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Gibson D, Mehler PS. A new conceptual model for anorexia nervosa: A role for connective tissue? Int J Eat Disord 2024; 57:537-542. [PMID: 38372082 DOI: 10.1002/eat.24172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/20/2024]
Abstract
The etiology of anorexia nervosa (AN) remains to be fully elucidated, and current theories also fail to account for the direct effect of starvation on the health of the organs and tissues, specifically the connective tissue present in most organs of the body. Individuals with hereditary disorders of connective tissue manifest with clinical symptoms that overlap with AN, as the abnormal connective tissue also contributes to many of the other extra-articular manifestations of these hereditary disorders. This article hypothesizes that a similar pathophysiology may also contribute to the clinical presentation of AN. Therefore, a better understanding is needed to elucidate: (1) the relationship between abnormal connective tissue and AN, (2) the impact of starvation toward the development of abnormal connective tissue and how this manifests clinically, (3) the etiology of autonomic nervous system changes contributing to the dysautonomia in AN, and (4) how the sensory signals sent from potentially abnormal connective tissue to the central nervous system impact interoception in AN. A conceptual model incorporating abnormal connective tissue is provided. PUBLIC SIGNIFICANCE: The etiology of AN remains poorly understood and current theories fail to account for the direct impact of starvation on the health of the organs and tissues of the body. There is significant clinical overlap between AN and hereditary connective tissue disorders. This paper attempts to provide a new conceptual model for AN in which abnormal connective tissue contributes to the underlying pathogenesis.
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Affiliation(s)
- Dennis Gibson
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Eating Recovery Center, Denver, Colorado, USA
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2
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Li X, Song Y, Wang H, Su X, Wang M, Li J, Ren Z, Zhong D, Huang Z. Evaluation of measurement accuracy of wearable devices for heart rate variability. iScience 2023; 26:108128. [PMID: 37867933 PMCID: PMC10587522 DOI: 10.1016/j.isci.2023.108128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/29/2023] [Accepted: 10/01/2023] [Indexed: 10/24/2023] Open
Abstract
This paper proposed a method based on heart rate variability (HRV) for evaluating the accuracy of wearable devices in measuring heart rate. HRV refers to the variation in time intervals between successive heartbeats, widely used in many fields such as clinical and sports fields. Wearable devices such as Electrocardiogram (ECG) electrode patches have gained popularity due to their portability and ease of use. However, they can be prone to measurement interference caused by environmental noise, human respiration, etc. The proposed method consists of four main components: selection of "gold standard measurement devices", identification of HRV measurement metrics, construction of an HRV evaluation framework, and quantification of measurement errors. The method is validated through simulated experiments using ECG patches. The evaluation framework and quantification model established in this method have significant implications in establishment of industry standards and diagnosis of diseases in clinical practice.
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Affiliation(s)
- Xiangchen Li
- China Institute of Sport Science, Beijing 100061, China
| | - Yuting Song
- School of Nursing, Qingdao University, Qingdao 266021, China
| | - Huang Wang
- China Institute of Sport Science, Beijing 100061, China
| | - Xinyu Su
- School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Mengyao Wang
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing 400044, China
| | - Jing Li
- Bioengineering College, Chongqing University, Chongqing 400044, China
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518063, China
| | - Zhiqiang Ren
- National Sports Technology Innovation Center Beijing Co., Ltd. Beijing 100061, China
| | - Daidi Zhong
- Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Zhiyong Huang
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing 400044, China
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3
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Mehler PS, Anderson K, Bauschka M, Cost J, Farooq A. Emergency room presentations of people with anorexia nervosa. J Eat Disord 2023; 11:16. [PMID: 36759897 PMCID: PMC9909152 DOI: 10.1186/s40337-023-00742-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
People with anorexia nervosa (AN) tend to shy away from engaging in typical primary care provider relationships in order to avoid detection. Therefore, they may seek care for their medical concerns through a local emergency department (ED). Inherently, AN is associated with a litany of medical complications, which become more prevalent as the severity of their eating disorder increases. Notwithstanding the typical young age at the onset of AN, no body system is immune to these medical complications. Thus, ED providers may need to pursue a medical diagnosis in order to explain presenting symptoms in people with AN. In addition to the medical issues, AN is also a serious mental illness with high mortality rates, including deaths by suicide. Therefore, ED providers also need to be familiar with relevant mental health issues for these people.
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Affiliation(s)
- Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA. .,University of Colorado School of Medicine, Denver, CO, USA.
| | - Kristin Anderson
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA
| | - Maryrose Bauschka
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeana Cost
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,Eating Recovery Center, Denver, CO, USA
| | - Asma Farooq
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
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4
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Friars D, Walsh O, McNicholas F. Assessment and management of cardiovascular complications in eating disorders. J Eat Disord 2023; 11:13. [PMID: 36717950 PMCID: PMC9886215 DOI: 10.1186/s40337-022-00724-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/18/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are serious conditions predominantly affecting adolescents and young adults (AYAs) and pose a considerable threat to their health and wellbeing. Much of this increased morbidity and mortality is linked to medical compromise, especially cardiovascular abnormalities. Rates of presentation to both community and inpatient medical settings have increased in all age groups following the Covid-19 pandemic and subsequent "lockdowns", with patients presentations being more medically compromised compared to previous years. This has implications for clinicians with regard to the performance of competent cardiovascular assessments and management of findings. AIMS This paper is a practical resource for clinicians working with AYAs in whom EDs may present. It will provide a brief summary of the physiological context in which cardiovascular complications develop, systematically outline these complications and suggest a pragmatic approach to their clinical evaluation. METHODS Relevant literature, guidelines and academic texts were critically reviewed. Conclusions were extracted and verified by a Child and Adolescent Psychiatrist and Adolescent Paediatrician, with suitable expertise in this clinical cohort. CONCLUSIONS The cardiovascular complications in EDs are primarily linked to malnutrition, and patients presenting with Anorexia Nervosa are most often at greatest risk of structural and functional cardiac abnormalities, including aberrations of heart rate and rhythm, haemodynamic changes and peripheral vascular abnormalities. Other cardiovascular abnormalities are secondary to electrolyte imbalances, as seen in patients with Bulimia Nervosa. More recently defined EDs including Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder are also likely associated with distinct cardiovascular complications though further research is required to clarify their nature and severity. Most cardiovascular abnormalities are fully reversible with nutritional restoration, and normalisation of eating behaviours, including the cessation of purging, though rare cases are linked to cardiac deaths. A detailed clinical enquiry accompanied by a thorough physical examination is imperative to ensure the medical safety of AYAs with EDs, and should be supported by an electrocardiogram and laboratory investigations. Consideration of cardiovascular issues, along with effective collaboration with acute medical teams allows community clinicians identify those at highest risk and minimise adverse outcomes in this cohort.
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Affiliation(s)
- Dara Friars
- Department of Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland. .,, Mount Pleasant, Australia.
| | - Orla Walsh
- Department of Paediatrics, Children's Health Ireland (CHI), Temple Street University Hospital, Dublin, Ireland
| | - Fiona McNicholas
- Department of Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland.,Lucena Child and Adolescent Mental Health Service (CAMHS), Dublin, Ireland.,Department of Psychiatry, Children's Health Ireland (CHI), Crumlin, Ireland
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5
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Maiorana N, Brugnera A, Galiano V, Ferrara R, Poletti B, Marconi AM, Garzia E, Ticozzi N, Silani V, Priori A, Ferrucci R. Emotional and autonomic response to visual erotic stimulation in patients with functional hypothalamic amenorrhea. Front Endocrinol (Lausanne) 2022; 13:982845. [PMID: 36531461 PMCID: PMC9755206 DOI: 10.3389/fendo.2022.982845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/11/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Functional hypothalamic amenorrhea (FHA) is a clinical condition associated with high levels of physiological and psychological stress ranging from weight loss to maladaptive behavior and coping skills. A reliable measure of the psychophysiological response to stress and the ability to cope with stimuli is heart rate variability (HRV). Through the sympathetic (SNS) and parasympathetic nervous system (PNS), the autonomic nervous system (ANS) promotes various changes in HRV that reflect the individual's psychophysiological response to stress. FHA patients are characterized by high levels of PNS activation during psychological load, suggesting that parasympathetic hyperactivation could be a pathology marker. Methods In the present study, we examine changes in HRV during observation of erotic, neutral, and disgusting images in 10 patients with FHA [(mean ± S.D.) age: 26.8 ± 5.9] and in 9 controls (age: 25.4 ± 6.4; BMI: 22.47 ± 2.97) to assess the differential activation of PNS and SNS between FHA patients and controls matched for age and without other clinical conditions. Results Our results showed that FHA patients had significantly higher HRV activation while observing high emotional value images and not during the observation of neutral images confirming a parasympathetic hyperactivation. Discussion HRV and cognitive and psychological testing, could provide new insights into understanding such a clinically understudied condition and provide further tools for clinical diagnosis and treatment.
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Affiliation(s)
- Natale Maiorana
- Aldo Ravelli Research Center, Department of Health Science, University of Milan, Milan, Italy
| | - Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | - Rosanna Ferrara
- Aldo Ravelli Research Center, Department of Health Science, University of Milan, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Anna Maria Marconi
- ASST-Santi Paolo e Carlo, Milan, Italy
- Department of Health Science, University of Milan, Milan, Italy
| | | | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - Alberto Priori
- Aldo Ravelli Research Center, Department of Health Science, University of Milan, Milan, Italy
- ASST-Santi Paolo e Carlo, Milan, Italy
| | - Roberta Ferrucci
- Aldo Ravelli Research Center, Department of Health Science, University of Milan, Milan, Italy
- ASST-Santi Paolo e Carlo, Milan, Italy
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Wollast R, Fossion P, Kotsou I, Rebrassé A, Leys C. Interoceptive Awareness and Anorexia Nervosa: When Emotions Influence the Perception of Physiological Sensations. J Nerv Ment Dis 2022; 210:390-393. [PMID: 35413032 DOI: 10.1097/nmd.0000000000001458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Anorexia nervosa (AN) is related to difficulties in emotion regulation, including a deficit in interoceptive awareness. The lack of interoceptive awareness is considered a vulnerability involved in the development and maintenance of anorexic symptoms. Surprisingly, no study has been conducted that focuses on these associations in an emotional context. This study measures the interoceptive awareness-using heartbeat self-counting and a sphygmomanometer-of 25 subjects suffering from AN and 25 control subjects, first at rest and then in an emotional situation. The results show that a deficit in interoceptive awareness was observed for the subjects suffering from AN at rest as well as when an emotional context was induced. This study encourages future investigations to focus on the impact of interoceptive deficit in AN to develop as efficient a care regimen as possible for these subjects.
