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Himmerich H, Keeler JL, Tchanturia K, Treasure J. Treatment escalation for people with anorexia nervosa: setting, therapies and nutritional interventions. Curr Opin Psychiatry 2024; 37:404-416. [PMID: 39239867 PMCID: PMC11426991 DOI: 10.1097/yco.0000000000000964] [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] [Indexed: 09/07/2024]
Abstract
PURPOSE OF REVIEW Adult patients with severe anorexia nervosa often receive the same unsuccessful treatment without changes regarding the setting, the therapies, or nutritional interventions. RECENT FINDINGS Settings where people with anorexia nervosa are treated include their general practitioner, an independent psychiatric practice, a community mental health team (CMHT), a specialized eating disorder outpatient service, eating disorder early intervention services, a highly intensive eating disorder outpatient or home treatment programme, eating disorder daycare, an inpatient eating disorder service, a general hospital or a general psychiatric hospital, or residential treatment. At a specialized eating disorder service, patients should be offered evidence-based psychotherapy for anorexia nervosa, dietary advice and physical health monitoring as a first step. Additionally, they may be allocated to a specific treatment pathway, family interventions and creative therapies. As a second step, clinicians may consider integrating interventions targeting psychiatric or physical comorbidities, medication for anorexia nervosa or noninvasive neurostimulation. After several years of futile treatment, deep brain stimulation (DBS) should be considered to prevent a chronic course of anorexia nervosa. Nutritional interventions can be escalated from nutritional counselling to nasogastric tube feeding. Patients who rely on nasogastric tube feeding might benefit from percutaneous endoscopic gastrostomy (PEG). Patients who vomit despite a nasogastric tube, might need nasojejunal tube feeding. SUMMARY Treatment for people with anorexia nervosa should be regularly reviewed and, if necessary, escalated to avoid a chronic and longstanding disease course.
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Affiliation(s)
- Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Johanna Louise Keeler
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London
| | - Kate Tchanturia
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London
- South London and Maudsley NHS Foundation Trust, London, UK
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2
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Abellaneda-Pérez K, Delgado-Martínez I, Salgado P, Ginés JM, Guardiola R, Vaqué-Alcázar L, Roca-Ventura A, Molist-Puigdomènech R, Manero RM, Viles-Garcia M, Medrano-Martorell S, Bartrés-Faz D, Pascual-Leone A, Pérez-Solà V, Villalba-Martínez G. Structural connectivity modifications following deep brain stimulation of the subcallosal cingulate and nucleus accumbens in severe anorexia nervosa. Acta Neurochir (Wien) 2024; 166:364. [PMID: 39261306 DOI: 10.1007/s00701-024-06258-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/24/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE Anorexia nervosa (AN) is a mental health disorder characterized by significant weight loss and associated medical and psychological comorbidities. Conventional treatments for severe AN have shown limited effectiveness, leading to the exploration of novel interventional strategies, including deep brain stimulation (DBS). However, the neural mechanisms driving DBS interventions, particularly in psychiatric conditions, remain uncertain. This study aims to address this knowledge gap by examining changes in structural connectivity in patients with severe AN before and after DBS. METHODS Sixteen participants, including eight patients with AN and eight controls, underwent baseline T1-weigthed and diffusion tensor imaging (DTI) acquisitions. Patients received DBS targeting either the subcallosal cingulate (DBS-SCC, N = 4) or the nucleus accumbens (DBS-NAcc, N = 4) based on psychiatric comorbidities and AN subtype. Post-DBS neuroimaging evaluation was conducted in four patients. Data analyses were performed to compare structural connectivity between patients and controls and to assess connectivity changes after DBS intervention. RESULTS Baseline findings revealed that structural connectivity is significantly reduced in patients with AN compared to controls, mainly regarding callosal and subcallosal white matter (WM) tracts. Furthermore, pre- vs. post-DBS analyses in AN identified a specific increase after the intervention in two WM tracts: the anterior thalamic radiation and the superior longitudinal fasciculus-parietal bundle. CONCLUSIONS This study supports that structural connectivity is highly compromised in severe AN. Moreover, this investigation preliminarily reveals that after DBS of the SCC and NAcc in severe AN, there are WM modifications. These microstructural plasticity adaptations may signify a mechanistic underpinning of DBS in this psychiatric disorder.
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Affiliation(s)
- Kilian Abellaneda-Pérez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ignacio Delgado-Martínez
- Human Anatomy and Embryology Unit, Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Purificación Salgado
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
| | - José María Ginés
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
| | - Rocío Guardiola
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
| | - Lídia Vaqué-Alcázar
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau-Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Roca-Ventura
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | | | | | | | | | - David Bartrés-Faz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Víctor Pérez-Solà
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
- Grupo de Investigación en Salud Mental del Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Gloria Villalba-Martínez
- Department of Neurosurgery, Hospital del Mar, Barcelona, Spain.
- Systems Neurologic and Neurotherapeutic Group at Research Institute Hospital del Mar, Barcelona, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
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Shirai T, Tanifuji T, Otsuka I, Okazaki S, Horai T, Yamaki N, Minami H, Miyachi M, Okada S, Hishimoto A. Preliminary development of a risk predictor for severe complication in patients with anorexia nervosa. Psychiatry Res 2024; 342:116151. [PMID: 39260070 DOI: 10.1016/j.psychres.2024.116151] [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: 12/22/2023] [Revised: 08/20/2024] [Accepted: 08/24/2024] [Indexed: 09/13/2024]
Abstract
Anorexia nervosa (AN) is life-threatening because of many physical complications, hence a quantitative indicator for early therapeutic intervention through hospitalization is needed. Here, we compared the demographics of 21 patients with AN who required intensive treatment in the internal medicine ward and those of 61 patients with AN who directly admitted to the psychiatric ward. We developed a risk score for severe physical complications in patients with AN, by using six items with significant differences between two groups; body mass index, blood urea nitrogen, corrected calcium, albumin, aspartate transaminase, and C-reactive protein (area under the curve = 0.824).
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Affiliation(s)
- Toshiyuki Shirai
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Takaki Tanifuji
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Ikuo Otsuka
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
| | - Satoshi Okazaki
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Tadasu Horai
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Naruhisa Yamaki
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Haruka Minami
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Masao Miyachi
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Shohei Okada
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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Cui S. A comprehensive review on the co-occurrence of scurvy and anorexia nervosa. Front Nutr 2024; 11:1466388. [PMID: 39296506 PMCID: PMC11409421 DOI: 10.3389/fnut.2024.1466388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 08/21/2024] [Indexed: 09/21/2024] Open
Abstract
Scurvy, a rare disease resulting from vitamin C deficiency, can occur in individuals with restrictive eating disorders like anorexia nervosa (AN), leading to severe health complications. This review explores the complex relationship between scurvy and AN, highlighting the overlapping symptoms and challenges in diagnosis and treatment. Vitamin C is essential for collagen synthesis, immune function, and neurotransmitter production, and its deficiency manifests as fatigue, gingival bleeding, joint pain, and perifollicular hemorrhages. AN exacerbates these symptoms through extreme food restriction, causing severe nutritional deficiencies. Analyzing nine case reports, this review reveals that patients with co-occurring AN and scurvy often present with gastrointestinal, psychiatric, and dermatological symptoms. Treatment with vitamin C supplementation typically results in rapid symptom improvement. However, the malnutrition inherent in AN complicates the clinical picture, making timely diagnosis and intervention crucial. This review underscores the importance of a comprehensive, multidisciplinary approach to managing these conditions, emphasizing the need for early recognition and treatment to prevent severe complications. Future research should include a more diverse patient population to enhance understanding of the interplay between AN and scurvy, aiming to improve patient outcomes through tailored treatment strategies.
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Affiliation(s)
- Sunny Cui
- Department of Biological Sciences, Dartmouth College, Hanover, NH, United States
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5
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Demolli P, Frey D. Romosuzumab used to treat a 29-year-old patient with anorexia nervosa related osteoporosis - A case report. Bone Rep 2024; 22:101803. [PMID: 39314548 PMCID: PMC11417517 DOI: 10.1016/j.bonr.2024.101803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/18/2024] [Accepted: 09/09/2024] [Indexed: 09/25/2024] Open
Abstract
Osteoporosis and decreased bone density is a frequent complication of anorexia nervosa (AN). As of yet, there have been no studies of accomplished treatment of AN-related osteoporosis with romosuzumab, a monoclonal antibody to sclerostin. We report the first case of a premenopausal, 29-year old patient in Switzerland with decreased bone density and osteoporotic fractures due to anorexia nervosa, who completed the treatment with romosuzumab. There was a significant increase in bone mineral density (BMD) after 12 months of therapy. No serious side effects were reported. To date, only bisphosphonates, denosumab and teriparatide have been evaluated in treatment of AN-related osteoporosis in adolescents and premenopausal individuals respectively. Our report demonstrates that romosuzumab might be an alternative treatment option in patients with anorexia nervosa who are at high risk for osteoporotic fractures. To assess the efficacy and safety of romosuzumab in individuals with AN further studies are needed.
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Affiliation(s)
- Pashija Demolli
- University Hospital Zurich (USZ), Department of Rheumatology, Switzerland
| | - Diana Frey
- University Hospital Zurich (USZ), Department of Rheumatology, Switzerland
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6
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Doersam AF, Throm JK, Sörensen F, Martus P, Kraegeloh-Mann I, Preissl H, Micali N, Giel KE. Mother-infant feeding interactions in mothers with and without eating disorder history: Results of a structured observational study. Appetite 2024; 200:107551. [PMID: 38857768 DOI: 10.1016/j.appet.2024.107551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND A growing body of evidence suggests that children of mothers with eating disorders (EDs) have a greater risk of early feeding problems. Recognizing and reacting adequately to the infant's signals during feeding is crucial for the child's development of internal and external regulatory mechanisms of food intake. Parental EDs might affect this ability. Therefore, we investigated the quality of mother-infant interactions during feeding using video recording and a structured coding system. METHODS The data of this pilot study was collected in a prospective cohort study investigating the influence of maternal EDs on child outcomes. Twenty women with ED history and 31 control women were videotaped while feeding their infant during a main meal at ten months postpartum. The mother-infant interactions were evaluated by two raters using the Chatoor Feeding Scale. We assessed birth outcomes, the mother's ED and depression status, breastfeeding practices, infant feeding problems and infant temperament by maternal self-report. RESULTS Mothers with and without ED history scored very similar on the Feeding Scale, however mothers from the control group experienced more struggle for control with their infants during feeding (p = 0.046) and made more negative comments about the infant's food intake (p = 0.010). Mothers with ED history were more concerned about infant feeding at three months postpartum and reported significantly more problems with solid foods in their children. Birth outcomes were comparable between groups, except for lower weight-for-length birth percentiles in children of women with ED history. CONCLUSION Whilst examined mothers with ED history are more concerned about feeding their children, ED psychopathology does not affect the quality of mother-infant interaction during feeding at the transition to autonomous eating at ten months of age.
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Affiliation(s)
- Annica Franziska Doersam
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany; Centre of Excellence for Eating Disorders (KOMET), University Hospital Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Tuebingen, Baden-Wuerttemberg, Germany; Graduate Training Centre of Neuroscience, International Max Planck Research School, Eberhard Karls University Tuebingen, Tuebingen, Germany.
| | - Jana Katharina Throm
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany; Centre of Excellence for Eating Disorders (KOMET), University Hospital Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Tuebingen, Baden-Wuerttemberg, Germany
| | - Ferdinand Sörensen
- Graduate Training Centre of Neuroscience, International Max Planck Research School, Eberhard Karls University Tuebingen, Tuebingen, Germany; Pediatric Neurology & Developmental Medicine, University Children's Hospital Tuebingen, Tuebingen, Germany; Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tuebingen, Tuebingen, Germany
| | - Peter Martus
- Institute for Medical Biometrics and Clinical Epidemiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Ingeborg Kraegeloh-Mann
- Pediatric Neurology & Developmental Medicine, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the Eberhard Karls University of Tuebingen, FMEG Center, German Centre for Diabetes Research (DZD), Tuebingen, Germany; Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tuebingen, Tuebingen, Germany; Institute of Pharmaceutical Sciences, Department of Pharmacy and Biochemistry, Interfaculty Centre for Pharmacogenomics and Pharma Research at the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Nadia Micali
- Mental Health Services of the Capital Region of Denmark, Center for Eating and Feeding Disorders Research, Psychiatric Centre Ballerup, Ballerup, Denmark; University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany; Centre of Excellence for Eating Disorders (KOMET), University Hospital Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Tuebingen, Baden-Wuerttemberg, Germany
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7
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Mottarlini F, Targa G, Rizzi B, Fumagalli F, Caffino L. Developmental activity-based anorexia alters hippocampal non-genomic stress response and induces structural instability and spatial memory impairment in female rats. Prog Neuropsychopharmacol Biol Psychiatry 2024; 134:111065. [PMID: 38901757 DOI: 10.1016/j.pnpbp.2024.111065] [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: 03/03/2024] [Revised: 05/18/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) is characterized by hyperactivation of the hypothalamic-pituitary-adrenal axis and cognitive deficits. However, little is known about the rapid non-genomic stress response involvement. This study investigates the molecular, structural and behavioral signatures of the anorexic phenotype induction in female rats on stress-related mechanisms in the hippocampus. METHOD Female adolescent rats, exposed to the combination of food restriction and wheel access, i.e., the activity-based anorexia (ABA) protocol, were sacrificed in the acute phase of the pathology (postnatal day [P]42) or following a 7-day recovery period (P49). RESULTS ABA rats, in addition to body weight loss and increased wheel activity, alter their pattern of activity over days, showing increased food anticipatory activity, a readout of their motivation to engage in intense physical activity. Corticosterone plasma levels were enhanced at P42 while reduced at P49 in ABA rats. In the membrane fraction of the hippocampus, we found reduced glucocorticoid receptor levels together with reduced expression of caldesmon, n-cadherin and neuroligin-1, molecular markers of cytoskeletal stability and glutamatergic homeostasis. Accordingly, structural analyses revealed reduced dendritic spine density, a reduced number of mushroom-shaped spines, together with an increased number of thin-shaped spines. These events are paralleled by impairment in spatial memory measured in the spatial order object recognition test. These effects persisted even when body weight of ABA rats was restored. DISCUSSION Our findings indicate that ABA induction orchestrates hippocampal maladaptive structural and functional plasticity, contributing to cognitive deficits, providing a putative mechanism that could be targeted in AN patients.
