Nervous Anorexia Research Articles

Body composition assessment in the patient of nervous anorexia they receive nutritional education

Body composition assessment in the patient of nervous anorexia they receive nutritional education

A case of true transsexualism complicated by nervous anorexia with dysmorphomania syndrome

The article examines the case history with long-term follow-up tracing of the course and clinical picture of comorbid psychosexual and eating disorders in a patient with true transsexualism complicated by anorexia nervosa with dysmorphomania syndrome.

A novel molecular imprinted polymer layer electrode for enhanced sensitivity electrochemical determination of the antidepressant fluoxetine

Fluoxetine is a selective serotonin re-uptake inhibitor (SSRI) drug, widely used to treat depression, nervous anorexia, autism and bulimia nervosa. The direct electrochemical behaviour of fluoxetine at a glassy carbon electrode (GCE) was studied in simple aqueous solution using voltammetric techniques. Subsequently, a novel molecular imprinted polymer (MIP) modified GCE was fabricated using itaconic acid and N, N-methylene-bis acrylamide as functional monomer and crosslinking agent, respectively, to produce a sensitive, selective fluoxetine sensor. Precipitation polymerization enabled drop coating of reproducible MIP layers on a GCE as a renewable affinity surface for fluoxetine detection. Initial baseline studies undertaken using CV and SWV allowed for rapid optimization of scan conditions and confirming the irreversible nature of the FXT reaction at a bare GCE but DPV finally allowed for the further and necessary high level sensitivity needed for assays. The binding efficiency and selectivity of the MIP affinity sites for fluoxetine were demonstrated using DPV and responses compared with a non-imprinted polymer layer (NIP). Conditions for MIP formation, loading and incubation were optimized to improve the analytical performance. Under optimized conditions, a linear fluoxetine calibration from 4.99 × 10−7 to 3.38 × 10−5 mol L−1 was obtained, with detection and quantification limits of 3.33 × 10−7 mol L−1 (115.01 μg L−1) and 1.11 × 10−6 mol L−1 (383.38 μg L−1), respectively. The sensor was employed to analyse fluoxetine extracted from blood serum.

Comorbilidades psiquiátricas de la anorexia y bulimia nerviosa en pediatría

Comorbilidades psiquiátricas de la anorexia y bulimia nerviosa en pediatría

Anorexia e bulimia nervosa: Percepção e atuação do psicólogo clínico de orientação psicanalítica

A Psicologia clínica contemporânea vem se deparando com o aumento na frequência de algumas patologias como a anorexia nervosa e a bulimia nervosa, as quais vêm comunicar um mal estar, despertando assim um impacto na sociedade atual. Isto traz a necessidade de melhor compreender como o psicólogo clínico de orientação psicanalítica percebe e trabalha com essas novas subjetividades. Com isso, pretende-se desvelar as percepções do psicólogo diante de sua prática com essas patologias, como entendem sua função nesses casos, bem como as formas de tratamento e rumos que devem ser tomados, no sentido de não só tratar bem como prevenir tais sintomas. Para tanto se utilizou a abordagem qualitativa e entrevistaram-se cinco psicólogos clínicos de orientação psicanalítica com tempo de formação entre 5 e 18 anos, que haviam atendido um ou mais casos de anorexia e/ou bulimia nervosa. Uma vez coletadas as informações, as entrevistas foram submetidas à análise de conteúdo. A partir da análise, verificaram-se os desdobramentos dos atendimentos, a função da Psicologia diante desses casos,características apresentadas, formas de tratamento, como também a concepção dos profissionais acerca os quadros.

Therapeutic itineraries of individuals with symptoms of anorexia and bulimia

The scope of this study is to identify and contextualize aspects of the therapeutic itineraries of patients treated at a university medical clinic specialized in nervous anorexia and bulimia. For this purpose, an attempt was made to reconstitute the succession of events triggered in 20 respondents and their families with the classification of anorexia and bulimia as "health problems." The narratives were analyzed in order to link the individual experiences and the social context of their occurrence (organization of health services, characteristics of treatment and medical knowledge and characteristics of contemporary subjectivity), in light of the theoretical studies of Public Health and Psychoanalysis. Data analysis revealed that these itineraries arise from connections and disconnections between two distinct approaches: one that organizes the management of patients and the other governing the conduct of health institutions and families. If the latter presuppose a quest for health, this is not what primarily concerns the individuals in question. Their refusal to moderate their own eating disorders is notable on their itineraries, and indicates the functionality of those practices. Such practices play a part in the reconstruction of their self-images.

