Mental Anorexia Research Articles

Mental anorexia as addiction, or the discontent in contemporary society

Depuis I’époque de Freud, l’anorexie mentale est une énigme pour la clinique psychanalytique. Cet article vise à montrer le lien entre anorexie et addiction, en soulignant le style de jouissance addictive comme typique de la société consumériste. Le symptôme anorexique se présent donc comme solution subjective au malaise dans la civilisation contemporaine. A travers deux cas cliniques, les implications diagnostiques seront aussi montrées, en relevant de la position singulière sujetpar rapport à l’Autre et à la jouissance.

Dilemmas concerning the course of pregnancy in patients with anorexia nervosa considering hormonal and somatic parameters.

Mental anorexia nervosa is a rare, potentially severe, chronic, and recurrent mental disorder that occurs more often in women than in men, especially during the childbearing years. The disorder is associated with an increased risk of mortality, mainly related to the physical consequences of severe malnutrition and suicide. Malnutrition of the body can cause serious hormonal and somatic problems. Despite significant hormonal disturbances that reduce fertility, a woman with anorexia can become pregnant. A new phenomenon now seen with increasing frequency is pregorexia, an eating disorder associated with pregnancy. It involves the use of dietary restrictions to avoid excessive weight gain during pregnancy. Pregnancy changes the hormonal economy mainly due to the development of the placenta, which secretes many hormones, not just sex hormones. Mental anorexia poses a significant risk to both mother and child if not diagnosed and treated properly. Treatment of anorexia involves simultaneous somatic and psychological treatment. During pregnancy, additional care should be taken to create an optimal environment for the developing foetus. Unfortunately, there is still a lack of research providing guidance in this area. Available studies are mainly case reports or reports focusing on specific clinical situations. It is worth noting that no study to date has attempted a comprehensive assessment of endocrine disruption in pregnant women with anorexia. Recognising the existing knowledge gap on endocrine disorders in pregnant women with anorexia nervosa, a systematic review of the literature was conducted.

Use of probiotics in the treatment of selected psychiatric disorders

Aim Probiotics are live microorganisms that are part of the human microbiota. The intestines are the habitat for approximately 1013-1014 microorganisms, mainly Firmicutes and Bacteroidetes. The gut microbiota is an individual characteristic for each person and can change due to many factors, including: age, diet, and health status. The gut microbiota plays a key role in the proper functioning of the brain-gut axis, thus contributing to human health and mental well-being. The aim of this study was to present the effect of probiotic use in the course of selected psychiatric disorders. Material and methods The literature review was performed using information from PubMed/Medline, ScienceDirect, and Polish Psychiatry databases that were published before 2022. Results and discussion: A factor associated with disorders such as depression, autism, Alzheimer's disease, and mental anorexia is the generalized inflammation taking place in the patient's body. Research indicates that the inflammatory response may be caused by an imbalance in the intestinal barrier and disruption of its continuity, which may result in translocation of bacteria into the blood and activation of the immune system. The use of probiotics may play a significant role in maintaining the bacterial balance in the gastrointestinal tract and the proper functioning of the gut-brain axis, which provides a link between gut function and the emotional and cognitive centers of the brain. Conclusions Probiotics may improve mental health and cognitive function, but more clinical studies are needed on the clinical significance of the effects and how they compare to current therapies.

Fantasmorphoses et machines à influencer dans l’univers de l’anorexie masculine

ObjectiveAlthough the amalgam of male anorexia and psychosis that has long dominated classical psychiatric literature needs to be put into perspective, the relations between male anorexia and “cold” psychosis, mono-symptomatic psychosis, or delusions of passivity nevertheless warrant further exploration in cases of patients who develop the most chronic symptoms. MethodRather surprising similarities and echoes will be shown through the cross-analysis of the fantasies of a patient suffering from restrictive mental anorexia since the age of twelve and the autobiographical and literary writings of Franz Kafka that attest to the presence of a unique imaginary world linked to particularly invasive preoccupations with food and eating. ResultsThis comparative analytical study of fantasies and fantasmorphoses involved in the issues of anorexia and in Kafka's universe highlights the important role of what Tausk described as “influencing machines,” which originate in the projection of one's own body considered in its entirety as a genital organ. Paradoxically, these influencing machines, by acting primarily as inhibitors of the drives, will mainly contribute to a weakening of the subjects’ virility. DiscussionTo identify the reasons behind this rejection of the pubertary process and genitality, we must consider that there is a defect in the structuring of the Superego, associated with a failure of bisexualization in this same Superego. One of the clinical hypotheses offered is that this failure or dislocation of the agency of the Superego is responsible for the emergence of a megalomaniacal and asexual Ego ideal. ConclusionWhereas Kafka was able to draw creative and sublimatory resources from this imaginary world, the defensive modes elicited by anorexic patients who develop the most troubling symptoms will generally not be enough to completely conceal the de-realizing impact of fantasmorphoses or the uncanny feelings caused by the underlying presence of such “influencing machines.”