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Affiliation(s)
- Francesca Mottarlini
- Department of Pharmacological and Biomolecular Sciences 'Rodolfo Paoletti', Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy
| | - Giorgia Targa
- Department of Pharmacological and Biomolecular Sciences 'Rodolfo Paoletti', Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy
| | - Beatrice Rizzi
- Department of Pharmacological and Biomolecular Sciences 'Rodolfo Paoletti', Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy; Center for Neuroscience, University of Camerino, Camerino, Italy
| | - Fabio Fumagalli
- Department of Pharmacological and Biomolecular Sciences 'Rodolfo Paoletti', Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy
| | - Lucia Caffino
- Department of Pharmacological and Biomolecular Sciences 'Rodolfo Paoletti', Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy.
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Cao J, Gorwood P, Ramoz N, Viltart O. The Role of Central and Peripheral Brain-Derived Neurotrophic Factor (BDNF) as a Biomarker of Anorexia Nervosa Reconceptualized as a Metabo-Psychiatric Disorder. Nutrients 2024; 16:2617. [PMID: 39203753 PMCID: PMC11357464 DOI: 10.3390/nu16162617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/26/2024] [Accepted: 08/04/2024] [Indexed: 09/03/2024] Open
Abstract
Neurotrophic factors play pivotal roles in shaping brain development and function, with brain-derived neurotrophic factor (BDNF) emerging as a key regulator in various physiological processes. This review explores the intricate relationship between BDNF and anorexia nervosa (AN), a complex psychiatric disorder characterized by disordered eating behaviors and severe medical consequences. Beginning with an overview of BDNF's fundamental functions in neurodevelopment and synaptic plasticity, the review delves into recent clinical and preclinical evidence implicating BDNF in the pathophysiology of AN. Specifically, it examines the impact of BDNF polymorphisms, such as the Val66Met variant, on AN susceptibility, prognosis, and treatment response. Furthermore, the review discusses the interplay between BDNF and stress-related mood disorders, shedding light on the mechanisms underlying AN vulnerability to stress events. Additionally, it explores the involvement of BDNF in metabolic regulation, highlighting its potential implications for understanding the metabolic disturbances observed in AN. Through a comprehensive analysis of clinical data and animal studies, the review elucidates the nuanced role of BDNF in AN etiology and prognosis, emphasizing its potential as a diagnostic and prognostic biomarker. Finally, the review discusses limitations and future directions in BDNF research, underscoring the need for further investigations to elucidate the complex interplay between BDNF signaling and AN pathology.
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Affiliation(s)
- Jingxian Cao
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM UMR-S 1266, F-75014 Paris, France (O.V.)
| | - Philip Gorwood
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM UMR-S 1266, F-75014 Paris, France (O.V.)
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte Anne, F-75014 Paris, France
| | - Nicolas Ramoz
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM UMR-S 1266, F-75014 Paris, France (O.V.)
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte Anne, F-75014 Paris, France
| | - Odile Viltart
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM UMR-S 1266, F-75014 Paris, France (O.V.)
- SCALab Laboratory, PsySEF Faculty, Université de Lille, UMR CNRS 9193, F-59650 Villeneuve d’Ascq, France
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9
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Todisco P, De Mico A, Meneguzzo P. Vitamin D Status and Behavioral Impulsivity in Anorexia Nervosa: Insights from a Longitudinal Study. Nutrients 2024; 16:2523. [PMID: 39125402 PMCID: PMC11314167 DOI: 10.3390/nu16152523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/19/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Anorexia nervosa (AN) is a severe psychiatric disorder marked by extreme weight control behaviors and significant impacts on physical and psychosocial health. This study explores the relationship between vitamin D (Vit-D) levels and impulsivity in women with AN. Forty-six cisgender White women participants were assessed upon admission and before discharge from a specialized eating disorder treatment center, with an average duration of 2.5 ± 0.10 months. Methods included self-reported questionnaires and behavioral tasks to measure impulsivity, alongside serum Vit-D levels. Our results showed significant improvements in Vit-D levels and certain impulsivity measures, such as faster reaction times and fewer errors on the go/no-go task, correlating with higher Vit-D levels. However, no significant correlations were found between Vit-D levels and self-reported impulsivity. These findings suggest that adequate Vit-D levels may enhance cognitive functions related to impulse control in AN. Given this study's limitations, including its exclusive focus on women and small sample size, future research should involve larger, more diverse populations and randomized clinical trials to better understand the causal relationships and therapeutic potential of Vit-D in managing AN-related impulsivity.
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Affiliation(s)
- Patrizia Todisco
- Eating Disorders Unit, Casa di Cura “Villa Margherita”—KOS Group, Via Costacolonna 20, 36057 Arcugnano, Italy;
| | - Alberto De Mico
- Eating Disorders Unit, Casa di Cura “Villa Margherita”—KOS Group, Via Costacolonna 20, 36057 Arcugnano, Italy;
| | - Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
- Padova Neuroscience Center, University of Padova, 35128 Padova, Italy
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10
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Palermo M, Rancourt D. Examining compulsive exercise as a risk factor for eating disorder symptoms in first-year college students using a latent change score modeling approach. Int J Eat Disord 2024; 57:1680-1690. [PMID: 38619370 DOI: 10.1002/eat.24219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Research suggests that both compulsive exercise and eating disordered behaviors increase during college. Despite strong cross-sectional associations between compulsive exercise and eating disorders, it is unknown if compulsive exercise is a variable risk factor for eating disorders or simply a correlate. It was hypothesized that increases in compulsive exercise would significantly and prospectively predict increases in overall number of eating disorder symptoms over the study period. METHOD A total of 265 first year college students who did not meet criteria for a full or subthreshold eating disorder diagnosis at Time 1 (age M = 18.15; SD = 0.42; 122 female [46%] at Time 1) completed reports of compulsive exercise and eating disorder symptoms via online questionnaires at four timepoints over the 9-month 2021-2022 academic year (76% retention rate). Hypotheses were tested using a bivariate latent change score model. RESULTS Hypotheses were not supported. Change in compulsive exercise did not predict change in number of eating disorder symptoms. Change in number of eating disorder symptoms also did not predict change in compulsive exercise. CONCLUSIONS Compulsive exercise did not emerge as a variable risk factor for the development of eating disorder symptoms among first year college students. The relationship between these behaviors should be investigated at different developmental timepoints, such as early adolescence, and potential third variables that may explain the observed co-occurrence should be explored. PUBLIC SIGNIFICANCE This study investigated whether increases in compulsive exercise predicted increases in number of eating disorder symptoms among first year college students. Compulsive exercise did not significantly predict number of eating disorder symptoms. Additional research is warranted to clarify the relationship between compulsive exercise and eating disorder symptoms.
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Affiliation(s)
- Madeline Palermo
- Department of Psychology, University of South Florida, Tampa, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, Tampa, USA
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Khoshro S, Abbasalizad Farhangi M. Major Dietary Patterns, Exercise Addiction, and Eating Disorders Among a Sample of Physically Active Young Adults. Nutr Metab Insights 2024; 17:11786388241258938. [PMID: 39070982 PMCID: PMC11273586 DOI: 10.1177/11786388241258938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 05/16/2024] [Indexed: 07/30/2024] Open
Abstract
Background Regular exercise has been widely acknowledged for its numerous health benefits, including improvements in physical fitness, body function, and mental well-being. However, excessive exercise and unhealthy dietary patterns can lead to adverse effects on individuals' physical and psychological well-being. This study aimed to examine the association of dietary patterns, exercise addiction, and eating disorders among physically active young adults. Method In this cross-sectional study, a total of 200 physically active young adults aged 18-35 years were included. The participants' dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ) consisting of 80 food items. To determine dietary patterns, factor analysis was employed. Exercise addiction was evaluated using The Exercise Addiction Inventory (EAI) and Exercise Dependence Questionnaire (EDQ), and eating disorders were assessed using The Eating Disorder Examination-Questionnaire Short (EDE-QS). Result Three main dietary patterns were identified: western, healthy, and traditional dietary patterns. The western dietary pattern was associated with increased waist-to-hip ratio (P = .01) that remained significant after adjustment for confounders (eg, age, gender, BMI, and physical activity P = .03), while the adherence to traditional dietary pattern was linked to higher waist circumference and body shape index (P < .05). Participants that followed the healthy dietary pattern showed a higher score of EAI and body shape concern (P = .04). Furthermore, in structural equation modelling (SEM), eating disorder was identified as a significant positive predictor of exercise addiction (r = .17, P < .05). Conclusion According to our finding, those with the higher adherence to healthy dietary pattern had higher scores of exercise addiction and body shape concern. Also, eating disorder was a potential predictor of exercise addiction among young physically active individuals. Further research and targeted interventions are needed to better understand these complex relationships and develop effective strategies to promote healthy behaviors and mitigate the risk of adverse outcomes.
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Affiliation(s)
- Sahar Khoshro
- Faculty of Nutrition, Department of Community Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
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12
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Cripps S, Serpell L, Pugh M. Processes of change in family therapies for anorexia nervosa: a systematic review and meta-synthesis of qualitative data. J Eat Disord 2024; 12:104. [PMID: 39054560 PMCID: PMC11270895 DOI: 10.1186/s40337-024-01037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/31/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE To synthesise young person and family member perspectives on processes of change in family therapy for anorexia nervosa (AN), including systemic family therapy and manualised family-based treatments, to obtain an understanding of what helps and hinders positive change. METHOD A systematic search of the literature was conducted to identify qualitative studies focussing on experiences of therapeutic change within family therapies for AN from the perspectives of young people and their families. Fifteen studies met inclusion criteria and underwent quality appraisal following which they were synthesised using a meta-synthesis approach. RESULTS Six overarching themes were generated: "A holistic focus on the young person's overall development"; "The therapeutic relationship as a vehicle for change"; "The therapist's confinement to a script and its impact on emotional attunement"; "A disempowering therapeutic context"; "Externalisation of the eating disorder (ED)"; and "The importance of family involvement". Positive change was helped by understanding and support given to the young person's overall development including their psychological, emotional, social and physical wellbeing, positive therapeutic relationships, relational containment within the family system and externalising conversations in which young people felt seen and heard. Positive change was hindered by inflexibility in the treatment approach, counter-effects of externalisation, negative experiences of the therapist, a narrow focus on food-intake and weight, as well as the neglect of family difficulties, emotional experiences, and psychological factors. CONCLUSIONS Positive change regarding the young person's eating-related difficulties ensued in the context of positive relational changes between the young person, their family members, the therapist and treatment team, highlighting the significance of secure and trusting relationships. The findings of this review can be utilised by ED services to consider how they may adapt to the needs of young people and their families in order to improve treatment satisfaction, treatment outcomes, and in turn reduce risk for chronicity in AN.
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Affiliation(s)
- Sophie Cripps
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Lucy Serpell
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Matthew Pugh
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
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Pruccoli J, di Torrepadula GR, Bergonzini L, Genovese V, Parmeggiani A. Unveiling vocal profiles in adolescent anorexia nervosa: a Software Based, Multiparametric Analysis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02524-5. [PMID: 39039221 DOI: 10.1007/s00787-024-02524-5] [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: 11/23/2023] [Accepted: 07/04/2024] [Indexed: 07/24/2024]
Abstract
Dysphonia, characterized by disturbances in voice quality and modulation, has been sporadically observed in individuals with Anorexia Nervosa (AN), potentially stemming from both organic and psychopathological factors. This study seeks to employ software-based voice analysis to compare the voices of girls with AN to those of female healthy controls (HC). Case-control study adopting "Praat" software to assess voices. Various parameters, including Acoustic Voice Quality Index (AVQI), Fundamental Frequency (F0), Yanagihara's Spectrographic Dysphonia Classifications, and "GIRBAS" perceptual qualitative voice rating, were investigated. Participants completed questionnaires for Vocal Fatigue Index (VFI) and the Reflux Symptoms Index (RSI). Puberty-related voice spectrum changes were considered, and Bonferroni-corrected BMI-adjusted Analyses of Covariance (ANCOVAs) were conducted. The study enrolled 15 girls with AN and 23 girls with HC. AN patients demonstrated greater impairment in voice tiredness/voice avoidance (VFI-1, p < 0.001), vocal physical discomfort (VIF-2, p = 0.002), and rest as alleviation (VFI-3, p = 0.012). Reflux-related scores were higher in AN (p < 0.001). Differences were observed in voice quality (AVQI) (p = 0.001), and GIRBAS scales showed alterations in multiple parameters. Spectrograms documented more frequent pathological findings in AN patients (p = 0.021). No difference was observed in Fundamental Frequency. These group (AN/HC) differences were independent of weight measures. This study is the first to connect voice irregularities in AN by employing standardized, non-invasive tools and accounting for weight-related factors. Young AN patients demonstrated substantial voice quality changes and heightened self-reported symptoms. Future research should expand on these findings with prospective designs and invasive investigations.
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Affiliation(s)
- Jacopo Pruccoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età evolutiva, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, 40126, Italy
| | | | - Luca Bergonzini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età evolutiva, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, 40126, Italy
| | - Valentina Genovese
- Corso di Laurea di Logopedia, Università di Bologna, Campus Ravenna, Bologna, Italy
- Direzione Infermieristica e Tecnica, Ausl Romagna, Faenza, Italy
| | - Antonia Parmeggiani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età evolutiva, Bologna, Italy.
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, 40126, Italy.
