Management Of Anorexia Nervosa Research Articles

Hypnosis: a complementary tool for managing adolescents affected by anorexia nervosa

Anorexia Nervosa (AN) mainly affects adolescent girls and requires specialized, multidisciplinary care. In Geneva, the HUG's AliNEA unit and the pediatric hypnosis consultation have been collaborating since 2021 to integrate hypnosis into the management of AN. Hypnosis is seen as a complementary tool to the Maudsley therapeutic model, but not a miracle solution. It needs to be adapted to each patient's individual needs and to the different phases of treatment : re-association with the body, reinforcement of motivation, exploration of interpersonal relationships and consolidation of progress. Although scientific evidence is limited, patient testimonials underline its beneficial potential as a non-medicinal, individualized form of support.

Pediatric acute hospitalization for anorexia nervosa: an economic evaluation.

Anorexia nervosa (AN) is a psychiatric disorders which may potentially led to a high risk of health medical complications, suicide and self-harming behaviour. Since Covid-19 pandemic onset in March 2020, evidence suggested an increase occurrence of AN. The main aim of the retrospective analysis is to define the cost of hospitalization in the acute phase (HAP) at IRCCS Bambino Gesù Children Hospital, Rome, Italy, over 2 years study. Secondary purposes are defining the main risk factors for a prolonged hospitalization (including age, sex and comorbidities) and the possible influence of Covid-19 pandemic on AN admission and hospital stay. for the purpose of the study, we included children and adolescents aged less than 18 years, admitted to IRCCS Bambino Gesù Children Hospital, Rome, Italy, with a diagnosis of AN. Medical costs were calculated consulting the Lazio Regional Health Service Tariffs. Basing on the date of hospital admission, patients were later divided into two subgroups: subgroup A included patients hospitalized prior than Covid-19 onset (from March 2019 to February 2020) and subgroup B those admitted after (from March 2020 to October 2022). a total of 260 patients has been included in the study with a median age of 15 years (range 6-18 years). The total health care cost of AN hospitalized patients was of EUR 3,352,333 with a median cost of EUR 11,124 for each admission (range EUR 930 - 45,739) and a median daily cost of EUR 593 (range EUR 557-930). Median cost was higher in case of comorbidities, guarded patients, enteral feeding. A prolonged hospitalization has been documented in subgroup A with a higher economic burden. the economic burden of eating disorders is of note. Adequate sanitary policies as well as health economic analyses are required to gain insight into the cost-effectiveness of AN management. 2526-OPBG-2021.

(113) “Isn't She Too Old for Treatment?” Challenges in the Management of Anorexia Nervosa in an Elderly Patient in the General Hospital

(113) “Isn't She Too Old for Treatment?” Challenges in the Management of Anorexia Nervosa in an Elderly Patient in the General Hospital

Impaired implicit learning in adults with anorexia nervosa.

Cognitive alterations play an important role in the pathophysiology and treatment of anorexia nervosa (AN). Previous studies suggest that some implicit learning processes may be inhibited in AN. However, this has not yet been fully explored. The purpose of this study is to analyze implicit learning in patients with AN in comparison to healthy controls. In this pilot-study, a total of 21 patients diagnosed with AN and 21 matched controls were administered the weather prediction task (WPT), a probabilistic implicit category learning task that consists of two sub-variants. During the feedback (FB) version of the task, participants learn associations between tarot cards and weather outcomes via an operant learning model through which they receive immediate FB on their answers, whereas during the paired associate (PA) variant, participants are directly asked to memorize given associations. AN patients showed selective impairment on the FB task where they scored significantly lower both in comparison to controls (p = .001) who completed the same task and when compared to their own performance on the PA variant (p = .006). Clinical measures showed no significant correlations with test scores. Our results demonstrate implicit FB learning deficiencies in adult patients with AN. These impairments may have an impact on the effect of psychotherapeutic interventions and could partially explain the lack of treatment response in AN. Further studies are necessary to derive when and through which mechanisms these alterations originate, and to what extent they should be considered during treatment of the disorder. Cognitive impairments pose a challenge in the management of anorexia nervosa. Improved comprehension of cognitive alterations could lead to a greater understanding of the disease and adaptation of psychotherapeutic treatments. In this study, we found that implicit feedback learning in anorexia nervosa is impaired compared to healthy controls. This could indicate the necessity of treatment adaptations in the form of therapy tools without feedback and a larger focus on psychoeducation.

