Severe Anorexia Research Articles

The endogenous development and pathogenicity of Eimeria anseris (Kotlan, 1932) in domestic goslings.

Twenty-one, 25-day-old, artificially reared, coccidia-free goslings (Anser cygnoides var. domestica) were inoculated orally with 0.5 × 104, 1 × 104, or 100 × 104 sporulated oocysts of Eimeria anseris and sacrificed at intervals from 24 to 216h post-inoculation (HPI). Nine uninfected goslings served as negative controls. Parts of the visceral organs from goslings, including the intestines, kidneys, and liver, were fixed, sectioned, and observed microscopically. The results revealed that two generations of meronts occurred in the life cycle of E. anseris. The first generation of meronts developed at 24-96 HPI and the second generation at 90-128 HPI. Each meront contained 4-10 merozoites. Development of gamonts began at 128 HPI and mature oocysts appeared at 168 HPI. Developmental stages presented mainly in the epithelial cells of crypts and lamina propria in the posterior parts of the jejunum and ileum. Parasites localized mostly in the cytoplasm and occasionally in the nuclei of host cells. Histological lesions were pronounced in the jejunum and ileum. Desquamation and necrosis of the epithelium of intestine and crypts, infiltration of inflammatory cells, and hemorrhage and mucosal edema were associated with aggregates of endogenous stages. The infected goslings mainly showed severe diarrhea, depression, anorexia, and emaciation, suggesting that E. anseris is highly pathogenic in goslings.

The medical risks of severe anorexia nervosa during initial re-feeding and medical stabilisation

Objective evidence about the risks associated with anorexia nervosa and how to manage them, is limited. The aim of this study is to describe the medical risk profile, management and outcomes of a cohort of patients with severe anorexia nervosa (sAN) during medical stabilisation treatment. Retrospective analysis of case records gathered medical risk data for a 90 day high risk period, on 65 patients with sAN admitted to two specialist services. Prospectively established definitions of medical risk variables and significant complications were applied to the data to describe the risk profiles and outcomes. Amongst this population with an average initial BMI of 12.8kg/m2, 74% developed no significant medical complications. Oral re-feeding over 60 days achieved an increase in mean BMI to 14.4kg/m2 and mean weight gain of 4kg. No patients developed severe hypophosphatemia (<0.45mmol/L) or any other indicators of a re-feeding syndrome. All the medical complications that arose were temporary. Initial re-feeding and medical stabilisation of patients with severe AN can be managed safely in specialist inpatient and community settings with slow re-feeding. Although the prevalence of complications was shown to be low, slight worsening of medical risk markers and increased incidence of complications did occur during initial re-feeding. The limited comparable published data appears to support slower rates of re-feeding, showing fewer abnormal results and complications. There is however a need for a definitive prospective multi-centre observational cohort study to investigate risks factors, and the effects of treatment on medical outcomes, in a large sample with varied rates of re-feeding.

Kampo formula "Hochu-ekki-to" suppressed carbon tetrachloride-induced hepatotoxicity in mice.

The aim of this study was to investigate whether pretreatment with the Japanese herbal medicine "Hochu-ekki-to" (TJ-41) has an ameliorative effect on carbon tetrachloride (CCl4)-induced hepatotoxicity through anorexia prevention. Twenty-four hours before CCl4 injection, TJ-41 or saline solution was intraperitoneally administered. Furthermore, 24h after TJ-41 injection, mice were intraperitoneally administered 1.6g/kg CCl4 or olive oil. Moreover, 24h after CCl4/olive oil injection, mice from each group were euthanized and bled for plasma analysis. Mice injected with CCl4 exhibited severe anorexia. Moreover, CCl4 increased the plasma levels of hepatic injury markers (i.e., alanine aminotransferase and aspartate aminotransferase) as well as lipid peroxidation and hepatic Ca levels. Pretreatment with TJ-41 recovered the CCl4-induced anorexia and plasma levels of the hepatic injury markers. Moreover, CCl4-induced lipid peroxidation and hepatic Ca levels decreased upon TJ-41 pretreatment. In addition, hepatic metallothionein levels in the TJ-41+CCl4-treated group were decreased by >50% compared with the levels in the TJ-41-treated group, implying that metallothionein was consumed by CCl4-induced radicals. Our results suggest that TJ-41 attenuates CCl4-induced hepatotoxicity, presumably by the induction of metallothionein, which in turn scavenges radicals induced by CCl4 exposure.