Dietary Modulation of Thymic Enzymes

Malnutrition is a complex syndrome caused by an inadequate intake of energy, protein, minerals and vitamins which affects the immune system. Nutritional imbalances, present in children with energy-protein malnutrition and infections, make defining the specific effects of each of them on the thymus difficult. For this reason, it is necessary to design an experimental model in animals that could define a single variable. As the thymus atrophy described in humans is similar to that observed in murines, a rat experimental model makes the extrapolation to man possible. Some authors suggest that the activity of Adenosine Deaminase (ADA) and Purine Nucleoside Phosphorylase (PNP)--involved in purine metabolism--have an influence on T lymphocyte development and the immune system, due to intracellular accumulation of toxic levels of deoxynucleotides. Studies in our group, performed in an experimental model on Wistar growing rats, have demonstrated that protein deficiency or imbalance in the profile of essential amino acids in the diet, produce loss of thymus weight, reduction in the number of thymocytes, a diminished proportion of T cells presenting the W3/13 antigenic determinant and DNA content with concomitant increase in cell size, and the proportion of immature T cells and activity of ADA and PNP, without modifying the activity of 5´Nucleotidase in the thymus. It is important to point out that there were neither differences in energy intake between experimental groups and their controls, nor clinical symptoms of deficiency of other nutrients. The increase in these thymic enzyme activities was an alternative mechanism to avoid the accumulation of high levels of deoxynucleotides, which would be toxic for T lymphocytes. On the other hand, the administration of a recovery diet, with a high amount of high quality protein, was able to reverse the mentioned effects. The quick reply of Adenosine Deaminase to nutritional disorders and the following nutritional recovery, points out to this determination as a potential functional marker of nutritional status. Some authors have demonstrated an increase in ADA activity, in serum and other biological fluids in patients with various diseases involving defense mechanisms. According to these findings, it could be inferred that ADA activity in serum would follow the same behavior as observed in a rat thymus. So, we have analyzed if its determination could be considered a functional biochemical parameter in populations at nutritional risk. We analyzed the serum ADA activity in groups of individuals with altered nutritional status evaluated through different markers--young adult patients with Nervous Anorexia, overweight or obese school children, children suffering cystic fibrosis. The results show a statistically significant increase in the ADA activity in all groups, with respect to their healthy controls--same age range and socio economic status. The results obtained to date suggest the importance of including the determination of serum Adenosine Deaminase activity in the biochemical evaluation of the nutritional status, as a functional marker related to defense mechanisms.

Особенности диагностики и лечения синдрома нервной анорексии у детей и подростков в условиях педиатрического стационара

Особенности диагностики и лечения синдрома нервной анорексии у детей и подростков в условиях педиатрического стационара

A cry for specialists in functional neurosurgery

A cry for specialists in functional neurosurgery

Instrumentos de avaliação da imagem corporal e dos hábitos alimentares na anorexia nervosa: análise da produção científica

Este estudo é uma revisão integrativa da literatura que tem o objetivo de descrever os instrumentos de mensuração utilizados na avaliação da imagem corporal e dos hábitos alimentares na anorexia nervosa. As bases consultadas foram LILACS e SciELO. Das 98 referências levantadas, oito foram selecionadas e recuperadas na íntegra para extração dos dados, constituindo o corpus da pesquisa. Constatou-se o predomínio de publicações na última década, principalmente a partir de 2000. Em termos gerais, os resultados indicaram que há poucos instrumentos que avaliam a imagem corporal e os hábitos alimentares de forma aprofundada, sendo que a maioria dos instrumentos encontrados visava a avaliar os sujeitos e a estabelecer o diagnóstico de transtorno alimentar (TA). Evidenciou-se, assim, a necessidade de mais estudos na área de elaboração e de validação de testes, escalas e inventários que tratem das síndromes parciais dos TAs, tais como a distorção da imagem corporal.

Anorexia and bulimia – perfect body versus death

Nervous anorexia and nervous bulimia are food disturbances (FD) of difficult treatment and of rise morbidity. The Programof Food Disturbances (Ambulim) of IPq-FMUSP is the first multidisciplinary Brazilian center for the treatment, teachingand research of the area. The service is based on multidisciplinary actions integrating essentially medical, nutritional andpsychological assistance. Physical activity is considered, since there are evidences of the association of dependence toexercise with FD. We observe a slow and gradual process leading to physical, emotional and social health worsening of apatient, with a morbid refusal to gaining weight. Her personal beliefs very often are based on the fact that “to be thin”, “staythin” is the key for her personal, affective and social success. The expectation about the body spread in the contemporarysociety, characterized by a notion of perfection connected to slimness, influences the physical image, essential element theetiology of FD. The media, by their turn, offer explicit instructions about how to reach the ideal of beauty, promoting thebelief that persons can, and in fact have to, to control his physical condition and weight. The work developed by a healthprofessional with a patient who develops FD is intense and full with challenges, and must go beyond health care. It is expectedthat professionals could share their knowledge with the population, warning it about the risks and care modalitiesin order to prevent FDs to be a life style choice for young people

