Severe Anorexia Research Articles

Intensive family exposure-based cognitive-behavioral treatment for adolescents with anorexia nervosa.

Anorexia nervosa exhibits high comorbidity rates and shared features with anxiety disorders and obsessive-compulsive disorder. Anxiety-based etiological models have proposed that fear of eating-related stimuli is the central mechanism around which avoidance of food and food-related rituals are performed. Building on this approach, exposure-based interventions have demonstrated promising results. Limited evidence in adolescents encourages the evaluation of exposure approaches in this population. The current study presents a preliminary evaluation, in eight adolescents with anorexia nervosa, of an exposure-based CBT featuring an intensive format and parental involvement. significant improvements in physical and psychological outcomes were observed. this case series provides preliminary support for the efficacy of intensive family exposure-based CBT for treating adolescents with severe anorexia nervosa.

511P - The role of neuropeptide y in cancer-associated anorexia and its correlation with interleukin-1 beta

Background: Anorexia has been known as a factor that can increase mortality and morbidity in cancer patients. Anorexia in cancer patients can be triggered by the cytokines which produced by tumor cells and cells that involved in immunological response to the tumor. One of that cytokines is interleukin-1 Beta (IL-1β). Neuropeptide Y (NPY) is an extremely powerful orexigenic peptide that stimulates energy deficiency as a hunger center and proopiomelanocortin (POMC) is an anorexigenic peptide for satiety. Cytokines produced by tumor cells inhibit NPY in the orexigenic pathway and excite the POMC on the anorexigenic pathway caused anorexia. In cancer, the most important process causes anorexia is inhibition of NPY. Methods: This study is an observational analytic with a cross-sectional approach. The research was conducted at Dr. M. Djamil Hospital. The sample of this study was all patients with cancer-associated anorexia who were treated in the Hematology and Medical Oncology Division, Internal Medicine Department of Dr. M. Djamil Hospital. Sample is a patient who satisfies the inclusion criteria taken consecutively (n = 30). Results: This study found the average levels of NPY in patients with cancer-associated anorexia is 2.11 ± 0.76 pg/ml. It is significantly lower than normal limit (5-90 pg/ml) (p < 0.05). However, the average levels of IL-1β is 37.75 ± 16.86 pg/ml. It is significantly higher than normal limit (<3.9 pg/ml) (p < 0.05). The results of statistical analysis showed significant difference between the average levels of NPY on moderate anorexia patients and the average levels of NPY on severe anorexia patients (p < 0.05). There is also a significant correlation between increased IL-1β levels and decreased levels of NPY in patients with cancer-associated anorexia (p < 0.05 and r = -0.547). Conclusions: The result of the study concludes that there is a decrease the average levels of NPY and increase the average levels of IL-1β in patients with cancer-associated anorexia, and there is a negative correlation between the levels of IL-1β and NPY levels in patients with cancer-associated anorexia. Legal entity responsible for the study: Division of Hematology and Medical Oncology, Internal Medicine Department, Dr. M. Djamil General Hospital, Padang, Indonesia. Funding: None Disclosure: All authors have declared no conflicts of interest.

Case Series; Experience of the Management of 2 Patients with Severe Anorexia Nervosa in Sligo University Hospital using the MARSIPAN protocol

Case Series; Experience of the Management of 2 Patients with Severe Anorexia Nervosa in Sligo University Hospital using the MARSIPAN protocol

Family Functioning and Relationship Quality for Adolescents in Family-based Treatment with Severe Anorexia Nervosa Compared with Non-clinical Adolescents.