A PILOT STUDY TO ASSESS CARDIAC ABNORMALITIES IN SEVERE ANOREXIA NERVOSA PATIENTS USING CARDIAC MAGNETIC RESONANCE IMAGING

Anorexia nervosa (AN) is associated with numerous cardiac abnormalities including bradyarrythmias, decreased myocardial mass and function, and pericardial effusions. This patient population has an increased mortality rate in comparison to other psychiatric illnesses. Cardiac evaluation of patients with anorexia nervosa generally involves routine ECG and transthoracic echocardiography. Little is known on the role of cardiac magnetic resonance imaging (CMR) for the noninvasive characterization of cardiac abnormalities in this patient cohort. The objective of this study is to characterize baseline CMR findings in adolescent patients who have been diagnosed with severe anorexia nervosa.

Exercise and physical therapy help restore body and self in clients with severe anorexia nervosa

Exercise in the context of anorexia nervosa is a multifaceted endeavour surrounded by controversy and uncertainty. A broader comprehension of this poorly understood phenomenon is required. Informed by the findings of a body examination of six individuals with anorexia nervosa, as well as exercise science, phenomenology and neurocognition, the purpose of this article is to elaborate on the potential role of exercise and physical therapy in the treatment of anorexia nervosa. The findings of the body assessment include constriction of posture, muscles and pattern of breathing. These bodily restraints are not necessarily merely associated with high levels of exercise, they may also reflect psychological strain accompanying the illness. The restricted breathing in particular is assumed to be associated with difficult thoughts and suppressed feelings. Based on the results of the body examination, as well as medical and psychological considerations accompanying the illness, it is suggested that interventions should focus on improving postural stability and restoring related muscular function. Integral to engaging in these activities, the potential to integrate proprioceptive information in this process may generate a more coherent experience of the body, as well as of the self, in these clients. Accordingly, constrictions of the body may have a vital role in constraining the experience of the self. As such, addressing bodily restraints in these clients may facilitate the experience of being the subject causing and controlling the movements. This is in marked contrast to clients' previous exercise experiences, which were associated with compulsion, rigidity and the absence of coherence and control.

Patients' perspective of a group intervention for perfectionism in anorexia nervosa: A qualitative study.

This study aimed to explore the experiences of adults with anorexia nervosa who took part in a perfectionism group intervention in an inpatient setting. Thematic analysis was used to explore patient feedback collected in focus groups. Patient feedback was generally positive and centred around three main themes: perceived benefits of the group, the content of the group and suggested improvements. The findings suggest that a brief perfectionism group intervention is an acceptable treatment with a range of perceived benefits for patients with severe anorexia nervosa. Understanding patients' experiences of the intervention can provide further important information to maximise therapeutic impact of the group in inpatient settings.

Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks.

BackgroundAs a significant proportion of patients receiving palliative care suffer from states of anxiety, depression, delirium, or other mental symptoms, psychiatry and palliative care already collaborate closely in the palliative care of medical conditions. Despite this well-established involvement of psychiatrists in palliative care, psychiatry does not currently explicitly provide palliative care for patients with mental illness outside the context of terminal medical illness.DiscussionBased on the WHO definition of palliative care, a, a working definition of palliative psychiatry is proposed. Palliative psychiatry focuses on mental health rather than medical/physical issues. We propose that the beneficiaries of palliative psychiatry are patients with severe persistent mental illness, who are at risk of therapeutic neglect and/or overly aggressive care within current paradigms. These include long-term residential care patients with severe chronic schizophrenia and insufficient quality of life, those with therapy-refractory depressions and repeated suicide attempts, and those with severe long-standing therapy-refractory anorexia nervosa. An explicitly palliative approach within psychiatry has the potential to improve quality of care, person-centredness, outcomes, and autonomy for patients with severe persistent mental illness.ConclusionsThe first step towards a palliative psychiatry is to acknowledge those palliative approaches that already exist implicitly in psychiatry. Basic skills for a palliative psychiatry include communication of diagnosis and prognosis, symptom assessment and management, support for advance (mental health) care planning, assessment of caregiver needs, and referral to specialized services. Some of these may already be considered core skills of psychiatrists, but for a truly palliative approach they should be exercised guided by an awareness of the limited functional prognosis and lifespan of patients with severe persistent mental illness.