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Gkintoni E, Kourkoutas E, Vassilopoulos SP, Mousi M. Clinical Intervention Strategies and Family Dynamics in Adolescent Eating Disorders: A Scoping Review for Enhancing Early Detection and Outcomes. J Clin Med 2024; 13:4084. [PMID: 39064125 PMCID: PMC11277612 DOI: 10.3390/jcm13144084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background: This systematic review investigated the impact of familial factors on individuals aged 10-17 who have clinical signs or symptoms of eating disorders. Simultaneously, it scrutinized the involvement of the family in therapy, as well as other forms of intervention. Methods: The PsycINFO, PubMed, and Scopus databases were used to search for research material comprehensively. After applying specific criteria, 46 articles were deemed suitable and included in the systematic review. The study comprised a cohort of 4794 adolescents who received a diagnosis of either Anorexia Nervosa (AN), Bulimia Nervosa (BN), or Binge-Eating Disorder (BED). In addition, controls were utilized for 1187 adolescents, 1563 parents, 1809 siblings, and 11 other relatives. Results: The connection between family factors and eating disorders is primarily determined by the families' level of functioning, satisfaction with the family dynamic, parents' attitudes toward their children, and the role of food within the family system. Family Therapy was the most used psychotherapeutic approach in the treatment of AN. The incidence of reports in BN closely paralleled that of Cognitive-Behavioral Therapy (CBT) models. Articles about (Enhanced) CBT were exclusively associated with BED. Conclusions: Family-based approaches are crucial in comprehending, preventing, and addressing eating disorders in adolescents. Incorporating the study of family dynamics and actively engaging families in the treatment process can significantly enhance recovery rates and decrease the occurrence of relapses.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Education and Social Work, University of Patras, 26504 Patras, Greece;
| | - Elias Kourkoutas
- Department of Primary Education, Research Center for the Humanities, Social and Education Sciences, University of Crete, 74150 Rethymno, Greece;
| | | | - Maria Mousi
- Department of Psychology, University of Crete, 74150 Rethymno, Greece;
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Praet N, Stevens J, Casteels K, Toelen J. The Association of Social Media Use and Eating Behaviour of Belgian Adolescent Girls Diagnosed with Anorexia Nervosa-A Qualitative Approach. CHILDREN (BASEL, SWITZERLAND) 2024; 11:822. [PMID: 39062271 PMCID: PMC11276355 DOI: 10.3390/children11070822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Social media have become integral in adolescents' lives, presenting both opportunities and risks, especially concerning psychiatric issues like eating disorders, prevalent in this vulnerable age group. METHODS This qualitative study employed semi-structured interviews with seven adolescent girls (aged 15-17) diagnosed with eating disorders. Interviews covered seven predefined topics, recorded and transcribed for thematic analysis. RESULTS Participants identified four key themes: exposure to selective content, biased interpretation, behavioural adaptation, and evolving perspectives during recovery. They highlighted social media's role in exacerbating body dissatisfaction and altering behaviours related to eating disorders. CONCLUSIONS This research underscores the critical need for awareness and guidance in adolescents' social media use to mitigate negative impacts, emphasizing the potential link between exposure to specific content and cognitive-behavioural changes in those with eating disorders. Further investigation is warranted to deepen our comprehension of these dynamics.
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Affiliation(s)
- Nathalie Praet
- Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium; (N.P.); (J.S.)
| | - Jeff Stevens
- Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium; (N.P.); (J.S.)
| | - Kristina Casteels
- Department of Paediatrics, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Child and Youth Institute, KU Leuven, 3000 Leuven, Belgium
| | - Jaan Toelen
- Department of Paediatrics, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Child and Youth Institute, KU Leuven, 3000 Leuven, Belgium
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Zimmermann-Rösner A, Prehn-Kristensen A. The Microbiome in Child and Adolescent Psychiatry. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024; 52:213-226. [PMID: 38240707 DOI: 10.1024/1422-4917/a000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Recent research has increasingly emphasized the function of the microbiome in human health. The gut microbiome is essential for digesting food and seems to play a vital role in mental health as well. This review briefly overviews the gut microbiome and its interplay with the central nervous system. We then summarize some of the latest findings on the possible role of the microbiome in psychiatric disorders in children and adolescents. In particular, we focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, anorexia nervosa, bipolar disorder, and major depressive disorder. Although the role of microbiota in mental development and health still needs to be researched intensively, it has become increasingly apparent that the impact of microbiota must be considered to better understand psychiatric disorders.
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Affiliation(s)
| | - Alexander Prehn-Kristensen
- Institute for Child and Adolescent Psychiatry, Center of Integrative Psychiatry GmbH, Kiel, Germany
- Department of Psychology, Faculty of Human Sciences, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Hamburg, Germany
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Paquet A, Girard M, Passerieux C, Boule MC, Lacroix A, Sazerat P, Olliac B, Nubukpo P. The body interior in anorexia nervosa: from interoception to conceptual representation of body interior. Front Psychol 2024; 15:1389463. [PMID: 38979073 PMCID: PMC11229774 DOI: 10.3389/fpsyg.2024.1389463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
Background Body image disorders are well documented in anorexia nervosa (AN); however, knowledge of interoceptive awareness (IA) in this population remains poor. This descriptive study investigated whether and how the representation of the interior of the body may have an impact on IA. Methods The representations and knowledge of the body interior were evaluated with a drawing task in 34 women with AN and 34 healthy controls (HCs). A lexicometric analysis was performed on the vocabulary used to describe the drawn body parts in a structured interview. It was assumed that the conceptual representation of the body interior could be affected by or influence IA. Thus, the relationship between IA, measured with the heartbeat task and the ischemia-induction test, and the drawings was explored. Other scales, such as those of body shape, awareness or satisfaction, were used to assess affective representations of the body. Results The drawing, lexicometric and IA results were similar in the two groups. No correlations were found among IA, body representation scores and representation level of body interior. Only the representation of bones by the AN group was significantly different. Discussion Increased visual attention to the skeleton or greater awareness of bone health could explain the stronger representation of bones in the AN group. The psychophysical therapy received by some AN participants (73%) did not seem to have influenced IA. Our results do not support a relationship between IA and the representation of the body interior.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT03988218.
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Affiliation(s)
- Aude Paquet
- Department of Research and Innovation, Centre Hospitalier Esquirol, Limoges, France
- INSERM, Univ. Limoges, IRD, U1094 EpiMACT, Institute of Epidemiology and Tropical Neurology, Limoges, France
- University Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France
| | - Murielle Girard
- Department of Research and Innovation, Centre Hospitalier Esquirol, Limoges, France
- INSERM, Univ. Limoges, IRD, U1094 EpiMACT, Institute of Epidemiology and Tropical Neurology, Limoges, France
| | - Céline Passerieux
- University Hospital Department of Child and Adolescent Psychiatry, Centre Hospitalier Esquirol, Limoges, France
| | - Marie-Christine Boule
- University Hospital Department of Child and Adolescent Psychiatry, Centre Hospitalier Esquirol, Limoges, France
| | - Aurélie Lacroix
- Department of Research and Innovation, Centre Hospitalier Esquirol, Limoges, France
- INSERM, Univ. Limoges, IRD, U1094 EpiMACT, Institute of Epidemiology and Tropical Neurology, Limoges, France
| | - Pierre Sazerat
- University Hospital Department of Addictology, Centre Hospitalier Esquirol, Limoges, France
| | - Bertrand Olliac
- INSERM, Univ. Limoges, IRD, U1094 EpiMACT, Institute of Epidemiology and Tropical Neurology, Limoges, France
- University Hospital Department of Child and Adolescent Psychiatry, Centre Hospitalier Esquirol, Limoges, France
| | - Philippe Nubukpo
- Department of Research and Innovation, Centre Hospitalier Esquirol, Limoges, France
- INSERM, Univ. Limoges, IRD, U1094 EpiMACT, Institute of Epidemiology and Tropical Neurology, Limoges, France
- University Hospital Department of Addictology, Centre Hospitalier Esquirol, Limoges, France
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18
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Giel KE, Bremer J, Rieß-Stumm S, Gregg B, Fritz A, Klemm I, Daugelat MC, Schag K. Enriching a randomized controlled treatment trial for anorexia nervosa by lived experience-Chances and effects of a lived experience council in the SUSTAIN study. Int J Eat Disord 2024; 57:1300-1310. [PMID: 37712498 DOI: 10.1002/eat.24050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The development and advancement of treatment and care options is one priority in the field of eating disorders. The inclusion of persons with lived experience with eating disorders into clinical research could enrich and accelerate this endeavor, as they can add different perspectives on the disease and its treatment. Although lived experience perspectives are increasingly part of eating disorder research, they have not been widely or structurally implemented into clinical trials and there is limited information on the practice of participatory research, its framework and consequences. AIMS The present work outlines the participatory collaboration with a lived experience council in the randomized controlled treatment trial SUSTAIN. MATERIALS & METHODS The manuscript is a participatory publication co-written by individuals with lived experience with anorexia nervosa and eating disorder researchers. RESULTS We report on motivations for this approach, our collaboration principles, structures and shared experience of working together in the trial, the potential burdens and benefits related to participation for people with lived experience. DISCUSSION We outline future directions and perspectives to integrate a participatory framework into clinical eating disorder research. CONCLUSION The involvement of people with experiential knowledge is complex, but possible in clinical research on ED and bears huge potential for the development of more effective care. PUBLIC SIGNIFICANCE Incorporating perspectives of people with lived experience into a participatory framework of mental health research bears huge potential on a societal level. This includes more relevant research topics and designs, more tailored and effective interventions, and facilitated implementation, as well as dissemination, higher credibility, destigmatization of mental illness, and patient empowerment. Participatory clinical research, however, needs structural anchorage within science and society.
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Affiliation(s)
- Katrin Elisabeth Giel
- Department of Psychosomatic Medicine und Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders (KOMET), Tübingen, Germany
- German Center for Mental Health (DZPG)
| | | | | | | | - Anke Fritz
- Lived experience representative SUSTAIN study
| | | | - Melissa-Claire Daugelat
- Department of Psychosomatic Medicine und Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders (KOMET), Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine und Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders (KOMET), Tübingen, Germany
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He Q, Zheng H, Zhang J, Yue L, Kang Q, Lian C, Guo L, Chen Y, Hu Y, Wang Y, Peng S, Wang Z, Liu Q, Chen J. Association between the frontoparietal network, clinical symptoms and treatment response in individuals with untreated anorexia nervosa. Gen Psychiatr 2024; 37:e101389. [PMID: 38808176 PMCID: PMC11131127 DOI: 10.1136/gpsych-2023-101389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/12/2024] [Indexed: 05/30/2024] Open
Abstract
Background Anorexia nervosa (AN) has been characterised as a psychiatric disorder associated with increased control. Currently, it remains difficult to predict treatment response in patients with AN. Their cognitive abilities are known to be resistant to treatment. It has been established that the frontoparietal control network (FPCN) is the direct counterpart of the executive control network. Therefore, the resting-state brain activity of the FPCN may serve as a biomarker to predict treatment response in AN. Aims The study aimed to investigate the association between resting-state functional connectivity (RSFC) of the FPCN, clinical symptoms and treatment response in patients with AN. Methods In this case-control study, 79 female patients with AN and no prior treatment from the Shanghai Mental Health Center and 40 matched healthy controls (HCs) were recruited from January 2015 to March 2022. All participants completed the Questionnaire Version of the Eating Disorder Examination (version 6.0) to assess the severity of their eating disorder symptoms. Additionally, RSFC data were obtained from all participants at baseline by functional magnetic resonance imaging. Patients with AN underwent routine outpatient treatment at the 4th and 12th week, during which time their clinical symptoms were evaluated using the same measures as at baseline. Results Among the 79 patients, 40 completed the 4-week follow-up and 35 completed the 12-week follow-up. The RSFC from the right posterior parietal cortex (PPC) and dorsolateral prefrontal cortex (dlPFC) increased in 79 patients with AN vs 40 HCs after controlling for depression and anxiety symptoms. By multiple linear regression, the RSFC of the PPC to the inferior frontal gyrus was found to be a significant factor for self-reported eating disorder symptoms at baseline and the treatment response to cognitive preoccupations about eating and body image, after controlling for age, age of onset and body mass index. The RSFC in the dlPFC to the middle temporal gyrus and the superior frontal gyrus may be significant factors in the treatment response to binge eating and loss of control/overeating in patients with AN. Conclusions Alterations in RSFC in the FPCN appear to affect self-reported eating disorder symptoms and treatment response in patients with AN. Our findings offer new insight into the pathogenesis of AN and could promote early prevention and treatment.
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Affiliation(s)
- Qianqian He
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Psychology, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Hui Zheng
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jialin Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Ling Yue
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Kang
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng Lian
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Guo
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Chen
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanran Hu
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuping Wang
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sufang Peng
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Wang
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Liu
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jue Chen
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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20
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Reed KK, Silverman AE, Abbaspour A, Burger KS, Bulik CM, Carroll IM. Energy expenditure during nutritional rehabilitation: a scoping review to investigate hypermetabolism in individuals with anorexia nervosa. J Eat Disord 2024; 12:63. [PMID: 38773635 PMCID: PMC11110272 DOI: 10.1186/s40337-024-01019-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/12/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Weight gain and nutritional rehabilitation are essential first steps to achieve medical stabilization in anorexia nervosa, and frequent resistance to weight gain requires patients to consume high kilocalorie loads. Adaptive hypometabolism is common when patients begin treatment, and rebound hypermetabolism is suspected to be a significant barrier to weight gain. The aim of this review was to summarize existing data describing metabolic changes in anorexia nervosa during weight restoration. The reported findings challenge current hypotheses of weight gain resistance and highlight key areas for future research. METHODS Using scoping review guidelines, three databases were searched for studies investigating metabolic changes in anorexia nervosa before and after renourishment. Two reviewers systematically screened the titles and abstracts of 447 articles, and full-text versions of 106 studies were assessed for eligibility. A total of 36 studies were included for review. Data regarding the study description, sample population (including age, weight, BMI, duration of treatment, and caloric intake), and metabolic variable descriptions were extracted. RESULTS Female patients with anorexia nervosa from studies across 13 countries were included. Across the studies, average BMI increased from 13.7 kg/m2 at admission to 17.57 kg/m2. Patients presented to treatment with clinically reduced energy expenditure levels. After varying levels of nutritional rehabilitation and weight restoration, measured energy expenditure increased significantly in 76% of the studies. Energy expenditure values at the second timepoint increased to the standard range for normal weight female teenagers and adults. Despite these increases, the studies do not indicate the presence of a hypermetabolic state during renourishment. Additionally, all studies including both measured and predicted energy expenditure reported that predicted energy expenditure overestimated measured values. CONCLUSION This study provides a detailed evaluation of the literature investigating energy expenditure and metabolic rate in patients with anorexia nervosa before and following a period of renourishment. The findings from this review identify important gaps in the current beliefs of energy expenditure in anorexia nervosa and highlight a need for further exploration of metabolic alterations during weight restoration.
