Primary Anorexia Nervosa Research Articles

A Double-Blind, Placebo-Controlled Study of Risperidone for the Treatment of Adolescents and Young Adults with Anorexia Nervosa: A Pilot Study

The purpose of this double-blind, placebo-controlled exploratory pilot study was to evaluate the safety and efficacy of risperidone for the treatment of anorexia nervosa. Forty female subjects 12 to 21 years of age (mean, 16 years) with primary anorexia nervosa in an eating disorders program were randomized to receive risperidone (n = 18) or placebo (n = 22). Subjects completed the Eating Disorder Inventory 2, Color-A-Person Test, Body Image Software, and Multidimensional Anxiety Scale for Children at baseline and regular intervals. Weight, laboratory values, and electrocardiograms were monitored. Study medication was started at 0.5 mg daily and titrated upward weekly in 0.5-mg increments to a maximum dose of 4 mg until the subject reached a study endpoint. The mean dose for the risperidone group was 2.5 mg and for the placebo group was 3 mg for a mean duration of 9 weeks. Subjects taking risperidone had a significant decrease on the Eating Disorder Inventory 2 Drive for Thinness subscale over the first 7 weeks (effect size, 0.88; p = .002), but this difference was not sustained to the end of the study (p = .13). The Eating Disorder Inventory 2 Interpersonal Distrust subscale decreased significantly more in subjects taking risperidone (effect size, 0.60; p = .03). Subjects taking risperidone had increased prolactin levels (week 7; p = .001). There were no significant differences between groups at baseline or the end of the study for the other rating scales, change in weight, or laboratory measurements. This study does not demonstrate a benefit for the addition of risperidone in adolescents with anorexia nervosa during the weight-restoration phase of care. Clinical trial registration information-A Double-Blind, Placebo-Controlled Study of Risperidone for the Treatment of Anorexia Nervosa, http://www.clinicaltrials.gov, NCT00140426.

A SLENDER GIRL AND A THIN PLOT: STARVATION AND SPECTACLE IN PERSUASION

Click to increase image sizeClick to decrease image size Bonnie Blackwell is an associate professor of English at TCU, where she teaches eighteenth-century literature, critical theory, women's studies, and film. She has published in journals such as ELH Genders, and Women's Writing; her essays focusing on film have appeared in Camera Obscura and College Literature She is currently completing a book on Swift and Modest Proposals. Notes 1 Deborah Kaplan finds “harlequinization” marring the film versions of Pride and Prejudice and Sense and Sensibility, by which she means that “like the mass-market romance, the focus is on a hero and heroine's courtship at the expense of other characters and other experiences, which are sketchily represented” (178). Andrew Higson's “Re-presenting the National Past: Nostalgia and Pastiche in the Heritage Film,” while not a reading of the Jane Austen boom, makes many salient points about “the nostalgic gaze” of Merchant Ivory productions which applies to the films I'm examining here. In particular, I have been persuaded by Higson's diagnosis that the films' use of “commodification, exhibition and display” creates a sort of “heritage space, rather than narrative space: that is, a space for the display of heritage properties rather than for the enactment of dramas” (109, 112, 117). 2 In a lecture at Chawton in July 2003, Andrew Higson disputed the common application of the term “failure” to Persuasion. He pointed out that it was made quite economically for BBC television and then released theatrically in the United States. The film had already recouped its production costs with advertising at the time it was aired in Britain, so its admittedly modest box office take represented a profit many times over its original cost. The standard definition of a box-office failure is that the film does not recover its cost at the box-office and may take some time in the rental, VHS and DVD sales markets to break even, a definition that clearly does not fit Persuasion. However, neither its critical reception nor its box-office take could compete with the warm critical and financial reception of the other Jane Austen adaptations, up until Patricia Rozema's widely reviled Mansfield Park (1999). 3 In a popular account called The Golden Cage, Hilda Bruch describes anorexics as locked in a “struggle against feeling enslaved, exploited, and not permitted to lead a life of their own. They would rather starve than continue a life of accommodation. In this blind search for a sense of identity and selfhood they will not accept anything that their parents, or the world around them, has to offer…In genuine or primary anorexia nervosa, the main theme is a struggle for control, for a sense of identity, competence and effectiveness” (qtd. in Bell 17). 4 “Popular since the Renaissance, a syllabub is a drink made of hot, but not curdled, milk or cream mixed with brandy, table wine, port, sherry, hard cider, or beer and sugar, beaten to a froth with whipped cream floated on top” (Trager 162). 5 Cf. The description of Jane Fairfax: “Her height was pretty, just such as almost everybody would think tall, and nobody could think very tall; her figure particularly graceful; her size a most becoming medium, between fat and thin, though a slight appearance of ill-health seemed to point out the likeliest evil of the two” (Emma 149).

