Specificity and wealth of autobiographical memories in restrictive and mixed anorexic patients

The reduced specificity of positive and negative autobiographical memories observed in anorexic (AN) patients may reflect a global disturbance in their emotional information processing. However, their emotional difficulties may differ according to the subtype of AN, implying possible differences in the manifestation of autobiographical memory impairments. The aims of the study were (1) to confirm the autobiographical memory deficits in AN patients in terms of specificity and wealth of memories, and (2) to compare autobiographical deficits according to the AN subtype: restrictive type (AR) or binge/purging type (AB). Ninety-five non-clinical (NC) individuals and 95 AN patients including 69 AR and 22 AB patients were administered the Williams' and Scott's Autobiographical Memory Test. The results confirmed a lack of specificity regardless of emotional valence in the overall AN patient group without any distinction of subtype, which was linked to the number of hospitalizations. When the AN subtype was considered, AR patients demonstrated reduced specificity for negative memories only, suggesting differences in emotional functioning or in the mechanisms underlying reduced specificity between AR and AB patients. Furthermore, the overall AN group demonstrated lower variability and complexity in their memory content than the NC group. However, this difference in the complexity of recalled memories was only found in response to negative cues. When AN subtypes were considered, AR patients showed fewer complex memories than NC individuals. Beyond a reduced specificity, AN patients also depict a poverty in the range of event recall and a difficulty in developing narrative content. The clinical implications of such autobiographical memory deficits need to be further investigated.

Emotional imagination of negative situations: Functional neuroimaging in anorexia and bulimia

Aim

The present study aims to extend the knowledge of the neural correlates of emotion processing in first episode subjects affected by anorexia nervosa (AN) or bulimia nervosa (BN). We applied an emotional distress paradigm targeting negative emotions thought to be relevant for interpersonal difficulties and therapeutic resistance mechanisms.

Methods

The current study applied to 44 female participants with newly diagnosed AN or BN and 20 matched controls a neuroimaging paradigm eliciting affective responses. The measurements also included an extensive assessment comprising clinical scales, neuropsychological tests, measures of emotion processing and empathy.

Results

AN and BN did not differ from controls in terms of emotional response, emotion matching, self-reported empathy and cognitive performance. However, eating disorder and psychopathological clinical scores, as well as alexithymia levels, were increased in AN and BN. On a neural level, no significant group differences emerged, even when focusing on a region of interest selected a priori: the amygdala. Some interesting findings put in relation the hippocampal activity with the level of Body Dissatisfaction of the participants, the relative importance of the key nodes for the common network in the decoding of different emotions (BN = right amygdala, AN = anterior cingulate area), and the qualitative profile of the deactivations.

Conclusions

Our data do not support the hypothesis that participants with AN or BN display reduced emotional responsiveness. However, peculiar characteristics in emotion processing could be associated to the three different groups. Therefore, relational difficulties in eating disorders, as well as therapeutic resistance, could be not secondary to a simple difficulty in feeling and identifying basic negative emotions in AN and BN participants.

Anorexia: a literature review of young people's experiences of hospital treatment

Anorexia nervosa is characterised by significantly low body weight, a fear of weight gain and persistent efforts to prevent the restoration of normal weight. It has potentially life-threatening physical and psychological complications, and many young people with anorexia present to hospital in a seriously compromised physical condition. While their physical symptoms require urgent treatment, addressing their emotional and psychological needs is equally important if they are to progress towards recovery. However, the conflicting thoughts common in anorexia mean that young people often feel highly ambivalent about treatment, which makes the disorder particularly challenging to treat. This article details a literature review undertaken to explore the perceptions and experiences of young people who have received hospital treatment for anorexia, with the aim of offering children's nurses insights into how they can optimally support these patients. The findings demonstrate the importance of listening to young people, treating them as individuals and understanding their experiences, in addition to addressing their physical health needs.