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Affiliation(s)
- Kylie K Reed
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ava E Silverman
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Smith College, Northampton, MA, USA
| | - Afrouz Abbaspour
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kyle S Burger
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cynthia M Bulik
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Ian M Carroll
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Karth M, Kinzig KP. Adolescent activity-based anorexia has a substantial and prolonged impact on social behavior in young adult female rats. Physiol Behav 2024; 279:114528. [PMID: 38531425 DOI: 10.1016/j.physbeh.2024.114528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/01/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
Activity-based anorexia (ABA) is a rodent model of anorexia nervosa (AN) that induces several key components of AN, including voluntary reduction in food intake, reduced body weight, hyperactivity, and alterations to the hypothalamic-pituitary-adrenal (HPA) axis. Previous research has demonstrated persistently increased anxiety-like behavior in the elevated plus maze (EPM), a test measuring avoidance of novel and open areas in adult female rats that experienced ABA during adolescence and are weight-restored in adulthood. Whether the same behavioral effects of two bouts of adolescent ABA emerge in response to different anxiety-provoking stimuli, however, has not been explored. We used the social partition (SP), novelty suppressed feeding (NSF), marble burying, and EPM tests to explore whether two bouts of adolescent ABA have persistent effects on anxiety-like behavior in weight restored young adult female rats. One-way ANOVA analyses revealed that female rats that experienced two bouts of ABA during adolescence had increased anxiety-like behavior in the EPM and SP tests in young adulthood following weight restoration compared with controls. These data demonstrate that the enduring behavioral effects of two bouts of adolescent ABA are specific to particular anxiety-provoking stimuli and suggest that adolescent ABA has enduring effects on social relationships.
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Affiliation(s)
- Melinda Karth
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Kimberly P Kinzig
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA; Purdue University Ingestive Behavior Research Center, Purdue University, West Lafayette, IN, USA.
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22
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McClure Z, Fuller-Tyszkiewicz M, Messer M, Linardon J. Predictors, mediators, and moderators of response to digital interventions for eating disorders: A systematic review. Int J Eat Disord 2024; 57:1034-1048. [PMID: 37886906 DOI: 10.1002/eat.24078] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE Digital interventions show promise as an effective prevention or self-management option for eating disorders (EDs). However, it remains unclear how, for whom, and through what mechanisms they work in this population, as a synthesis of outcome predictors, moderators, and mediators is lacking. This systematic review synthesized empirical research investigating predictors, mediators, and moderators of response to digital interventions for EDs. METHOD Six databases were searched (PROSPERO CRD42022295565) for studies that assessed predictors, moderators, or mediators of response (i.e., uptake, drop-out, engagement, and symptom level change) to a digital prevention or treatment program for EDs. Variables were grouped into several overarching categories (demographic, symptom severity, psychological, etc.) and were synthesized qualitatively across samples without a formally diagnosed ED (typically prevention-focused) and samples with a formally diagnosed ED (typically treatment-focused). RESULTS Eighty-six studies were included. For studies recruiting samples without a formal diagnosis (n = 70 studies), most predictors explored were statistically unrelated to outcome, although participant age, baseline symptom severity, confidence to change, motivation, and program engagement showed preliminary evidence of prognostic potential. No robust moderators or mediators were identified. Few studies recruiting samples with a formal diagnosis emerged (n = 16), of which no reliable predictors, moderators, or mediators were identified. DISCUSSION It remains unclear how, for whom, and under what circumstances digital programs targeting EDs work. We offer several recommendations for future research with the aim of advancing understanding of client characteristics and intervention elements that signal success from this intervention modality. PUBLIC SIGNIFICANCE Digital interventions have shown potential as an effective, scalable, and accessible intervention option for EDs. However, responsiveness varies, so advancing understanding of predictors, mediators, and moderators of outcome to digital interventions for EDs is needed. Such knowledge is important for enabling safe and efficient treatment matching, and for informing future development of effective digital interventions.
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Affiliation(s)
- Zoe McClure
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
| | - Mariel Messer
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
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23
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Suzuki Y, Itagaki S, Nodera M, Suyama K, Yabe H, Hosoya M. Comparison of metabolic parameters between oral and total parenteral nutrition in children with severe eating disorders. Fukushima J Med Sci 2024; 70:75-85. [PMID: 38599829 PMCID: PMC11140198 DOI: 10.5387/fms.2023-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/19/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND This study investigated changes of lipid parameters in children with severe eating disorders during refeeding in order to explore the optimal timing for lipid preparation administration. METHODS We prospectively assessed the physical conditions of patients with eating disorders after the start of nutrition therapy. The assessments were performed at admission and at 2 and 4 weeks. Lipid metabolism was assessed based on triglyceride (TG), total cholesterol (TC), and free carnitine (FC) levels, as well as acylcarnitine/free carnitine (AC/FC) ratio. RESULTS A total of 18 patients were included. Of these, 12 and 6 received an oral diet (OD group) and total parenteral nutrition (TPN group), respectively. The mean body mass indexes at hospital admission were 12.8 kg/m2 in the OD group and 12.7 kg/m2 in the TPN group. At 2 weeks after the start of refeeding, TC, TG, and AC/FC levels were significantly lower in the TPN group than in the OD group. Other blood test results did not show any significant differences between the two groups. CONCLUSIONS Fat-free glucose-based nutrition promoted lipid metabolism over a 2-week period after the start of refeeding, suggesting that balanced energy and lipid intake are essential, even in TPN.
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Affiliation(s)
- Yuichi Suzuki
- Department of Pediatrics, Fukushima Medical University School of Medicine
| | - Shuntaro Itagaki
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine
| | - Maki Nodera
- Department of Pediatrics, Fukushima Medical University School of Medicine
| | - Kazuhide Suyama
- Department of Pediatrics, Fukushima Medical University School of Medicine
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine
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24
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Zeeck A, Lau I, Endorf K, Schaefer L, Euler S, Lahmann C, Hartmann A. Mentalizing in psychotherapeutic processes of patients with eating disorders. Front Psychiatry 2024; 15:1367863. [PMID: 38707623 PMCID: PMC11067051 DOI: 10.3389/fpsyt.2024.1367863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Background Improvement in the capacity to mentalize (i.e., reflective functioning/RF) is considered both, an outcome variable as well as a possible change mechanism in psychotherapy. We explored variables related to (in-session) RF in patients with an eating disorder (ED) treated in a pilot study on a Mentalization-Based Treatment (MBT) - oriented day hospital program. The research questions were secondary and focused on the psychotherapeutic process: What average RF does the group of patients show in sessions and does it change over the course of a single session? Are differences found between sections in which ED symptomatology is discussed and those in which it is not? Does RF increase after MBT-type interventions? Methods 1232 interaction segments from 77 therapy sessions of 19 patients with EDs were rated for RF by reliable raters using the In-Session RF Scale. Additionally, content (ED symptomatology yes/no) and certain MBT interventions were coded. Statistical analysis was performed by mixed models. Results Patients showed a rather low RF, which increased on average over the course of a session. If ED symptomatology was discussed, this was associated with significantly lower RF, while MBT-type interventions led to a significant increase in RF. Conclusions Results suggest that in-session mentalizing can be stimulated by MBT-typical interventions. RF seems to be more impaired when disorder-specific issues are addressed. Further studies have to show if improving a patient´s ability to mentalize their own symptoms is related to better outcomes.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Inga Lau
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Katharina Endorf
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Laura Schaefer
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zürich, Zürich, Switzerland
| | - Claas Lahmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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25
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Prosser A, Leslie F. Eating disorders: is there a correlation between severity of physical compromise and admission outcomes? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S10-S16. [PMID: 38639753 DOI: 10.12968/bjon.2024.33.8.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND The Medical Emergencies in Eating Disorders (MEED) report was first released by the Royal College of Psychiatrists in 2022 (updated 2023) to aid clinicians in recognising medical compromise due to an eating disorder and to provide guidance for management. AIMS This study looked at admissions over 5 years to explore whether there is a correlation between MEED medical compromise parameters and three outcomes: length of stay, detainment under the Mental Health Act 1983, and discharge destination. METHODS A retrospective study of 26 patients admitted to a large teaching hospital for an eating disorder between 2018 and 2023. The risk assessment from the MEED report was used to create a score for physical compromise and analysed to determine whether there was a correlation between the score and discharge destination, detainment under the Mental Health Act and length of stay. FINDINGS Demographic data were comparable with larger studies, with increasing numbers and 19.2% having autism spectrum disorder. There was no correlation between the scoring tool and detainment under the Act, discharge destination or length of stay. CONCLUSION Increasing numbers of patients are presenting with eating disorders. Physical compromise was not a predictor for admission outcomes, but this could be further explored in larger studies.
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Affiliation(s)
| | - Fiona Leslie
- Consultant in Gastroenterology, Manchester Royal Infirmary, Honorary Senior Lecturer, University of Manchester
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26
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Targa G, Mottarlini F, Rizzi B, Taddini S, Parolaro S, Fumagalli F, Caffino L. Anorexia-Induced Hypoleptinemia Drives Adaptations in the JAK2/STAT3 Pathway in the Ventral and Dorsal Hippocampus of Female Rats. Nutrients 2024; 16:1171. [PMID: 38674862 PMCID: PMC11054075 DOI: 10.3390/nu16081171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Leptin is an appetite-regulating adipokine that is reduced in patients with anorexia nervosa (AN), a psychiatric disorder characterized by self-imposed starvation, and has been linked to hyperactivity, a hallmark of AN. However, it remains unknown how leptin receptor (LepR) and its JAK2-STAT3 downstream pathway in extrahypothalamic brain areas, such as the dorsal (dHip) and ventral (vHip) hippocampus, crucial for spatial memory and emotion regulation, may contribute to the maintenance of AN behaviors. Taking advantage of the activity-based anorexia (ABA) model (i.e., the combination of food restriction and physical activity), we observed reduced leptin plasma levels in adolescent female ABA rats at the acute phase of the disorder [post-natal day (PND) 42], while the levels increased over control levels following a 7-day recovery period (PND49). The analysis of the intracellular leptin pathway revealed that ABA rats showed an overall decrease of the LepR/JAK2/STAT3 signaling in dHip at both time points, while in vHip we observed a transition from hypo- (PND42) to hyperactivation (PND49) of the pathway. These changes might add knowledge on starvation-induced fluctuations in leptin levels and in hippocampal leptin signaling as initial drivers of the transition from adaptative mechanisms to starvation toward the maintenance of aberrant behaviors typical of AN patients, such as perpetuating restraint over eating.
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Affiliation(s)
- Giorgia Targa
- Department of Pharmacological and Biomolecular Sciences ‘Rodolfo Paoletti’, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy; (G.T.); (F.M.); (B.R.); (S.T.); (S.P.); (F.F.)
| | - Francesca Mottarlini
- Department of Pharmacological and Biomolecular Sciences ‘Rodolfo Paoletti’, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy; (G.T.); (F.M.); (B.R.); (S.T.); (S.P.); (F.F.)
| | - Beatrice Rizzi
- Department of Pharmacological and Biomolecular Sciences ‘Rodolfo Paoletti’, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy; (G.T.); (F.M.); (B.R.); (S.T.); (S.P.); (F.F.)
- Center for Neuroscience, University of Camerino, 62032 Camerino, Italy
| | - Sofia Taddini
- Department of Pharmacological and Biomolecular Sciences ‘Rodolfo Paoletti’, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy; (G.T.); (F.M.); (B.R.); (S.T.); (S.P.); (F.F.)
| | - Susanna Parolaro
- Department of Pharmacological and Biomolecular Sciences ‘Rodolfo Paoletti’, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy; (G.T.); (F.M.); (B.R.); (S.T.); (S.P.); (F.F.)
| | - Fabio Fumagalli
- Department of Pharmacological and Biomolecular Sciences ‘Rodolfo Paoletti’, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy; (G.T.); (F.M.); (B.R.); (S.T.); (S.P.); (F.F.)
| | - Lucia Caffino
- Department of Pharmacological and Biomolecular Sciences ‘Rodolfo Paoletti’, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milano, Italy; (G.T.); (F.M.); (B.R.); (S.T.); (S.P.); (F.F.)