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Affiliation(s)
| | - Pierre Fossion
- CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
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7
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Paysal J, Thireau J, Terral D, Rochette E, Obert P, Merlin E, Nottin S. Cardiac Remodeling and Its Determinants in Anorexia Nervosa Adolescents: Impact of Weight Recovery. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040458. [PMID: 35455501 PMCID: PMC9031014 DOI: 10.3390/children9040458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Abstract
Cardiovascular alterations in anorexia nervosa (AN) adolescents include bradycardia and decreased systolic blood pressure and left ventricular mass. However, their determinants remain poorly understood. We assessed the associations between morphological and functional left ventricular (LV) remodeling, autonomic control by heart rate variability (HRV) analysis, thyroid hormones and brain natriuretic peptide (BNP) levels in AN female adolescents without or with weight recovery (WR). Fifty-nine female adolescents including 16 AN patients without WR (mean age 13.9 years (10−16)), 10 AN patients with WR (15.7 years (12−18)) and 33 controls (14.1 years (10−18)) underwent night heart rate (HR) recording to measure HRV (and especially SD1/SD2, the ratio between instantaneous (SD1) and long-term (SD2) standard deviation of R-R intervals, reflecting sympatho-vagal balance), speckle tracking echocardiography to assess LV global longitudinal strain (GLS) and blood test for dosage of tri-iodothyronine (T3) hormone and NT-proBNP. Compared to controls, AN patients without WR presented with lower HR (55 ± 7 vs. 68 ± 6 bpm; p < 0.001), parasympathetic hyperactivity, and higher GLS (−19.2 ± 1.8 vs. −16.9 ± 2.8%; p = 0.009). These alterations were partly abolished in AN patients with WR. In a multivariate regression analysis, T3 was the main factor explaining the variance of SD1/SD2, a sympatho-vagal balance marker. NT-proBNP levels were not correlated with cardiac alterations. AN patients had parasympathetic hyperactivity linked with their rate of T3, and a higher GLS. These alterations were partly restored in AN patients with WR.
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Affiliation(s)
- Justine Paysal
- LAPEC UPR 4278, Avignon University, 84000 Avignon, France; (J.P.); (P.O.)
- Néonatologie et Réanimation Pédiatrique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Jérôme Thireau
- CNRS, INSERM, PhyMedExp, University of Montpellier, 34000 Montpellier, France;
| | - Daniel Terral
- Pédiatrie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (D.T.); (E.R.); (E.M.)
| | - Emmanuelle Rochette
- Pédiatrie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (D.T.); (E.R.); (E.M.)
- INSERM, CIC 1405, Unité CRECHE, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Philippe Obert
- LAPEC UPR 4278, Avignon University, 84000 Avignon, France; (J.P.); (P.O.)
| | - Etienne Merlin
- Pédiatrie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (D.T.); (E.R.); (E.M.)
- INSERM, CIC 1405, Unité CRECHE, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Stéphane Nottin
- LAPEC UPR 4278, Avignon University, 84000 Avignon, France; (J.P.); (P.O.)
- Correspondence: ; Tel.: +334-901-629-31
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8
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Flamarique I, Vidal B, Plana MT, Andrés-Perpiñá S, Gárriz M, Sánchez P, Pajuelo C, Mont L, Castro-Fornieles J. Long-term cardiac assessment in a sample of adolescent-onset anorexia nervosa. J Eat Disord 2022; 10:12. [PMID: 35101147 PMCID: PMC8802465 DOI: 10.1186/s40337-022-00533-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND High mortality rates have been reported in patients with anorexia nervosa, mainly due to cardiovascular alterations. The purpose of the present study was to assess cardiac structural and functional abnormalities some 20 years after initial treatment in a sample of adolescent-onset anorexia nervosa (A-AN) and to compare them with matched healthy controls (HC). METHODS A sample of 29 women diagnosed and treated for AN during adolescence (A-AN) were assessed more than 20 years later. A complete cardiac evaluation was carried out including an electrocardiogram (ECG) and a standard 2D echocardiography. Thirty matched HC were also assessed. RESULTS In the A-AN group, four subjects had a body mass index lower than 18.5 and met full DSM 5 criteria for AN at follow-up (Low-Weight group). They were compared with the rest of the sample (n = 25) who had normalized their weight (Normal-Weight group), though some still showed some eating disorder symptoms. Both groups were compared with the HC group. Subjects in the Low-Weight group presented statistically significant decreases in the left ventricular end-diastolic and left atrium dimensions and left ventricular mass in comparison with the Normal-Weight group and the HC. No other differences in cardiac parameters were found between groups. CONCLUSIONS Echocardiographic and ECG parameters of adults who had presented A-AN twenty years earlier and currently maintained normal weight were similar to those of HC who had never been treated or diagnosed with AN. Adult subjects with A-AN who still had low weight in the long term present certain cardiac abnormalities similar to those seen in short-lasting disease. More studies are needed to confirm these results in a larger sample.
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Affiliation(s)
- I Flamarique
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Clinic Institute of Neurosciences, Hospital Clínic Universitari de Barcelona, IDIBAPS, CIBERSAM, C/Villarroel, 170, 08036, Barcelona, Spain.
| | - B Vidal
- Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Instituto de Salud Carlos III (CB16/11/00354), CIBERCV, Madrid, Spain
| | - M T Plana
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Clinic Institute of Neurosciences, Hospital Clínic Universitari de Barcelona, IDIBAPS, CIBERSAM, C/Villarroel, 170, 08036, Barcelona, Spain
| | - S Andrés-Perpiñá
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Clinic Institute of Neurosciences, Hospital Clínic Universitari de Barcelona, IDIBAPS, CIBERSAM, C/Villarroel, 170, 08036, Barcelona, Spain
| | - M Gárriz
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar de Barcelona, Llull, 410, 08019, Barcelona, Spain
| | - P Sánchez
- Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Instituto de Salud Carlos III (CB16/11/00354), CIBERCV, Madrid, Spain
| | - C Pajuelo
- Department of Cardiology, Hospital Plató, Barcelona, Spain
| | - L Mont
- Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Instituto de Salud Carlos III (CB16/11/00354), CIBERCV, Madrid, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - J Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Clinic Institute of Neurosciences, Hospital Clínic Universitari de Barcelona, IDIBAPS, CIBERSAM, C/Villarroel, 170, 08036, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
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9
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Assalone C, Leonardi L, Franceschi R, Fumanelli J, Maines E, Marini M, Quintarelli S, Genovese A, Soffiati M. Determinants of severe bradycardia in adolescents hospitalized for anorexia nervosa. Pediatr Int 2022; 64:e14967. [PMID: 34418241 DOI: 10.1111/ped.14967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Severe bradycardia is an indication supporting hospitalization in adolescents with eating disorders. Some adolescents with anorexia nervosa (AN) and significant weight loss present with a normal pulse rate at admission, whereas others have severe bradycardia, suggesting that total weight loss is not the most important determinant of bradycardia. The aims of this study were to define the prevalence of severe bradycardia as the cause for hospital admission in adolescents with AN, to evaluate correlations between known determinants of severe bradycardia and pulse rate at admission, and to evaluate the average time required to recover from severe bradycardia after re-feeding. METHODS Ninety-nine hospitalized patients with AN were enrolled. Weight loss history, anthropometric, laboratory, and electrocardiogram data were collected at admission to and at discharge from hospital. Multivariate analysis was performed to detect the most important determinants of severe bradycardia. RESULTS Forty-eight percent of the AN patient admissions were due to severe bradycardia (AN-B+ group). Patients in this group had a higher maximum lifetime weight (P = 0.0045), greater premorbid weight loss (P = 0.0011), and more rapid weight loss (P = 0.0001). Multivariate analysis showed that recent weight loss is an independent predictor of bradycardia at hospital admission (R2 : 0.35, P = 0.0001). Severe bradycardia normalized after minimal weight gain of 0.25 ± 0.18 kg/day for 3-10 days. CONCLUSIONS This study confirms that recent weight loss is probably the most important determinant of severe bradycardia in adolescents with AN.
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Affiliation(s)
- Chiara Assalone
- Division of Paediatrics, S. Chiara General Hospital, Trento, Italy.,Provincial Centre for Eating Disorders, Trento, Italy
| | - Letizia Leonardi
- Division of Paediatrics, S. Chiara General Hospital, Trento, Italy
| | | | | | - Evelina Maines
- Division of Paediatrics, S. Chiara General Hospital, Trento, Italy
| | | | | | - Aldo Genovese
- Provincial Centre for Eating Disorders, Trento, Italy
| | - Massimo Soffiati
- Division of Paediatrics, S. Chiara General Hospital, Trento, Italy
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10
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Smythe J, Colebourn C, Prisco L, Petrinic T, Leeson P. Cardiac abnormalities identified with echocardiography in anorexia nervosa: systematic review and meta-analysis. Br J Psychiatry 2021; 219:477-486. [PMID: 32026793 DOI: 10.1192/bjp.2020.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Anorexia nervosa affects most organ systems, with 80% suffering from cardiovascular complications. AIMS To define echocardiographic abnormalities in anorexia nervosa through systematic review and meta-analysis. METHOD Two reviewers independently assessed eligibility of publications from Medline, EMBASE and Cochrane Database of Systematic Reviews registries. Studies were included if anorexia nervosa was the primary eating disorder and the main clinical association in described cardiac abnormalities. Data was extracted in duplicate and quality-assessed with a modified Newcastle-Ottawa scale. For continuous outcomes we calculated mean and standardised mean difference (SMD), and corresponding 95% confidence interval. For dichotomous outcomes we calculated proportion and corresponding 95% confidence interval. For qualitative data we summarised the studies. RESULTS We identified 23 eligible studies totalling 960 patients, with a mean age of 17 years and mean body mass index of 15.2 kg/m2. Fourteen studies (469 participants) reported data suitable for meta-analysis. Cardiac abnormalities seen in anorexia nervosa compared with healthy controls were reduced left ventricular mass (SMD 1.82, 95% CI 1.32-2.31, P < 0.001), reduced cardiac output (SMD 1.92, 95% CI 1.38-2.45, P < 0.001), increased E/A ratio (SMD -1.10, 95% CI -1.67 to -0.54, P < 0.001), and increased incidence of pericardial effusions (25% of patients, P < 0.01, 95% CI 17-34%, I2 = 80%). Trends toward improvement were seen with weight restoration. CONCLUSIONS Patients with anorexia nervosa have structural and functional cardiac changes, identifiable with echocardiography. Further work should determine whether echocardiography can help stratify severity and guide safe patient location, management and effectiveness of nutritional rehabilitation.