This longitudinal study explored family functioning and relationship quality for adolescents with severe anorexia nervosa (AN). An important outcome given healthy family functioning supports effective adolescent development. Fifty-four female adolescents and their parents, treated with family-based treatment after inpatient admission, and 49 non-clinical age-matched adolescents and their parents were compared at assessment and 6months after session 20. At baseline, AN group mothers and fathers reported poorer family function. AN adolescents were notably similar to controls, reporting poorer function in only one domain. There were no changes for adolescents, an improvement for mothers in the AN group, but an increase in perceived impairment for fathers in both groups, with AN fathers more affected. The similarity in adolescent reports and the increase for fathers over time may indicate that normal adolescent family processes occur even in the midst of serious illness. There is a need to provide intervention to ameliorate the impact of treatment on parents. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

PT07.2: Accuracy of REE Predictive Equation in Female Patients with Severe Anorexia Nervosa

PT07.2: Accuracy of REE Predictive Equation in Female Patients with Severe Anorexia Nervosa

Immersıon Anesthesia with Alfaxalone in a Goldfısh (Carassius auratus)

An alfaxalone anesthesia protocol was used to perform a coeliotomy in a goldfish diagnosed with multiple ovarian cysts. The 7-year-old, 460g, female goldfish presented for severe coelomic distension and anorexia. Full-body radiographic images were unremarkable, but coelomic ultrasound revealed multiple ovarian cysts. Ultrasound-guided aspiration of a large cyst was performed. Cytology revealed lysed leukocytes that contained numerous intracellular bacilli suggestive of septic suppurative inflammation. An exploratory coeliotomy was performed and 90mL of semi-clear fluid was aspirated from the largest cysts. For anesthesia, three plastic fish tanks were prepared for induction (10mg/L of alfaxalone), maintenance (5mg/L alfaxalone), and recovery (no anesthetic agent). Water in the fish tanks was saturated with oxygen. The goldfish was immersed in the induction tank and once the labyrinthine-righting reflex was lost (5 minutes), the fish was placed in the maintenance tank. The goldfish was then placed on a platform and supported in a supine position on wet Perlon wool. The head of the goldfish was submerged in water while the coelomic area of the surgical field was maintained out of water. During surgery, the respiratory rate (32 to 53 opercula movements per minute) and heart rate (35 to 45beats per minute) were monitored. Butorphanol (0.4mg/kg IM) was administered for analgesia. The anesthetic event was 60 minutes, with the recovery period being 35 minutes. There were no complications associated with recovery and the goldfish returned to its normal position 12 hours after surgery. Immersion anesthesia with alfaxalone permitted deep anesthesia for surgery with an uncomplicated recovery. The anesthetic protocol described appears to be a safe and easy protocol for general practitioners and, furthermore, uses anesthetic agent commonly available to veterinarians.

Naturalistic follow-up of subjects affected with anorexia nervosa 8 years after multimodal treatment: Personality and psychopathology changes and predictors of outcome

BackgroundEating disorders (EDs) are serious mental illnesses of growing clinical and social impact. Despite their severity, there is still no satisfactory evidence-based treatment. Follow-up investigations are the most reliable studies to enlighten long-term outcome predictors and modifiers. MethodsIn total, 59 subjects affected with anorexia nervosa were assessed 8 years after their admission into an outpatient multimodal treatment program for eating disorders. The follow-up changes in diagnostic criteria were compared with Chi-square test. Improved and not-improved subjects were compared. Clinical, personality and psychopathology features between T0 and T1 were compared with t-test for repeated measures. Correlation between T0 features and changes at T1 in personality and psychopathology features were assessed. ResultsThe rate of complete remission was 42%, an overall rate of 67.8% improved, a rate of 18.6% worsened. Concerning personality, a significant decrease of harm avoidance and increase in self-directedness were evidenced. Interoceptive awareness, drive for thinness, bulimia were significantly reduced at follow-up. Many T0 personality facets were related to personality and psychopathology improvement at follow-up. ConclusionMultimodal treatment encompassing psychiatric, nutritional and psychological approaches is at the moment the most reliable approach for the treatment of moderate to severe anorexia nervosa with a discrete rate of improvement. Some personality and psychopathology characteristics may represent specific factors which favor resistance and impair improvement. Future approaches should consider the personalization of therapeutic approach according to these features.