Assessment, treatment parameters, and prognostic indicators for patients with obsessive-compulsive spectrum disorders

Assessment and treatment parameters for obsessive-compulsive spectrum disorders (obsessive-compulsive disorder, body dysmorphic disorder, hypochondriasis, primary anorexia nervosa, Gilles de la Tourette's syndrome, and trichotillomania) are presented. The aim of this paper is to augment the emerging general guidelines for clinicians who are treating patients with these conditions. We outline how to determine what type of treatment to use and at what frequency it should be administered. Different locations of treatment—from inpatient to outpatient, homes, and residencies—are discussed. Prognostic indicators are also discussed.

Interrelationships of high fat diets, obesity, hormones, and cancer.

Obesity is defined as excess body fat and results from an imbalance of energy intake and expenditure (1). This simple definition and the application of thermodynamic principles of energy balance do not adequately express the fact that much remains unknown about this complex disorder (2). In common with other chronic diseases including cancer, it is rare for obesity to be the expression of a pure genetic or medical disorder. In the majority of cases, obesity results from a combination of physiological, psychological and environmental factors (3). A genetic predisposition to obesity mediated by a large number of genes is likely to interact with a permissive high fat diet in the presence of reduced physical activity to result in obesity(4). Obesity is the most prevalent disorder in the United States affecting up to one-third of the population. The endocrine system which is critically involved in many common forms of cancer has also been shown to translate environmental influences into excess adiposity (5). Many hormones involved in obesity also play a role in the initiation and promotion of cancer both at a cellular, paracrine, and systemic level (6). For example, reproductive hormones are critically involved in both obesity and cancer. In patients with primary anorexia nervosa and malnutrition, reproductive hormone secretion is reduced and can result in infertility. Conversely, with obesity excess secretion of reproductive hormones (e.g. estrogens) has been observed and implicated in the etiology of breast cancer (7). This chapter will examine the potential role of hormones in the etiology of obesity in the hopes of stimulating additional research on the role of obesity in modulating the risk of developing several common forms of cancer.KeywordsBreast CancerGrowth HormonePremenopausal WomanReproductive HormoneHigh Fiber DietThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Influence of primary anorexia nervosa on bone tissue and growth

While source localization methods are increasingly developed to identify brain areas underlying scalp electro/magnetoencephalographic data (EEG/MEG), these methods have not yet been used to identify the sources of intracerebral signals which offer highly detailed information. Here, we adapted the minimum current estimates method to intracranial data in order to localize supratemporal sources of intracerebral auditory 1-kHz-tone-evoked potentials occurring within 100 ms after stimulus onset. After an evaluation of localization method and despite inter-subject variability, we found a common spatiotemporal pattern of activities, which involved the first Heschl's gyrus (H1) and sulcus (HS), the Planum Temporale (PT), H2/H3 when present, and the superior temporal gyrus (STG). Four time periods of activity were distinguished, corresponding to the time range of the scalp components P0, Na, Pa/Pb, and N100. The sources of the earliest components P0 (16–19 ms) and Na (20–25 ms) could be identified in the postero-medial portion of HS or H1. Then, several areas became simultaneously active after 25 ms. The Pa/Pb time range (30–50 ms) was characterized by a medio-lateral and postero-anterior propagation of activity over the supratemporal plane involving successively H1/HS, the Planum Temporale, H2/H3 when present, and the STG. Finally, we found to a large extent that the N100 (55–100 ms) involved almost the same areas as those active during the Pa/Pb complex, with a similar propagation of activities. Reconstructing scalp data from these sources on fictive EEG/MEG channels reproduced classical auditory evoked waveforms and topographies. In conclusion, the spatiotemporal pattern of activation of supratemporal auditory areas could be identified on the individual anatomy using current estimates from intracerebral data. Such detailed localization approach could also be used prior to epilepsy surgery to help identify epileptogenic foci and preserve functional cortical areas.