Electrodermal Response to Mirror Exposure in Relation to Subjective Emotional Responses, Emotional Competences and Affectivity in Adolescent Girls With Restrictive Anorexia and Healthy Controls.

Objective: Body image disturbances and the attendant negative emotions are two of the major clinical symptoms of eating disorders. The objective of the present experimental study was to shed more light on the degree of association or dissociation between the physiological and emotional response to mirror exposure in patients with restrictive mental anorexia, and on the relationships between the physiological response and characteristics connected with emotional processing.Materials and Methods: Thirty adolescent girls with the restrictive type of anorexia and thirty matched healthy controls underwent bilateral measurement of skin conductance (SC) during rest, neutral stimulus exposure, and mirror exposure, and completed a set of measures focused on emotion regulation competencies, affectivity, and eating disorder pathology.Results: Compared to healthy controls, girls with restrictive anorexia rated mirror exposure as a subjectively more distressful experience. Differences in skin conductance response (SCR) were not significant; however, variance in SCR was substantially greater in the group of anorexia patients as compared to healthy controls. The overall skin conductance level (SCL) was lower in anorexia patients. Increase in SCR during mirror exposure, as opposed to exposure to neutral stimuli, was positively related to the tendency to experience negative emotions, interoceptive sensitivity, body dissatisfaction and suppression, but not to other symptoms of eating pathology or emotional awareness. A post hoc analysis suggested that physiological reactivity might be associated with interoceptive sensitivity to mirror exposure especially in anorectic patients.Conclusion: The study seems to demonstrate some degree of dissociation between psychophysiological reactivity and subjective response to body exposure in patients with restrictive anorexia. Factors affecting differences in psychophysiological responsiveness to body exposure in anorectic patients require further exploration.

Lymphamatosis Cerebri With Rare Marginal Zone Lymphoma Phenotype: An Autopsy Case Report In A Patient With History Of Peripheral Diffuse Large B Cell Lymphoma And Chronic Lymphocytic Leukemia

Abstract Introduction/Objective Lymphomatosis cerebri (LC) is a term used to describe primary central nervous system lymphomas which may present as diffuse, non-enhancing, infiltrative lesions. Although most of these are diffuse large B-cell lymphomas, there are other cases in the literature of low-grade B-cell lymphoma, Burkitt lymphoma and T-cell lymphoma. Methods We present a 76-year-old male with a past medical history of chronic lymphocytic leukemia (2014), diffuse large B cell lymphoma of right jaw (2019) s/p chemotherapy, prostate cancer s/p prostatectomy and radiation. The patient presented 3 weeks prior to admission due to generalized weakness with rapidly declining mental status, anorexia and deconditioning. MRI brain revealed scattered T2/FLAIR signal abnormalities in the cerebrum and cerebellum. An assessment of encephalitis was rendered. The patient continued to worsen and passed away. Results On autopsy of the brain, there was extensive involvement of the basal ganglia, cerebellum and all cerebral lobes by a lymphoid process. It had a predominant perivascular, parenchymal and leptomeningeal distribution. Microscopically, there was a diffuse proliferation of small to intermediate sized lymphocytes with mature chromatin. These lymphocytes were neoplastic B cells which stained for CD20, CD43 and negative for CD5, CD3 and CD23. It also showed low Ki67 index. This immunophenotype is most consistent with a marginal zone lymphoma. Conclusion It is quite rare that our patient’s infiltrative process was a small mature B-cell lymphoma most compatible with marginal zone B-cell lymphoma. Our case illustrates the importance of recognizing this entity, particularly in context with different morphology since our patient had three different types of lymphoma. The dilemma in diagnosing such lesions can lead to delay in diagnosis and institution of appropriate management. Thus, knowledge about its imaging and morphological features is very critical for correct categorization and to avoid potential misdiagnosis.