Cortisol Levels and Gastrointestinal Disorders After Stressful Surgery in Rabbits

Rabbits are widely used in biomedical studies because they are docile and manageable. However, they are prone to gastrointestinal disorders due to their vulnerability to stress. Eighteen adult rabbits were used for allogenic tracheal surgery. The tracheas for allograft, 20-mm length, were transplanted into 20-mm tracheal defects. Immediately after surgery, most rabbits suffered from poor appetite. Food and water intake gradually recovered within 7 days after surgery, but six rabbits had severe anorexia from day 7 post-surgery. Four of these rabbits developed symptoms of diarrhea after surgery; three of them died several days after the onset of diarrhea, while one rabbit recovered. Gastrointestinal disorders need to be prevented in rabbits undergoing stressful surgery. Furthermore, it is important to choose the proper type and dose of analgesics in order to relieve postoperative pain. With this observation in mind, rabbits are not considered to be an appropriate model for stressful surgery.

Cannabinoid Toxicity Post Therapeutic Intraperitoneal Injection

Since November 2016, medicinal cannabis has been able to prescribed under the provision of a controlled drug in the Australian Poisons Standard. However there are multiple state and federal laws required for patients to navigate access, and imported products can be expensive. Some patients are growing and using their own supply while awaiting the health outcomes research required for streamlined access. A 56 year old female with stage IV ovarian cancer with peritoneal metastases presented to hospital with fevers, abdominal distension and severe pain, vomiting, anorexia, dehydration and confusion. The patient reported receiving an intraperitoneal injection on two days prior to presentation (administered by a deregistered medical practitioner) containing 12 g of cannabis oil. Plasma concentrations of THC and OH-THC (active metabolite) were 43 ng/mL and 25 ng/mL. A week post admission THC and OH-THC remained elevated at 34 ng/mL and 33 ng/mL. Pharmacokinetics showed THC concentrations consistent with the clinical state but not with the known pharmacokinetics of cannabis. The pharmacokinetics of this case suggested there is a large amount unknown about cannabis pharmacokinetics. In particular: the human intraperitoneal pharmacokinetics of a cannabinoid emulsion, the effect of peritoneal metastases, inflammation and altered vasculature, reservoirs, the role of the excipient (coconut oil in this case), the concentration at which saturation of hepatic glucuronyl transferase system responsible for conjugation occurs, cell transport characteristics within tumors considering both theoretical predictions and experimental measurements suggest very limited penetration of drugs into tissues including tumors adjacent to the peritoneal cavity, the effect of cachexia, role of the liver and liver metastases in metabolism, possible vehicle-induced inhibition of cannabidiol metabolism and/or transport processes as well as direct enhancement of tissue permeability for micellous surfactants. These and the pharmacokinetic data presented are all relevant to understanding the altered pharmacokinetics of cannabinoids in the severe cancer setting.

A Case Study of Gestational Gigantomastia

Gestational gigantomastia is a rare condition characterized by rapid breast growth during pregnancy. The increased breast size leads to pain, ulceration, infection, bleeding, necrosis, and difficulty with mobility and can be fatal. Management is challenging and requires pain control, extensive wound care, psychological counseling, and surgical intervention. This case of bilateral gestational gigantomastia resulted in pregnancy termination. A 33-year-old woman presented to the quaternary academic medical center with gigantomastia at 15 weeks gestation. On presentation, her breasts were erythematous, firm, and tender. Laboratory findings included hypercalcemia; decreased intact parathyroid hormone levels; and elevated white blood cells, lactate levels, and parathyroid hormone-related protein. She reported severe constipation, anorexia, visual changes, headache, and fatigue. Diagnostic studies included abdominal and thyroid ultrasounds, chest computed tomography, and biopsy of chest wall tissue mass. Nephrolithiasis, breast hyperplasia, and axillary lymphadenopathy were confirmed. Treatment was initiated with intravenous fluids and calcitonin. The breast mass continued to grow, and she developed venous stasis ulcers that required frequent wound care. She agreed to pregnancy termination because of worsening gigantomastia and potentially poor surgical outcomes related to increased risk of hemorrhage. Interdisciplinary collaboration was imperative for provision of holistic care and successful patient outcomes. Nurse accountability for patient education and emotional support continued throughout an extensive hospitalization. Nurses supported the woman through the difficult decision to terminate her pregnancy, provided anticipatory guidance regarding probable mastectomies, and offered coping strategies for separation anxiety.

Oral Treatment with the Ghrelin Receptor Agonist HM01 Attenuates Cachexia in Mice Bearing Colon-26 (C26) Tumors.