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27
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Seidel M, Geisler D, King JA, Winter M, Poller NW, Arold D, Gramatke K, Roessner V, Ehrlich S. Dynamic Changes in Local Brain Connectivity and Activity: A Longitudinal Study in Adolescent Anorexia Nervosa. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:447-458. [PMID: 38301885 DOI: 10.1016/j.bpsc.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Resting-state functional connectivity analysis has been used to study disruptions in neural circuitries underlying eating disorder symptoms. Research has shown resting-state functional connectivity to be altered during the acute phase of anorexia nervosa (AN), but little is known about the biological mechanisms underlying neural changes associated with weight restoration. The goal of the current study was to investigate longitudinal changes in regional homogeneity (ReHo) among neighboring voxels, degree centrality (DC) (a voxelwise whole brain correlation coefficient), voxel-mirrored homotopic connectivity (VMHC) (measuring the synchronization between hemispheres), and the fractional amplitude of low-frequency fluctuations associated with weight gain during AN treatment. METHODS Resting-state functional connectivity data were acquired and analyzed from a sample of 174 female volunteers: 87 underweight patients with AN that were scanned before treatment and again after at least 12% body mass index increase, as well as 87 age-matched healthy control participants. RESULTS Longitudinal changes in ReHo, DC, VMHC, and the fractional amplitude of low-frequency fluctuations were observed in most regions identified to differ between patients with AN before treatment and healthy control participants. However, the degree of normalization varied for each parameter, ranging from 9% of all clusters in DC to 66% in VMHC. Longitudinal changes in ReHo and VMHC showed a linear association weight gain. CONCLUSIONS Resting-state functional magnetic resonance imaging measures, including ReHo, DC, VMHC, and the fractional amplitude of low-frequency fluctuations, show varying degrees of recovery after short-term weight restoration. Although only some of these changes were related to weight gain, our results provide an overall positive message, suggesting that weight restoration is associated with changes in functional brain measures that point toward normalization.
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Affiliation(s)
- Maria Seidel
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Daniel Geisler
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Joseph A King
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Marie Winter
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Nico W Poller
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Dominic Arold
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Katrin Gramatke
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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28
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Alkhamis M, Alotaibi WD, Alharbi GJ, Alsaeed AM, Almuhaysin FA. Outcomes of Anorexia Nervosa in a Male Patient Treated With Paroxetine: A Case Report. Cureus 2024; 16:e58765. [PMID: 38654963 PMCID: PMC11036029 DOI: 10.7759/cureus.58765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
Eating disorders (EDs) are among the most dangerous mental illnesses, that are characterized by high mortality rates, multisystem comorbidity, and an often chronic and relapsing disease course. EDs occur most commonly in the female gender, with a ratio of 10 females to 1 male for anorexia nervosa (AN). We present the case of a 15-year-old Saudi boy who presented with weight loss (BMI 11.6 kg/m2) and began to have symptoms of obsessive-compulsive disorder (OCD) in prayer and ablution. His first treatment plan was psychoeducation. He then developed a fear of gaining weight and began to count calories; he was diagnosed with AN and started on olanzapine 2.5 mg. The patient had a history of multiple admissions due to electrolyte imbalance, hypokalemia, hypoglycemia, and anal fissure due to constipation, and was prescribed olanzapine 5 mg, fluoxetine 20. His last admission was the worst, as he became semi-comatose with a Glasgow Coma Scale (GCS) of 13, was diffused and disoriented to time and person, unable to walk or sit, and was uncooperative in answering questions. During admission, we changed the fluoxetine to paroxetine 25 mg and increased the olanzapine to 10 mg, and the patient showed a huge improvement physically and mentally. This case emphasizes the significance of including paroxetine in the treatment of diagnoses for AN to prevent unnecessary wasting of time and effort.
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29
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Schnapp WI, Kim J, Wang Y, Timilsena S, Fang C, Cai H. Development of activity-based anorexia requires PKC-δ neurons in two central extended amygdala nuclei. Cell Rep 2024; 43:113933. [PMID: 38460131 PMCID: PMC11003439 DOI: 10.1016/j.celrep.2024.113933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/12/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024] Open
Abstract
Anorexia nervosa (AN) is a serious psychiatric disease, but the neural mechanisms underlying its development are unclear. A subpopulation of amygdala neurons, marked by expression of protein kinase C-delta (PKC-δ), has previously been shown to regulate diverse anorexigenic signals. Here, we demonstrate that these neurons regulate development of activity-based anorexia (ABA), a common animal model for AN. PKC-δ neurons are located in two nuclei of the central extended amygdala (EAc): the central nucleus (CeA) and oval region of the bed nucleus of the stria terminalis (ovBNST). Simultaneous ablation of CeAPKC-δ and ovBNSTPKC-δ neurons prevents ABA, but ablating PKC-δ neurons in the CeA or ovBNST alone is not sufficient. Correspondingly, PKC-δ neurons in both nuclei show increased activity with ABA development. Our study shows how neurons in the amygdala regulate ABA by impacting both feeding and wheel activity behaviors and support a complex heterogeneous etiology of AN.
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Affiliation(s)
- Wesley Ilana Schnapp
- Department of Neuroscience, University of Arizona, Tucson, AZ 85721, USA; Graduate Interdisciplinary Program in Neuroscience, University of Arizona, Tucson, AZ 85721, USA
| | - JungMin Kim
- Department of Neuroscience, University of Arizona, Tucson, AZ 85721, USA
| | - Yong Wang
- Department of Neuroscience, University of Arizona, Tucson, AZ 85721, USA; Department of Physiology and Pathophysiology, Xi'an Jiaotong University Health Science Center, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, PR China
| | - Sayujya Timilsena
- Department of Neuroscience, University of Arizona, Tucson, AZ 85721, USA
| | - Caohui Fang
- Department of Neuroscience, University of Arizona, Tucson, AZ 85721, USA
| | - Haijiang Cai
- Department of Neuroscience, University of Arizona, Tucson, AZ 85721, USA; Bio5 Institute and Department of Neurology, University of Arizona, Tucson, AZ 85721, USA.
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30
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Suzuki Y, Itagaki S, Nodera M, Suyama K, Yabe H, Hosoya M. Comparison of metabolic parameters between oral and total parenteral nutrition in children with severe eating disorders. Fukushima J Med Sci 2024:2023_02. [PMID: 38522893 DOI: 10.5387/fms.2023_02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND This study investigated changes of lipid parameters in children with severe eating disorders during refeeding in order to explore the optimal timing for lipid preparation administration. METHODS We prospectively assessed the physical conditions of patients with eating disorders after the start of nutrition therapy. The assessments were performed at admission and at 2 and 4 weeks. Lipid metabolism was assessed based on triglyceride (TG), total cholesterol (TC), and free carnitine (FC) levels, as well as acylcarnitine/free carnitine (AC/FC) ratio. RESULTS A total of 18 patients were included. Of these, 12 and 6 received an oral diet (OD group) and total parenteral nutrition (TPN group), respectively. The mean body mass indexes at hospital admission were 12.8 kg/m2 in the OD group and 12.7 kg/m2 in the TPN group. At 2 weeks after the start of refeeding, TC, TG, and AC/FC levels were significantly lower in the TPN group than in the OD group. Other blood test results did not show any significant differences between the two groups. CONCLUSIONS Fat-free glucose-based nutrition promoted lipid metabolism over a 2-week period after the start of refeeding, suggesting that balanced energy and lipid intake are essential, even in TPN.
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Affiliation(s)
- Yuichi Suzuki
- Department of Pediatrics, Fukushima Medical University School of Medicine
| | - Shuntaro Itagaki
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine
| | - Maki Nodera
- Department of Pediatrics, Fukushima Medical University School of Medicine
| | - Kazuhide Suyama
- Department of Pediatrics, Fukushima Medical University School of Medicine
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine
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31
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Sudo Y, Ota J, Takamura T, Kamashita R, Hamatani S, Numata N, Chhatkuli RB, Yoshida T, Takahashi J, Kitagawa H, Matsumoto K, Masuda Y, Nakazato M, Sato Y, Hamamoto Y, Shoji T, Muratsubaki T, Sugiura M, Fukudo S, Kawabata M, Sunada M, Noda T, Tose K, Isobe M, Kodama N, Kakeda S, Takahashi M, Takakura S, Gondo M, Yoshihara K, Moriguchi Y, Shimizu E, Sekiguchi A, Hirano Y. Comprehensive elucidation of resting-state functional connectivity in anorexia nervosa by a multicenter cross-sectional study. Psychol Med 2024:1-14. [PMID: 38500410 DOI: 10.1017/s0033291724000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Previous research on the changes in resting-state functional connectivity (rsFC) in anorexia nervosa (AN) has been limited by an insufficient sample size, which reduced the reliability of the results and made it difficult to set the whole brain as regions of interest (ROIs). METHODS We analyzed functional magnetic resonance imaging data from 114 female AN patients and 135 healthy controls (HC) and obtained self-reported psychological scales, including eating disorder examination questionnaire 6.0. One hundred sixty-four cortical, subcortical, cerebellar, and network parcellation regions were considered as ROIs. We calculated the ROI-to-ROI rsFCs and performed group comparisons. RESULTS Compared to HC, AN patients showed 12 stronger rsFCs mainly in regions containing dorsolateral prefrontal cortex (DLPFC), and 33 weaker rsFCs primarily in regions containing cerebellum, within temporal lobe, between posterior fusiform cortex and lateral part of visual network, and between anterior cingulate cortex (ACC) and thalamus (p < 0.01, false discovery rate [FDR] correction). Comparisons between AN subtypes showed that there were stronger rsFCs between right lingual gyrus and right supracalcarine cortex and between left temporal occipital fusiform cortex and medial part of visual network in the restricting type compared to the binge/purging type (p < 0.01, FDR correction). CONCLUSION Stronger rsFCs in regions containing mainly DLPFC, and weaker rsFCs in regions containing primarily cerebellum, within temporal lobe, between posterior fusiform cortex and lateral part of visual network, and between ACC and thalamus, may represent categorical diagnostic markers discriminating AN patients from HC.
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Affiliation(s)
- Yusuke Sudo
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Chiba University, Chiba, Japan
- Department of Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Junko Ota
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Applied MRI Research, Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan
| | - Tsunehiko Takamura
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Rio Kamashita
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan
- Research Center for Child Mental Development, Fukui University, Eiheizi, Japan
| | - Noriko Numata
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan
| | - Ritu Bhusal Chhatkuli
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Applied MRI Research, Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan
| | - Tokiko Yoshida
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Jumpei Takahashi
- Department of Psychiatry, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Hitomi Kitagawa
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Michiko Nakazato
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Yasuhiro Sato
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
| | - Yumi Hamamoto
- Department of Psychology, Northumbria University, Newcastle-upon-Tyne, UK
- Department of Human Brain Science, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Japan
| | - Tomotaka Shoji
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
- Department of Internal Medicine, Nagamachi Hospital, Sendai, Japan
- Department of Psychosomatic Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Tomohiko Muratsubaki
- Department of Psychosomatic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Motoaki Sugiura
- Department of Human Brain Science, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Japan
- Cognitive Sciences Lab, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Shin Fukudo
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
- Department of Psychosomatic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiko Kawabata
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Momo Sunada
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomomi Noda
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keima Tose
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masanori Isobe
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoki Kodama
- Division of Psychosomatic Medicine, Department of Neurology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shingo Kakeda
- Department of Radiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masatoshi Takahashi
- Division of Psychosomatic Medicine, Department of Neurology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shu Takakura
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Motoharu Gondo
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kazufumi Yoshihara
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshiya Moriguchi
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan
| | - Atsushi Sekiguchi
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
- Center for Eating Disorder Research and Information, National Center of Neurology and Psychiatry, Kodaira, Japan
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Applied MRI Research, Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan
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Maciejewska B, Maciejewska-Szaniec Z, Małaczyńska B, Rajewska-Rager A, Michalak M, Iwanowski P. Effects of Age-Dependent Hormonal Changes and Estrogen Supplementation on Voice in Girls with Anorexia Nervosa-Preliminary Report. J Voice 2024:S0892-1997(24)00028-6. [PMID: 38493018 DOI: 10.1016/j.jvoice.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Human development includes lots of physical and emotional changes. The human voice depends on age. Voice production is a complex physiological and acoustic phenomenon that depends on many factors such as structure, hormone level, degree of fatigue or nutrition and hydration of the body, systemic diseases, and emotional state. All these factors can be present in anorexia nervosa (AN), such as excessive weight loss, generated hydro-electrolytic changes, nutritional deficiencies, hormonal disturbances in the function of the hypothalamic-pituitary-adrenal axis, the hypothalamic-pituitary-thyroid axis, the hypothalamic-pituitary-ovarian axis, and emotional distress. The prevalence of AN ranges between 0.3% and 3%, and it is the third most common chronic disease affecting adolescent girls. However, voice changes related to AN have not been fully investigated. OBJECTIVE The purpose of this study was to evaluate the impact of AN on age-related changes in the voice of adolescent women-before and after puberty, particularly through acoustic analysis. An additional objective was to evaluate estrogen substitution in female patients with AN in order to investigate their effect on voice condition. MATERIALS AND METHODS 126 girls diagnosed with AN (15.32 ± 2.12 years, range 12-19, BMI = 14.38 ± 1.67), were assessed for the condition of the voice such as perceptual voice evaluation on the GRBAS scale, maximal phonation time (MPT), laryngoscopy, with special attention to voice acoustic analysis-Multi-Dimensional Voice Program (MDVP). The control group (B) included 93 girls without eating disturbances (aged 12-19, mean age 15.52 ± 2.40, BMI = 21.50 ± 1.54). Perceptual voice assessment, aerodynamic test MPT, and acoustic parameters were analyzed in age groups (≤16 years and >16 years). The human vocal tract is sensitive to sex hormones, so the analysis was carried out in the group up to the age of 16 and above 16 to check possible effects. RESULTS GRBAS scale was higher in girls with AN compared to the control group for breathiness (B) (P = 0.0002) and asthenia (A) (P < 0.05). The median GRBAS scale for the older group of anorexic women was the highest (2.0). The mean MPT for group A was significantly lower (15.40 ± 3.51 seconds). Comparing age subgroups there was a prolongation of MPT in the healthy group (in groups ≤16 years and >16 years respectively 21.13 seconds versus 25.40 seconds) and a shortening in the anorectic group (≤16 years versus >16 years: 17.06 seconds versus 14.17 seconds). There was no difference between groups A and C up to 16 years of age, but above 16 years of age appeared (14.17 seconds versus 25.40 seconds). Acoustic analysis revealed lower F0 values in group A and C in older subgroups (215,85 Hz versus 236,01 Hz-statistically significant), as well as between subgroups both groups (A: 251,38 Hz versus 215,85 Hz; C: 248,20 Hz versus 236,01 Hz). A narrowing of the vocal range in girls over 16 years in group A was observed. There were no statistically significant differences in F0 between subgroups ≤16 years in groups A and C (251.38 Hz versus 248.20 Hz). The ENT study found that more than half of the girls (54.55%) over the age of 16 who took hormone supplementation manifested laryngeal structure that was normal for their age, there was no effect of hormone supplementation on any of the MDVP parameters between the drug-taking and non-drug-taking groups. CONCLUSIONS The acoustic results of the voice in MDVP measurements in adolescent women with AN are not within the normal range and do not mimic the normal developmental changes of the voice. The most important acoustic characteristics of the voice are changes in the fundamental frequency F0 and the range of the voice tended to be more severe in anorectic women >16 years of age and to increase with age, indicating a possible cumulative effect of malnutrition-related disorders as well as hormonal dysfunctions. MDVP can be considered a simple, non-invasive method of assessing the voice organ in AN. MPT differentiated the study groups well: statistically significant differences were noted both between the groups, as well as between age groups. There was no significant effect of oral hormone supplementation on any parameters of the voice. In conclusion, body mass and fat volume in AN may be related to voice production/physiology, affecting voice quality, voice acoustic parameters, voice aerodynamics, and phonatory range in an age-dependent manner. Future studies are needed to assess the long-term efficacy of estrogen treatment in AN.