Manger à l’hôpital et en famille avec les adolescentes anorexiques : une lecture anthropologique du repas familial thérapeutique

The hospitalization of anorexic teenagers is usually long and comes, most of the time, after different kinds of care. Family support in the treatment of mental anorexia among teenagers is a fundamental focus in the context of hospitalization. As a transition at the end of the hospitalization, the implementation of a therapeutic family meal with families and caregivers become part of the rite of passage that hospitalization embodies for the suffering teenagers and for their family. The ritual approach, socio-anthropological considerations, the question of the status of the teenager, the transition between the hospitalization and the house, the nature of the relationship between care-givers and care-receivers, are so many themes that allow to understand the peculiar interest of the therapeutic family meal.

Scorbut atypique associé à une anorexie mentale

Scurvy, or "Barlow's disease", is a widely described disease involving cutaneous and mucosal lesions resulting from vitamin C deficiency. Herein, we report a case of scurvy in a 48-year-old woman that was unusual in its atypical cutaneous-mucosal presentation as well as its association with anorexia nervosa. A 48-year-old woman treated for depression for several years was admitted to hospital for her impaired general state of health. Over the last year, she had presented palmoplantar rash and episodes of perimalleolar oedema. The clinical examination showed the patient to have wasting syndrome, with a BMI of 11.9kg/m2, lower-limb oedema, palmoplantar fissures, geographic tongue, telogen effluvium and purpuric petechiae on her right knee. However, no gingival bleeding was noted and there was no loss of tooth enamel. The remainder of the clinical examination was normal. Blood tests revealed extremely low vitamin C levels without any other associated deficiencies, as well as laboratory signs of cytolysis and anicteric cholestasis without inflammatory syndrome. The diagnosis of anorexia nervosa was made by psychiatrists, despite the unusual age of onset. Favorable clinical outcome was rapidly achieved via a one-month course of vitamin C supplements at a daily dose of 1g. The absence of classical buccal-dental symptoms and the presence of keratotic dermatosis with fissures and ulcers on the hands and feet are atypical in scurvy; however, this diagnosis was confirmed by the existence of purpura evoking capillary fragility, the patient's drastically low vitamin C level and the rapid subsidence of symptoms following treatment with oral vitamin C alone. Anorexia nervosa was doubtless the cause of deficiency. This situation is rare and a systematic review of the literature in Medline via PubMed showed that only three reports of scurvy associated with mental anorexia have been published since 1975.

MMPI for personality characteristics of patients with different diseases.

In the field of psychosomatic medicine the relationship between personality characteristics and diseases is supposed to be an important issue. The aim of this article is to present group's MMPI profiles obtained for patients with different chronic diseases and to discuss about possible specific features of these different groups. We summarized results obtained by psychological testing of following groups of patients: adult patients treated with chronic maintenance dialysis, patients with diabetic retinopathy, general anxiety group, attack panic syndrome, parents of children with rheumatoid arthritis, as well as adolescents with mental anorexia, cystic fibrosis, diabetes mellitus and leukemia. Two control groups comprised adults and adolescents, both without any health problems, selected randomly. As a psychometric test MMPI-201 was used. Statistic 10 package is used for statistical analysis. In our presentation it can be seen some typical personality characteristics for patients with chronic conditions. These findings could be helpful for clinicians concerning treatment planning and follow-up. In general, the MMPI helps us to obtain a global, factual picture from the self-assessment of the patient, explained in a psycho-technical language. Group's profile could be used in clinical practice for planning treatment and to suppose the prognosis of the illness.