Mental capacity to consent to treatment in anorexia nervosa: explorative study.

BackgroundMental capacity to consent to treatment in anorexia nervosa is a neglected area in clinical decision-making.AimsTo examine clinical and neuropsychological parameters associated with diminished mental capacity in anorexia nervosa.MethodAn explorative study was conducted in 70 adult female patients with severe anorexia nervosa. Mental capacity to consent to treatment was assessed by experienced psychiatrists. Further measurements included the MacCAT-T (to assess mental capacity status), a range of clinical measures (body mass index (BMI) and comorbidity) and neuropsychological tests assessing decision-making, central coherence and set-shifting capacity.ResultsDiminished mental capacity occurs in a third of patients with severe anorexia nervosa and is associated with a low BMI, less appreciation of illness and treatment, previous treatment for anorexia nervosa, low social functioning and poor set shifting.ConclusionsAssessment of diminished mental capacity in anorexia nervosa requires careful evaluation of not only BMI, but also the degree of appreciation of illness and treatment, history and the tendency to have a rigid thinking style.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Benefits of group cognitive remediation therapy in anorexia nervosa: case series.

SummaryBackgroundCognitive remediation therapy (CRT) is a treatment targeting cognitive difficulties in psychiatric disorders. CRT has been used with patients with severe anorexia nervosa (AN) in individual and group formats. Research of group CRT in AN is limited.MethodsEvaluation of a series of CRT groups delivered in inpatient and intensive daycare services was performed. Participants’ self-reported cognitive flexibility and central coherence, as well as motivation to change were assessed pre- and post-group. Additionally, patients’ evaluative feedback was collected after completion of the group.ResultsThere was a significant improvement in the patients’ self-reported cognitive flexibility and bigger picture thinking, as well as in their self-efficacy to change. The feedback questionnaires highlighted that patients found the sessions useful and reported confidence in using some of the skills and strategies they learnt in the group.ConclusionIn line with evidence from small-scale reports, this larger scale case series study indicates that group CRT leads to increased flexibility and bigger picture thinking, as well as improved confidence in the ability to change for participants. CRT in a group format seems to be a practical and helpful intervention for patients with AN in intensive treatment programmes.

Association between anorexia nervosa and type 2 diabetes in Sweden: Etiological clue for the primary prevention of type 2 diabetes

ABSTRACTAim: Caloric restriction has been found to be protective against the development of type 2 diabetes mellitus (T2D) in experimental animal studies. However, studies examining this association in humans are limited. In the present study, we examined whether individuals with anorexia nervosa, one marker of severe caloric restriction in humans, have a low incidence of T2D by using several Swedish registries. Methods: Individuals with anorexia nervosa were identified from the Swedish Hospital Discharge Register and Outpatient Register between 1964 and 2010. Standardized incidence ratios (SIRs) for T2D were studied among individuals with anorexia nervosa compared to those without the disorder. Results: A total of 17,135 individuals were identified with anorexia nervosa in Sweden. From this tally, 34 of them developed T2D, demonstrating a reduced risk of T2D with a SIR of 0.70, compared to individuals without anorexia nervosa. Patients with severe anorexia, indicated by more frequent hospitalizations, had a statistically non-significant lower incidence of T2D than those with fewer hospitalizations. A sibling study, controlled for familial confounding, found a statistically non-significant association between anorexia nervosa and T2D. Conclusion: Our study found that severe caloric restriction by using individuals with anorexia nervosa as a proxy was negatively associated with T2D, which might provide a biological basis for the primary prevention of T2D. Further studies are needed to explore whether moderate caloric restriction can effectively prevent the development of T2D in general population.

A novel virulence-associated protein, vapE, in Streptococcus suis serotype 2.