The use of electroconvulsive therapy in patients with intractable anorexia nervosa

The history of the treatment of anorexia nervosa includes the majority of psychological and somatic therapies devised by psychiatrists, psychologists, and general physicians. We review the history of one of these treatments, electrical convulsive therapy (ECT), and discuss three patients treated with ECT for primary anorexia nervosa. Two had a positive response to this treatment, one did not. She later responded favorably to a course of treatment with fluoxetine.

Erythromycin effects on gastric emptying, antral motility and plasma motilin and pancreatic polypeptide concentrations in anorexia nervosa.

In primary anorexia nervosa, gastric motility is often impaired and ensuing symptoms further discourage eating. Prokinetic agents have been shown to accelerate gastric emptying in affected patients. This study investigated whether emptying of a radiolabelled semisolid 1168 kJ meal and antral contractility were enhanced by intravenous erythromycin. Eight women and two men with anorexia nervosa (21-46 years, 50-75% of ideal body weight) received 200 mg erythromycin or placebo under crossover double blind conditions. Gastric emptying and antral contractility were recorded scintigraphically for 90 minutes. In addition, plasma motilin and pancreatic polypeptide concentrations were determined. With placebo, antral contractions were of regular 3 cycles/minute frequency. With erythromycin, less frequent and partly arrhythmic long duration contractions set in and emptying was accelerated: after 90 minutes, the activity remaining in the stomach was markedly less than with placebo in all patients (Sign test, p < 0.002). Basal motilin and pancreatic polypeptide concentrations were normal and showed a normal response to the meal in all patients. Motilin concentrations decreased slightly more and pancreatic polypeptide concentrations increased markedly more with erythromycin than with placebo, possibly because the meal reached the intestine earlier. In conclusion, erythromycin accelerated emptying markedly and in most patients induced an antral motor activity characterised by long duration contractions occurring at often irregular intervals.

Primary anorexia nervosa: Gastric emptying and antral motor activity in 53 patients

In 53 consecutive patients with primary anorexia nervosa, gastric emptying of a semisolid meal was significantly slower than in 24 healthy subjects. Slow emptying tended to be associated with low serum potassium, low body weight, and long illness duration. Antral contraction amplitudes were lower than in healthy subjects and failed to increase postcibally, whereas contraction frequency and rhythmicity seemed unaffected. After the gastric prokinetic agent, cisapride, 8 mg intravenously administered double-blind, emptying was significantly faster than after placebo. The recognition of impaired gastric motility may be important in the management of anorexia nervosa.

Anorexia nervosa in males

AbstractAnorexia nervosa in males is relatively uncommon and therefore is difficult to research. Nevertheless, the study of such cases is important and may yield valuable clues to the aetiological mechanisms and expression of this disorder. This study compared the characteristics of 12 males with primary anorexia nervosa with 36 female anorectics. The pattern of the disorder was remarkably similar in both sexes. Our findings are discussed with relevance to the available literature on this topic.

Symptoms of achalasia in young women mistaken as indicating primary anorexia nervosa

The case of a young women with dysphagia, regurgitation, and weight loss, who was diagnosed as having anorexia nervosa but in whom reevaluation showed that achalasia was causing the symptoms, is presented together with related observations. Misinterpretation of esophageal symptoms may occur not only as a consequence of inadequate history taking and of being biased by a patient's emaciation, age, and gender, which leads to view certain aspects of the patient's history and behavior as suggesting a pathologic attitude towards eating and body weight, but also as a consequence of a misinterpretation of the symptoms as indicative of an eating disorder by the patients themselves. In some cases a disordered attitude toward eating and body weight may develop together or coexist with achalasia. The clinical evaluation of patients with symptoms suggestive of anorexia nervosa but also of bulimia nervosa should include the taking of a thorough history regarding swallowing and vomiting in order to recognize a possible esophageal motor disorder.

Oesophageal and gastric motor activity in patients with bulimia nervosa.