Laparoscopic modified Orr-Loygue mesh rectopexy for rectal prolapse in children

AimWe present an operating technique inspired from the Orr-Loygue mesh rectopexy adapted for laparoscopy, and detail the technical steps that differ from laparoscopic posterior suture rectopexy more commonly described in the paediatric literature. MethodWe present a retrospective study of all children who underwent a modified Orr-Loygue procedure for recurrent complete rectal prolapse from 1999 to 2012 after failure of conservative treatment. Pathological conditions, technical details of the procedure (excision of the Douglas pouch, use of a prerectal non-absorbable mesh to suspend the rectum to the presacral fascia and promontory avoiding any tension on the rectal wall) and postoperative results were reviewed. ResultsEight patients were included, median age 6.5years (range, 2–17). Median symptoms duration before surgery was 14months (range, 6–24). Four patients presented with associated pathological conditions: 1 neurological impairment (Williams–Beuren syndrome), 1 severe malnutrition (mental anorexia), 1 solitary rectal ulcer with frequent bleeding, 1 syringomyelic cavity in the spinal cord. All procedures were completed laparoscopically with a median operative time of 98minutes (range, 80–125). Median hospital stay was 3.5days (range, 2–5). No postoperative constipation or recurrence was reported during the median follow-up period of 6years (range 2–13). ConclusionThe laparoscopic modified Orr-Loygue mesh rectopexy is a simple operating technique, reproducible and efficient as surgical treatment of nonresolving recurrent complete rectal prolapse in children. To avoid postoperative constipation, it is important to perform a tension-free rectopexy which can be achieved by the use of a mesh to simply suspend and not “fix” the redundant rectosigmoid. Nonetheless, a greater number of patients as well as colorectal electromyography or anorectal manometry would be necessary to prove the absence of postoperative deleterious functional disorder.

L’encéphalomyopathie neuro-gastro-intestinale mitochondriale : un tableau d’anorexie mentale atypique

Mitochondrial neurogastrointestinal encephalopathy disease (MNGIE) is a rare autosomal-recessive syndrome, resulting from mutations in the TYMP gene, located at 22q13. The mutation induces a thymidine phosphorylase (TP) deficit, which leads to a nucleotide pool imbalance and to instability of the mitochondrial DNA. The clinical picture regroups gastrointestinal dysmotility, cachexia, ptosis, ophthalmoplegia, peripheral neuropathy, and asymptomatic leukoencephalopathy. The prognosis is unfavorable. We present the case of a 14-year-old Caucasian female whose symptoms started in early childhood. The diagnosis was suspected after magnetic resonance imaging (MRI), performed given the atypical features of mental anorexia, which revealed white matter abnormalities. She presented chronic vomiting, postprandial abdominal pain, and problems gaining weight accompanied by cachexia. This diagnosis led to establishing proper care, in particular an enteral and parenteral nutrition program. There is no known specific effective treatment, but numerous studies are in progress. In this article, after reviewing the existing studies, we discuss the main diagnostic and therapeutic aspects of the disease. We argue for the necessity of performing a cerebral MRI given the atypical features of a patient with suspected mental anorexia (or when the clinical pattern of a patient with mental anorexia seems atypical), so that MNGIE can be ruled out.

New Insights Into the Physiology of Bone Regulation: the Role of Neurohormones

Bone metabolism is regulated by interaction between two skeletal cells - osteoclasts and osteoblasts. Function of these cells is controlled by a number of humoral factors, including neurohormones, which ensure equilibrium between bone resorption and bone formation. Influence of neurohormones on bone metabolism is often bimodal and depends on the tissue, in which the hormone is expressed. While hypothalamic beta-1 and beta-2-adrenergic systems stimulate bone formation, beta-2 receptors in bone tissue activate osteoclatogenesis and increases bone resorption. Chronic stimulation of peripheral beta-2 receptors is known to quicken bone loss and alter the mechanical quality of the skeleton. This is supported by the observation of a low incidence of hip fractures in patients treated with betablockers. A bimodal osteo-tropic effect has also been observed with serotonin. While serotonin synthetized in brain has osteo-anabolic effects, serotonin released from the duodenum inhibits osteoblast activity and decreases bone formation. On the other hand, both cannabinoid systems (CB1 receptors in the brain and CB2 in bone tissue) are unambiguously osteo-protective, especially with regard to the aging skeleton. Positive (protective) effects on bone have also been shown by some hypophyseal hormones, such as thyrotropin (which inhibits bone resorption) and adrenocorticotropic hormone and oxytocin, both of which stimulate bone formation. Low oxytocin levels have been shown to potentiate bone loss induced by hypoestrinism in postmenopausal women, as well as in girls with mental anorexia. In addition to reviewing neurohormones with anabolic effects, this article also reviews neurohormones with unambiguously catabolic effects on the skeleton, such as neuropeptide Y and neuromedin U. An important aim of research in this field is the synthesis of new molecules that can stimulate osteo-anabolic or inhibiting osteo-catabolic processes.