“Your mind doesn’t have room for anything else”: a qualitative study of perceptions of cognitive functioning during and after recovery from anorexia nervosa

BackgroundPast research has indicated the presence of cognitive difficulties in individuals with anorexia nervosa (AN), although it is unclear how these are experienced in real life. Moreover, it is unclear how and whether the experience of cognitive difficulties changes in nature and intensity over the course of the illness and following recovery.MethodsTwenty-one female participants (AN = 11; recovered AN = 10) participated in online semi-structured interviews, utilising open-ended questions and exploring topics relating to their experiences of their cognitive function, changes over time and their perspectives on the future. Reflexive thematic analysis was conducted on the resulting transcripts.ResultsSix themes were identified, centred around the effects of the illness on mental and physical function, cognition, adaptation to living with the illness, similarities between AN and other psychopathology, tentative optimism for the future and recovery as a representation of liberation. Whilst respondents with AN appeared to perform remarkably well in their professional and educational lives, the cognitive difficulties were described as significantly impacting their ability to engage in life, particularly in the context of leisure and socialising. Respondents recovered from AN noted the importance of developing a non-AN identity as well as better emotion-regulation skills as central to recovery.ConclusionsWhilst people with AN may be able to adapt their lives to the demands of the illness, they report significant cognitive difficulties that interfere with their engagement in many aspects of daily life. This should be considered by professionals working in the clinical management of AN. Treatments focused on ameliorating cognitive difficulties, and promoting emotional regulation and identity in AN are warranted.

Escitalopram should be investigated in anorexia nervosa: Rationale and review of mechanisms.

One of the biggest ambitions in the field of anorexia nervosa (AN) research is to find a reliable and effective pharmacological treatment. The fact that currently no pharmacological treatment is safe and effective in this disease is worrying and also challenging. On the basis of the progress in our understanding of AN neurobiology, we propose that escitalopram, a widely available drug, might be a safe and effective option that needs to be investigated. Escitalopram is the only selective serotonin reuptake inhibitor, without any catecholaminergic effect. As studies have shown decreased serotonergic and increased dopaminergic transmission in AN, we hypothesized that an ideal drug for AN management should boost serotonin levels to increase serotonergic and decrease dopaminergic transmission, the two main features of escitalopram action. Here, we present a short overview of pharmacological research in AN and discuss the theoretical rationale for escitalopram use in AN. We also call for double-blind, randomized, placebo-controlled trials to test whether this theoretical framework translates into clinical efficacy.

Évaluer un programme de remédiation cognitive dans l’anorexie : nouveaux outils

The management of anorexia nervosa (AN) remains complex with insufficient success rates. Based on clinical and empirical observations implicating neuropsychological difficulties in AN, cognitive remediation (CR) therapy appears to show positive effects. Nevertheless, these results remain subject to debate as some studies do not show this improvement, or in the case of positive improvements, a smaller effect size on cognitive performance. A possible explanation could lie in the cognitive tests used to assess CR. The aim of this study is to propose a new protocol for the evaluation of cognitive remediation for patients suffering from ED through the presentation of a case study.

Anorexia nervosa and pancreatitis.

Acute pancreatitis is a condition whereby erroneous activation of trypsin and zymogen results in pancreatic autodigestion. There are many aetiologies, with alcohol intake and gallstones being the most common. Anorexia nervosa is an eating disorder in which patients' reduced food intake and psychological aversion of weight gain can result in low body weight and malnourishment. The link between pancreatitis and anorexia nervosa is not well understood; this article explores the theorised pathophysiology connecting the two conditions, as well as the optimal management of patients when the conditions co-exist based on current literature. A literature search was performed using MEDLINE, EMBASE and CINAHL databases for all journal articles on the topic of presentations of acute or chronic pancreatitis in adults with anorexia nervosa. The literature proposes various links between anorexia nervosa and pancreatitis. It is theorised that pancreatitis may arise as a result of malnourishment itself or secondary to the refeeding process. Some explanations focus on the histopathological changes to the pancreas that malnourishment induces, while others focus on the enzymatic changes and oxidative damage that arise in the malnourished state. More mechanical mechanisms such as gastric dilatation, gastrointestinal ileus and compartmental fluid shift during refeeding have also been proposed as explanations for the link between the conditions. Some medications used in the management of anorexia nervosa have also been linked to pancreatitis.