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Affiliation(s)
- Jodie Smythe
- Consultant Intensivist and Anaesthetist, Intensive Care Unit, Royal Berkshire NHS Foundation Trust, UK
| | - Claire Colebourn
- Consultant Medical Intensivist, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Lara Prisco
- Consultant Intensivist and Anaesthetist and Senior Clinical Research Fellow, Neuroanaesthesia and Neurointensive Care, Oxford University Hospitals NHS Foundation Trust; and Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Tatjana Petrinic
- Outreach Librarian, Bodleian Healthcare Libraries, University of Oxford, Oxford University Hospitals NHS Foundation Trust, UK
| | - Paul Leeson
- Professor of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford University Hospitals NHS Foundation Trust, UK
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11
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Buchhorn R, Baumann C, Willaschek C. Pathophysiological mechanisms of bradycardia in patients with anorexia nervosa. Health Sci Rep 2021; 4:e331. [PMID: 34322602 PMCID: PMC8299991 DOI: 10.1002/hsr2.331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/29/2021] [Accepted: 07/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this investigation was to examine heart rate variability (HRV), interbeat interval (IBI), and their interrelationship in healthy controls, bradycardic hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) mutation carriers, and patients with anorexia nervosa (AN). We tested the hypothesis that neural mechanisms cause bradycardia in patients with AN. Therefore, we assumed that saturation of the HRV/IBI relationship as a consequence of sustained parasympathetic control of the sinus node is exclusively detectable in patients with AN. METHODS Patients with AN between the ages of 12 and 16 years admitted to our hospital due to malnutrition were grouped and included in the present investigation (N = 20). A matched-pair group with healthy children and adolescents was created. Groups were matched for age and sex. A 24-hour Holter electrocardiography (ECG) was performed in controls and patients. More specifically, all patients underwent two 24-hour Holter ECG examinations (admission; refeeding treatment). Additionally, the IBI was recorded during the night in HCN4 mutation carriers (N = 4). HRV parameters were analyzed in 5-minute sequences during the night and plotted against mean corresponding IBI length. HRV, IBI, and their interrelationship were examined using Spearman's rank correlation analyses, Mann-Whitney U tests, and Wilcoxon signed-rank tests. RESULTS The relationship between IBI and HRV showed signs of saturation in patients with AN. Furthermore, signs of HRV saturation were present in two HCN4 mutation carriers. In contrast, signs of HRV saturation were not present in controls. CONCLUSIONS The existence of HRV saturation does not support the existence of parasympathetically mediated bradycardia. Nonneural mechanisms, such as HCN4 downregulation, may be responsible for bradycardia and HRV saturation in patients with AN.
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Affiliation(s)
- Reiner Buchhorn
- Department of PediatricsCaritas‐Krankenhaus Bad MergentheimBad MergentheimGermany
| | | | - Christian Willaschek
- Department of PediatricsCaritas‐Krankenhaus Bad MergentheimBad MergentheimGermany
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12
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Jenkins ZM, Eikelis N, Phillipou A, Castle DJ, Wilding HE, Lambert EA. Autonomic Nervous System Function in Anorexia Nervosa: A Systematic Review. Front Neurosci 2021; 15:682208. [PMID: 34262430 PMCID: PMC8273292 DOI: 10.3389/fnins.2021.682208] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/18/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Autonomic nervous system (ANS) dysfunction has been suggested to contribute to the high prevalence of cardiovascular complications in individuals with anorexia nervosa (AN), yet has not been thoroughly investigated. The current review aimed to synthesize the evidence of basal ANS function in individuals with a current diagnosis of AN and those with a previous diagnosis who had achieved weight restoration, as compared to controls. Methods: A systematic review of nine databases was conducted and studies that were published in a peer-review journal, in English, that included at least one assessment of ANS function in individuals with a current or previous diagnosis of AN were selected. Forty-six studies were included with a total of 811 participants with a current diagnosis of AN and 123 participants with a previous diagnosis of AN. Results: ANS function was assessed through heart rate variability (n = 27), orthostatic challenge, blood pressure variability or baroreflex sensitivity (n = 11), adrenergic activity (n = 14), skin conductance level (n = 4), and pupillometry (n = 1). Individuals with AN demonstrated increased parasympathetic activity and decreased sympathetic activity, suggestive of autonomic dysregulation. Following weight restoration, autonomic function trended toward, or was equivalent to, control levels. Discussion: Autonomic dysregulation is indicated through a range of assessments in individuals with AN. Future investigations should utilize a variety of assessments together in order to conclusively establish the nature of autonomic dysfunction in AN, and following extended weight restoration. Moreover, investigation into the co-occurrence of ANS function and cardiovascular risk is required.
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Affiliation(s)
- Zoe M Jenkins
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, VIC, Australia.,Department of Mental Health, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Nina Eikelis
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Andrea Phillipou
- Department of Mental Health, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia.,Department of Mental Health, Austin Health, Melbourne, VIC, Australia
| | - David J Castle
- Department of Mental Health, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Helen E Wilding
- Library Service, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Elisabeth A Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, VIC, Australia
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13
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Heiss S, Vaschillo B, Vaschillo EG, Timko CA, Hormes JM. Heart rate variability as a biobehavioral marker of diverse psychopathologies: A review and argument for an "ideal range". Neurosci Biobehav Rev 2020; 121:144-155. [PMID: 33309905 DOI: 10.1016/j.neubiorev.2020.12.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/02/2020] [Indexed: 01/21/2023]
Abstract
Heart rate variability (HRV), a measure of the variability in intervals between subsequent heart beats, is now widely considered an index of emotion regulatory capacity and the ability to adapt flexibly to changing environmental demands. Abnormalities in HRV are implicated in a host of psychopathologies, making it a potentially powerful transdiagnostic biobehavioral change mechanism in treatment interventions. While most mental illnesses are associated with low HRV, eating disorders have been linked to elevated HRV. We examined 62 research articles on HRV in psychopathology to test the hypothesis that there is an "ideal range" of HRV that predicts optimal functioning. Relationships between symptom severity and parameters that quantify HRV were examined graphically. More extreme time-domain HRV measures, both high and low, were associated with psychopathology, whereas healthy controls displayed mid-range values. Findings preliminarily support the hypothesis that there is an "ideal range" of HRV that could be targeted in biofeedback interventions.
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Affiliation(s)
- Sydney Heiss
- Department of Psychology, University at Albany, State University of New York, USA.
| | - Bronya Vaschillo
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, USA
| | - Evgeny G Vaschillo
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, USA
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, State University of New York, USA
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14
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Peyser D, Scolnick B, Hildebrandt T, Taylor JA. Heart rate variability as a biomarker for anorexia nervosa: A review. EUROPEAN EATING DISORDERS REVIEW 2020; 29:20-31. [PMID: 32975349 DOI: 10.1002/erv.2791] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/17/2020] [Accepted: 08/19/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) typically begins in early adolescence and other than weight status has few reliable biomarkers. Early diagnosis is a critical prognostic factor, but this can be clinically challenging. Heart rate variability (HRV), the beat-by-beat variance in heart rate (HR), may provide a unique assessment for the presence of AN because it has clinical utility as a biomarker of cardiac autonomic control in various populations (e.g., athletes, the aged, those with cardiovascular diseases, etc.). We present a review of the literature examining HRV in those with AN. METHOD Relevant publications were selected from PubMed using the search terms 'anorexia nervosa AND (HR OR HRV)'. Twenty papers were selected and reviewed. RESULTS The majority of studies suggest that those with AN have markedly and consistently elevated HRV compared to controls, even greater than among young athletes. However, no studies have explored HRV as a biomarker for AN. DISCUSSION Future studies on HRV should elucidate its role as a diagnostic biomarker for AN as well as its responsiveness with serial measurement to track response rates and predict relapse.
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Affiliation(s)
- Deena Peyser
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara Scolnick
- Department of Psychology, Boston University, Boston, Massachusetts, USA
| | - Tom Hildebrandt
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Andrew Taylor
- Spaulding Research Institute and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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15
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Watford TS, Braden A, O'Brien WH. Resting state heart rate variability in clinical and subthreshold disordered eating: A meta-analysis. Int J Eat Disord 2020; 53:1021-1033. [PMID: 32437089 DOI: 10.1002/eat.23287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Research has demonstrated mixed results regarding the direction of the association between vagal activation and disordered eating. The current meta-analysis examined studies testing the link between resting-state heart rate variability indices of vagal activation (vmHRV), and both clinical and subthreshold disordered eating. METHOD A systematic search of the literature resulted in the inclusion of studies that were correlational (associations between HRV and disordered eating symptoms) and that examined group differences (e.g., control group vs. disordered eating group), for a total of 36 samples. RESULTS Findings indicated a small but reliable association of vmHRV with disordered eating, r = 0.12, indicating greater vagal activation in individuals with disordered eating compared to those with little or no disordered eating behavior. Moderation analyses identified predictors of the vmHRV/disordered eating association. Bulimia nervosa was found to have a large, positive effect size with vmHRV, r = 0.60, which was significantly greater than all other types of disordered eating, Q T = 10.74, p = .047. Compared to subthreshold disordered eating, clinical eating disorders demonstrated significant, persistent increased vagal activation with a medium, reliable effect size, r = 25, QT = 3.94, p = .045. CONCLUSION These insights contribute to an improved understanding of the pathophysiology in disordered eating.
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Affiliation(s)
| | - Abby Braden
- Bowling Green State University, Bowling Green, Ohio, USA
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16
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Abstract
Anorexia nervosa, one of the more frequent and severe eating disorders, is a chronic psychiatric disease with potentially serious somatic consequences. This behavioral symptomatology leads to weight loss, undernutrition, and more or less severe-potentially life-threatening-somatic complications including respiratory, hepatic, digestive and cardiac features, electrolyte disturbances, endocrine and bone impairment, immunodepression, and related opportunistic infections. In this review, the authors report an overview of cardiac diseases in this disease.