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Affiliation(s)
- Barbara Maciejewska
- Department and Clinic of Phoniatrics and Audiology, Poznan University of Medical Sciences
| | | | - Bogna Małaczyńska
- Department and Clinic of Phoniatrics and Audiology, Poznan University of Medical Sciences
| | | | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences
| | - Piotr Iwanowski
- Department of Neurology, Poznan University of Medical Sciences.
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Hebebrand J, Gradl-Dietsch G, Peters T, Correll CU, Haas V. The Diagnosis and Treatment of Anorexia Nervosa in Childhood and Adolescence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:164-174. [PMID: 38170843 DOI: 10.3238/arztebl.m2023.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious disease with a lifetime prevalence of up to 3.6% in women and 0.3% in men. Abnormally low weight and the associated starvation partly account for its somatic and mental manifestations. METHODS This review is based on publications retrieved by a selective search concerning AN in childhood and adolescence. RESULTS The peak age of onset of AN is 15.5 years. The frequency of inpatient treatment for AN rose by 40% during the COVID pandemic, indicating the importance of environmental factors; the heritability of AN is estimated at 0.5. The ICD-11 sets the threshold for AN-associated underweight at the fifth percentile for age of the body mass index, as long as the remaining diagnostic criteria are met. The main goal of the multiprofessional treatment of AN is the return to normal body weight, which is a central prerequisite for regaining somatic and mental health. The mean duration of AN is 3.4 years, and approximately twothirds of patients recover from the disease over the long term. CONCLUSION Marked weight loss in childhood and adolescence can trigger AN in the presence of a predisposition to this disease. Patients and their families should receive psychoeducation regarding the symptoms of starvation and their overlap with those of AN. Important objectives are to shorten the duration of the illness, minimize mortality and the risk of chronic illness, and to identify pharmacological approaches to treatment.
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Affiliation(s)
- Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, LVR-Klinikum Essen, University of Duisburg-Essen; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin; The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; German Center for Mental Health (DZPG), Partner Site Berlin
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Vrabel KR, Waller G, Goss K, Wampold B, Kopland M, Hoffart A. Cognitive behavioral therapy versus compassion focused therapy for adult patients with eating disorders with and without childhood trauma: A randomized controlled trial in an intensive treatment setting. Behav Res Ther 2024; 174:104480. [PMID: 38310672 DOI: 10.1016/j.brat.2024.104480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 01/07/2024] [Accepted: 01/17/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE Treatments for eating disorders are moderately effective, with cognitive behavior therapy (CBT) providing the strongest evidence. However, it remains important to investigate other interventions, particularly for eating disorders with greater complexity (e.g., substantial comorbidity; trauma history) or for patients who have not responded adequately to previous treatments. METHOD This randomized controlled trial compared CBT against compassion-focused therapy for eating disorders (CFT-E), where half of the sample had a childhood trauma history. The study was pre-registered and adequately powered. A total of 130 patients were randomly assigned to CBT or CFT-E and were assessed at pre-treatment, post-treatment and one-year follow-up. The primary outcome measure was the total score on the Eating Disorder Examination-Interview (EDE), and secondary outcome measures were the Symptom Checklist-90, Inventory of Interpersonal Problems-64 and Post-Traumatic Symptom Scale. Attrition during treatment was low (13%), suggesting good acceptability. RESULTS Eating pathology (EDE scores) reduced substantially overall, with large effect sizes, and there were no differences between therapies. However, at follow-up, for patients with a childhood trauma history, CFT-E maintained benefits better than CBT. CONCLUSION While both CBT and CFT-E resulted in significant reductions in eating pathology, CFT-E showed superior maintenance of benefits for patients with a history of childhood trauma at one-year follow-up, underlining the necessity of tailored interventions for specific patient subgroups.
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Affiliation(s)
- KariAnne R Vrabel
- Research Institute of Modum Bad, Vikersund, Norway; University of Oslo, Oslo, Norway.
| | | | - Ken Goss
- Coventry Eating Disorder Service, UK
| | - Bruce Wampold
- Research Institute of Modum Bad, Vikersund, Norway; University of Wisconsin, Madison, USA
| | | | - Asle Hoffart
- Research Institute of Modum Bad, Vikersund, Norway
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Halbeisen G, Laskowski N, Brandt G, Waschescio U, Paslakis G. Eating Disorders in Men. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:86-91. [PMID: 38019152 PMCID: PMC11002438 DOI: 10.3238/arztebl.m2023.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Eating disorders are seen mainly as a problem affecting women, not just by the public at large, but also in specialized circles. Although it is true that more women than men suffer from all types of eating disorder, pertinent reviews have clearly shown that they do indeed occur in men, and that the available evidence on the matter is limited. The stigmatization of men with eating disorders makes it harder for these men, and for the relevant professionals, to recognize the symptoms and to seek or provide help. METHODS This review is based on publications retrieved by a selective search in PubMed on the epidemiological, diagnostic, clinical, and therapeutic aspects of eating disorders in men. RESULTS Current estimated lifetime prevalences in men are 0.2% for anorexia nervosa, 0.6% for bulimia nervosa, and 1% for bingeeating disorder; the corresponding figures for women are 1.4%, 1.9%, and 2.8%. Men and women may display different manifestations. Women are thought to be mainly seeking a slim figure and weight reduction; men, a muscular build. The established Germanlanguage screening and diagnostic tools, however, do not cover the types of symptoms that are more common in men. Little is known about whether treatment yields comparable results in men and women. CONCLUSION It is important to combat the stigmati - zation of men with eating disorders and to remove the obstacles to their appropriate diagnosis and treatment. The current methods of screening and diagnosis need to be adapted to take account of the special aspects of abnormal eating behavior in men. It remains unclear whether and how the disorderspecific treatment of these conditions in men should differ from their treatment in women.
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Affiliation(s)
- Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
| | - Nora Laskowski
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
| | - Gerrit Brandt
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
| | | | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
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Zhu R, Lan Y, Qian X, Zhao J, Wang G, Tian P, Chen W. Streptococcus salivarius subsp. thermophilus CCFM1312 enhanced mice resilience to activity-based anorexia. Food Funct 2024; 15:1431-1442. [PMID: 38224462 DOI: 10.1039/d3fo04663j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Probiotic intervention, already showing promise in the treatment of various psychiatric disorders like depression, emerges as a potential therapy for anorexia nervosa (AN) with minimal side effects. In this study, we established an activity-based anorexia (ABA) model to probe the pathogenesis of AN and assess the impact of probiotics on ABA mice. ABA resulted in a compensatory increase in duodenal ghrelin levels, impairing the regulation of feeding and the brain reward system. Intervention with Streptococcus salivarius subsp. thermophilus CCFM1312 ameliorated these ABA-induced effects, and the activation of neurons in the nucleus tractus solitarius (NTS) was observed following probiotic administration, revealing the advantageous role of probiotics in AN through the vagus nerve. Furthermore, our metabolomics analysis of cecal contents unveiled that S. salivarius subsp. thermophilus CCFM1312 modulated gut microbiota metabolism and thereby regulated intestinal ghrelin levels.
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Affiliation(s)
- Ran Zhu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, P. R China.
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Yuming Lan
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, P. R China.
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Xin Qian
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, P. R China.
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, P. R China.
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, Jiangsu 214122, China
- (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
| | - Gang Wang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, P. R China.
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, Jiangsu 214122, China
- (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
| | - Peijun Tian
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, P. R China.
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Wei Chen
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, P. R China.
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, Jiangsu 214122, China
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Zhao W, Kodancha P, Das S. Gut Microbiome Changes in Anorexia Nervosa: A Comprehensive Review. PATHOPHYSIOLOGY 2024; 31:68-88. [PMID: 38390943 PMCID: PMC10885100 DOI: 10.3390/pathophysiology31010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/03/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
Anorexia nervosa (AN) remains a challenging condition in psychiatric management and its pathogenesis is not yet fully understood. An imbalance in the gut microbiota composition may contribute to its pathophysiology. This review aims to explore the link between the human gut microbiota and AN (objective 1) or refeeding syndrome in AN (objective 2). The online databases MEDLINE and PsycINFO were searched for relevant studies. A total of 14 studies met the inclusion and exclusion criteria and only answered objective 1. A total of 476 AN patients, 554 healthy-weight (HC) controls, and 0 patients with other psychiatric disorders were included. Compared to HC, there were consistently reduced abundances of Faecalibacterium prausnitzii and Roseburia inulinivorans, and increased Methanobrevibacter smithii, in AN patients. Changes in alpha diversity were inconsistent, while beta diversity increased in four of six studies. Our model suggests that an imbalance in gut microbiota composition leads to reduced short-chain fatty acids, contributing to a proinflammatory state in AN, which is also common in other psychiatric comorbidities. Microbial changes may also contribute to the semistarvation state through endocrine changes and altered energy utilization.
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Affiliation(s)
- Wendi Zhao
- Department of Psychiatry, University of Melbourne, Parkville, Melbourne 3052, Australia
| | | | - Soumitra Das
- Unit of Psychiatry, Western Health, Melbourne 3021, Australia
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Haas V, Wechsung K, Kaiser V, Schmidt J, Raile K, Busjahn A, Le Grange D, Correll CU. Comparing family-based treatment with inpatient treatment in youth with anorexia nervosa eligible for hospitalization: A 12-month feasibility study. Int J Eat Disord 2024; 57:388-399. [PMID: 38082440 DOI: 10.1002/eat.24098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Family-based treatment (FBT) for youth with anorexia nervosa (AN), has not been compared to inpatient, multimodal treatment (IMT). METHOD Prospective, non-randomized pilot feasibility study of adolescents with AN receiving FBT (n = 31), and as a reference point for exploratory outcome comparisons IMT (n = 31), matched for baseline age and percent median BMI (%mBMI). Feasibility of FBT in youth fulfilling criteria for IMT was assessed via study recruitment and retention rates; acceptability via drop-out and caregiver strain; safety via adverse events; preliminary treatment effectiveness between groups was assessed via a change in %mBMI, AN psychopathology (Eating Disorder Examination-Questionnaire, EDE-Q), and hospital days, over 12 months with intent-to-treat, mixed models repeated measures analyses covering post-intervention usual care until 12 months. RESULTS Taking into account that 8 FBT patients (25.8%) crossed over to IMT due to lack of weight gain or psychiatric concerns, FBT and IMT were similarly feasible, acceptable, and safe, apart from more physical antagonism toward others in FBT (p = .010). FBT lasted longer (median [interquartile range, IQR]; 33.6 [17.4, 49.9] vs. 17.3 [14.4, 24] weeks, p < .001), but required fewer hospital days than IMT (median, [IQR], FBT = 1 [0, 16] vs. IMT = 123 [101, 180], p < .001). Baseline comorbidity-adjusted changes over 12 months did not differ between groups in %mBMI (FBT = 12.6 ± 11.9 vs. IMT = 13.7 ± 9.1; p = .702) and EDE-Q global score (median, [IQR]; FBT = -1.2 [-2.3, 0.2] vs. IMT = -1.3 [-2.8, -0.4]; p = .733). DISCUSSION Implementing FBT in this pilot study was feasible, acceptable, and safe for youth eligible for IMT according to German S3 guidelines. Non-inferiority of FBT versus IMT requires confirmation in a sufficiently large multicenter RCT. PUBLIC SIGNIFICANCE This pilot study with 62 adolescent patients with anorexia nervosa demonstrated that for 2/3rd of patients eligible for a long hospitalization in the German health care system, outpatient, Family-based treatment (FBT) was a safe and feasible treatment alternative. Over 12 months, FBT lead to similar weight gain and reduction in eating disorder cognitions as inpatient treatment with fewer hospital days. This pilot study needs to be followed up by a larger, multicenter trial.
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Affiliation(s)
- Verena Haas
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Katja Wechsung
- Center for Social-Pediatric Care/Paediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Vivien Kaiser
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Janine Schmidt
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Klemens Raile
- Department of Pediatric Endocrinology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, USA
- Department of Psychiatry and Behavioral Neurosciences, The University of Chicago (Emeritus), Chicago, USA
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- German Center for Mental Health (DZPG), Berlin, Germany
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Hussain MS, Sharma N, Khurana N. An Update on Eating Disorders. CURRENT NUTRITION & FOOD SCIENCE 2024; 20:167-174. [DOI: 10.2174/1573401319666230329135010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 03/31/2023]
Abstract
Abstract:
It is no surprise that eating disorders (EDs) are increasing all over the planet. With the
emergence of global westernization, development in technology, and societal changes, nearly all
regions of the globe have been influenced by the concept of a perfect body image and height.