The gastrointestinal hormone ghrelin reduces energy expenditure and stimulates food intake. Ghrelin analogs are a possible treatment against cancer anorexia-cachexia syndrome (CACS). This study aimed to investigate whether oral treatment with the non-peptidergic ghrelin receptor agonist HM01 counteracts CACS in colon-26 (C26) tumor-bearing mice. The C26 tumor model is characterized by pronounced body weight (BW) loss and muscle wasting in the absence of severe anorexia. We analyzed the time course of BW loss, body composition, muscle mass, bone mineral density, and the cytokines interleukin-6 (IL-6) and macrophage-inhibitory cytokine-1 (MIC-1). Moreover, we measured the expression of the muscle degradation markers muscle RING-finger-protein-1 (MuRF-1) and muscle atrophy F-box (MAFbx). After tumor inoculation, MIC-1 levels increased earlier than IL-6 and both cytokines were elevated before MuRF-1/MAFbx expression increased. Oral HM01 treatment increased BW, fat mass, and neuronal hypothalamic activity in healthy mice. In tumor-bearing mice, HM01 increased food intake, BW, fat mass, muscle mass, and bone mineral density while it decreased energy expenditure. These effects appeared to be independent of IL-6, MIC-1, MuRF-1 or MAFbx, which were not affected by HM01. Therefore, HM01 counteracts cachectic body weight loss under inflammatory conditions and is a promising compound for the treatment of cancer cachexia in the absence of severe anorexia.

The patient experience of illness, treatment, and change, during intensive community treatment for severe anorexia nervosa

ABSTRACTThis study explores experiences of intensive community treatment, illness, and change among patients with severe anorexia nervosa (sAN), particularly seeking to understand the processes involved in change and inability to change. A qualitative design with purposive semi-stratified sampling, using semi-structured interviews and interpretive phenomenological analysis, investigated in detail the experiences of five participants. Participants all had sAN at the start of treatment and represented a spectrum of outcomes from deterioration to full recovery. Six super-ordinate themes emerged from the analysis: treatment experience, function of anorexia, self-criticism versus self-acceptance, isolation versus connection, hopelessness versus hope, and stuckness versus change. Results describe the valued function of the illness, barriers to change, the lengthy struggle for change, and how this can be supported by intensive community-based treatment. Necessary ingredients in the process of change, arising from the analysis, are proposed. We conclude that the experiences of these patients reflect the particular functions of AN for each individual, and that both clinical deterioration and full recovery can occur with prolonged intensive community treatment.

Bone marrow fat content in 70 adolescent girls with anorexia nervosa: Magnetic resonance imaging and magnetic resonance spectroscopy assessment.

Adolescents and women with anorexia nervosa have increased bone marrow fat and decreased bone formation, at least in part due to hormonal changes leading to preferential stem cell differentiation to adipocytes over osteoblasts. The purpose of this study was to evaluate marrow fat content and correlate with age and disease severity using knee MRI with T1 relaxometry (T1-R) and MR spectroscopy (MRS) in 70 adolescents with anorexia nervosa. We enrolled 70 girls with anorexia nervosa who underwent 3-T knee MRI with coronal T1-W images, T1-R and single-voxel proton MRS at 30 and 60ms TE. Metaphyses were scored visually on the T1-W images for red marrow. Visual T1 score, T1 relaxometry values, MRS lipid indices and fat fractions were analyzed by regression on age, body mass index (BMI) and bone mineral density (BMD) as disease severity markers. MRS measures included unsaturated fat index, T2 water, unsaturated and saturated fat fractions. All red marrow measures declined significantly with age. T1-R values were associated negatively with BMI and BMD for girls ≤16years (P=0.03 and P=0.002, respectively) and positively for those≥17years (P=0.05 and P=0.003, respectively). MRS identified a strong inverse association between T2 water and saturated fat fraction from 60ms TE data (r=-0.85, P<0.0001). There was no association between unsaturated fat index and BMI or BMD. The association between T1 and BMI and BMD among older girls suggests more marrow fat in those with severe anorexia nervosa. In contrast, the physiological association between marrow fat content and age remained dominant in younger patients. The strong association between T2 water and saturated fat may relate to the restricted mobility of water with increasing marrow fat.