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Affiliation(s)
- Abdallah Fayssoil
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France. .,Service de neurologie, Institut de Myologie, boulevard de l'hôpital, 75013, Paris, France. .,Pitié Salpetrière Hospital, APHP, boulevard de l'hôpital, 75013, Paris, France.
| | - Jean Claude Melchior
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France
| | - Mouna Hanachi
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France
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17
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Smith KE, Mason TB, Juarascio A, Schaefer LM, Crosby RD, Engel SG, Wonderlich SA. Moving beyond self-report data collection in the natural environment: A review of the past and future directions for ambulatory assessment in eating disorders. Int J Eat Disord 2019; 52:1157-1175. [PMID: 31313348 PMCID: PMC6942694 DOI: 10.1002/eat.23124] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In recent years, ecological momentary assessment (EMA) has been used to repeatedly assess eating disorder (ED) symptoms in naturalistic settings, which has allowed for increased understanding of temporal processes that potentiate ED behaviors. However, there remain notable limitations of self-report EMA, and with the rapid proliferation of technology there are ever-increasing possibilities to improve ambulatory assessment methods to further the understanding and treatment of EDs. Therefore, the purpose of this review was to (a) systematically review the studies in EDs that have utilized ambulatory assessment methods other than self-report, and (b) provide directions for future research and clinical applications. METHOD A systematic literature search of electronic databases was conducted, and data regarding study characteristics and methodological quality were extracted. RESULTS The search identified 17 studies that used ambulatory assessment methods to gather objective data, and focused primarily on autonomic functioning, physical activity, and cognitive processes in ED and control groups. DISCUSSION Together the literature demonstrates the promise of using a range of ecologically valid ambulatory assessment approaches in EDs, though there remains limited research that has utilized methods other than self-report (e.g., wearable sensors), particularly in recent years. Going forward, there are several technology-enhanced momentary assessment methods that have potential to improve the understanding and treatment of EDs.
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Affiliation(s)
- Kathryn E Smith
- Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Tyler B Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | | | - Lauren M Schaefer
- Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota
| | - Ross D Crosby
- Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Scott G Engel
- Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Stephen A Wonderlich
- Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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18
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Abstract
Eating disorders affect a significant number of individuals across the life span and are found among all demographic groups (including all genders, socioeconomic statuses, and ethnicities). They can cause malnutrition, which can have significant effects on every organ system in the body. Cardiovascular complications are particularly dangerous and cause eating disorders to have the highest mortality rate of all mental illnesses. This article outlines the medical assessment and treatment of malnutrition due to disordered eating.
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Affiliation(s)
- Rebecka Peebles
- Eating Disorder Assessment and Treatment Program, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Roberts Center for Pediatric Research, 2716 South Street, Room 14360, Philadelphia, PA 19146, USA.
| | - Erin Hayley Sieke
- The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard 9NW55, Philadelphia, PA 19104, USA
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19
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Autonomic Nervous System Response during Light Physical Activity in Adolescents with Anorexia Nervosa Measured by Wearable Devices. SENSORS 2019; 19:s19122820. [PMID: 31238575 PMCID: PMC6630965 DOI: 10.3390/s19122820] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
Abstract
Anorexia nervosa (AN) is associated with a wide range of disturbances of the autonomic nervous system. The aim of the present study was to monitor the heart rate (HR) and the heart rate variability (HRV) during light physical activity in a group of adolescent girls with AN and in age-matched controls using a wearable, minimally obtrusive device. For the study, we enrolled a sample of 23 adolescents with AN and 17 controls. After performing a 12-lead electrocardiogram and echocardiography, we used a wearable device to record a one-lead electrocardiogram for 5 min at baseline for 5 min during light physical exercise (Task) and for 5 min during recovery. From the recording, we extracted HR and HRV indices. Among subjects with AN, the HR increased at task and decreased at recovery, whereas among controls it did not change between the test phases. HRV features showed a different trend between the two groups, with an increased low-to-high frequency ratio (LF/HF) in the AN group due to increased LF and decreased HF, differently from controls that, otherwise, slightly increased their standard deviation of NN intervals (SDNN) and the root mean square of successive differences (RMSSD). The response in the AN group during the task as compared to that of healthy adolescents suggests a possible sympathetic activation or parasympathetic withdrawal, differently from controls. This result could be related to the low energy availability associated to the excessive loss of fat and lean mass in subjects with AN, that could drive to autonomic imbalance even during light physical activity.
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20
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Beauchaine TP, Bell Z, Knapton E, McDonough-Caplan H, Shader T, Zisner A. Respiratory sinus arrhythmia reactivity across empirically based structural dimensions of psychopathology: A meta-analysis. Psychophysiology 2019; 56:e13329. [PMID: 30672603 DOI: 10.1111/psyp.13329] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022]
Abstract
Low resting respiratory sinus arrhythmia (RSA) is observed in many mental health conditions, including anxiety disorders, mood disorders, schizophrenia spectrum disorders, disruptive behavior disorders, and nonsuicidal self-injury, among others. Findings for RSA reactivity are more mixed. We evaluate associations between RSA reactivity and empirically derived structural categories of psychopathology-including internalizing, externalizing, and thought problems-among physically healthy adults. We searched multiple electronic databases for studies of RSA among participants who were assessed either dimensionally using well-validated measures or diagnostically using structured interviews. Strict inclusion criteria were used to screen 3,605 published reports, which yielded 37 studies including 2,347 participants and 76 effect sizes. We performed a meta-analysis, with meta-analytic regressions of potential moderators, including psychopathology subtypes. The sample-wide meta-analytic association between RSA reactivity and psychopathology was quite small, but heterogeneity was considerable. Moderation analyses revealed significant RSA reactivity (withdrawal) specifically in externalizing samples. Additional moderators included (a) stimulus conditions used to elicit RSA reactivity (only negative emotion inductions were effective), (b) sex (women showed greater RSA reactivity than men), and (c) adherence to established methodological guidelines (e.g., higher electrocardiographic sampling rates yielded greater RSA reactivity). These findings indicate that associations between RSA reactivity and psychopathology are complex and suggest that future studies should include more standardized RSA assessments to increase external validity and decrease measurement error.
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Affiliation(s)
| | - Ziv Bell
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Erin Knapton
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | | | - Tiffany Shader
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Aimee Zisner
- Department of Psychology, The Ohio State University, Columbus, Ohio
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21
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Escudero CA, Potts JE, Lam PY, De Souza AM, Duff K, Mugford GJ, Sandor GGS. Echocardiographic Assessment of Ventricular Function During Exercise in Adolescent Female Patients With Anorexia Nervosa. J Am Soc Echocardiogr 2019; 32:394-403.e3. [PMID: 30638724 DOI: 10.1016/j.echo.2018.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with anorexia nervosa (AN) have altered physiologic responses to exercise. The aim of this study was to investigate exercise capacity and ventricular function during exercise in adolescent patients with AN. METHODS Sixty-six adolescent female patients with AN and 21 adolescent female control subjects who exercised to volitional fatigue on a semisupine ergometer, using an incremental step protocol of 20 W every 3 min, were retrospectively studied. Heart rate, blood pressure, and echocardiographic Doppler indices were measured at rest and during each stage of exercise. Fractional shortening, rate-corrected mean velocity of circumferential fiber shortening, stress at peak systole, cardiac output, and cardiac index were calculated. Minute ventilation, oxygen consumption, carbon dioxide production, and respiratory exchange ratio were measured using open-circuit spirometry. RESULTS Patients with AN had significantly lower body mass index (16.7 vs 19.7 kg/m2, P < .001), total work (1,126 vs 1,914 J/kg, P < .001), and test duration (13.8 vs 20.8 min, P < .001) compared with control subjects. Peak minute ventilation, oxygen consumption, and carbon dioxide production were significantly decreased in patients with AN. Heart rate, systolic blood pressure, cardiac index, fractional shortening, and rate-corrected mean velocity of circumferential fiber shortening demonstrated similar patterns of increase with progressive exercise between groups but were decreased at peak exercise in patients with AN. Body mass index percentile, age, peak oxygen consumption, and peak cardiac output were independently associated with exercise duration. CONCLUSIONS Adolescent patients with AN have reduced exercise capacity and peak cardiovascular indices compared with control subjects but normal patterns of cardiovascular response during progressive exercise. Systolic ventricular function is maintained during exercise in adolescents with AN.
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Affiliation(s)
- Carolina A Escudero
- Children's Heart Centre, British Columbia Children's Hospital, Canada; Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - James E Potts
- Children's Heart Centre, British Columbia Children's Hospital, Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine, British Columbia Children's Hospital and Provincial Specialized Eating Disorders Program, Vancouver, Canada
| | - Astrid M De Souza
- Children's Heart Centre, British Columbia Children's Hospital, Canada
| | - Kathryn Duff
- Sports Science Program, Douglas College, New Westminster, British Columbia, Canada
| | - Gerald J Mugford
- Faculty of Medicine and Discipline of Psychiatry, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, Canada.
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Grandemange M, Costet N, Doyen M, Monfort C, Michineau L, Saade MB, Multigner L, Cordier S, Pladys P, Rouget F. Blood Pressure, Heart Rate Variability, and Adiposity in Caribbean Pre-pubertal Children. Front Pediatr 2019; 7:269. [PMID: 31355164 PMCID: PMC6635797 DOI: 10.3389/fped.2019.00269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/14/2019] [Indexed: 11/30/2022] Open
Abstract
Childhood obesity prevalence has increased over the last 30 years. The Heart Rate Variability (HRV) studies performed in adults suggest a possible relation between abnormal autonomic regulation and hypertension in the situation of overweight or obesity. Objective: The aims of this study were to explore the early relationships between adiposity and blood pressure and HRV in pre-pubertal children. Methods: Data were collected during the medical examination of the follow-up at 7 years of the TIMOUN mother-child cohort in Guadeloupe. Body Mass Index z-score (zBMI), sum of tricipital and subscapular skinfold thickness, percentage of fat mass, and Waist-to-Height Ratio were measured. A global corpulence score was computed using a Principal Component Analysis (PCA). Systolic Blood Pressure (SBP) and HRV parameters (cardiac holter monitoring) were collected under 2 conditions (calm and tachycardial period). Relations between HRV, SBP, each adiposity indicator and the corpulence score were studied with restricted cubic splines models, and linear regression models. The age at adiposity rebound (AR) was estimated from the individual growth curves. Results: 575 children were included in the SBP study (mean age: 7.7 years, from 85 to 99 months). SBP was linearly correlated with the corpulence score and the zBMI. An increase of 1 in the zBMI was associated with an increase of 2.3 (±0.28) mmHg in SBP. The effect-size of zBMI on SBP was higher in children with early age at AR. Compared to children with normal BMI, children with a zBMI <™2SD had their RMSSD, SDNN, LF and HF indicators in tachycardial conditions significantly reduced by -30, -21, -37, and -48%, respectively. In boys with a zBMI >2SD, we observed a global increase in all HRV parameters (under tachycardial conditions), particularly the LF [β = 0.43 (±0.18)]. Conclusion: In pre-pubertal period a positive correlation between adiposity excess and SBP was observed with significant changes of HRV in boys, arguing for an early abnormal autonomic regulation and for early preventive intervention in the infancy period, particularly in case of overweight or obesity. Thinness was associated with a reduction in almost all the HRV parameters studied, when compared to normal corpulence, suggesting a decrease in autonomic influence.