EDs are a considerable public concern, a bewilderment for psychologists and a challenge for
physicians. The primary EDs include anorexia nervosa (AN), bulimia nervosa (BN), and binge
eating disorder (BED). AN is an ED that is psychological and possibly life-threatening. Usually,
people with AN experience an exceedingly low body weight due to their height and body shape.
The highest rate of occurrence is between 14 and 17 years of age. BN is an extreme, lifethreatening,
neurological ED in which you have binge eating cycles. You may not have any
sense of balance in your diet throughout these binges. The weight-control engagement of patients
with AN and BN results in various physiological shifts. EDs can control your lives and can be
quite hard to cope with. Yet you will develop a better understanding of who you are by therapy,
return to healthy eating and exercise, and undo any of the severe complications of AN. Investigation
into EDs has yielded valuable new information over the past few decades, notably involving
the psychological features and care of patients. The purpose of this study/review is to expand the
knowledge of the people about these EDs, their global burden, diagnostic criteria, risk factors,
medical complications, management, and the newly added avoidant/restrictive food intake disorder.
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Affiliation(s)
- Md. Sadique Hussain
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Neha Sharma
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Navneet Khurana
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
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Heywood L, Conti J, Touyz S, Madden S, Hay P. Key-in-session identity negotiations in a first line treatment for adult anorexia nervosa. J Eat Disord 2024; 12:20. [PMID: 38297339 PMCID: PMC10832269 DOI: 10.1186/s40337-024-00979-0] [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: 09/02/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Exploration of client identity negotiations during treatment for Anorexia Nervosa (AN) is a relatively new area of research. Research suggests that difficulties with identity negotiations may present as a barrier to treatment. This study sought to explore individuals' identity negotiations during therapy sessions using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN). Analysis focused on moments in therapy where individuals' identities were dominated or defined by AN and where alternative identities could be generated. METHOD 40 in-session transcripts from sessions at early, mid and end points of the CBT-AN (with LEAP) treatment were qualitatively analysed for nine of the 78 participants in the original randomised control trial. Through a constructivist framework, thematic analysis was used to identify surface and latent meanings and discursive material participants used to negotiate their identities in the context of therapy sessions. RESULTS Analysis of in-therapy transcripts generated two themes pertaining to identity negotiations: (1) troubled identities and (2) rebuilding identities and lives outside of AN. Early therapy sessions explored fragmented and AN dominated identities, including how AN was troubling to participants' sense of self, contributed to conflicted identities, positioned them outside of normality, and was associated with isolated and othering identities. Within therapy sessions, participants engaged in a recursive process of shifting relationships with AN and themselves and building identities and lives outside of the AN identity. This included generating hopes for recovery and the future more frequently in mid- to late- therapy sessions. CONCLUSION Identity negotiations evident in the therapeutic conversations aligned with the key components of the CBT-AN intervention, including addressing (1) the characterisation of oneself as 'an anorexic' and (2) the diversification of roles and activities to broaden and enhance self-concepts. Future developments of therapeutic interventions for AN would benefit from greater consideration of ways to assist individuals to more comprehensively address problematic identities, including uncovering identities hidden by the AN identity and generating preferred identities. TRIAL REGISTRATION Ethics approval was obtained at the time of the initial study and for this embedded research by the HREC at the Western Sydney University (HR777332).
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Affiliation(s)
- Lauren Heywood
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Janet Conti
- School of Psychology, Western Sydney University, Sydney, Australia.
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Stephen Touyz
- Inside Out Institute, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Sloan Madden
- School of Medicine and Heath, University of Sydney, Ramsay Clinic Northside, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
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Woodruff K, Joy EA, Burns RD, Summers SA, Metos JM, Jordan KC. A Retrospective Chart Review Suggests That Coordinated, Multidisciplinary Treatment for Patients with Anorexia Nervosa Improves Odds of Weight Restoration. J Multidiscip Healthc 2024; 17:339-351. [PMID: 38284120 PMCID: PMC10821668 DOI: 10.2147/jmdh.s437376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/08/2024] [Indexed: 01/30/2024] Open
Abstract
Purpose The objective of this study was to conduct a secondary data analysis of clinical information documented in the electronic medical record to assess the clinical outcomes of patients who received three different treatment approaches on clinical outcomes for treatment of patients with anorexia nervosa (AN). Patients and methods Historical electronic medical record (EMR) data on patients aged 6 to 80 years diagnosed with AN seen in a healthcare system between 2007 and 2017 were stratified, according to services received, into three groups: Group A (n = 48) received hospital-based services; Group B (n = 290) saw one or two provider types; Group C (n = 26) received outpatient coordinated multidisciplinary care from three provider types. Clinical outcomes [body mass index for adults (BMI), body mass index percentile (BMI%ile) for pediatric patients] defined AN severity and weight restoration. EMR data were analyzed using a generalized mixed-effects model and a Markov Transition model to examine the odds of weight restoration and the change in odds of weight restoration across the number of provider visits, respectively. Results Patients receiving coordinated multidisciplinary care had significantly higher odds of weight restoration compared with patients receiving hospital-based services only (OR = 3.76, 95% CI [1.04, 13.54], p = 0.042). In addition, patients receiving care from 1 to 2 providers (OR = 1.006, 95% CI [1.003, 1.010], p = 0.001) or receiving coordinated multidisciplinary care (OR = 1.005, 95% CI [1.001, 1.011], p = 0.021) had significantly higher odds of weight restoration per provider visit day compared with patients receiving hospital-based services only. Conclusion This retrospective chart review supports the coordinated, multidisciplinary care model for the weight restoration in patients with AN in an outpatient setting.
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Affiliation(s)
- Kary Woodruff
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth A Joy
- Office of Health Promotion and Wellness, Intermountain Health, Salt Lake City, UT, USA
| | - Ryan D Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Scott A Summers
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Julie M Metos
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Kristine C Jordan
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
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Kiely L, Conti J, Hay P. Anorexia nervosa through the lens of a severe and enduring experience: 'lost in a big world'. J Eat Disord 2024; 12:12. [PMID: 38254163 PMCID: PMC10804804 DOI: 10.1186/s40337-023-00953-2] [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: 09/04/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Severe and enduring anorexia nervosa (SE-AN), is a serious and persistent illness, despite 'state of the art' treatment. Criteria have been theoretically proposed, but not tested, and may not adequately capture illness complexity, which potentially inhibits treatment refinements. The clinical reality of death as an outcome for some people who experience SE-AN (1 in 20) and broadening access to voluntary assisted dying, further complicates the field, which is undeveloped regarding more fundamental concepts such as nosology, treatment, recovery definitions and alternative conceptualisations of SE-AN. The present paper is in response to this and aims to build upon qualitative literature to enhance phenomenological understandings of fatal SE-AN. METHOD A published book, being the legacy of a 32-year-old professional artist offers a rich account of a life lived with AN, for 18 years with continuous treatment. A polysemous narrative via the interrelationship between the languages of the artist's words and visual art is translated via interpretative phenomenological analysis (IPA), offering rich insight into the SE-AN experience. FINDINGS The process of analysis induced three superordinate themes (1) Disappearing Self (2) Dialectical Dilemma (3) Death and Dying: Finding Meaning. Two cross cutting themes traversed these themes: (a) Colour and (b) Shifting Hope, where the former produced a visual representation via the 'SE-AN Kaleidoscope'. Collectively the themes produce a concept of SE-AN, grounded in the data and depicted visually through the artist's paintings. CONCLUSIONS The picture of SE-AN revealed in the analysis extends upon conceptualisations of SE-AN, highlighting key processes which are thus far under explored. These factors are implicated in illness persistence eliciting opportunities for further research testing including diagnostic considerations and treatment directions. In SE-AN, distorted body image extends to a global distortion in the perception of self. Additional criteria for the severe and enduring stages of illness related to (1) self and identity processes (2) measures of 'global impoverishment' across life domains are proposed for consideration in the future testing of putative defining features of SE-AN.
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Affiliation(s)
- Laura Kiely
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Janet Conti
- School of Psychology, Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
- Mental Health Services, Camden and Campbelltown Hospitals, SWSLHD, Campbeltown, NSW, 2560, Australia
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Salaün C, Courvalet M, Rousseau L, Cailleux K, Breton J, Bôle-Feysot C, Guérin C, Huré M, Goichon A, do Rego JC, Déchelotte P, Ribet D, Achamrah N, Coëffier M. Sex-dependent circadian alterations of both central and peripheral clock genes expression and gut-microbiota composition during activity-based anorexia in mice. Biol Sex Differ 2024; 15:6. [PMID: 38217033 PMCID: PMC10785476 DOI: 10.1186/s13293-023-00576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/16/2023] [Indexed: 01/14/2024] Open
Abstract
RATIONALE Patients with anorexia nervosa (AN) often present sleep disorders and circadian hormonal dysregulation. The role of the microbiota-gut-brain axis in the regulation of feeding behavior has emerged during the last decades but its relationships with the circadian rhythm remains poorly documented. Thus, we aimed to characterize the circadian clock genes expression in peripheral and central tissues in the activity-based anorexia mouse model (ABA), as well as the dynamics of the gut-microbiota composition. METHODS From day 1 to day 17, male and female C57Bl/6 mice were submitted or not to the ABA protocol (ABA and control (CT) groups), which combines a progressive limited access to food and a free access to a running wheel. At day 17, fasted CT and ABA mice were euthanized after either resting (EoR) or activity (EoA) phase (n = 10-12 per group). Circadian clock genes expression was assessed by RT-qPCR on peripheral (liver, colon and ileum) and central (hypothalamic suprachiasmatic nucleus or SCN) tissues. Cecal bacterial taxa abundances were evaluated by qPCR. Data were compared by two-way ANOVA followed by post-tests. RESULTS ABA mice exhibited a lower food intake, a body weight loss and an increase of diurnal physical activity that differ according with the sex. Interestingly, in the SCN, only ABA female mice exhibited altered circadian clock genes expression (Bmal1, Per1, Per2, Cry1, Cry2). In the intestinal tract, modification of clock genes expression was also more marked in females compared to males. For instance, in the ileum, female mice showed alteration of Bmal1, Clock, Per1, Per2, Cry1, Cry2 and Rev-erbα mRNA levels, while only Per2 and Cry1 mRNAs were affected by ABA model in males. By contrast, in the liver, clock genes expression was more markedly affected in males compared to females in response to ABA. Finally, circadian variations of gut-bacteria abundances were observed in both male and female mice and sex-dependent alteration were observed in response to the ABA model. CONCLUSIONS This study shows that alteration of circadian clock genes expression at both peripheral and central levels occurs in response to the ABA model. In addition, our data underline that circadian variations of the gut-microbiota composition are sex-dependent.
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Affiliation(s)
- Colin Salaün
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
| | - Marine Courvalet
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
| | - Léna Rousseau
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
| | - Kévin Cailleux
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
| | - Jonathan Breton
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
| | - Christine Bôle-Feysot
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
| | - Charlène Guérin
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
| | - Marion Huré
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
| | - Alexis Goichon
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
| | - Jean-Claude do Rego
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
- Univ Rouen Normandie, Inserm, CNRS, Normandie Univ, HERACLES US 51 UAR 2026, Behavioural Analysis Platform SCAC, 76000, Rouen, France
| | - Pierre Déchelotte
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
- Department of Nutrition, CHU Rouen, 76000, Rouen, France
| | - David Ribet
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
| | - Najate Achamrah
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France
- Department of Nutrition, CHU Rouen, 76000, Rouen, France
| | - Moïse Coëffier
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR 1073, Nutrition Inflammation and Microbiota Gut Brain Axis, UFR Santé, 22 Boulevard Gambetta, 76183, Rouen Cedex, France.
- Univ Rouen Normandie, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France.
- Department of Nutrition, CHU Rouen, 76000, Rouen, France.
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Conway-Jones R, James A, Goldacre MJ, Seminog OO. Risk of self-harm in patients with eating disorders: English population-based national record-linkage study, 1999-2021. Int J Eat Disord 2024; 57:162-172. [PMID: 37949682 DOI: 10.1002/eat.24091] [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: 05/29/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders associated with high rates of self-harm (SH). This is the first national study in England to quantify this association in a hospital population. METHOD A retrospective cohort study using a linked national dataset of Hospital Episode Statistics for 1999-2021. The exposure cohort included individuals aged <35 years admitted to hospital with a diagnosis of AN or BN. The reference cohort included hospital controls. We calculated the rate ratio (RR) of SH in each cohort. The individuals in the two cohorts were matched on multiple socio-demographic indicators. The main outcome was a subsequent hospitalization or death record with an SH diagnosis. RESULTS We identified 15,004 females and 1411 males with AN, and 6055 females and 741 males with BN. The RR with 95% confidence intervals (95%CI) for a subsequent admission with intentional self-harm after admission with AN was 4.9 (95%CI 4.7-5.1) in females and 4.8 (95%CI 3.9-5.8) in males. For BN it was 9.0 (95%CI 8.4-9.6) in females and 9.8 (95%CI 7.7-12.2) in males. There were strong associations between AN and BN and other SH. DISCUSSION Women and men admitted to English hospitals with AN or BN have a very high risk of a subsequent admission with SH. For some SH behaviors, such as alcohol intoxication, the RR was >10-fold elevated. The magnitude of risk was higher for BN than for AN. Clinicians should be aware of the scale of risk increase. Providing those at risk with appropriate support is required. PUBLIC SIGNIFICANCE This study is the first national study in an English hospital population that confirms and quantifies the association between eating disorders and self-harm. We have found that both women and men admitted to hospital with anorexia nervosa or bulimia nervosa are at an increased risk of subsequent admission with self-harm. It is important that clinicians are aware of this increased risk to support those at highest risk of self-harm.