Are low body weight and psychological symptoms associated with cognitive function in children and adolescents with anorexia nervosa?

IntroductionDespite an increasing focus on cognitive functions in eating disorders, only limited and contradictory knowledge regarding the relationship between cognitive functions and anorexia nervosa symptomatology currently exist.ObjectivesThe aim of this study was to investigate potential associations between cognitive functions and anorexia nervosa symptomatology in children and adolescents.MethodEating disorder symptoms and cognitive functions were examined in this cross-sectional, multi-centre study. Diagnostic scores i.e. BMI, psychological symptoms, and global EDE-16 were stratified on cognitive function. Children and adolescents suffering from severe recent-onset anorexia nervosa (n = 94) and healthy controls (n = 94), between the age 10.6 and 17.9 years (mean age 14.9 years, SD 1.8), participated in the study. The patients were divided into two groups, respectively above and below the median of cognitive functions.ResultsThe study findings revealed that Global EDE score significantly increased with age (P = 0.002, CI 0.08–0.36). Besides this, no significant associations between low body weight or psychological symptoms and cognitive functions were found. However, a large variability in cognitive functions was found on all measure in patients with anorexia nervosa than healthy controls.ConclusionWhile age seems to be significantly correlated to symptom burden the study results indicate that patients with anorexia nervosa is a much more heterogeneous group with regard to cognition than healthy controls. However, cognitive functions and anorexia nervosa symptomatology does not appear to be associated.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Are lifetime affective disorders predictive of long-term outcome in severe adolescent anorexia nervosa?

Depression and anxiety are commonly associated with anorexia nervosa (AN) and contribute to difficulties in social integration, a negative factor for outcome in AN. The link between those disorders and AN has been poorly studied. Thus, our objective was to investigate (1) the link between outcome nine years after hospitalisation for AN and the occurrence of lifetime anxious or depressive comorbidities; (2) the prognostic value of these comorbidities on patient outcome; 181 female patients were hospitalised for AN (between 13 and 22years old), and were re-evaluated for their psychological, dietary, physical and social outcomes, from 6 to 12years after their hospitalisation. The link between anxious and depressive disorders (premorbid to AN and lifetime) and the outcome assessment criteria were tested through multivariate analyses; 63% of the participants had good or intermediate outcome, 83% had presented at least one anxiety or depression disorder in the course of their lives, half of them before the onset of AN. Premorbid obsessive compulsive disorders (OCD), BMI at admission, and premenarchal AN all contribute to poor prognosis. Social phobia and agoraphobia affect the subjects' quality of life and increase eating disorder symptoms. These results encourage a systematic assessment of, and care for, anxiety and depression comorbidities among female adolescent patients with a particular focus on premorbid OCD.

A comparison of the metabolic complications and hospital course of severe anorexia nervosa by binge-purge and restricting subtypes

ABSTRACTThis study examines adult patients with severe, life-threatening anorexia nervosa who were admitted to an inpatient, medical stabilization unit between October 1, 2008 and December 31, 2014. Specifically, the study compares anorexia nervosa, binge purge subtype (AN-BP) and anorexia nervosa, restricting subtype (AN-R) on admission measures, hospital course, and outcomes. Of the 232 patients, 46% (N = 108) had AN-BP. Patients with AN-R manifested a higher frequency of underweight-mediated medical complications, including bone marrow dysfunction, hepatic dysfunction, and hypoglycemia. Understanding the pathophysiologic differences between severe AN-R and AN-BP is essential to understanding the abnormalities seen on clinical presentation, guiding appropriate clinical treatment, and predicting medical complications during refeeding.