Suggestions for a sustainable medical quality-centered approach within a predictive, preventive and personalized medicine: the promotion of alternatives to conventional hospitalization in an era of financial constraint

Alternatives to traditional hospital acute care for medical disorders address to benefits for the Health Systems, which experience budget constraints [1]. The comprehensive approach to the use of high-tech medicine for improved health care provided by the European Association for Predictive, Preventive, and Personalized Medicine (EPMA) is exactly along this line of intervention [2]. The rubber hits the road in the doctor-patient relationship, and the collective health-care knowledge must be applied to the particular patient's health-care situation [2]. A sustainable answers are the “Quick diagnosis units” [3] often reported with limited clinical description. In our Institution we shifted, beginning in 2004, part of the patients addressed by our emergency department toward an autonomous out-patient Diagnostic and Therapy Medical Unit (DTU), which has essential point of care laboratory test facility and certified competence of the Medical staff (two senior and two Junior Medical Doctors) in Medical Ultrasound, Echocardiography and dietary/physical exercise assessment and prescription[4], helped by a part-time dietitian, health psychologist and a nurse with intensive care experience. All procedures, including echo-guided diagnostic-therapeutic intervention, are performed by the components of the staff. Admittances are primarily oriented toward the care of patients with chronic liver disease, secondary anemia, severe malnutrition (including mental anorexia), heart failure; 25% of patients had a diagnosis of Cancer; 18% of patients were diagnosed by biopsies of various organs. The stay in DH was 6.3±2.1 non consecutive days, with a shortage of costs, with a case mix index (1.39±0.23. The DTU is a place of training for Post-Graduate MDs of the School of Internal Medicine and of the Postgraduate School of Medical Ultrasound. It provides quick and timely diagnosis, by ultrasound and lifestyle assessment, and articulated therapeutic strategies, including dietary and physical exercise prescription [5]. The critical contribution of DTU [3] is medical-quality centered more than medical-accountancy-centered. Greater focus on staff professional competences in sustainable diagnostic procedures, such as ultrasound, lifestyle assessment and dietary and health-psychology intervention is needed for enhancing effectiveness. Such strategy will fasten diagnosis and follow-up, allowing affordable therapeutic personalized approaches [4,5]. These issues were and are object of controlled studies that were and will be published on peer-reviewed high impact medical journals.

Flow-mediated vasodilatation in the patients with anorexia nervosa

To compare flow-mediated vasodilatation in patients with anorexia nervosa and healthy subjects. Endothelial dysfunction is present in the patients with anorexia nervosa. However, flow-mediated vasodilatation in the patients with anorexia nervosa in comparison with control subjects has not been yet evaluated. Flow-mediated vasodilatation in the brachial artery was examined in 30 patients with anorexia nervosa admitted to metabolic care unit for realimentation and compared to 30 control subjects. The average age of the patients with mental anorexia was 25.0±5.2 compared to 25.5±4.5 years of the healthy control subjects (NS). BMI was in 14.0±1.7 kg/m2 in patients with anorexia nervosa comparing to 20.4±1.0 kg/m2 in the healthy control subjects (p<0.001). The baseline mean diameter of the right brachial artery was 0.33±0.06 cm in the anorexia nervosa patients and 0.35±0.05 cm in the control subjects (NS). The absolute increase of brachial artery size after reactive hyperemia was 0.029±0.006 cm (9%) in the anorexia nervosa patients and 0.039±0.006 cm (11 %) in the control subjects (p=0.002). After realimentation, the baseline mean diameter of the right brachial artery was comparable to the result before nutrition intervention - 0.34±0.05 cm but brachial artery increase due to reactive hyperemia was 0.036±0.05 cm (10.5 %). It was for 19 % higher compared to the first examination (p<0.001). Flow-mediated vasodilatation is decreased in the patients with anorexia nervosa in comparison with the healthy control subjects and improves after realimentation (Tab. 1, Ref. 20).