Previous studies showed that symptoms of oesophageal motor disorders can be misinterpreted as indicating anorexia nervosa and that in primary anorexia nervosa gastric motility is frequently impaired. We investigated in 32 women with bulimia nervosa whether symptoms of oesophageal motor disorders could be obscured by or be mistaken as forming part of bulimic behaviour, and whether impaired gastric motility was frequent as well. Oesophageal motility was normal in 18 of 26 patients studied, another four had incomplete lower oesophageal sphincter relaxation. Two patients had vigorous achalasia and each one achalasia and diffuse oesophageal spasm, all of whom experienced two types of vomiting: one self-induced and one involuntary, in which the vomit was non-acidic and tasted as the preceding meal. Gastric emptying of a semisolid meal was studied in all patients except of the eight with oesophageal motor abnormalities. Emptying was significantly slower than in healthy controls and grossly delayed in nine of 24 patients. Antral contraction amplitudes were lower and increased less postcibally than in controls. In conclusion (i) bulimic behaviour can obscure symptoms of oesophageal motor disorders and (ii) gastric emptying is frequently delayed in bulimia nervosa.

Impairment of taste perception in anorexia nervosa and bulimia

Nine women diagnosed as having primary anorexia nervosa (ANs), five women diagnosed as having bulimia (Bs), and seven normal control women (NCs) were tested for perception of taste quality and intensity using the method of magnitude estimation. The four taste stimuli used were sucrose, hydrochloric acid (HCI), sodium chloride (NaCl), and quinine hydrochloride (QHCI). Four different log molar concentrations of each of these four taste stimuli were employed. No significant differences were found among the three groups in ability to identify taste quality. However, there were significant differences (p <.05) in magnitude estimates of the 3 higher concentrations of the HCI solution, the 2 higher concentrations of the sucrose and NaCl solutions, and the QHCl solution of the highest concentration. The magnitude estimates of the ANs and Bs were consistently lower than those of the NCs. The results indicate that poor gustatory sensitivity is significantly associated with the abnormal eating behavior characteristic of both anorexia nervosa and bulimia.

The movement behavior of anorectics: The control issue

This pilot study explores the “control issue” of anorectics through an analysis of the movement behavior of female anorectics (ages 17–22 years) as compared to non-anorectics and as a reflection of their Internal-External Locus of Control. This personality construct is an operationalization of Bruch's “ineffectiveness” dimension of primary anorexia nervosa. Five hospitalized anorectics and five non-anorectic controls were videotaped individually while performing three standard movement sequences and the Reid-Ware Multi-dimensional Locus of Control scale was administered to each participant. Movement videotapes were analysed by two Certified Movement Analysts in terms of the anorectic/non-anorectic distinction, the total locus of control scores, and for each of the subdimensions. While there were no significant differences between anorectics and controls in terms of the locus of control scale, a cluster of movement parameters was significantly reflective of the anorectic disorder. These movement behaviors were indicative of a lack of sense of centre, lack of flow control and a distorted sense of time, space and weight. The study concludes with a theoretical interpretation of the movement findings for anorectics and a discussion of implications for treatment.

Symptomatology, psychosexual development and gender identity in 42 anorexic males.

Forty-two male patients with an anorexic syndrome were assessed. Twenty-nine of them had a primary anorexia nervosa (most of them also had bulimic symptoms). They were compared with a series of 23 female anorexia nervosa patients. The males scored more highly than female patients on a number of symptoms, but generally more similarities than differences in symptomatology were apparent. Male patients with primary anorexia nervosa also showed several signs of a disturbed psychosexual and gender identity development. The data support the hypothesis that males with atypical gender role behaviour have an increased risk for developing anorexia nervosa or bulimia in adolescence.