Add-on stiripentol elevates serum valproate levels in patients with or without concomitant topiramate therapy

ObjectiveStiripentol (STP), valproate (VPA) and topiramate (TPM) are reported to have efficacy for Dravet syndrome. In this study, we sought to elucidate the mechanisms underlying the increased serum VPA concentrations following STP adjunctive therapy in patients with Dravet syndrome. MethodsTwenty-eight patients with Dravet syndrome (age range, 1–35 years) undergoing combination therapy with VPA and STP were included in this study. We evaluated VPA and clobazam (CLB) serum concentrations before and after add-on STP. We also investigated potential factors impacting VPA metabolism during add-on STP therapy, including add-on TPM and CYP2C9 and CYP2C19 gene polymorphisms. The effect of STP on the metabolism of concomitantly administered CLB was also investigated. ResultsAdd-on STP was significantly associated with the serum concentration-to-dose (CD) ratio of VPA. Two patients, who were concomitantly treated with TPM, developed severe anorexia and thrombocytopenia because of marked increases in serum VPA concentrations. Further analysis revealed that the rate of increase in the VPA CD ratio was positively correlated with TPM dose. In patients not receiving TPM, STP enhanced the rate of increase in the VPA CD ratio to a significantly greater extent in CYP2C19 extensive metabolizers than in CYP2C19 poor metabolizers. Add-on STP was also associated with significant increases in CLB and N-desmethyl-CLB serum concentrations. ConclusionOur findings suggest that serum VPA concentrations should be carefully monitored during STP adjunctive therapy, particularly in patients receiving concomitant TPM therapy.

CANINE HEARTWORM DISEASE IN A BRAZILIAN NON-ENDEMIC AREA

Canine Heartworm Disease (CHD) is a mosquito-borne disease caused by Dirofilaria immitis. In this study, two mature adult-senior dogs from a non-endemic area to CHD presented clinical signs suggestive to the disease. The first one presented skin lesions, loss of appetite, weakness, pale mucosa membrane, and hyperthermia, whereas the second one presented severe ascites, anorexia and exercise intolerance, lateral decumbency, and marked heart murmurs. Both presented tachypnea, thrombocytopenia, leukocytosis, and microfilaremia. Multiplex-PCR (COI gene) resulted positive to D. immitis research in both cases, confirmed by sequencing, with 98% homology to D. immitis (Gen Bank accession n.AJ537512-1). In addition, both animals have never had any prophylactic treatment to CHD, and no reports about traveling to coastal areas. This study reported two unusual cases of D. immitis infection in non-endemic area from Brazil.

Hurry Up and “Weight”: Innovative Inter-Professional Outpatient Care for a Service User With Severe Anorexia Nervosa Awaiting Admission to (Specialized Elective) Inpatient Care in Canada

Inpatient care for adults with eating disorders in Canada is limited. An innovative outpatient interdisciplinary approach and a service use example are presented. With no current benchmark, this approach may offer a practical solution for outpatient teams seeking to be helpful when service users are left to wait for inpatient care.

Utilization of Distilled Water Lavage for Localized Fluid Collection After Combined Hepatectomy and Cyst Fenestration for Polycystic Liver Disease

Ascites necessitating persistent drainage or paracentesis after drain removal has been found among early postoperative complications after combined hepatectomy and cyst fenestration (CHCF) for polycystic liver disease (PLD). It has been reportedly observed in 20% to 70% of cases and seemed to easily cause recurrent symptoms unless properly treated. We utilized distilled water lavage for treating localized fluid collection after combined hepatectomy and cyst fenestration for PLD. A 63-year-old female patient underwent CHCF for PLD, which caused severe abdominal fullness. Early postoperative course was uneventful until 10 days after surgery when the patient suffered sudden abdominal fullness and resultant severe anorexia because of right subphrenic massive localized monolocular fluid collection diagnosed by abdominal computed tomography—although total liver volume was reduced to less than half of that before surgery. Percutaneous drainage relieved symptoms immediately, but the drainage tube could not be removed because of massive outflow. Then we utilized distilled water lavage for treating this condition. After that, drain outflow dramatically reduced and the drainage tube was successfully removed. Total liver volume of the patient continued to reduce up to 1 year after surgery and retained less than one-third of preoperative total liver volume thereafter. Sustained reduction of total liver volume in the present case suggested a sclerosant effect of hypotonic cytocidal property of distilled water for cyst endothelium and/or retrieved effectiveness of fenestration. Hence, we consider this approach to be useful for patients with PLD receiving CHCF and thus present it here.