychopathology and self-starvation were classified as eating disorders not otherwise specified or 'atypical' because of some menstrual function or final weight above 85%. The groups showed few statistically significant differences on demographics, illness history, and treatment response, psychopathology, or bone density. Amenorrhea may not be a useful diagnostic criterion. Also, requiring below 85% of healthy weight may need generalization.

A case of marked cerebellar atrophy in a woman with anorexia nervosa and cerebral atrophy and a review of the literature

While cerebral atrophy has been shown in patients with anorexia nervosa, cerebellar atrophy has never been reported in these patients. We report a case of cerebral atrophy with marked cerebellar atrophy in a 20-year-old woman with anorexia nervosa admitted to our hospital for severe weight loss. Neuroradiological examinations of the patient showed morphological brain alteration without focal parenchymal lesions. Cranial computerized tomography (CCT) showed an enlargement of the external cerebrospinal fluid spaces, especially those close to the cerebellar cistern. A brain magnetic resonance imaging (MRI) study confirmed the results of the CCT and dynamic single-photon emission tomography (d-SPECT) showed a reduced perfusion of the left brain areas. The reported case shows that some forms of anorexia nervosa have a concomitant presence of cerebral and cerebellar morphological anomalies. At present, it is not possible to demonstrate the whole correlation between the imaging reports and the clinical or neurological symptomatology. Some forms of brain alteration could be secondary to undernutrition; on the other hand, cerebral and cerebellar atrophy and eating disorders are far from clear and may also be an expression of an unknown common denominator. © 1998 by John Wiley & Sons, Inc. Int J Eat Disord 24: 443–447, 1998.

Follow-up of bone mineral density in 27 cases of anorexia nervosa.

Cortical and trabecular bone loss can lead to osteoporosis in chronic forms of anorexia nervosa (AN). As there is some debate about the reversibility of this condition, we performed a longitudinal follow-up study of 27 cases in which clinical, biological, X-ray and lumbar and femoral neck dual photon absorptiometry examinations were conducted every 6 months for up to 30 months. Three groups were distinguished: G1, untreated amenorrheic AN (N = 14, total follow-up 126 months); G2, effectively treated AN (N = 11, total follow-up 192 months), with two subgroups: fluoride (N = 5) and estrogen (N = 6); and G3, remitting AN with normalization of the gonadic function (N = 2, total follow-up 36 months). Results were adjusted for each patient to a 6-month variation. Semestrial variations in lumbar bone mineral density (BMD) were -2.1 +/- 1.3%, +2.8 +/- 1.5%, and -0.3 +/- 1.3% (mean +/- SEM), respectively for G1, G2 and G3; those for femoral neck BMD semestrial variations were -5.9 +/- 2.1%, -3.8 +/- 1.2% and -1.0 +/- 0.6%. Femoral neck and lumbar BMD variations for G1 were mainly correlated positively with bone-forming markers (serum osteocalcin, alkaline phosphatase) and negatively with initial lumbar BMD. Estrogen alone increased lumbar BMD by +1.4 +/- 2.3% every 6 months but did not stabilize femoral neck BMD (-3.5 +/- 1.4%). Fluoride increased lumbar BMD by 4.8 +/- 1.8%. Both lumbar and femoral neck BMD were stabilized in the remission group (-0.3 +/- 1.3% and -1.0 +/- 0.6%), despite half of the follow-up time with amenorrhea. In conclusion, untreated AN is associated with a marked trabecular and cortical bone loss (4-10% per year), which can lead to osteoporotic fractures. In prevention of bone loss, the efficacy of estrogen is difficult to investigate in AN, even with a well-controlled trial. Our study could provide argument that, when the observance of this preventive treatment is assessed, lumbar BMD can be stabilized in chronic forms of AN.

Wheel running induces conditioned taste aversion in rats trained while hungry and thirsty

Rats while both hungry and thirsty were given three exposures to either a salt solution or a sour solution followed by a brief period of wheel running. On other occasions, these rats while hungry and thirsty were exposed to the alternate solution without wheel running. Conditioned aversion to the flavor paired with wheel running was evident after two pairings. During final tests with each solution, the rats were thirsty but not hungry. As expected, conditioned aversion to the particular flavor paired with wheel running was still observed despite a change in deprivation state from training to test. These results indicate that wheel running can induce sickness. Because sickness suppresses eating, activity anorexia in rats and some forms of anorexia nervosa in humans may be caused, at least in part, by sickness.

Соматоэндокринные расстройства при нервной анорексии

Anorexia nervosa (AN) is expressed in the extremely stubborn desire to lose weight through targeted, long-term self-restraint in food, sometimes accompanied by intense physical exercise or taking large doses of a laxative. If it is impossible to withstand prolonged starvation, patients resort to a method such as inducing artificial vomiting. AN is a pathology characteristic of adolescent girls and young girls, although it can sometimes occur in males of puberty or adolescence. AN is more common at the age of 15-25 years. The incidence among women is on average 10 times higher than among men. There is no information on the prevalence of AN in our country. According to foreign authors, the frequency of AN is 112 per 100,000 of the population. However, these data are underestimated, since only patients with severe, protracted forms of the course of AN go to the hospital and are subject to accounting. Patients with mild forms of AN remain outside the field of vision of doctors. The beginning of a scientific study of AN was laid by W. Gull (1868) and E.-Ch. Laseque (1873). However, despite the increasing number of studies devoted to this interesting problem, AN still causes numerous discussions regarding its etiology, pathogenesis, and neuroendocrine disorders, and methods for their correction. In this review, we tried to summarize the available data of recent years. One of the first reviews on the nature of neuroendocrine shifts in AN was made in 1984.

Sexual adjustment and eating disorders: Differences between typical and atypical anorexic adolescent females

The study of the sexual behavior of 42 anorexic female patients, with the classification of them as “typical” or “atypical,” and the comparison with a control group, has demonstrated the existence of significant differences between both groups. In the present article such differences are expounded and their possible relation to the underlying psychopathological structure of each of the forms is discussed. In the authors' opinion, the results obtained confirm the clinical validity of the division between full-blown and atypical forms of anorexia nervosa.

Chronicity in anorexia nervosa: Pregnancy and birth complications as risk factors

The chronic form of anorexia nervosa (AN) affects about one-quarter of patients and has serious somatic and psychological consequences. This paper presents evidence in support of the hypothesis that pregnancy and birth complications (PBCs) associated with neuropathology may be risk factors for chronic anorexia nervosa. There is increasing evidence that PBCs are risk factors for other psychiatric and somatic disorders. Recent findings of possible premorbid neuropathology in patients with anorexia nervosa suggest that PBCs may be risk factors for chronicity in anorexia nervosa. Topics discussed include the origins of constitutional vulnerability to anorexia nervosa, correlates of PBCs and of chronic anorexia nervosa, the relationship of PBCs to neurological and neurochemical abnormalities, chronicity of anorexia nervosa in relation to PBCs and to neurological and neurochemical abnormalities, and the research implications of the hypothesis that PBCs and associated neuropathology are risk factors for chronicity in anorexia nervosa.