The prolactin, growth hormone, and cortisol responses to insulin-induced hypoglycemia in anorexia nervosa

Plasma levels of prolactin and their response to insulin-induced hypoglycemia or to the thyrotropin-releasing hormone (TRH) were measure in 17 females with primary anorexia nervosa when they were 54.9-73.2% of ideal body weight (IBW) (group 1) and in 15 cases during or after weight gain (75.1-100.4% of IBW, group 2). Basal prolactin concentrations were well within the normal range (less than 25 ng/ml) in all anorectic patients except in one patient who had a value of 42.3 ng/ml. Prolactin response to insulin-induced hypoglycemia was markedly impaired or absent in 16 out of the patients in Group 1 but improved dramatically in 9 of the patients in Group 2. Direct stimulation of the pituitary with TRH, however, produced a prolactin release in all anorectic patients studied. Plasma GH response to insulin-induced hypoglycemia was impaired in 12 of the patients in group 1 and 12 of the patients in group 2. Plasma cortisol response to insulin-induced hypoglycemia was impaired in 11 of the patients in group 1 and in 3 of the patients in group 2. These findings indicate that the hypothalamic function in anorectic patients is altered.

Intravenous Cisapride Accelerates Delayed Gastric Emptying and Increases Antral Contraction Amplitude in Patients With Primary Anorexia Nervosa

Delayed gastric emptying is common in primary anorexia nervosa. We investigated in 12 patients whether gastric emptying could be accelerated by the prokinetic drug cisapride. Patients were studied on two occasions 1 wk apart and received, under random double-blind conditions, 8 mg of cisapride and placebo intravenously. Gastric emptying of an isotopically labeled semisolid meal and antral motor activity were measured using a dual-headed gamma-camera for 50 min. Emptying was significantly slower (half-emptying time, 50-191 min; median, 121 min) than in 24 healthy volunteers (half-emptying times, 21-119 min; median, 47 min). Cisapride accelerated emptying significantly (p less than 0.001; half-emptying time after cisapride, 22-80 min; median, 42 min). Antral contraction amplitude increased and contraction frequency decreased significantly (p less than 0.001), whereas the propagation velocity of contractions remained unchanged. We concluded that intravenous cisapride accelerates gastric emptying and increases antral contraction amplitude in patients with anorexia nervosa. Whether or not these effects can prove beneficial in diminishing the patients' symptoms and in helping them to gain weight can only be answered from studies involving long-term treatment with cisapride.

Perception of hunger and satiety induced by 2-deoxy-D-glucose in anorexia nervosa and bulimia nervosa

The effect of intracellular glucopenia induced by 2-deoxy-D-glucose (2-DG) on changes in hunger ratings, blood glucose, plasms cortisol, and prolactin levels were examined in six female patients with primary anorexia nervosa, three patients with bulimia nervosa, and six age-and sex-matched volunteers. In the normal subjects, hunger ratings obtained by the linear visual analog technique increased significantly at 60 minutes after 2-DG infusion and remained elevated. In Patients with anorexia nervosa, however, hunger ratins paradoxically decreased significantly at 90 minutes. In normal subjects, the ingestion of a 20-minute lunch relieved hunger, but neither the anorexic patients nor bulimic patients felt satiety even after food intake. These results suggest that the perception of hunger induced by 2-DG in anorexia nervosa and that of satiety in anorexia nervosa and bulimia nervosa are disturbed.

The Body Politic: Normal Female Adolescent Development and the Development of Eating Disorders

The Body Politic: Normal Female Adolescent Development and the Development of Eating Disorders

Anorexic syndromes in the male

Forty-two male patients with an anorexic syndrome were assessed personally ( n = 29) or by reviewing the case-notes. Twenty-nine male patients were classified as primary anorexia nervosa and they were compared to our series of atypical male patients and a series of 23 female anorexia nervosa patients. There was no difference between male and female patients in the age at onset. Male and female anorexia nervosa cases were very similar in their personality profile and symptomatology; however, male cases were more preoccupied in their thoughts with food, weight etc., and showed more hyperactivity, more achievement orientation and more sexual anxiety than female cases. The mothers age at the male patients' birth was significantly younger than in the female group. Male anorexia nervosa patients were more extraverted and scored “superfeminine” on the masculinity vs feminity scale (FPI). A continuum from “true” anorexia nervosa to atypical cases and to secondary loss of appetite was observed.

Self-starvation in a diabetic adolescent

The case of a 14-year-old girl who began food refusal shortly after the development of diabetes mellitus is presented. Her dieting eliminated the need for insulin and urine testing and, as a result, allowed the patient to deny that she had diabetes. Although her course resembled that seen in primary anorexia nervosa, this patient was felt to have atypical anorexia nervosa, in this case an extreme form of illness denial probably associated with psychosis.