Association of Zinc Deficiency and Depression in the Patients With End-stage Renal Disease on Hemodialysis

Depression is a common psychological symptom in patients undergoing chronic hemodialysis. In the general population, low serum zinc level is associated with major depression. The current study surveys the possible relationship between the prevalence of depression and plasma level of zinc in patients on hemodialysis (HD). A total of 135 patients with end-stage renal disease (ESRD) on HD were enrolled in the study. The severity of depression was assessed using Beck Depression Inventory (BDI). Plasma zinc level was measured from fasting samples. Mean age of the patients was 52.45 (standard deviation: 15.33) years. In all, 76% of the patients had some degree of depression according to BDI scoring system (BDI >14). The mean level of plasma zinc in the depressed patients was significantly lower than the rest of the patients (67.46 ± 29.7 vs. 85.26 + 40.05). Zinc deficiency may be a reversible cause which might contribute to the increased rate of depression in HD patients. This is the first study reporting the association of zinc deficiency with the presence of depression in HD patients; therefore, these findings need further investigations.

Empyema necessitatis revisited

Empyema necessitatis (EN) is a rare disease, with unknown incidence, which has received little attention from a dermatological point of view but it is essential to recognize it because of the possibility of causing mortality if not treated properly and in time. We report a 32-year-old woman, diagnosed with nervous anorexia, with an enlarging mass on the anterior right thoracic wall. Cultures showed Actinomyces gerencseriae as the main etiological agent of her empyema "necessitatis". She was successfully treated with amoxicillin with clavulanic acid. We found that 1) M. tuberculosis (35%) is still the most frequent agent, but Actinomyces (25%) and MRSA (10%) are becoming more relevant; 2) the most frequent dermatological finding is a subacute erythematous mass on costal wall; 3) new treatments have lowered mortality. Any enlarging and painful subacute thoracic mass with fluctuation should be considered as an EN suspicious lesion and the diagnostic approach must include a chest X-ray to rule out lung infection. Dermatologists should know about this infrequent entity in order to properly identify the potentially life-threatening process under these cutaneous lesions, achieving an early diagnosis and proper treatment.

Eating disorders

At the present time, research into Eating Disorders is being carried out in very different areas: clinical and diagnostic, epidemiological, comorbidity, aetiopathogeny, treatment and forms of care. This paper reviews this type of pathology, and aims to update the most important data in the different fields. The epidemiological studies of recent decades would indicate a considerable increase in the rates of incidence and prevalence of both Nervous Anorexia and Nervous Bulimia. On the other hand, there is increasing confirmation of an early appearance of these disorders. Similarly, the discovery of certain physiopathological appetite markers and/or regulators opens a new path for understanding this phenomenon. Research into these problems has reached a certain consensus in aspects such as: a multidimensional consideration of the ethiopathogeny, increasingly purified diagnostic criteria, care and therapeutic procedures and resources to be used in treatment.

Privacidade e confidencialidade na assistência à saúde do adolescente: percepções e comportamentos de um grupo de 711 universitários

To understand the opinion and behavior of a group of college students about the degree of privacy considered appropriate in several clinical settings and in which situations breach of confidentiality is admitted. An anonymous questionnaire about confidentiality in clinical settings was answered by 711 college students. The study had a transversal, descriptive, qualitative-quantitative design. We studied recognition of the ethical criteria for confidentiality limitation, and in which situations, common in adolescent morbidity, disclosure of this information is accepted. Data analysis used Epi-Info 6.04 and Microsoft Excel, 1997. The research was approved by PUCRS' IRB. The ideal situation for disclosing information was considered by 82% of the adolescents as the previous granting of authorization, which differs from other forms of breaching confidentiality. In cases of non-authorized disclosure, most of them admitted that it in case of suicidal ideation (85%), violence (84.2%), sexual abuse (81.7%), nervous anorexia (81.3%) and risk of life to third parties (72.3%). Half of them agree to it in HIV/AIDS (57.9%), drug abuse (51.7%) and STD (44.7%) situations; less than one third accept it in situations of pregnancy (33.6%), homosexuality (20.7%) and sexual activity (15.6%). Participants assigned different grades to the value of confidentiality in their health care, accepting that information may be disclosed to others when the patient authorizes it. The higher the risk to their integrity, the easier it was for them to admit non-authorized disclosure of information, however in aspects related to their sexuality disclosure is practically denied.