Streptococcus suis serotype 2 (SS2) is an important pathogen that affects pigs. However, neither its virulence nor its pathogenesis of infection has yet to be fully elucidated. The present study identifies a novel virulence‑associated protein E gene (vapE) of SS2. To investigate the importance of vapE in SS2 infection, a vapE knock‑out mutant based on SS2 wild‑type strain ZY458 was designated 458ΔvapE. 458ΔvapE was generated through homologous recombination, using a combined plasmid with a vapE knock‑out fragment and a pSET4s suicide vector. Additionally, the 458ΔvapE strain was transformed by a pAT18 shuttle plasmid containing the vapE gene. A functionally complemented strain for the vapE gene [termed 458ΔvapE (pvapE)] was constructed. Animal experiments demonstrated that mice infected with ZY458 and 458ΔvapE (pvapE) exhibited severe clinical symptoms, including depression, apathy, fever, anorexia, emaciation, swollen eyes and neural disorders, and died within two days of infection. All mice infected with ZY458, and 85% of mice infected with 458ΔvapE (pvapE), died within 2 days of infection. In contrast, mice inoculated with 458ΔvapE exhibited only mild clinical symptoms in the first 2 days following infection, and recovered within a week. A bacterial colonization assay demonstrated the ability of the 458ΔvapE mutant SS2 strain to colonize the heart, liver, spleen, lung and kidney of infected mice. PCR analysis of the vapE gene revealed that functional vapE was detected in virulent strains, but not in avirulent and carrier strains of S. suis SS2. These findings indicate that vapE is important for the pathogenesis of SS2.

Imiquimod Treatment Causes Systemic Disease in Mice Resembling Generalized Pustular Psoriasis in an IL-1 and IL-36 Dependent Manner.

Generalized pustular psoriasis (GPP) is a severe form of psoriasis that can be caused by missense mutations in the interleukin-36 (IL-36) receptor antagonist. In addition to neutrophil rich skin inflammation, GPP patients typically also experience anorexia, fever, malaise, and pain. The imiquimod-induced skin inflammation mouse model has rapidly become a popular way to study plaque psoriasis, which typically does not involve symptoms of systemic disease. In this model, neutrophil recruitment to the skin is dependent upon the inflammatory mediators IL-1, via its receptor IL-1R1, and IL-36α. Unexpectedly, we observed that mice also exhibited signs of anorexia (weight loss and decreased food intake), general malaise (decreased activity and loss of interest in building nests), and pain (nose bulging and hunched posture). A scoring system allowing quantitative comparisons of test groups was developed. Female mice were found to develop more severe disease than male mice. Furthermore, mice deficient in both IL-1R1 and IL-36α are nearly disease-free, while mice lacking only one of these inflammatory mediators have less severe disease than wild type mice. Hence, the imiquimod-induced skin inflammation mouse model recapitulates not only plaque psoriasis, but also the more severe symptoms, that is, anorexia, malaise, and pain, seen in GPP.

Asunaprevir/daclatasvir療法により難治性の帯状疱疹が出現した超高齢C型肝硬変症例

A-82 year old woman with liver cirrhosis type C (Child A) was treated with asunaprevir/daclatasvir. At 6 weeks of the treatment she suddenly suffered from severe fatigue and anorexia (Grade 3). Her body weight was reduced from 50.1 to 40.2 kg. The treatment was discontinud. After that wide spread herpes zoster from left upper and lower abdomen to buttochs appeard. The herpes zoster was treated with famciclovir and aciclovir ointment. It took about 2 months to recover from herpes zoster. HCV-RNA was continuously negative since then and finally she achiteved SVR 24. The reason why wide spread herpes zoster appeared in this patient seamed to be immunodeficiency due to, severe weight loss, old age and leukopenia.

