Medical Complications of Anorexia Nervosa and Bulimia Nervosa

The impact of the COVID-19 pandemic on help-seeking behaviors in individuals suffering from eating disorders and their caregivers

OBJECTIVE

To describe the impact of the COVID-19 pandemic on help-seeking behaviors among individuals with eating disorders and caregivers.

METHODS

We analyzed service utilization data from the National Eating Disorder Information Centre (NEDIC). We compared the number of contacts and symptom frequency between the pandemic period and previous years.

RESULTS

NEDIC was contacted 609 times during March 1-April 30, 2020 (72.1% individuals affected by disordered eating, 20.4% caregivers). The number of total contacts significantly increased from 2018 to 2019 and 2018 to 2020 (X²(3) = 50.34, p < .001). Among affected individuals (80.4% women), the number of contacts during the pandemic period was significantly higher (n = 439; X²(2) = 92.74, p < .001) compared to 2018 (n = 197) and 2019 (n = 312). There were higher rates of eating disorder symptoms, anxiety, and depression in 2020 compared to previous years. Thematic analysis of instant chats from the pandemic year revealed four emerging themes: 1) lack of access to treatment, 2) worsening of symptoms, 3) feeling out of control, and 4) need for support.

CONCLUSION

These findings point toward the impact of COVID-19 in individuals affected by disordered eating and hold implications for service delivery during times of crises.

Non-alcoholic fatty liver disease (NAFLD) as a neglected metabolic companion of psychiatric disorders: common pathways and future approaches

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis in over 5% of the parenchyma in the absence of excessive alcohol consumption. It is more prevalent in patients with diverse mental disorders, being part of the comorbidity driving loss of life expectancy and quality of life, yet remains a neglected entity. NAFLD can progress to non-alcoholic steatohepatitis (NASH) and increases the risk for cirrhosis and hepatic carcinoma. Both NAFLD and mental disorders share pathophysiological pathways, and also present a complex, bidirectional relationship with the metabolic syndrome (MetS) and related cardiometabolic diseases.

MAIN TEXT

This review compares the demographic data on NAFLD and NASH among the global population and the psychiatric population, finding differences that suggest a higher incidence of this disease among the latter. It also analyzes the link between NAFLD and psychiatric disorders, looking into common pathophysiological pathways, such as metabolic, genetic, and lifestyle factors. Finally, possible treatments, tailored approaches, and future research directions are suggested.

CONCLUSION

NAFLD is part of a complex system of mental and non-communicable somatic disorders with a common pathogenesis, based on shared lifestyle and environmental risks, mediated by dysregulation of inflammation, oxidative stress pathways, and mitochondrial function. The recognition of the prevalent comorbidity between NAFLD and mental disorders is required to inform clinical practice and develop novel interventions to prevent and treat these complex and interacting disorders.

Eating Disorders among College Students in France: Characteristics, Help-and Care-Seeking

The aim of this paper was to identify the characteristics of broader categories of eating disorders (ED) and help- and care-seeking among college students. An online cross-sectional study was conducted among students of the University of Rouen-Normandy, France. The Expali-validated algorithmic tool, combining SCOFF test (Sick, Control, One stone, Fat, Food) and body mass index, was used to screen eating disorders into three diagnostic categories: restrictive eating disorders, bulimic eating disorders, and hyperphagic eating disorders. A total of 1493 college students were included; mean age was 20.1 years (SD = 1.9). The prevalence of likely cases of eating disorder was 24.8% (95% CI, 22.6-27.0). Percentage distributions of bulimic eating disorders, hyperphagic eating disorders, and restrictive eating disorders were 13.3%, 8.6%, and 2.9%, respectively. The two main resources for help-seeking in emotional stress situations were friends and family, whatever the ED. Students with eating disorders consulted their general practitioner more often for stress or anxiety than students without eating disorders: hyperphagic eating disorders (44.9%), restrictive eating disorders (35.1%), bulimic eating disorders (30.2%), and no eating disorder (20.4%) (p < 0.0001). The prevalence of healthcare renunciation was 21.9%, with a higher risk among students with bulimic eating disorders (AOR CI 95% 1.91 (1.34-2.72). The findings show one quarter of students screened positive for an eating disorder. Stress management was not necessarily different between students with eating disorders and students without eating disorders, but the former had a greater risk of renouncing treatment, especially related to a fear of seeing a general practitioner.