A auto-imagem corporal na anorexia nervosa: uma abordagem sociológica

A anorexia é um transtorno no comportamento alimentar com a distorção na auto-imagem corporal, sendo sua principal característica o medo mórbido de engordar e uma forma pervertida de realizar a restrição alimentar. O objetivo deste trabalho foi compreender os mecanismos de formação da imagem corporal na anorexia nervosa, bem como depreender os sentidos manifestos na construção da obesidade no corpo anoréxico. O caminho metodológico trilhado compreendeu a etnografia e o método biográfico, com a coleta de histórias de vida de anoréxicos. É um trabalho descritivo e interpretativo sobre a questão da imagem corporal na anorexia nervosa e, para tanto, dialoga com a Sociologia e com a Psicologia. Diante da análise do conteúdo dos depoimentos, nota-se que a construção da imagem corporal não é um trabalho solitário, mas resulta da intercomunicação entre o indivíduo e o mundo social. O indivíduo utiliza outras imagens para definir sua própria imagem corporal, bem como esse processo implica numa troca relacional entre indivíduos.

Regulation of muscle cathepsin B proteolytic activity in protein-depleted patients with chronic diseases

Background & aims: The lysosomal cathepsin system contributes to degrading cellular skeletal muscle proteins in many catabolic diseases. We have assessed the relationships between cathepsin B mRNA levels and the enzyme activity for this protease in the skeletal muscle of acutely ill patients with severe trauma ( n=7) and in patients with a variety of chronic disease states (hemodialysis, n=3; nervous anorexia, n=1; type 2 diabetes, n=2; prolonged immobilization, n=1). Methods: Muscle biopsies were taken from the vastus lateralis muscle in patients and controls to assess tissue levels of cathepsin B mRNA by competitive–quantitative polymerase chain reaction, cathepsin B proteolytic activity and myofibrillar protein content as alkali-soluble protein to DNA ratio (ASP/DNA). In the trauma patients, muscle protein loss was assessed by the arteriovenous balance technique as rate of phenylalanine release from leg muscle. Results: The acute trauma patients exhibited a significant net phenylalanine release from leg muscle (33±4 nmol phenylalanine/min/100 ml leg volume) despite a continuous nutritional support. The muscle ASP/DNA ratio was lower ( P<0.05) in the patients with chronic diseases (383±33) than in groups of healthy controls (554±41) or of uncomplicated, moderately obese subjects (525±26). Cathepsin B mRNA levels were 6–10 times greater ( P<0.05) in the patients with acute trauma or chronic catabolic diseases than in the healthy subjects. Cathepsin B enzymatic activity were 2–3 times greater ( P<0.05) in the chronic and acute patients than in the group of uncomplicated, moderately obese subjects. Regression analysis between cathepsin B mRNA and cathepsin B enzymatic activity indicates a significant direct correlation ( r=0.84; P<0.05) in the chronic catabolic conditions, but not in the acute trauma patients ( r=−0.05). Conclusions:In skeletal muscle of patients with stable chronic catabolic diseases, cathepsin B activity is directly related to cathepsin B mRNA levels, suggesting that in these patients this enzyme could be mainly regulated at the level of gene transcription.

Prevalence of Asymptomatic Cardiac Valve Anomalies in Idiopathic Scoliosis

The prevalence of asymptomatic cardiac valve anomalies was determined in 82 patients (69 females and 13 males) diagnosed as having idiopathic scoliosis and scheduled for corrective surgery (mean age at surgery 16.3 years). The preoperative study in each patient included echocardiography and ultrasound Doppler. Twenty-three valvular anomalies were found in 20 patients (24.4%). The most frequent was mitral valve prolapse. The occurrence of valvular anomalies did not correlate with sex, curve magnitude, or age at diagnosis. Eighteen patients presented a total of 20 comorbid conditions: positive family history of scoliosis (five cases), isthmic spondylolisthesis (five cases), nervous anorexia (two cases), hereditary exostosis, cystic fibrosis, ureteral stenosis, mammary hypoplasia, slipped capital femoral epiphysis, psoriasis, celiac disease, and lactose intolerance. A significant relationship was found between valvular anomalies and comorbidity. Valvular anomalies were detected in 11 out of 64 patients (17.2%) with no comorbidity and in nine out of 18 patients (50%) with a comorbid condition (Chi-square 8.2, p = 0.004). In this latter group of patients, routine echocardiographic study seems advisable in the preoperative evaluation.

A Contribution to the Problem of Anorexia Nervosa (with Respect to One of the Causes of Secondary Anorexia)

Anorexia — refusal of food for various reasons — is not only a psychiatric problem, but also interests therapeutists, endocrinologists and pediatricians. The definition, nervous anorexia substantially narrows this affection to a rather distinctive clinical picture, in which young women (considerably less often, young men) are described who stubbornly refuse to eat, and not infrequently reach a stage of pronounced cachexia.