Terminating a Group

Terminating a Group Jill Lewis1 issn 0362-4021 © 2016 Eastern Group Psychotherapy Society group, Vol. 40, No. 4, Winter 2016 357 1 Private practice, Atlanta, GA. Correspondence should be addressed to Jill Lewis, MA, LCSW, CEDS, 1867 Independence Square, Suite 105, Atlanta, GA 30338. E-mail jill@jlewistherapy.com. I started my outpatient mixed eating disorder recovery group in June 2010. I ran it every Monday night, unless I was out of town or it was a holiday. I have truly loved the experience of running this group. It started with five women and at its maximum had nine but usually stayed around six or seven. It was made up entirely of women in recovery from an eating disorder. They came from all walks of eating disorder history, from multiple higher levels of care to having this group as their first exposure to outpatient treatment. The group ebbed and flowed from more of a support group to more interpersonal, depending on the level of insight and on the capabilities of the group. At times, some group members became so sick that it was quite difficult to do true interpersonal group work, which was a huge barrier to treatment, but the group always worked through it. The current group members are as follows. The silent member—we will call her Ashley—is also my individual patient, whom I see twice a week. She is currently a restrictor and binger. Ashley speaks very little and has extreme social anxiety. She becomes very defensive when anyone invites her into the group discussion. She is insightful and smart as a whip. She teases the group when she does speak, because she knows how interpersonal groups are run from her years of being in residential and inpatient facilities. She sees and says things that no one else has the guts to say. She is valuable to the group, but she cannot see any value in herself. She has intense self-hatred and self-loathing that she thinks about everything before she says it and is constantly worried about all of the feedback. She often drops stuff into the room and it is just left there, because the group is unsure how to respond. She enacts her own sense of loneliness and isolation right into the group. 358 lewis Rachel has a history of severe anorexia nervosa, which switched to bulimia and then binge eating. She has also been to residential and many outpatient facilities. She is the “co-facilitator,” and her insight and enthusiasm are brought into the group every week. She can be quite high and low; she brings the drama. She is, however, able to call you out and actually see you. She feels the passion of everyone in the room; it is powerful and incredible. Her favorite line, and something that gets repeated, is “often I go home at night and just rub AHAVA products all over my jiggly body to show myself I am beautiful.” She has become very comfortable with who she is, even discussing the nature of her differently sized breasts. She is a singer and an artist and has created songs about her time in treatment and her eating disorder. Lauren is the recovery-minded member. I worked with her individually for about 14 months when she eventually decided she wanted a dialectical behavior therapy (DBT) therapist and it was time to transition out. I had seen her through three programs and felt quite hurt when she left, because I felt like our work was just getting started. The work between Lauren and me only continues to grow stronger in the group. She and I have a wonderful therapeutic connection, and she has said that I scare her because I see her. She came from a religious background, and she finds safety in Judaism. I also had an inkling that she was a lesbian. Eight months later, she shared that she did not want to be a religious Jew and that she was gay. She has also since transitioned from seeing the DBT therapist to seeing a Modern Orthodox eating disorder specialist, whom she felt was a better fit. Lauren is a powerful group member; she has the...

Suppressive Effect of Kampo Formula “Juzen-taiho-to” on Carbon Tetrachloride-Induced Hepatotoxicity in Mice

The aim of the present study was to investigate whether pretreatment with the Japanese herbal medicine, "Juzen-taiho-to" (JTX), had an ameliorative effect on carbon tetrachloride (CCl4)-induced hepatotoxicity through anorexia prevention. Mice injected with CCl4 exhibited severe anorexia. Moreover, CCl4 increased the plasma levels of hepatic injury markers (i.e., alanine aminotransferase and aspartate aminotransferase), lipid peroxidation, and hepatic Ca(2+) levels. Pretreatment with JTX recovered the CCl4-induced anorexia. In addition, JTX pretreatment decreased CCl4-induced plasma levels of hepatic injury markers. Increased Ca(2+) is a known indicator of the final progression to hepatocyte death, and CCl4-induced hepatotoxicity is mainly caused by oxidative stress. The present study indicated CCl4-induced lipid peroxidation and hepatic Ca(2+) content decreased with JTX pretreatment. Our results suggest that JTX has potential to protect of CCl4-induced anorexia, and the modulation of oxidative stress.

Cardiovascular complications of anorexia nervosa: A systematic review.

Anorexia nervosa portends the highest mortality among psychiatric diseases, despite primarily being a disease of adolescents and younger adults. Although some of this mortality risk is attributable to suicide, many deaths are likely cardiovascular in etiology. Recent studies suggest that adverse myocardial structural changes occur in this condition, which could underlie the increased mortality. Given limited prevalence of severe anorexia there is a paucity of clinical and autopsy data to discern an exact cause of death. Given this background we conducted a systematic review of the medical literature to provide a contemporary summary of the pathobiologic sequelae of severe anorexia nervosa on the cardiovascular system. We sought to elucidate the impact of anorexia nervosa in four cardiovascular domains: structural, repolarization/conduction, hemodynamic, and peripheral vascular. A number of cardiac abnormalities associated with anorexia nervosa have been described in the literature, including pericardial and valvular pathology, changes in left ventricular mass and function, conduction abnormalities, bradycardia, hypotension, and dysregulation in peripheral vascular contractility. Despite the prevalent theory that malignant arrhythmias are implicated as a cause of sudden death in this disorder, data to support this causal relationship are lacking. It is reasonable to obtain routine electrocardiography and measurements of orthostatic vital signs in patients presenting with anorexia nervosa. Echocardiography is generally not indicated unless prompted by clinical signs of disease. Admission to an inpatient unit with telemetry monitoring is recommended for patients with severe sinus bradycardia or junction rhythm, marked prolongation of the corrected QT interval, or syncope.