The role of leptin in patients recovering from Anorexia Nervosa

Abstract Introduction: Anorexia nervosa (AN) is a mental disorder with the highest death rate. The characteristic feature of AN is endocrine dysregulations, including changes in adipose-tissue secreted hormones, especially adipokines. The most widely studied of them is leptin whose role in the pathophysiology and prognosis of AN is confirmed in more and more studies. The aim of the study was to summarize the role of endocrine disruptions with particular emphasis on leptin in the pathophysiology of AN. Material and methods: For the literature review, the electronic databases PubMed, Cochrane and Google Scholar search were used with the following keywords: eating disorders, adipokines, leptin, metreleptin, satiety, hunger, anorexia, obesity, for studies listed from database inception to October 2021. Results: Leptin, produced mainly by white adipose tissue, inhibits the hunger center in the hypothalamus by negative feedback with ghrelin secreted by the gastrointestinal tract. Leptin is involved in numerous biological functions, including body weight regulation, innate and adaptive immunity regulation, reproduction, and bone formation. Studies confirm decreased leptin levels in AN individuals. In recent years, extensive experience has been gained with leptin as a drug in clinical trials. The studies suggested that treatment can restore menstrual function and bone health and improve mood with unclear body weight effects. Conclusions: Focusing on leptin-related changes is a promising approach to improve AN management. Assessment of leptin levels in AN patients could be a useful tool for therapy monitoring. Treatment with leptin could reverse unfavourable changes induced by diet restriction, including mood symptoms, loss of bone mass and menstrual function. However, the results of these studies need confirmation on larger groups of patients.

Assessment and management of anorexia nervosa during COVID-19

Management of the high rates of medical and psychiatric complications, including self-harm and suicide, associated with anorexia nervosa requires regular clinical review. However, during the current pandemic, face-to-face clinical assessments carry the risk of infection and transmission in this vulnerable cohort already compromised by low weight and lowered immunity. This paper describes how one service has had to adapt usual care during the COVID-19 pandemic without contributing excessively to carer burden or compromising patient safety.

Is it time to review NICE guidelines on family therapy for anorexia in young people?

SUMMARYFamily therapy is recommended by the National Institute for Health and Care Excellence (NICE) for the management of anorexia nervosa in children and young people, but there is limited evidence to back this recommendation. The Cochrane Review under consideration evaluates the efficacy of different family therapy approaches compared with other treatments for anorexia nervosa, and this commentary puts the findings into clinical perspective.

Anorexia Nervosa with Markedly High Bone Turnover and Hyperphosphatemia During Refeeding Rectified by Denosumab.

We describe a unique case of hyperphosphatemia associated with a very high bone turnover rate in a 51-year-old postmenopausal woman with undiagnosed anorexia nervosa (AN) who presented with a low-trauma hip fracture. In view of her severely malnourished state, she was not fit for surgery. She was treated according to a refeeding protocol that mandated bed rest. Contrary to expectation, she developed sustained hyperphosphatemia and borderline hypercalcemia. Bone remodelling markers, both resorption and formation, were markedly elevated. Parathyroid hormone (PTH) was low-normal at 1.7pmol/L, C-terminal fibroblast growth factor 23 (FGF23) was high at 293RU/ml, but tubular maximum reabsorption of phosphate (TmPO4/GFR) was elevated at 1.93mmol/L. Denosumab 60mg was administered that was followed by: rapid normalisation of serum phosphate; normalisation of resorption markers, transient hypocalcaemia with secondary hyperparathyroidism, and normalisation of both TmPO4/GFR and C-terminal FGF23. We speculate that prolonged immobilization as part of AN management led to a high remodelling state followed by hyperphosphatemia and high-normal calcium with appropriate suppression of PTH and that marked hyperphosphatemia and high TmP/GFR despite high FGF23 indicates the necessity of PTH adequacy for excess FGF23 to lower TmP/GFR.