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Affiliation(s)
| | - Nathalie Costet
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | | | - Christine Monfort
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Léah Michineau
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | | | - Luc Multigner
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Sylvaine Cordier
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Patrick Pladys
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Florence Rouget
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
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23
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Predictors of Complications in Anorexia Nervosa and Atypical Anorexia Nervosa: Degree of Underweight or Extent and Recency of Weight Loss? J Adolesc Health 2018; 63:717-723. [PMID: 30454732 DOI: 10.1016/j.jadohealth.2018.08.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/02/2018] [Accepted: 08/14/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE Adolescents with atypical anorexia nervosa (AAN) can experience severe physical complications despite not being underweight, posing questions about the contribution of weight loss to complications experienced in restrictive eating disorders (EDs). This study compared total weight loss and recent weight loss with admission weight as predictors of physical and psychological complications. METHODS Retrospective (2005-2010) and prospective (2011-2013) studies were undertaken of 12- to 19-year-old hospitalized adolescents with anorexia nervosa (AN) or AAN, defined as meeting criteria for AN except underweight (≥85% median body mass index). Predictors were total weight loss (from lifetime maximum), recent weight loss (past 3 months), and admission weight. Outcomes were hypophosphatemia, clinical, anthropometric, and psychometric markers during admission. RESULTS In 171 participants (AN, 118 [69%]; AAN, 53 [31%]), there was little evidence of an association between weight measures and hypophosphatemia. Greater total weight loss (regression coefficient [Coeff]: -1.70, 95% confidence interval [CI]: -2.77, -.63, p = .002) and greater recent weight loss (Coeff: -3.37, 95% CI: -5.77, -.97, p = .006), but not admission weight, were associated with a lower pulse rate nadir. Greater total weight loss (odds ratio [OR]: 1.70, 95% CI: 1.19, 2.24, p = .003) and greater recent weight loss (OR: 2.12, 95% CI: 1.11, 4.02, p = .02) were also associated with a higher incidence of bradycardia. CONCLUSIONS In adolescents with restrictive EDs, total weight loss and recent weight loss were better predictors than admission weight of many physical complications. This suggests that future diagnostic criteria for AN place greater emphasis on weight loss.
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Scolnick B. Hypothesis: Clues From Mammalian Hibernation for Treating Patients With Anorexia Nervosa. Front Psychol 2018; 9:2159. [PMID: 30483182 PMCID: PMC6240652 DOI: 10.3389/fpsyg.2018.02159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/19/2018] [Indexed: 12/30/2022] Open
Abstract
This hypothesis is that anorexia nervosa (AN) is a biologically driven disorder, and mammalian hibernation may offer clues to its pathogenesis. Using this approach, this hypothesis offers suggestions for employing heart rate variability as an early diagnostic test for AN; employing the ketogenic diet for refeeding patients, attending to omega 3:6 ratio of polyunsaturated fatty acids (PUFAs) in the refeeding diet; and exploring clinical trials of the endocannabinoid-like agent, palmitoylethanolamde for patients with AN. This hypothesis also explores the role of lipids and autoimmune phenomena in AN, and suggest a lipodomics study to search for antibodies in the serum on patients with AN.
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Affiliation(s)
- Barbara Scolnick
- Psychology and Brain Science, Boston University, Boston, MA, United States
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Gordon D, Drescher M, Shiber S. Security Hunger-Strike Prisoners in the Emergency Department: Physiological and Laboratory Findings. J Emerg Med 2018; 55:185-191. [PMID: 29858143 DOI: 10.1016/j.jemermed.2018.04.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/15/2018] [Accepted: 04/20/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Medical treatment of hunger-strike patients, especially those in incarceration facilities, may pose clinical and treatment challenges for the treating physicians. OBJECTIVE The aim of our study is to describe the epidemiology and clinical and laboratory characteristics of hunger-strike prisoners presenting to the emergency department (ED) and to describe etiologies of hospitalization and complications among this group. METHOD We retrospectively examined clinical and laboratory manifestations of 50 hunger-strike prisoners who were referred for evaluation to the ED after a longstanding fast. RESULTS After a mean of 38 (28-44) days of a hunger strike, the most common complaints were chest pain and abdominal pain (14/60 [23.3%], 13/60 [21.6%], respectively). Mean weight loss percentage was 18.5%, and most patients were bradycardic (25/40 [62.5%]), and some hypothermic (16/50, [32%]). We describe several laboratory disturbances observed in these patients; leukopenia was the most common hematologic manifestation (31/50 [62%]), and a prolonged international normalized ratio was observed in 12/29 (41.3%) patients. We hospitalized 12% of the patients; the most common hospitalization cause was bradycardia (3/6 [50%]). CONCLUSIONS Our study found that the most common clinical symptom was chest pain, which has not been previously reported among hunger strikers. We observed a substantial number of laboratory disturbances due to muscle wasting and protein loss and due to presumed vitamin and micronutrient deficiencies. We suggest monitoring electrocardiograms for heart rate, blood count, chemistry, coagulation tests, and vitamin levels.
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Affiliation(s)
| | - Michael Drescher
- Department of Emergency Medicine, Rabin Medical Centre, Beilinson Campus, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachaf Shiber
- Department of Emergency Medicine, Rabin Medical Centre, Beilinson Campus, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Janzen ML, Malhi N, Laksman ZWM, Puyat J, Krahn AD, Hawkins NM. The QT Interval in Anorexia Nervosa: A Meta-Analysis. JACC Clin Electrophysiol 2018; 4:839-841. [PMID: 29929679 DOI: 10.1016/j.jacep.2018.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 11/17/2022]
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Nagata JM, Carlson JL, Kao JM, Golden NH, Murray SB, Peebles R. Characterization and correlates of exercise among adolescents with anorexia nervosa and bulimia nervosa. Int J Eat Disord 2017; 50:1394-1403. [PMID: 29112280 PMCID: PMC5761671 DOI: 10.1002/eat.22796] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/06/2017] [Accepted: 10/18/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To characterize exercise behaviors among adolescents with anorexia nervosa (AN), atypical AN, or bulimia nervosa (BN), and determine associations between exercise and medical risk. STUDY DESIGN Cross-sectional electronic medical records of all patients evaluated by the Eating Disorder Program at Stanford between January 1997 and February 2011 were retrospectively reviewed. RESULTS 1,083 subjects (961 females, 122 males; mean age 15.6) met eligibility criteria. Most patients (89.7%) reported exercise (mean 7.0 h per week over mean 5.4 days per week) prior to presentation. Running (49.9%), calisthenics (40.7%), walking (23.4%), soccer (20.9%), and swimming (18.2%) were the most common exercises; a majority (60.6%) reported team sport participation. Males were less likely to report team exercise (p = .005). Bradycardia (heart rate <50) at presentation was associated with team sport participation (adjusted odds ratio [AOR] 1.66, 95% confidence interval [CI] 1.02-2.72) and hours of exercise per week (AOR 1.05, 95% CI 1.02-1.09), controlling for diagnosis, sex, age, duration of illness, rate of weight loss, and percent median body mass index (%mBMI). DISCUSSION Adolescents with AN, atypical AN, and BN reported high levels of exercise. Females reported more team sport participation. Greater exercise frequency and team sport participation were associated with bradycardia. Further studies assessing the relationship between exercise and bradycardia may help inform the medical management of adolescents with these eating disorders who are more physically active.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, Stanford University, Palo Alto, California
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | | | - Jessica M. Kao
- Sloan School of Management, Massachusetts Institute of Technology, Boston, Massachusetts
| | - Neville H. Golden
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Stuart B. Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Rebecka Peebles
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Shuttleworth E, Sharma S, Lal S, Allan PJ. Medical complications of anorexia nervosa. Br J Hosp Med (Lond) 2016; 77:287-93. [PMID: 27166107 DOI: 10.12968/hmed.2016.77.5.287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Anorexia nervosa is a psychiatric disorder with potential life-threatening medical sequelae. This article reviews the principal medical complications associated with anorexia nervosa, highlights associated diagnostic pitfalls and emphasizes the importance of a multidisciplinary approach to management.
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Affiliation(s)
- E Shuttleworth
- Specialty Trainee in Gastroenterology and General Internal Medicine in the Department of Gastroenterology, University Hospital of South Manchester, Manchester M23 9LT
| | - S Sharma
- Consultant Psychiatrist in the Priory Eating Disorder Services, The Priory Hospital Cheadle Royal, Cheadle
| | - S Lal
- Consultant Gastroenterologist in the Intestinal Failure Unit, Salford Royal Foundation NHS Trust, Salford
| | - P J Allan
- Consultant Gastroenterologist in the Department of Gastroenterology, John Radcliffe Hospital, Oxford
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Sardar MR, Greway A, DeAngelis M, Tysko EO, Lehmann S, Wohlstetter M, Patel R. Cardiovascular Impact of Eating Disorders in Adults: A Single Center Experience and Literature Review. Heart Views 2016; 16:88-92. [PMID: 27326349 PMCID: PMC4590190 DOI: 10.4103/1995-705x.164463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Eating disorders have multiple medical sequelae, including potentially life-threatening cardiovascular complications. This article describes our cardiology practice experience of treating adults with eating disorders in the outpatient setting and documents baseline cardiac findings in this complex patient population. We describe our findings in patients across the spectrum of eating disorders; past studies have generally focused on anorexia only. This article also includes a review of the current literature on cardiovascular complications associated with disordered eating.