Problematic Exercise in Anorexia Nervosa: Testing Potential Risk Factors against Different Definitions.

“Hyperactivity” has a wide prevalence range of 31% to 80% in the anorexia nervosa literature that could be partly due to the plethora of definitions provided by researchers in this field. The purpose of this study was two-fold: 1) To assess the variance across prevalence rates of problematic exercise encountered in patients with anorexia nervosa, in relation to seven different definitions found in the literature. 2) To examine how core eating disorder symptoms and the dimensions of emotional profile are associated with these different definitions and the impact of these definitions on the assessment of patients’ quality of life. Exercise was evaluated in terms of duration, intensity, type and compulsion using a semi-structured questionnaire administered to 180 women suffering from severe anorexia nervosa. Seven different definitions of problematic exercise were identified in the literature: three entailing a single dimension of problematic exercise (duration, compulsion or intensity) and four combining these different dimensions. Emotional profile scores, obsessive-compulsive symptoms, eating disorder symptomatology, worries and concerns about body shape, self-esteem and quality of life were assessed using several established questionnaires. The prevalence of problematic exercise varied considerably from, 5% to 54%, depending on the number of criteria used for its definition. The type and level of eating disorder symptomatology was found to be associated with several definitions of problematic exercise. Surprisingly, a better self-reported quality of life was found among problematic exercisers compared to non-problematic exercisers in three of the definitions. The different definitions of problematic exercise explain the broad prevalence ranges and the conflicting associations generally reported in the literature between problematic exercise and eating disorder-related psychological parameters. There is an urgent need for a valid consensus on the definition of problematic exercise in anorexia nervosa. This will support the development of further research on the etiology and treatment of problematic exercise.

Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome.

This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory-2 (EDI-2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m(2). Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI-2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI-2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non-responders.

Denosumab improves bone density in a female patient with severe anorexia nervosa

Denosumab improves bone density in a female patient with severe anorexia nervosa

An interdisciplinary early simultaneous palliative approach in advanced lung cancer (a-LC): Preliminary data in outpatient setting experience.

138 Background: To integrate Simultaneous Palliative Care with standard cancer care is a growing-interest concept; hence, a global patient-centered care rather than disease-directed intervention is a major issue in advanced Lung Cancer (a-LC). These patients are often characterized by high tumor burden and comorbidities related to smoking history and elderly; furthermore, malnutrition could contribute to worse outcome. Some landmark experiences have demonstrated that a-LC patients benefit from simultaneous palliative care in early phase of treatment. The initial results of a pilot experience on early simultaneous interdisciplinary palliative approach in a-LC patients, referring to the Thoracic Oncology outpatient department of a Clinical Cancer Center, are reported. Methods: From October 2014 to May 2015, 35 patients with stage IV disease, receiving first-line therapy, were accrued. The team includes medical oncologists, a palliative care specialist, a psychologist, a nutritional expert and a research nurse. The baseline assessment comprised the disease status and comorbidities, psychosocial distress, pain and Mini-nutritional assessment (MNA). Smoking habits were recorded and information about smoking cessation programs was provided. A survey about the grade of satisfaction of patients during this multimodal approach was conducted. Results: The main patients’ characteristics are shown in Table.18/35 patients required pain treatment reassessment, while 13/35 patients had severe malnutrition. The most frequent symptoms were pain (24/35), severe psychological distress (24/35), asthenia (23/35) and anorexia (20/35). Conclusions: This approach is suggested due to multiple unmet needs of these patients; these preliminary data confirm that an interdisciplinary early palliative care is feasible in an outpatient setting with good compliance and satisfaction of patients as well as of caregivers. [Table: see text]