Exploring the Link Between Emotional Child Abuse and Anorexia Nervosa: A Psychopathological Correlation.

Eating disorders (ED) are well known psychiatric disorders associated with dysregulated eating behaviors and related thoughts and emotions. Common eating disorders are bulimia nervosa (BN), anorexia nervosa (AN), and binge eating disorders (BED). There is an active link between child abuse and eating disorders, emotional child abuse being the important subtype of CA and has a strong comorbid psychopathological relationship with EDs, including AN. The PubMed database was searched for the related articles about child abuse, including emotional childhood maltreatment and their psychopathology associated with EDs, especially AN. No filters were used for the date of publication and article types. Childhood abuse, including physical, sexual, and emotional maltreatment, has an active link with psychopathology associated with dysregulated eating behaviors. However, emotional childhood maltreatment including emotional abuse, neglect, and/or exposure to intimate partner violence (IPV) has been least studied, but studies have shown a strong relationship with the symptoms of anorexia nervosa such as weight concern, negative self-image, and maladaptive emotional response. Emotional dysregulation is the crucial psychopathological factor involved in mediating the effects of emotional childhood maltreatment and symptoms of anorexia nervosa and is strongly associated with long-term morbidity in patients with AN. Conducting more clinical studies in the future would help explore the temporal causation, and this association may help the practitioners to develop new diagnostic and therapeutic strategies in the management of AN.

Deep Brain Stimulation as a Treatment Approach for Anorexia Nervosa: a Systematic Literature Review

AbstractAnorexia nervosa is a psychiatric disorder characterized by distortions of body size, weight, and shape perception, as well as by food restriction and/or binge and purging behaviors. It mostly affects young women and causes severe negative impacts on their physical, psychological, and social health. Recent studies have analyzed deep brain stimulation (DBS), a neurosurgical procedure that involves electrode implantation in strategical brain areas, to obtain remission of the symptoms of anorexia nervosa. The results showed that the stimulation of areas associated to the neurocircuitry of anorexia nervosa, such as nucleus accumbens, anterior cingulate cortex, ventral striatum, and bed nucleus of the stria terminalis, provokes beneficial responses in terms of body mass index, quality of life, social functioning, and psychiatric comorbidities. Nevertheless, broader investigations are needed to endorse the clinical usage of DBS in the management of anorexia nervosa.

Role of antidepressants in the treatment of adults with anorexia nervosa.

Introduction:Anorexia nervosa (AN) is a severe psychiatric disorder that is difficult to treat and is associated with frequent relapses and high mortality rates. Psychiatric symptomatology (eg, depression, anxiety, obsessive-compulsive disorder/behaviors) are common comorbidities. This review provides current information about safety and efficacy of antidepressant therapy for management of AN in adults.Methods:A literature review of randomized controlled trials, open-label studies, and case reports with adults or adults/adolescents was conducted. PubMed and Medline were searched using anorexia management and treatment, antidepressants, selective serotonin reuptake inhibitors (SSRIs), fluoxetine, sertraline, citalopram, and mirtazapine in AN, relapse prevention in AN, and psychotropic medications in AN.Results:The role and utility of antidepressants in AN were published in double-blind, placebo-controlled studies; open-label trials; and a retrospective study. Antidepressants should not be used as sole therapy for AN although their use for confounding symptomatology makes discerning efficacy difficult as they are given together with other therapies. Neurobiological changes due to starvation and AN itself complicate results interpretation. For safety, tricyclic antidepressants and monoamine oxidase inhibitors are not recommended, and bupropion is contraindicated. Use of SSRIs during acute treatment lacks efficacy. Use of SSRIs—primarily fluoxetine and to some extent citalopram, sertraline, or mirtazapine—may aid in relapse prevention and improvement of psychiatric symptomatology in weight-restored anorexic patients.Discussion:Health care professionals should use clinical judgment regarding fluoxetine or possibly citalopram, sertraline or mirtazapine as adjunctive treatment to psychotherapy for relapse prevention, improvement of depressive and anxiety symptoms, and/or obsessive-compulsive behaviors unresolved with nutritional rehabilitation and psychotherapy.