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Affiliation(s)
| | - Andrea Greway
- Lankenau Heart Institute, Cooper University Hospital, New Jersey, USA
| | - Michael DeAngelis
- Lankenau Heart Institute, Cooper University Hospital, New Jersey, USA
| | | | - Shawn Lehmann
- Renfrew Center, Cooper University Hospital, New Jersey, USA
| | | | - Riti Patel
- Lankenau Heart Institute, Cooper University Hospital, New Jersey, USA
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Abstract
UNLABELLED Introduction Anorexia nervosa is an eating disorder, which is associated with many different medical complications as a result of the weight loss and malnutrition that characterise this illness. It has the highest mortality rate of any psychiatric disorder. A large portion of deaths are attributable to the cardiac abnormalities that ensue as a result of the malnutrition associated with anorexia nervosa. In this review, the cardiac complications of anorexia nervosa will be discussed. METHODS A comprehensive literature review on cardiac changes in anorexia nervosa was carried out. RESULTS There are structural, functional, and rhythm-type changes that occur in patients with anorexia nervosa. These become progressively significant as ongoing weight loss occurs. CONCLUSION Cardiac changes are inherent to anorexia nervosa and they become more life-threatening and serious as the anorexia nervosa becomes increasingly severe. Weight restoration and attention to these cardiac changes are crucial for a successful treatment outcome.
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Medical complications of anorexia nervosa and their treatments: an update on some critical aspects. Eat Weight Disord 2015; 20:419-25. [PMID: 26138740 DOI: 10.1007/s40519-015-0202-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/17/2015] [Indexed: 12/18/2022] Open
Abstract
Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Many of the deaths are attributable to medical complications which arise as the malnutrition and weight loss worsens. Every body system may be adversely affected by anorexia nervosa. Yet, remarkably, most of the medical complications of anorexia nervosa are treatable and reversible with optimal medical care, as part of a multidisciplinary team who are often involved in the care of these patients. Herein, we will describe the medical complications of anorexia nervosa and their treatments.
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Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GGS. An Echocardiographic Study of Left Ventricular Size and Cardiac Function in Adolescent Females with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2015; 24:26-33. [DOI: 10.1002/erv.2409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - James E. Potts
- Children's Heart Centre; British Columbia Children's Hospital; Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine and Provincial Specialized Eating Disorders Program; British Columbia Children's Hospital; Canada
| | | | - Gerald J. Mugford
- Faculty of Medicine and Discipline of Psychiatry; Memorial University of Newfoundland; Canada
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Nakai Y, Fujita M, Nin K, Noma S, Teramukai S. Relationship between duration of illness and cardiac autonomic nervous activity in anorexia nervosa. Biopsychosoc Med 2015; 9:12. [PMID: 25908939 PMCID: PMC4407323 DOI: 10.1186/s13030-015-0032-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/16/2015] [Indexed: 12/04/2022] Open
Abstract
Background The mortality rate associated with anorexia nervosa (AN) is high, and death is mainly attributable to cardiac events. A wide range of autonomic nervous system disturbances may be mechanisms underlying the increased cardiovascular mortality and sudden death of patients with AN. Heart rate variability (HRV) has been proven to be a reliable noninvasive method for quantitative assessment of sympathetic and parasympathetic regulation of heart rate (HR). The longer the duration of illness of AN patients, the higher the mortality rate. However, there have been few reports on the relationship between the duration of illness and HRV in AN. Hence, the aims of this study were to compare the cardiac autonomic nervous activity (CANA) of female patients with AN and age-matched female controls and to evaluate the relationship between the duration of illness and the CANA of the AN patients. Methods We studied 14 female patients with AN and 22 age-matched healthy women. Beat-to-beat heart rate variability, recorded in a supine position, was investigated using power spectral analysis. Result Mean heart rate was positively correlated with normalized high-frequency (HF: 0.15 to 0.40 Hz) power and negatively correlated with the low-frequency (LF: 0.04 to 0.15 Hz)/HF power (LF/HF) ratio of the controls. On the other hand, duration of illness was negatively correlated with normalized HF power and positively correlated with the LF/HF ratio of the AN patients. Conclusions These results suggest that, given that the LF/HF ratio is an estimate of cardiac sympathovagal balance, anorectic patients with a long illness duration display lower vagal tone (parasympathetic withdrawal) and high sympathetic tone.
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Affiliation(s)
- Yoshikatsu Nakai
- Kyoto Institute of Health Sciences, Miyako Bldg. 502, Karasuma Oike Agaru Higashigawa, Nakagyo-ku, Kyoto 604-0845 Japan
| | - Masatoshi Fujita
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuko Nin
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shun'ichi Noma
- Department of Psychiatry, School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
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Billeci L, Tartarisco G, Brunori E, Crifaci G, Scardigli S, Balocchi R, Pioggia G, Maestro S, Morales MA. The role of wearable sensors and wireless technologies for the assessment of heart rate variability in anorexia nervosa. Eat Weight Disord 2015; 20:23-31. [PMID: 24923563 DOI: 10.1007/s40519-014-0135-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Bradycardia and abnormal cardiac autonomic function are related to increased mortality in anorexia nervosa (AN). The aim of this study was to assess heart rate (HR) and HR variability of young adolescents with AN as compared to controls by means of wearable sensors and wireless technologies. METHOD The ECG signal was recorded in 27 AN girls and 15 healthy girls at rest using a wearable chest strap. The tachogram, the mean intervals between R peaks (meanRR), the root mean square of successive differences (RMSSD), the power of low-frequency (LF) and high-frequency (HF) bands and the LF/HF ratio were assessed. RESULTS All AN girls showed a reduced HR and an increased meanRR and RMSSD. An HF increase, a LF decrease, and a LF/HF reduction indicated a prevalence of the parasympathetic on sympathetic activity. CONCLUSIONS The instruments used in this pilot study were feasible, unobtrusive and extremely suitable in AN subjects who are burdened by high incidence of cardiovascular mortality; their application could open to new approaches of vital signs monitoring in hospitals as well as in home settings.
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Affiliation(s)
- Lucia Billeci
- Institute of Clinical Physiology, National Research Council of Italy (CNR), via Moruzzi 1, 56124, Pisa, Italy,
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Maintenance of parasympathetic inhibition following emotional induction in patients with restrictive type anorexia nervosa. Psychiatry Res 2015; 225:651-7. [PMID: 25500345 DOI: 10.1016/j.psychres.2014.11.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 10/30/2014] [Accepted: 11/07/2014] [Indexed: 11/21/2022]
Abstract
This study aimed to explore changes in heart rate variability (HRV), a proxy for parasympathetic activity characterizing emotion regulation processes before, during and after negative emotional induction in patients suffering from restrictive type anorexia nervosa (AN-RT). We compared two methods of HRV analysis, the Fast Fourier Transform high frequency (FFT-HF) and a specific HRV high frequency analysis technique, namely, the wavelet transform HRV (WT-HRV). A sample of 16 inpatients with AN-RT was compared to 24 control participants. Heart rate (HR) was continuously recorded for 5 min before the beginning of the video until 5 min after the video. The participants answered questionnaires concerning their eating behaviors, mood disorders and difficulties in emotion regulation. During the entire procedure, the FFT-HF in patients was lower than that in controls. Using the WT-HRV, the patients did not differ from the controls at baseline, and only the controls showed a decrease during emotional induction. After the video, the WT-HRV in patients began to decrease during the first 2 min of emotional recovery although the WT-HRV in controls was already increased. These results highlighted the disturbances in the physiological dynamics of emotion regulation processes in patients with AN-RT.
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Di Cola G, Jacoangeli F, Jacoangeli F, Lombardo M, Iellamo F. Cardiovascular disorders in anorexia nervosa and potential therapeutic targets. Intern Emerg Med 2014; 9:717-21. [PMID: 25056404 DOI: 10.1007/s11739-014-1107-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/05/2014] [Indexed: 10/25/2022]
Abstract
Anorexia nervosa (AN) is an eating disorder in which a distorted self-perception of body image and an excessive fear of gaining weight result in extreme restrictions in eating habits. AN may be divided into two types: a "binge-eating/purging type" during which the individual regularly engages in overeating and then purging behavior, and a "restricting type", in which she does not. AN is a serious medical problem in young people in Western societies. It is widely reported that patients with AN exhibit an enhanced mortality rate as compared with age-matched healthy subjects, which has been mainly ascribed to cardiac complications. At least one-third of all deaths in patients with anorexia nervosa are estimated to be due to cardiac causes, mainly sudden death. Cardiovascular complications of AN can be present in up to 80% of cases, and among them alterations in cardiac electrical activity, structure and hemodynamics have been reported as causes of morbidity and mortality. The objective of this brief review is to summarize current knowledge on the main cardiovascular complications of AN, their underlying mechanisms and the possible therapeutic approaches.
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Affiliation(s)
- Giovanni Di Cola
- Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata, Via O. Raimondo, 8, 00173, Rome, Italy
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Abstract
Despite their high prevalence, associated morbidity and mortality, and available treatment options, eating disorders (EDs) continue to be underdiagnosed by pediatric professionals. Many adolescents go untreated, do not recover, or reach only partial recovery. Higher rates of EDs are seen now in younger children, boys, and minority groups; EDs are increasingly recognized in patients with previous histories of obesity. Medical complications are common in both full and subthreshold EDs and affect every organ system. No single cause of EDs has emerged, although neurobiological and genetic predispositions are emerging as important. Recent treatment paradigms acknowledge that they are not caused by families or chosen by patients. EDs present differently in pediatric populations, and providers should have a high index of suspicion using new Diagnostic and Statistical Manual, 5th edition diagnostic criteria because early intervention can affect prognosis. Outpatient family-based treatment focused on weight restoration, reducing blame, and empowering caregivers has emerged as particularly effective; cognitive behavioral therapy, individual therapy, and higher levels of care may also be appropriate. Pharmacotherapy is useful in specific contexts. Full weight restoration is critical, often involves high-calorie diets, and must allow for continued growth and development; weight maintenance is typically inappropriate in pediatric populations. Physical, nutritional, behavioral, and psychological health are all metrics of a full recovery, and pediatric EDs have a good prognosis with appropriate care. ED prevention efforts should work toward aligning with families and understanding the impact of antiobesity efforts. Primary care providers can be key players in treatment success.
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Affiliation(s)
- Kenisha Campbell
- The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecka Peebles
- The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Bomba M, Corbetta F, Gambera A, Nicosia F, Bonini L, Neri F, Tremolizzo L, Nacinovich R. Heart rate variability in adolescents with functional hypothalamic amenorrhea and anorexia nervosa. Psychiatry Res 2014; 215:406-9. [PMID: 24359810 DOI: 10.1016/j.psychres.2013.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/16/2013] [Accepted: 11/12/2013] [Indexed: 11/15/2022]
Abstract
Aim of this study consisted in assessing the 24-h heart rate variability (HRV), a measure of autonomic nervous system (ANS) imbalance, in 21 adolescents with functional hypothalamic amenorrhea (FHA, 11 normogonadotropic, N-FHA, and 10 hypogonadotropic, Hy-FHA) compared to 21 patients with anorexia nervosa (AN) and 21 controls. As expected, subjects with AN showed a significant dysregulation in multiple HRV parameters, while Hy-FHA patients presented with a dysregulation in a few domains (SDNN, HFr), which was not present in girls with N-FHA, who showed values largely similar to controls. FHA might represent part of the AN biological spectrum, and a link between these two conditions might exist, possibly related to the degree of psychological and/or hormonal dysfunction.