AgRP neurons control compulsive exercise and survival in an activity-based anorexia model

Hypothalamic agouti-related peptide (AgRP) and neuropeptide Y-expressing neurons have a critical role in driving food intake, but also in modulating complex, non-feeding behaviours¹. We interrogated whether AgRP neurons are relevant to the emergence of anorexia nervosa symptomatology in a mouse model. Here we show, using in vivo fibre photometry, a rapid inhibition of AgRP neuronal activity following voluntary cessation of running. All AgRP neuron-ablated, food-restricted mice die within 72 h of compulsive running, while daily activation of AgRP neurons using a chemogenetic tool increases voluntary running with no lethality of food-restricted animals. Animals with impaired AgRP neuronal circuits are unable to properly mobilize fuels during food-restriction-associated exercise; however, when provided with elevated fat content through diet, their death is completely prevented. Elevated fat content in the diet also prevents the long-term behavioural impact of food-restricted fit mice with elevated exercise volume. These observations elucidate a previously unsuspected organizational role of AgRP neurons, via the mediation of the periphery, in the regulation of compulsive exercise and its related lethality with possible implications for psychiatric conditions, such as anorexia nervosa.

How should the law determine capacity to refuse treatment for anorexia?

This article critically assesses the way a certain court has determined the capacity of a person diagnosed with anorexia to refuse medical treatment. It is shown that when making this determination, the court has adopted a process of circular reasoning, meaning anyone with the diagnosis will be found to lack capacity to refuse its treatment. This circular reasoning means that indicia of capacity that ought to be considered by the court is ignored. The result is a procedure in which the anorexic patient has no voice, and an outcome against which he or she has no effective legal recourse. This problem, it is argued, can be overcome in two ways. Firstly, courts must make sure that the 'functional' test of capacity is properly applied, meaning any finding of incapacity must rest on evidenced deficits in decision-making ability. Secondly, courts must properly engage with the subjective reasoning of the person making the treatment refusal.

[Anorexia in prepubescent adolescents]

Anorexia in young prepubescent patients is often linked to clinical signs occurring in early childhood. While therapies offer somatic, dietetic or medication-based treatments, the psychotherapeutic approach gives children and their families the opportunity to talk.

Differences in Symptom Burden Among Cancer Patients With Different Stages of Cachexia

CONTEXT

Cancer patients with cachexia may suffer from significant burden of symptoms and it can severely impair patients' quality of life. However, only few studies have targeted the symptom burden in cancer cachexia patients, and whether the symptom burden differed in different cachexia stages is still unclear.

OBJECTIVES

The aims of this study were to evaluate the symptom burden in cancer cachexia patients and to compare the severity and occurrence rates of symptoms among cancer patients with non-cachexia, pre-cachexia, cachexia, and refractory cachexia.

METHODS

Advanced cancer patients (n = 306) were included in this cross-sectional study. Patients were divided into four groups, based on the cachexia stages of the international consensus. The M.D. Anderson Symptom Inventory added with eight more cachexia-specific symptoms were evaluated in our patients. Differences in symptom severity and occurrence rates among the four groups were compared using one-way ANOVA or Kruskal-Wallis test analyses.

RESULTS

Lack of appetite, disturbed sleep, fatigue, lack of energy, and distress were the symptoms with highest occurrence rates and severity scores in all four groups and were exacerbated by the severity of cachexia stages. After confounders were adjusted for, significant differences were seen in symptoms of pain, fatigue, disturbed sleep, remembering problems, lack of appetite, dry mouth, vomiting, numbness, feeling dizzy, early satiety, lack of energy, tastes/smell changes, and diarrhea.

CONCLUSION

This study identified higher symptom burden in cancer patients with cachexia and it increased with the stages of cachexia, which emphasized the importance of screening in multiple co-occurring symptoms for cachexia patients.

[Between filiation and affiliation, constructing an identity through drawing in anorexia]

Claire, a French-Korean teenager suffering from anorexia, favours drawing as a means of self-expression. Her graphic creations illustrate the search for identity of this child of migrants. Struggling with an impossible identification linked to her filiation, drawing represents for her a real object of mediation. It gives meaning to what dwells within her and constitutes the medium of her creativity.

Anorexia of aging and its role for frailty

PURPOSE OF REVIEW

The purpose of this review is to examine the concept of anorexia of aging, including its complex pathophysiology and the multifaceted interventions required to prevent adverse health consequences from this geriatric syndrome.