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Affiliation(s)
| | - A James
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - M J Goldacre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - O O Seminog
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Wiener M, Bengesser SA, Wagner-Skacel J, Haidacher FNA, Lahousen-Luxenberger T, Wenninger J, Hasiba-Seebacher K, Fellendorf FT, Painold A, Kreuzer K, Butler M, Lackner S, Pilz R, Mörkl S. Impaired implicit learning in adults with anorexia nervosa. Int J Eat Disord 2024; 57:195-200. [PMID: 37870449 DOI: 10.1002/eat.24075] [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: 03/08/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE Cognitive alterations play an important role in the pathophysiology and treatment of anorexia nervosa (AN). Previous studies suggest that some implicit learning processes may be inhibited in AN. However, this has not yet been fully explored. The purpose of this study is to analyze implicit learning in patients with AN in comparison to healthy controls. METHODS In this pilot-study, a total of 21 patients diagnosed with AN and 21 matched controls were administered the weather prediction task (WPT), a probabilistic implicit category learning task that consists of two sub-variants. During the feedback (FB) version of the task, participants learn associations between tarot cards and weather outcomes via an operant learning model through which they receive immediate FB on their answers, whereas during the paired associate (PA) variant, participants are directly asked to memorize given associations. RESULTS AN patients showed selective impairment on the FB task where they scored significantly lower both in comparison to controls (p = .001) who completed the same task and when compared to their own performance on the PA variant (p = .006). Clinical measures showed no significant correlations with test scores. DISCUSSION Our results demonstrate implicit FB learning deficiencies in adult patients with AN. These impairments may have an impact on the effect of psychotherapeutic interventions and could partially explain the lack of treatment response in AN. Further studies are necessary to derive when and through which mechanisms these alterations originate, and to what extent they should be considered during treatment of the disorder. PUBLIC SIGNIFICANCE Cognitive impairments pose a challenge in the management of anorexia nervosa. Improved comprehension of cognitive alterations could lead to a greater understanding of the disease and adaptation of psychotherapeutic treatments. In this study, we found that implicit feedback learning in anorexia nervosa is impaired compared to healthy controls. This could indicate the necessity of treatment adaptations in the form of therapy tools without feedback and a larger focus on psychoeducation.
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Affiliation(s)
- Markus Wiener
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Jolana Wagner-Skacel
- Department of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Fiona N A Haidacher
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | | | - Julian Wenninger
- Department of Medical and Chemical Laboratory Diagnostics, LKH Hochsteiermark, Leoben, Austria
| | - Karin Hasiba-Seebacher
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Kathrin Kreuzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Mary Butler
- Department of Psychiatry and Clinical Neuroscience, University College Cork, Cork, Ireland
| | - Sonja Lackner
- Division of Immunology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - René Pilz
- Department of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Pruccoli J, Parmeggiani A, Cordelli DM, Lanari M. The involvement of the adrenergic system in feeding and eating disorders. A systematic review. World J Biol Psychiatry 2024; 25:1-15. [PMID: 37691603 DOI: 10.1080/15622975.2023.2245458] [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: 06/05/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Adrenergic dysregulation has been proposed as a possible underlying mechanism in feeding and eating disorders (FED). This review aims to synthesise the current evidence on the role of adrenergic dysregulation in the pathogenesis and management of FED. METHODS A systematic review was conducted in MEDLINE, Cochrane Library, and Clinicaltrials.gov. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was adopted. Preclinical, clinical, and pharmacological studies assessing the adrenergic system in FED were included. RESULTS Thirty-one out of 1415 recognised studies were included. Preclinically, studies on adrenaline's anorectic impact, receptor subtypes, and effects on hepatic function in rats show that catecholamine anorexia is primarily alpha-adrenergic, whereas beta-adrenergic anorexia can be obtained only after puberty, implying an impact of sexual hormones. Clinically, catecholamine levels may be higher in FED patients than in healthy controls (HC). Individuals with anorexia nervosa (AN) may show higher epinephrine-induced platelet aggregability response than HC. Pharmacological trials suggest that the alpha-2-adrenergic medication clonidine may not lower AN symptoms, but agents regulating the adrenaline-noradrenaline neurotransmission (bupropion, reboxetine, duloxetine, sibutramine) have been found to improve binge eating symptoms. CONCLUSION Adrenergic dysregulation may be involved in the pathophysiology of FED. More research is needed to comprehend underlying mechanisms and treatment implications.
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Affiliation(s)
- Jacopo Pruccoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età evolutiva, U.O. Neuropsichiatria dell'età pediatrica, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Antonia Parmeggiani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età evolutiva, U.O. Neuropsichiatria dell'età pediatrica, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Duccio Maria Cordelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età evolutiva, U.O. Neuropsichiatria dell'età pediatrica, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marcello Lanari
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Pediatric Emergency Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Morisaki Y, Miyata N, Nakashima M, Hata T, Takakura S, Yoshihara K, Suematsu T, Nomoto K, Miyazaki K, Tsuji H, Sudo N. Persistence of gut dysbiosis in individuals with anorexia nervosa. PLoS One 2023; 18:e0296037. [PMID: 38117788 PMCID: PMC10732397 DOI: 10.1371/journal.pone.0296037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/03/2023] [Indexed: 12/22/2023] Open
Abstract
Recent evidence suggests a crucial role of the gut microbiota in the pathogenesis of anorexia nervosa (AN). In this study, we carried out a series of multiple analyses of the gut microbiota of hospitalized individuals with AN over three months using 16S or 23S rRNA-targeted reverse transcription-quantitative polymerase chain reaction (PCR) technology (YIF-SCAN®), which is highly sensitive and enables the precise quantification of viable microorganisms. Despite the weight gain and improvements in psychological features observed during treatment, individuals with AN exhibited persistent gut microbial dysbiosis over the three-month duration. Principal component analysis further underscored the distinct microbial profile of individuals with AN, compared with that of age-matched healthy women at all time points. Regarding the kinetics of bacterial detection, the detection rate of Lactiplantibacillus spp. significantly increased after inpatient treatment. Additionally, the elevation in the Bifidobacterium counts during inpatient treatment was significantly correlated with the subsequent body weight gain after one year. Collectively, these findings suggest that gut dysbiosis in individuals with AN may not be easily restored solely through weight gain, highlighting the potential of therapeutic interventions targeting microbiota via dietary modifications or live biotherapeutics.
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Affiliation(s)
- Yukiko Morisaki
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriyuki Miyata
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Megumi Nakashima
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomokazu Hata
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shu Takakura
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazufumi Yoshihara
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
| | - Takafumi Suematsu
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Nomoto
- Faculty of Life Sciences, Department of Molecular Microbiology, Tokyo University of Agriculture, Setagaya City, Japan
| | | | | | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Anton-Păduraru DT, Trofin F, Nastase EV, Miftode RS, Miftode IL, Trandafirescu MF, Cojocaru E, Țarcă E, Mindru DE, Dorneanu OS. The Role of the Gut Microbiota in Anorexia Nervosa in Children and Adults-Systematic Review. Int J Mol Sci 2023; 25:41. [PMID: 38203211 PMCID: PMC10779038 DOI: 10.3390/ijms25010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Among the factors incriminated in the appearance of eating disorders, intestinal microbiota has recently been implicated. Now there is evidence that the composition of gut microbiota is different in anorexia nervosa. We gathered many surveys on the changes in the profile of gut microbiota in patients with anorexia nervosa. This review comprehensively examines the contemporary experimental evidence concerning the bidirectional communication between gut microbiota and the brain. Drawing from recent breakthroughs in this area of research, we propose that the gut microbiota significantly contributes to the intricate interplay between the body and the brain, thereby contributing to overall healthy homeostasis while concurrently impacting disease risk, including anxiety and mood disorders. Particular attention is devoted to elucidating the structure and functional relevance of the gut microbiota in the context of Anorexia Nervosa.
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Affiliation(s)
- Dana-Teodora Anton-Păduraru
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-T.A.-P.); (D.E.M.)
- “Sf. Maria” Children Emergency Hospital, 700309 Iasi, Romania; (E.C.); (E.Ț.)
| | - Felicia Trofin
- Department of Preventive Medicine and Interdisciplinarity—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Clinical Hospital of Infectious Diseases “Sf. Parascheva”, 700116 Iasi, Romania;
| | - Eduard Vasile Nastase
- Clinical Hospital of Infectious Diseases “Sf. Parascheva”, 700116 Iasi, Romania;
- Department of Internal Medicine II—Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Radu Stefan Miftode
- Department of Internal Medicine I—Cardiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- “Sf. Spiridon” Clinical Hospital, 700111 Iasi, Romania
| | - Ionela-Larisa Miftode
- Clinical Hospital of Infectious Diseases “Sf. Parascheva”, 700116 Iasi, Romania;
- Department of Internal Medicine II—Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mioara Florentina Trandafirescu
- Department of Morphofunctional Sciences I—Histology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Elena Cojocaru
- “Sf. Maria” Children Emergency Hospital, 700309 Iasi, Romania; (E.C.); (E.Ț.)
- Department of Morphofunctional Sciences I—Pathology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Țarcă
- “Sf. Maria” Children Emergency Hospital, 700309 Iasi, Romania; (E.C.); (E.Ț.)
- Department of Surgery II—Pediatric Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dana Elena Mindru
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-T.A.-P.); (D.E.M.)
- “Sf. Maria” Children Emergency Hospital, 700309 Iasi, Romania; (E.C.); (E.Ț.)
| | - Olivia Simona Dorneanu
- Department of Preventive Medicine and Interdisciplinarity—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Clinical Hospital of Infectious Diseases “Sf. Parascheva”, 700116 Iasi, Romania;
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Rometsch C, Guthoff M, Zipfel S, Stengel A. Renal failure following insulin purging in atypical anorexia nervosa and type 1 diabetes mellitus. Front Psychiatry 2023; 14:1325021. [PMID: 38152359 PMCID: PMC10752605 DOI: 10.3389/fpsyt.2023.1325021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
Objective Anorexia nervosa (AN) and atypical anorexia nervosa (AAN) are severe and complex eating disorders that can be prevalent among individuals with type 1 diabetes mellitus (T1DM). Insulin purging, characterized by the intentional underuse / omission of insulin to control weight, is under-recognized in medicine and is a purging strategy of patients with AN or AAN and comorbid T1DM. Often, this can lead to renal failure, necessitating a (pancreas-) kidney transplantation. This article presents a comprehensive overview of the interplay between AN/AAN and T1DM and summarizes the evidence in literature. Methods A narrative review is presented on basis of a detailed case study of a 32-year-old female with end-stage renal failure seeking (pancreas-) kidney transplantation displaying etiology, diagnosis, comorbidities, complications, and treatment of AN and AAN with emphasis on those patients with T1DM. Results Insulin purging in patients with AN/AAN and coexisting T1DM can exacerbate T1DM complications, including accelerating the onset of end-stage renal failure. A multidisciplinary approach including nutrition treatment and psychotherapeutic techniques was considered necessary for treatment, focusing on psychosomatic in-patient care before and after organ transplantation. Conclusion Insulin purging in patients with AAN and T1DM poses severe health risks, including accelerated renal complications. For those considering transplantation, insulin purging has explicitly to be diagnosed and a holistic treatment addressing both the renal condition and psychosomatic symptoms/disorders is crucial for successful post-transplant outcomes.
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Affiliation(s)
- Caroline Rometsch
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martina Guthoff
- Department of Internal Medicine IV, Diabetology, Endocrinology, Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Patel N, Tyagi R, Biswas D, Birjees A, Rajesh C, Khan S. Anorexia Nervosa: Evaluating Disparities in Places of Death in the United States Over 22 Years Using the CDC WONDER Database. Cureus 2023; 15:e51245. [PMID: 38288199 PMCID: PMC10823200 DOI: 10.7759/cureus.51245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Anorexia nervosa is a severe and occasionally fatal eating disorder characterized by extreme weight loss and a distorted body image in which the affected individuals typically exhibit a strong fear of gaining weight, leading to rigid dietary restrictions and excessive activity. This condition can cause severe health problems, such as hunger, cardiovascular issues, and organ destruction. Anorexia nervosa is a key subject for research in the context of end-of-life care disparities due to its psychological and physical challenges. Aims: This study examines differences in the places of death for people with anorexia nervosa during a 22-year period in the USA, taking into account four important factors: age group, gender, race, and U.S. census region. METHODOLOGY Data were collected from the CDC WONDER website on August 31, 2023, and spans years 1999 to 2020, using the particular ICD-11 code F50.0 for anorexia nervosa. The study aims to uncover the important determinants impacting the location of death within this specific population using sophisticated statistical methods, including univariate logistic regression. RESULTS The analysis of aggregate data yielded notable findings. The patient's principal site of death was at home or in hospice care. Other sites were less prevalent, with medical facilities or nursing homes ranking second. The place of death was highly influenced by age groups with diverse patterns. Gender had no significant impact; however, geographical inequalities were noticeable. Individuals in the Northeast, Midwest, and South were less likely than those in the West to die at home or in hospice care. The location of death was unaffected by race. CONCLUSIONS In conclusion, this study found that death in home and hospice was more common than in medical or hospital nursing facilities in all four analyzed groups. These findings highlight the critical need for significant advancements in end-of-life care, particularly in home and hospice settings.
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Affiliation(s)
- Nirmal Patel
- Internal Medicine, St. George's University School of Medicine, West Indies, GRD
| | - Rahul Tyagi
- Family Medicine, Leeds General Practitioner Confederation, Leeds, GBR
- Family Medicine, Royal College of General Practitioners, London, GBR
| | | | - Ayesha Birjees
- Internal Medicine, Fathima Institute of Medical Sciences, Kadapa, IND
| | - Chetana Rajesh
- Pediatrics and Child Health, Sri Ramachandra Medical College and Research Institute, Chennai, IND
| | - Sadia Khan
- Internal Medicine, Karachi University, Karachi, PAK
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