Gastric malignancy presenting as adrenal insufficiency: A case report

Introduction: carcinomas in the lung, breast, and lymphomas are known to metastasize to the adrenal gland. However, these metastases initially do not present with signs and symptoms of adrenal insufficiency leading to a decreased chance of adrenal insufficiency being diagnosed. We report a case of adrenal insufficiency due to bilateral adrenal metastases as the presenting manifestation of gastric carcinoma. case report: A 72-year-old male was admitted to our hospital due to altered mental status, weakness, anorexia, hematemesis and urinary incontinence for three days. Hyponatremia, hyperkalemia, anemia, and mild metabolic acidosis were detected. A diagnosis of gastric carcinoma along with bilateral metastases of the adrenal glands was made after biopsy computed tomography and positron emission tomography scans. Initiation of mineralocorticoid replacement therapy, improved the condition of patient. conclusion: there are only a few reports of adrenal insufficiency or true Addisonian crisis being the

PP167-SUN FLOW-MEDIATED VASODILATATION IN THE PATIENTS WITH ANOREXIA NERVOSA

Rationale: Flow-mediated vasodilatation has not been yet evaluated in the patients with anorexia nervosa despite the presence of endothelial dysfunction. Methods: Flow-mediated vasodilatation in the brachial artery was examined in 30 patients with anorexia nervosa admitted to metabolic care unit for realimentation and compared with 30 control subjects. Results: The average age of the patients with mental anorexia was 25.0±5.2 comparing to 25.5±4.5 years of healthy control subjects (NS). BMI was in 14.0±1.7 kg/m2 in patients with anorexia nervosa comparing to 20.4±1.0 kg/m2 in healthy control subjects (p < 0.001). The mean diameter of the right brachial artery was 0.33±0.06 cm in anorexia nervosa patients and 0.35±0.05 cm in control subjects (N.S.). The increase of brachial artery size after reactive hyperemia was 0.029±0.006 cm (9%) in anorexia nervosa patients and 0.039±0.006 cm (11%) in control subjects (p = 0.002). After realimentation brachial artery reactive hyperemia has significantly increased comparing to the first examination in patients with anorexia (0.036±0.05 cm, 10.5%, p < 0.001). Conclusion: Flow-mediated vasodilatation is decreased in the patients with anorexia nervosa in comparison with healthy control subjects and improves after realimentation.

La folie contagieuse : étude de différentes entités et de leurs conditions d’apparition

IntroductionCertain “unrealistic” human behaviour and thoughts can be transferred from one subject to another, within the intimacy of the family circle or according to an epidemic including numerous protagonists. We will re-address the different contagious entities which can be distinguished according to the duration of the disorder and the number of subjects involved. Thus we can easily oppose the “folie à deux” (shared psychosis) of the panic reaction, distinct from the delusive belief of the crowd. Mass psychogenic phenomena take the shape of epidemics limited to the school and working environment. A dissemination of psychosis can also take an endemic route, as shown by the increase in emerging syndromes described by the medical profession. Certain psychopathological determinants unite these different nosographic contexts and enable the psychopathogenic mechanisms of contagion to be clarified. Clinical findingsThe mass panic reaction which associates stereotyped behaviour of numerous individuals in a short space of time eludes the concepts of psychosis and mass hysteria to consider a single entity for which its phylogenetic origin is primary behaviour, acquired early in the evolution of species and implying the role of mirror neurons. Very different from panic, in cases of “folie à deux”, if we consider the index subject as delirious, this delirium can be shared by a neurotic or a psychotic subject. The transmission mechanisms are thus different: hysterical delirium can be transmitted in the same way as cases of mass hysteria. In the course of history, epidemics of possession and hystero-demonopathy in convents have been substituted by health fears concerning the environment and potential pollution as well as infections or nuclear risk. Dispassionate communication with a dimensional approach to disorders considering mixed organic and mental contagions can be shared with “intoxicated” subjects. A proband contaminated by a toxic substance can show symptoms that spread by mimicry in other physically non-intoxicated employees. Sometimes the phenomenon is totally psychogenic and the proband has suffered no toxic reaction. Thus an authentic somatic illness can be secondarily epidemic: its propagation is psychogenic while the first organic medical entity remains. It is thus very difficult to establish a distinction between a somatic illness and the eponymous psychosomatic disorder of which the cardinal symptoms are the same, although expressed differently in the discourse. DiscussionIf the different entities that are the location of psychological contagion are very diverse according to their temporal determinants and the number of subjects involved, certain psychopathological dimensions are combined. The dynamics of transmission involve mechanisms of identification, imitation and suggestion which will federate the individuals around a symptom. The solution of psychosis sometimes varies according to a socially well-defined mode that can be described as a model of misconduct. Thus the epidemics of hystero-demonopathy in convents echo emerging pathologies of the modern era which enable certain subjects to express their suffering. ConclusionsOther disorders have spread through society such as toxicophilic behaviour or even mental anorexia which has spread to continents where it was practically absent. According to certain forecasts, depression will be a major health problem in 2030 resulting in two million suicides a year worldwide. These evolutions question not only mental health but also sociology and politics. The role of the media here can be deleterious or preventive. It is undoubtedly necessary to inform the leaders and the general population on the possibility of this type of mass reaction which can take the shape of panic or a highly contagious complex functional syndrome.