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Affiliation(s)
- Monica Bomba
- Clinic of Child and Adolescent Mental Health, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy.
| | - Fabiola Corbetta
- Clinic of Child and Adolescent Mental Health, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Alessandro Gambera
- Department of Gynecological Endocrinology, Spedali Civili, Brescia, Italy
| | - Franco Nicosia
- Geriatric Unit, Spedali Civili, Department of Medical and Surgery Sciences, University of Brescia, Brescia, Italy
| | - Luisa Bonini
- Department of Childhood and Adolescent Neuropsychiatry, Spedali Civili, Brescia, Italy
| | - Francesca Neri
- Clinic of Child and Adolescent Mental Health, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Lucio Tremolizzo
- Department of Neurology - University of Milano-Bicocca, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Renata Nacinovich
- Clinic of Child and Adolescent Mental Health, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
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Yahalom M, Spitz M, Sandler L, Heno N, Roguin N, Turgeman Y. The significance of bradycardia in anorexia nervosa. Int J Angiol 2014; 22:83-94. [PMID: 24436590 DOI: 10.1055/s-0033-1334138] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Anorexia nervosa (AN) is a life-threatening condition, with a significant risk for death, due to cardiovascular complications. It is characterized by abnormal eating behavior and has the highest mortality rate of all psychiatric disorders. It has been associated with bradycardia (a heart rate [HR] of less than 60 beats per minute) (up to 95%), hypotension, mitral valve prolapse, and heart failure. The diagnosis of AN can be elusive, and more than half of all cases are undetected. The purpose of this study was to raise and improve awareness to the possible diagnosis of AN in adolescent and young adult patients with weight loss displaying bradycardia and new cardiac disorders. Clinical characteristics, HR, and electrocardiographic data of 23 consecutive patients (20 females) with AN and of 10 young adults (8 females) without AN, between the years 2006 and 2009, were recorded and summarized. At presentation 16/23 (69.6%) showed HR < 50 bpm. The mean lowest HR of all patients was 44 ± 6 (range 26 to 68) bpm. No patient needed pacemaker therapy. Bradycardia in young adults, especially females with weight loss, should raise the possible diagnosis of AN, so it can be treated early in-time, and thus prevent premature death.
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Affiliation(s)
- Malka Yahalom
- HaEmek Medical Center, Heart Institute, Afula, Israel
| | - Marcelo Spitz
- Department of Children and Psychiatry, Western Galilee Hospital, Nahariya, Israel
| | - Ludmila Sandler
- Department of Children and Psychiatry, Western Galilee Hospital, Nahariya, Israel
| | - Nawaf Heno
- Department of Pediatrics, Western Galilee Hospital, Nahariya, Israel
| | - Nathan Roguin
- Rappaport School of Medicine, Technion, Haifa, Israel
| | - Yoav Turgeman
- HaEmek Medical Center, Heart Institute, Afula, Israel ; Rappaport School of Medicine, Technion, Haifa, Israel
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Scolnick B, Mostofsky DI, Keane RJ. Pilot study employing heart rate variability biofeedback training to decrease anxiety in patients with eating disorders. J Eat Disord 2014; 2:17. [PMID: 24917934 PMCID: PMC4050420 DOI: 10.1186/2050-2974-2-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/28/2014] [Indexed: 12/03/2022] Open
Abstract
Heart rate variability (HRV) biofeedback, a technique which encourages slow meditative breathing, was offered to 25 in-patients with various eating disorder diagnoses-anorexia nervosa, bulimia nervosa and binge eating disorder. We found that this modality had no serious side effects, and was subjectively useful to most participants. An enhanced ability to generate highly coherent HRV patterns in patients with recent onset anorexia nervosa was observed.
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Affiliation(s)
- Barbara Scolnick
- Department of Psychology, Boston University, 64 Cummington Street, Boston, MA 02215, USA
| | - David I Mostofsky
- Department of Psychology, Boston University, 64 Cummington Street, Boston, MA 02215, USA
| | - Robert J Keane
- Clinical Operations, Walden Behavioral Care, 9 Hope Avenue, Waltham, MA 024533-2711, USA
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41
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ED management of patients with eating disorders. Am J Emerg Med 2013; 31:859-65. [PMID: 23623238 DOI: 10.1016/j.ajem.2013.02.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/21/2013] [Accepted: 02/25/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Eating disorders are one of the "great masqueraders" of the twenty-first century. Seemingly healthy young men and women with underlying eating disorders present to emergency departments with a myriad of complaints that are not unique to patients with eating disorders. The challenge for the Emergency Medicine physician is in recognizing that these complaints result from an eating disorder and then understanding the unique pathophysiologic changes inherent to these disorders that should shape management in the emergency department. OBJECTIVE In this article, we will review, from the perspective of the Emergency Medicine physician, how to recognize patients with anorexia and bulimia nervosa, the medical complications and psychiatric comorbidities, and their appropriate management. CONCLUSIONS Anorexia and bulimia nervosa are complex psychiatric disorders with significant medical complications. Recognizing patients with eating disorders in the ED is difficult, but failure to recognize these disorders, or failure to manage their symptoms with an understanding of their unique underlying pathophysiology and psychopathology, can be detrimental to the patient. Screening tools, such as the SCOFF questionnaire, are available for use by the EM physician. Once identified, the medical complications described in this article can help the EM physician tailor management of the patient to their underlying pathophysiology and effectuate a successful therapeutic intervention.
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Tokumura M, Watanabe H, Esaki T. Convalescent resting tachycardia predicts unfavorable outcome of anorexia nervosa. Pediatr Int 2012; 54:844-8. [PMID: 22823590 DOI: 10.1111/j.1442-200x.2012.03703.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with anorexia nervosa (AN) who have tachycardia during the clinical course, difficulty in treatment has been observed. The purpose of the present study was to evaluate the association between heart rate (HR) in the weight loss and weight recovery periods, and outcome. METHODS The subjects consisted of 40 girls with AN (age at onset, 8-16 years). The outcome 1-5 years after the initiation of treatment was regarded as favorable for both bodyweight within 15% of the standard weight and regular menstruation during the last 6 months, and unfavorable for bodyweight <85% of the standard weight and absent or nearly always absent menstruation. HR during the weight loss period was obtained at the outpatient clinic on the first visit. For HR during the weight recovery period, we used the resting and peak HR obtained in exercise tolerance test, which was performed when the bodyweight successfully increased along with improvement in physical complications. The association between each HR and outcome was evaluated. RESULTS Favorable outcomes were observed in 19 of the 40 patients after the 1 year follow up but in 32 after the 5 year follow up. Resting HR during the weight recovery period was higher throughout the 5 years in the unfavorable than in the favorable outcome group, with significant differences after the 2, 4, and 5 year follow ups. CONCLUSION In AN, resting tachycardia during the convalescent period is associated with unfavorable outcome.
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Krantz MJ, Gaudiani JL, Johnson VW, Mehler PS. Exercise electrocardiography extinguishes persistent junctional rhythm in a patient with severe anorexia nervosa. Cardiology 2012; 120:217-20. [PMID: 22343463 DOI: 10.1159/000335481] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Indexed: 11/19/2022]
Abstract
Among psychiatric conditions, anorexia nervosa carries the highest mortality, in part due to the propensity for rhythm disturbances among patients with advanced disease. Patients with anorexia nervosa are prone to both bradycardia and tachyarrhythmias, though mortality has not been associated with the former. To date, only one case of junctional rhythm in the setting of anorexia nervosa has been previously described, which was unremitting and required prolonged hospitalization. We report a case of persistent accelerated junctional rhythm where a formal exercise electrocardiography study demonstrated rapid reversion to sinus rhythm with graded exercise. Despite a 22-day hospitalization the patient never reverted permanently to sinus rhythm. This underscores the heightened vagal tone that may be seen among patients with severe anorexia nervosa. Despite this, it may be rapidly extinguished with sympathetic overdrive during exercise. In this context, exercise electrocardiography appears to be a safe, noninvasive means of assessing cardiac conduction and chronotropic reserve in this population.
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Affiliation(s)
- Mori J Krantz
- Division of Cardiology, Denver Health Medical Center and University of Colorado, Denver, Colo. 80204-4507, USA.
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Kastner S, Salbach-Andrae H, Renneberg B, Pfeiffer E, Lehmkuhl U, Schmitz L. Echocardiographic findings in adolescents with anorexia nervosa at beginning of treatment and after weight recovery. Eur Child Adolesc Psychiatry 2012; 21:15-21. [PMID: 22086424 DOI: 10.1007/s00787-011-0227-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 11/03/2011] [Indexed: 10/15/2022]
Abstract
Anorexia nervosa (AN) is an eating disorder with somatic complications. The aim of the study was to analyse echocardiographic abnormalities in patients with AN at initial examination and after weight restoration. A total of 173 consecutively admitted adolescents (aged 12-17 years), diagnosed with DSM-IV AN (307.1) were evaluated in a child and adolescent psychiatric department of a major university hospital from December 1997 to August 2008. In addition, 40 healthy adolescents of the same age with normal weight were examined. In patients with AN, 34.7% had a pericardial effusion (PE) which was clinically silent. In contrast, none of the controls presented with PE (p < 0.001). No differences across AN subtypes were observed. Patients with PE showed significantly lower body mass index (BMI) (p = 0.016) than patients without PE. They had more prominent low-T3 syndrome (p = 0.003) and longer duration of hospitalisation (p = 0.008) after controlling for BMI at admission. Remission of PE was observed in 88% of the patients after weight restoration. Left ventricular end-diastolic and end-systolic dimensions in AN were significantly lower than in controls (p < 0.001). There were no differences in interventricular septum thickness, posterior wall thickness and fractional shortening. This report indicates that adolescents with AN show cardiac abnormalities in comparison to healthy young women. Furthermore, PE is a frequent cardiac complication in patients with AN and it is associated with BMI, low T3 serum levels and duration of hospitalisation.