RECENT FINDINGS

Anorexia of aging is extremely common, occurring in up to 30% of elderly individuals; however, this diagnosis is frequently missed or erroneously attributed to a normal part of the aging process. With aging, impairments in smell and taste can limit the desire to eat. Alterations in stress hormones and inflammatory mediators can lead to excess catabolism, cachexia, and reduced appetite. In addition, mood disorders, such as anxiety and depression, are powerful inhibitors of appetite. Anorexia of aging, with its negative consequences on weight and muscle mass, is a risk factor for the development of frailty and is important to screen for, as early intervention is key to reversing this debilitating condition.

SUMMARY

Anorexia of aging is a complex geriatric syndrome and a direct risk factor for frailty and thus should not be accepted as normal consequence of aging. Early diagnosis and formulating a plan for targeted interventions is critical to prevent disability and preserve function in elderly patients.

[Pharmacists as part of an outpatient palliative care team]

Pharmacists are an integral factor in palliative medical care, especially in the context of specialised outpatient palliative care (in Germany „SAPV“). As part of a multi professional team, pharmacists take care of patients especially in complex supply situations. The drug therapy is always checked for side-effects and interactions, and the medication is adjusted to application methods which are still possible (e. g. subcutaneous administration or administration via gastro-intestinal probes). A 24/7 supply of urgently needed medicines needs to be ensured and clinical nutrition must be suited to the real needs of the patient. Prompt aseptic manufacturing of analgesic pumps and the supply of medical devices is a priority of regional specialised pharmacies, whilst the basic support can be provided by all pharmacies who wish to engage in this ethically demanding field.

An Interpretative Phenomenological Analysis of Participation in a Pro-anorexia Internet Site and Its Relationship with Disordered Eating

Pro-anorexia Internet sites aim to promote, support and discuss anorexia nervosa. Media coverage has raised concerns that sites may increase the level of eating disorders. This research examines the meaning of participation in a pro-anorexia Internet site and its relationship with disordered eating by using an interpretative phenomenological analysis of fifteen separate message ‘threads’ followed over a six-week period. Four themes were identified: (1) tips and techniques; (2) ‘ana’ v. anorexia nervosa; (3) social support; and (4) need for anorexia. Findings suggest participation was multi-purpose, providing a coping function in relation to weight loss, and the contribution of sites to increased levels of eating disorders is not inevitable.

Oxytocin: A Conditional Anorexigen whose Effects on Appetite Depend on the Physiological, Behavioural and Social Contexts

Central oxytocin suppresses appetite. Neuronal activity and the release of oxytocin coincide with satiation, as well as with adverse events (e.g. hyperosmolality, toxicity or excessive stomach distension) that necessitate an immediate termination of eating behaviour. Oxytocin also decreases consumption driven by reward, especially as derived from ingesting carbohydrates and sweet tastants. This review summarises current knowledge of the role of oxytocin in food intake regulation and highlights a growing body of evidence showing that oxytocin is a conditional anorexigen [i.e. its effects on appetite differ significantly with respect to certain (patho)physiological, behavioural and social contexts].

A parametric Probabilistic Context-Free Grammar for food intake analysis based on continuous meal weight measurements

Monitoring and modification of eating behaviour through continuous meal weight measurements has been successfully applied in clinical practice to treat obesity and eating disorders. For this purpose, the Mandometer, a plate scale, along with video recordings of subjects during the course of single meals, has been used to assist clinicians in measuring relevant food intake parameters. In this work, we present a novel algorithm for automatically constructing a subject's food intake curve using only the Mandometer weight measurements. This eliminates the need for direct clinical observation or video recordings, thus significantly reducing the manual effort required for analysis. The proposed algorithm aims at identifying specific meal related events (e.g. bites, food additions, artifacts), by applying an adaptive pre-processing stage using Delta coefficients, followed by event detection based on a parametric Probabilistic Context-Free Grammar on the derivative of the recorded sequence. Experimental results on a dataset of 114 meals from individuals suffering from obesity or eating disorders, as well as from individuals with normal BMI, demonstrate the effectiveness of the proposed approach.

[Anorexia and refusal to eat in the elderly]

The question of the links between anorexia and the refusal to eat in the elderly is often the cause of major difficulties with regard to therapeutic strategies within caregiving teams. Likewise, few studies have been carried out into the diachronic links between teenage anorexia and that of the elderly. The role of the multi-disciplinary team is essential.