Centropontine Myelinolysis Related to Refeeding Syndrome in an Adolescent Suffering from Anorexia Nervosa

Centropontine myelinolysis (CPM) is a rare neurologic disorder defined by symmetric demyelination in the central pons, mostly due to alcoholism, malnutrition, or water-electrolyte abnormalities. We report an unusual case of CPM likely due to hypophosphatemia, related to a refeeding syndrome in the context of mental anorexia. A 15-year-old girl with mental anorexia presented with hypophosphatemia in the following days of enteral refeeding, and then suffered from confusion, neurological signs, and typical MRI lesions of CPM. Hypophosphoremia may be considered as a causative agent in CPM related to refeeding syndrome. This clinical observation also highlights the importance of recognizing patients at high risk of refeeding syndrome to initiate a balanced nutrition with careful monitoring.

Étude de prévalence des conduites addictives chez les femmes enceintes dans une maternité universitaire

Epidemiological study on addictive disorders during pregnancy. An epidemiological study about addictive disorders has been led in the maternity of the University Hospital of Nantes in 2008 on a sample of 300 women, just after childbirth. The prevalence of consumption of drugs was assessed on declared consumption of legal and illegal substances and on the Fagerström questionnaire, the AUDIT questionnaire and the CAST questionnaire. Diagnostic of eating disorders was based on DSM IV criteria of mental anorexia and bulimia nervosa. At the beginning of pregnancy, 34% of women used tobacco, 63% alcohol and 8% cannabis. Among the women of the study 0.7% had criteria for mental anorexia, 2.3% for bulimia nervosa and 9% for sub clinic forms. After the first trimester, 22% of women declared using tobacco, 20% alcohol and 3% cannabis. The use of various drugs during pregnancy concerned 6.3% of women, and 38% used at least one drug after the first trimester. The high prevalence of addictive disorders during pregnancy should incite professional of prenatal care to improve their screening methodology and not only when tobacco or alcohol is suspected.

A case of Klinefelter syndrome, mosaicism (46,XY/47,XXY), associated with anorexia nervosa

We report the case of a 12.4-yr-old boy who presented Klinefelter syndrome (KS) mosaicism (46,XY/47,XXY), associated with mental retardation and anorexia nervosa (AN). KS was undiagnosed before hospitalization in a psychiatric unit. The patient was referred to a child psychiatric unit for restrictive eating. The medical history showed long standing feeding difficulties and failure to thrive. The patient was pre-pubertal and other clinical characteristics were: microcephaly, short stature and dysmorphic traits. Cytogenetic analysis revealed a mosaicism, 46,XY[11] and 47,XXY[19] karyotype. The psychiatric assessment demonstrated the presence of AN and low mood. No specific pathophysiological links between the alterations of KS and the development of AN should be hypothesized on the basis of this case report. In pre-pubertal boys with mental disorders, the possibility of KS should be considered, independently of the presence of eating disorders. Nevertheless, the case shows that KS can be first detected during an assessment for eating disorders. Few cases of the association of KS with AN have been previously reported in literature. This is the first description of KS, mosaicism (46,XY/47,XXY), associated with AN and mental retardation. This case report illustrates the need, for clinicians who work with eating disorders, to investigate the possible association between AN and KS, a rare but intriguing one.