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Affiliation(s)
- Sabrina Kastner
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Germany.
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Pollatos O, Herbert BM, Füstös J, Weimer K, Enck P, Zipfel S. Food Deprivation Sensitizes Pain Perception. J PSYCHOPHYSIOL 2012. [DOI: 10.1027/0269-8803/a000062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
While food deprivation has known effects on sympathovagal balance, little is known about hunger’s influence on the perception of pain. Since autonomic activities influence many cognitive and emotional processes, this suggests that food deprivation should interact with the perception of pain. This study analyzed the possible effects of short-term food deprivation on pain sensitivity in healthy female participants. This study was comprised of 32 healthy female participants who underwent a 48-hr inpatient hospital investigation. Prior to testing, heart rate and heart rate variability were assessed. After a standardized breakfast, day 1 measurements were taken. Food intake was then not allowed again until the following evening for 22 participants (experimental group), while 12 participants were served standard meals (control group). Pain threshold and tolerance were assessed at 10:00 a.m. on both days using a pressure algometer. Additionally pain experience was examined. Food deprivation significantly reduced pain thresholds and tolerance scores in the experimental group. Additionally, the sympathovagal balance changed, characterized by a decrease in parasympathetic activation. Higher vagal withdrawal after food deprivation was associated with higher pain sensitivity in the experimental group. Furthermore, perceived unpleasantness and pain intensity increased for threshold and tolerance stimuli in the experimental group. We conclude that short-term food deprivation sensitized pain perception in healthy females. An imbalance in sympathovagal activation evoked by food deprivation accounted for this effect. Our results might be a pathogenic mechanism for the development of emotional difficulties associated with disturbed eating behavior.
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Affiliation(s)
- Olga Pollatos
- Department of Psychology, University of Potsdam, Germany
| | - Beate M. Herbert
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Tübingen, Eberhard-Karls-University, Tübingen, Germany
| | - Jürgen Füstös
- Department of Psychology, University of Potsdam, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Tübingen, Eberhard-Karls-University, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Tübingen, Eberhard-Karls-University, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Tübingen, Eberhard-Karls-University, Tübingen, Germany
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Mazurak N, Stein J, Kipphan S, Muth ER, Teufel M, Zipfel S, Enck P. Heart rate variability in anorexia nervosa and the irritable bowel syndrome. Neurogastroenterol Motil 2011; 23:e470-8. [PMID: 21917084 DOI: 10.1111/j.1365-2982.2011.01785.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Many studies have reported disturbances of heart rate variability (HRV) in patients with psychosomatic disorders such as anorexia nervosa (AN) and the irritable bowel syndrome (IBS). However, both have never been directly compared. METHODS We compared HRV in AN (n = 21) and in IBS (n = 21) (all females) with 42 healthy female control subjects who were matched for age and in IBS to body mass index (BMI). Recovery periods between different cardiac load tests were compared with baseline recordings and tilt test to estimate time [mean successive difference (MSD)] and frequency domain (Goldberger dimension, frequency of HF peak location and HF power, log HF power) values and to assess general reactivity of the autonomic nervous system (ANS). KEY RESULTS Significantly longer inter-beat intervals (IBIs) in AN patients and lower values of MSD in IBS patients were found in comparison with respective controls; both were independent from experimental conditions and are found in baseline recordings only. Both effects were independent of age and BMI. We also demonstrate a significant relationship between age, BMI and some HRV parameters. CONCLUSIONS & INFERENCES Opposite autonomic patterns were found in AN and IBS: stronger vagal withdrawal in IBS and weaker vagal inhibition in AN patients. Records made at rest and without any autonomic load may be representative for assessment of ANS function. Age and BMI should be taken into consideration during assessment of HRV data.
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Affiliation(s)
- N Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
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Monteleone P, Scognamiglio P, Monteleone AM, Mastromo D, Steardo L, Serino I, Maj M. Abnormal diurnal patterns of salivary α-amylase and cortisol secretion in acute patients with anorexia nervosa. World J Biol Psychiatry 2011; 12:455-61. [PMID: 21745126 DOI: 10.3109/15622975.2011.590226] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The evidence that the activity of the sympathetic nervous system (SNS) is decreased in acute anorexia nervosa (AN) is not consistent. Therefore, we aimed to assess the SNS basal activity in malnourished AN patients through the measurement of diurnal salivary levels of α-amylase, whose secretion is regulated by the SNS. As secondary aim, we measured also salivary cortisol. METHODS Eight symptomatic female patients with restrictive AN and eight age-matched healthy women underwent saliva sample collection at awakening and over the day. α-amylase and cortisol were assayed by ELISA method. RESULTS In both patients and controls, saliva α-amylase levels significantly decreased during 60 min after awakening and then progressively rose towards the afternoon/evening. AN patients exhibited significantly reduced levels of the salivary enzyme with a significant decrease in its overall diurnal secretion and a dysregulated secretory pattern. As compared to control women, AN patients exhibited significantly enhanced levels of salivary cortisol at awakening, an enhanced and advanced cortisol secretion after awakening but no significant change in the overall diurnal secretion of the salivary hormone. CONCLUSIONS These results suggest that the activity of the SNS, evaluated through the assessment of the diurnal secretion of salivary α-amylase, is impaired in the acute phase of AN whereas the cortisol awakening response is enhanced.
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Mazurak N, Enck P, Muth E, Teufel M, Zipfel S. Heart rate variability as a measure of cardiac autonomic function in anorexia nervosa: a review of the literature. EUROPEAN EATING DISORDERS REVIEW 2010; 19:87-99. [PMID: 25363717 DOI: 10.1002/erv.1081] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Patients with anorexia nervosa (AN) exhibit a wide range of autonomic system disturbances; these patients have also high mortality risk due to cardio-vascular complications. Origin and pathogenesis of such changes are not absolutely clear. METHODS Relevant publications were drawn from PUBMED using the keywords 'anorexia nervosa' AND 'autonomic'. Fifty two abstracts were identified and screened for papers that measured the state of autonomic regulation by means of analysis of heart rate variability either during 24-hour electrocardiography (ECG) monitoring or during a short-term laboratory test. Studies selected were analysed for the number of patients included, the presence and quality of control groups, gender, age and body mass index (BMI) of patients, type of AN as well as methods used to determine heart rate variability (HRV). RESULTS Twenty papers on HRV in patients with anorexia were identified and analysed, revealing three distinct positions regarding changes of autonomic nervous system (ANS) functions in patients with AN. The majority of papers identified parasympathetic/sympathetic imbalance with parasympathetic dominance and decreased sympathetic modulation; others could not replicate these findings, but instead described sympathetic dominance; finally a group of papers could not identify any autonomic differences in comparison to control samples. We conclude that in its current state of analysis HRV may not be suitable for routine assessment of ANS function in AN patients but rather remains a research tool.
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Affiliation(s)
- Nazar Mazurak
- Department of Psychosomatic Medicine, University Hospital, Tübingen, Germany; Department of Internal Medicine, Ivano-Frankivsk National Medical University, Ukraine
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Koschke M, Boettger MK, Macholdt C, Schulz S, Yeragani VK, Voss A, Bär KJ. Increased QT variability in patients with anorexia nervosa--an indicator for increased cardiac mortality? Int J Eat Disord 2010; 43:743-50. [PMID: 19816863 DOI: 10.1002/eat.20765] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Increased mortality in anorexia nervosa is associated with autonomic dysfunction and prolongation of the QT interval. In this study, we examined the relative importance of repolarization abnormalities and vagal modulation of heart rate. In particular, we hypothesized that patients with anorexia nervosa show increased QT interval variability, particularly since this measure has been shown to correlate with serious cardiac arrhythmias. METHOD We assessed linear and nonlinear heart rate variability (HRV) parameters as well as measures of QT variability in 20 female patients with anorexia nervosa and 20 controls. In patients, parameters were correlated with serum electrolytes. RESULTS QT variability was significantly increased in the patient group and correlated negatively with serum potassium concentrations. HRV measures showed a shift of autonomic balance towards vagal predominance. DISCUSSION The increase in QT variability might at least in part account for the higher risk of cardiac arrhythmias in patients with anorexia nervosa. Once validated in a prospective study design, parameters of QT variability might serve as surrogate markers for arrhythmia risk stratification in anorexia nervosa. Supplementation with potassium might normalize QT variability abnormalities.
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Affiliation(s)
- Mandy Koschke
- Department of Psychiatry and Psychotherapy, University Hospital, Jena, Germany
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DiVasta AD, Walls CE, Feldman HA, Quach AE, Woods ER, Gordon CM, Alexander ME. Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2010; 164:706-13. [PMID: 20679161 PMCID: PMC3205985 DOI: 10.1001/archpediatrics.2010.138] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the effects of malnutrition on hemodynamic status of adolescents hospitalized for anorexia nervosa. DESIGN Longitudinal observational study. SETTING Tertiary care pediatric hospital. Patients Thirty-eight adolescents with anorexia nervosa, aged 13 to 21 years, with a mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 15.9 (1.8). Intervention Subjects received standard care, including bed rest and graded nutritional therapy. A subsample of subjects (n=19) returned 11 to 57 weeks following hospitalization for a second cardiac evaluation. MAIN OUTCOME MEASURES Results from a 15-lead electrocardiogram, echocardiogram, treadmill stress test, and spinal bone mineral density measurement. RESULTS On admission, 26 subjects (68%) had sinus bradycardia. Bradycardia was less common in participants with a longer duration of illness (P=.04). Left ventricle mass was lower than predicted for age (Z score<-1.0) in 11 subjects (31%). Exercise tolerance was normal by all measures. Both heart rate and QT interval were predictors of spinal bone mineral density. In those who returned for follow-up, absolute measures of left ventricle mass did not change (P=.27). However, the corresponding Z scores declined over time (mean [SD] change, -0.9 [1.3]; P=.02). CONCLUSIONS In acutely malnourished adolescents with anorexia nervosa, few truly pathologic cardiac findings were identified. Sinus bradycardia was observed in most cases. Mild reductions in left ventricle mass and left ventricle function were seen both at baseline and at follow-up, suggesting early sparing of cardiac muscle in the face of moderate malnutrition as well as a relative delay of cardiac muscle restoration. The association of hemodynamic status with altered spinal bone mineral density emphasizes the range of systems affected by malnutrition in anorexia nervosa.
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Affiliation(s)
- Amy D DiVasta
- Department of Cardiology, Children's Hospital Boston, 333 Longwood Ave, Boston, MA 02115, USA.
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