Gastrointestinal complications and refeeding guidelines in patients with anorexia nervosa.

Anorexia nervosa (AN) is the third most common disorder, after obesity and asthma, in the population of adolescents between 13-18 years of age. Food intake reduction is associated with whole body dysfunction, affecting its physical, psychological and social spheres. As a result of starvation, dysfunction develops in virtually all systems and organs. However, most frequently patients with AN complain of digestive symptoms, such as a feeling of fullness after meals, pain in the upper abdomen, dysphagia, nausea, bloating and constipation. They can have mild functional character, but may also reflect serious complications, including diseases requiring urgent surgical intervention. In addition, gastric complaints may hinder nutritional management of AN. Care of AN patients requires cooperation of many specialists in the field of psychiatry, psychology, paediatrics, internal medicine and nutrition. However, it is often difficult to organize such a team. Therefore, we decided to approach the issues of gastrointestinal symptoms and complications in the course of AN, and the rules of nutritional therapy.

The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects.

Anorexia nervosa (AN) is a severe psychiatric disorder without approved medication intervention. Every class of psychoactive medication has been tried to improve treatment outcome; however, randomized controlled trials have been ambiguous at best and across studies have not shown robust improvements in weight gain and recovery. Here we review the available literature on pharmacological interventions since AN came to greater public recognition in the 1960s, including a critical review of why those trials may not have been successful. We further provide a neurobiological background for the disorder and discuss how cognition, learning, and emotion-regulating circuits could become treatment targets in the future. Making every effort to develop effective pharmacological treatment options for AN is imperative as it continues to be a complex psychiatric disorder with high disease burden and mortality.

Applying evidence-based management to anorexia nervosa

AimThis paper considers how the three principles of evidence based practice (clinical expertise, scientific evidence, and patient preference) can be applied to the complexity of treatment for anorexia nervosa AN.MethodA...

G502(P) Risk assessment of children with eating disorders: a retrospective analysis of inpatient admissions

Background In 2012 the Royal College of Psychiatrists published the Junior MARSIPAN guideline on the management of anorexia nervosa in patients under 18 years of age. A risk assessment framework was proposed at this time to aid identification of patients at risk of serious complications. Aim To evaluate current clinical practice, with a focus on risk assessment at time of admission, and to compare this with the risk assessment framework proposed by the Royal College of Psychiatrists. Methods All patients with an eating disorder requiring paediatric inpatient admission were identified over the period of June 2009 to February 2014. A retrospective casenote analysis was performed and data extracted using a standard proforma. Initial assessment of each patient was reviewed for documentation of BMI, weight, cardiovascular health (heart rate, syncope, significant orthostatic changes, irregular heart rate), ECG abnormalities, hydration status, temperature, biochemical abnormalities, disordered eating behaviours, engagement with management plan, activity and exercise, muscular weakness, self-harm/suicide, other mental health diagnoses as well as other potential co-existing risk factors. Results A total of 14 patients were identified with 22 admissions over the data collection period. 15 patients were admitted electively via the local CAMHS team, 4 patients via A&E and 3 patients following GP referral. No patients had a formal risk assessment performed. Assessment performed at the time of admission was highly variable. With the information available 10 patients were categorised as high risk, 11 patients were categorised as alert to high concern, and 1 admission was categorised as moderate risk. No patients were classified as low risk. Conclusion This study highlighted the fact that children with eating disorders are treated in paediatric inpatient wards as well as in specialist centres. Admissions to the paediatric wards are infrequent. Initial assessment and investigation of this patient group is highly variable and does not adhere to current guidance. Implementation of a formal risk assessment framework is required in order to identify patients at risk of complications. The development of specific admission documentation based on Royal College guidance would aid assessment and help guide inpatient management, thereby providing a more consistent approach to patient care.