Eating disorders

Eating disorders are disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning. Disturbed attitudes towards weight, body shape, and eating play a key role in the origin and maintenance of eating disorders. Eating disorders have been increasing over the past 50 years and changes in the food environment have been implicated. All health-care providers should routinely enquire about eating habits as a component of overall health assessment. Six main feeding and eating disorders are now recognised in diagnostic systems: anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder, pica, and rumination disorder. The presentation form of eating disorders might vary for men versus women, for example. As eating disorders are under-researched, there is a great deal of uncertainty as to their pathophysiology, treatment, and management. Future challenges, emerging treatments, and outstanding research questions are addressed.

Altered regional gray matter volume in Chinese female patients with bulimia nervosa

BACKGROUND

Bulimia nervosa (BN) is a psychiatric disorder with unclear pathophysiology. Several studies have associated BN with structural and functional changes in the brain, but findings have been inconsistent. Here we explored this potential association in a small group of Chinese women with BN.

METHODS

This retrospective study examined 34 women with BN and 34 age-matched healthy controls, all of whom underwent T1-weighted magnetic resonance imaging (MRI). Voxel-based morphometry was carried out to explore alterations in regional grey matter volume (GMV) that may be associated with BN.

RESULTS

The BN group showed smaller GMV in the left medial superior frontal gyrus (SFGmed.L), right superior temporal gyrus (STG.R), right median cingulate and paracingulate gyri (DCG.R), left median cingulate and paracingulate gyri (DCG.L) and left dorsolateral superior frontal gyrus (SFGdor.L). No regions showing GMV increases in BN were identified. The GMV reduction did not correlate with body mass index, duration of illness, or patients' self-esteem or overall self-evaluation. GMV reduction correlated negatively with age in the SFGmed. L (r = - 0.516, P < 0.005), DCG. R (r = - 0.556, P < 0.005), DCG. L (r = - 0.576, P < 0.05) and SFGdor. L (r = - 0.576, P < 0.005).

CONCLUSIONS

Women with BN show reduced GMV in several brain regions, but it is difficult to know whether these changes are the result of BN pathology or of binge-eating and compensatory behavior. These changes may be associated with impaired inhibitory control, body dissatisfaction and emotion dysregulation.

Severity and Endurance in Eating Disorders: An Exploration of a Clinical Sample From Chile

INTRODUCTION

One in five patients with eating disorders (EDs) may take a lasting course. It has been proposed that this enduring group exhibits increased severity, such as low treatment response, severe symptomatology, and poor quality of life. However, there is no consensus defining this group. Moreover, most of the literature comes from high-income societies and may not apply to developing countries.

AIMS

This study aimed to evaluate the association between endurance (length of ED) and severity (previous treatments, hospitalizations, medical complications, symptomatology and clinical impairment) in individuals with EDs from Chile. In addition, it aimed to explore the association between endurance and delays seeking specialized treatment.

METHODS

Forty-one women with EDs (16 with anorexia nervosa, 11 with bulimia nervosa, 10 with binge eating disorder and 4 with other specified EDs) completed a social-demographic survey, the Eating Disorders Examination Questionnaire, and the Clinical Impairment Assessment. Also, Body Mass Index, length of ED, and complications were retrieved from participants' medical records. Spearman correlation coefficient and linear regression were used to explore the association between length of ED and measures of severity and treatment seeking behavior.

RESULTS

There was no significant association between endurance (length of ED) and measures of severity. There was a significant association between length of ED and delays seeking specialized treatment (r_s=0.72; p<0.01). Regression indicated that for each month in delay visiting a specialized ED treatment team, the ED duration increased by 0.87 months (F(1,38)=75.93; p<0.01; R²= 0.66).

DISCUSSION

The findings suggest that in developing countries, where specialized treatment access is not widespread, defining SEED solely by the length of illness may not be clinically significant, and other criteria (e.g., timely access to evidence-based treatments) should be considered.

Off-label uses of drugs for depression

The prescription of drugs for depression is rising rapidly. One of the reasons for this trend is their many off-label uses. Up to one third of all prescriptions are for non-indicated use, which in addition to drug repurposing includes different dosing or duration than those recommended. In this review, we elaborate on what antidepressants can treat besides depression. The five classes of drugs for depression are introduced, and their mechanisms of action and serious side effects are described. The most common off-label uses of antidepressants are discussed, with a special focus on treating eating disorders, sleep problems, smoking cessation and managing chronic pain. Depression is often a comorbidity when antidepressants are chosen as therapy, but good therapeutic effects have been observed for other conditions also when depression is not involved. Finally, a new type of antidepressant developed from the hallucinogenic "party drug" ketamine is briefly introduced. This recent development suggests that antidepressants will keep playing a central role in medicine for years to come.