Tardy male anorexia nervosa ultimately responded to ECT

© 2015 Naguy et al; licensee Herbert Publications Ltd. This is an Open Access article distributed under the terms of Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0). This permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Correspondence Anorexia Nervosa (AN) is one of the few ‘real’ psychiatric emergencies [1], with 10-15% mortality rate; 2/3 due to medical complications and 1/3 due to suicidality. Crow et al., reported a crude mortality rate of 4% [2]. Incidence of 0.5%, female outnumbers male by a ratio of 10:1. AN is commonly thought of as a female disorder. Even though as much as 25% of the clinical population is male, research on AN in males is limited [3]. It is defined clinically with marked distortion of body image, pathologic desire for thinness, and self-induced weight loss with body mass index (BMI) of 17.5 or less. Mean age of onset is 16-17 years for females and 12 years for males [4]. A combined approach is recommended for management of AN; pharmacologic (best evidence for fluoxetine and olanzapine), psychologic (family therapy and cognitive-behavioural therapy CBT) and bibliotherapy [5]. Pharmacotherapy is generally of limited value especially acutely but might help with relapse prevention . Hospitalization is indicated in presence of serious medical sequelae [6]. Male gender and late onset (“tardy AN”) generally portend poor prognostication [7,8]. Electroconvulsive therapy (ECT) in recalcitrant AN is supported by few case reports in the literature [9]. A 42-year-old Kuwaiti gentleman was referred to us from a private facility in accompaniment of his wife, with a diagnosis of AN-restricting subtype that failed a 3 months trail of fluoxetine (Prozac®) 20 mg and cyproheptadine(Periactin®) 8 mg/d. He was also engaged in 12 sessions of weekly high-quality CBT. Extensive workup was contemplated including laboratory investigations, electrolyte panel, thyroid function (TFT), B12 and folate, toxicologic (UTox) screen, electrocardiography (ECG), electroencephalography (EEG), magnetic-resonance imaging (MRI) Brain with gadolinium (Gd ) enhancement and rheumatologic profile. Hypochromic microcytic anaemia, mild hypokalaemia, sinus bradycardia and a pattern of “pseudoatrophy” [10] were noted. Anthropometry was accomplished as well as Quetlet formula showing BMI of 17. Patient has obvious longitudinal anankastic personality traits (‘anal character’) as reported by his wife with the characteristic triad of obstinacy, parsimony and pedantism. Elaborative psychometry entailed Ideal Body Stereotype Scale-Revised, Perceived Sociocultural Pressure Scale, Eating Disorder Diagnostic Scale, Yale-Brown obsessive-compulsive scale (Y-BOCS), Beck’s depression inventory (BDI), Minnesota mutiphasic personality inventory-2 (MMPI-2) and Brown assessment of beliefs scale (BABS). Patient was partially insighted, with no depressive overlay or frank psychosis. We pushed fluoxetine to 40 mg/d and introduced olanzapine (Zyprexa®) 10 mg/d in lieu of cyproheptadine. After 4 weeks, the course was relentlessly deteriorating and the patient was losing much weight (BMI dropped to 16) and totally refusing food. He was hospitalized for intravenous (IV) drips and correction of concomitant dyselectrolaemia. He was pallid, sallow and gaunt, albeit, very resistive and disengaging. He refused to pursue with psychotropic medications. He endorsed no suicidality but was ostensibly demoralized and in marked distress. We opted for ECT on emergency basis. After 3 sessions of bitemporal modified ECT, he began to be more brightened, engaging, serene, less preoccupied, and, above all compliant with meds which then changed to fluoxetine 60 mg/d and quetiapine (Seroquel XR®) 300mg/d. We continued to a totality of 6 sessions. No cognitive side-effects were reported. CBT was reinstituted. Patient was discharged and followed up in OPD. After 2, 4, 8 and 12 weeks, he kept exponentially improving, put on 4 kgs, and faring well both socially and vocationally. Although he is still ‘obsessed’ with ‘ideal’ body weight, he is maintained on a well-balanced diet with our nutritionist, attending weekly CBT sessions and treatment-adherent. We opine that ECT remains a viable option to explore in cases of severe AN, especially in life-threatening conditions even in the absence of comorbid depression as this case illustrates. We theorize that efficacy of ECT in AN could be ascribed to presumed ‘anti-obsessional’ actions [11], independent of its antidepressant actions. Moreover, it is postulated that ECT acutely increases NE activity and endogenous opiates [12], and this could rectify the replicated findings of deficits in MHPG (methoxyhydroxyphenylglycol) and endogenous opiates activity in AN [13]. *Correspondence: ahmednagy@hotmail.co.uk