Using the Activity-based Anorexia Rodent Model to Study the Neurobiological Basis of Anorexia Nervosa

Anorexia nervosa (AN) is a psychiatric illness characterized by excessively restricted caloric intake and abnormally high levels of physical activity. A challenging illness to treat, due to the lack of understanding of the underlying neurobiology, AN has the highest mortality rate among psychiatric illnesses. To address this need, neuroscientists are using an animal model to study how neural circuits may contribute toward vulnerability to AN and may be affected by AN. Activity-based anorexia (ABA) is a bio-behavioral phenomenon described in rodents that models the key symptoms of anorexia nervosa. When rodents with free access to voluntary exercise on a running wheel experience food restriction, they become hyperactive - running more than animals with free access to food. Here, we describe the procedures by which ABA is induced in adolescent female C57BL/6 mice. On postnatal day 36 (P36), the animal is housed with access to voluntary exercise on a running wheel. After 4 days of acclimation to the running wheel, on P40, all food is removed from the cage. For the next 3 days, food is returned to the cage (allowing animals free food access) for 2 hr daily. After the fourth day of food restriction, free access to food is returned and the running wheel is removed from the cage to allow the animals to recover. Continuous multi-day analysis of running wheel activity shows that mice become hyperactive within 24 hr following the onset of food restriction. The mice run even during the limited time during which they have access to food. Additionally, the circadian pattern of wheel running becomes disrupted by the experience of food restriction. We have been able to correlate neurobiological changes with various aspects of the animals' wheel running behavior to implicate particular brain regions and neurochemical changes with resilience and vulnerability to food-restriction induced hyperactivity.

Anorexia in human and experimental animal models: physiological aspects related to neuropeptides

Anorexia, a loss of appetite for food, can be caused by various physiological and pathophysiological conditions. In this review, firstly, clinical aspects of anorexia nervosa are summarized in brief. Secondly, hypothalamic neuropeptides responsible for feeding regulation in each hypothalamic nucleus are discussed. Finally, three different types of anorexigenic animal models; dehydration-induced anorexia, cisplatin-induced anorexia and cancer anorexia-cachexia, are introduced. In conclusion, hypothalamic neuropeptides may give us novel insight to understand and find effective therapeutics strategy essential for various kinds of anorexia.

[Anorexia, treating and caring for the mistreated body]

Anorexia is a complex, multifactorial disease, emerging during puberty and requiring cross-disciplinary care. The body, taken hostage, expresses psychological suffering and the patient's developmental impasse. Compassionate treatment and the care given to this mistreated and undernourished body facilitate the access to the psychological care and are an essential step towards recovery.

Male anorexia and bulimia nervosa: Disorder symptoms and impulsive behaviour during hospital treatment and one year follow-up period

BACKGROUND

The study aimed to evaluate treatment efficacy in male patients with anorexia (AN) and bulimia nervosa (BN) treated at the Eating Disorder Unit, University Psychiatric Clinic Ljubljana, Slovenia (EDU UPCL), using longitudinal assessments of eating disorder (ED) symptoms and selected impulsive behaviours highly correlated with these entities from hospital admission till twelve months after.

SUBJECTS AND METHODS

35 male AN and 35 male BN patients were included. Participants were aged 17 or more and somatically stable with the BMI>12 kg/m(2). Patients with psychiatric comorbidity, mental disorder due to a general medical condition, or serious somatic or neurological disease were excluded. Intensity of ED symptoms and presence of selected impulsive behaviours were evaluated at hospital admission and discharge, and three, six and twelve months after, using an internal Eating Disorder Unit Questionnaire. For statistical analysis multivariate analysis of variance was used.

RESULTS

Throughout the research period the appropriate changes in BMI were observed in both patient groups. In both, AN and BN patient groups, the evaluation of longitudinal differences regarding the intensity of all ED symptoms and the presence of studied impulsive behaviours showed a significant decline at discharge and all subsequent assessments compared to the results obtained upon admission to the hospital. The re-hospitalization rates of patients with AN and BN in the first year after discharge from the hospital were 3.84% vs. 3.7% respectively.

CONCLUSIONS

In male patients with AN and BN treated at the EDU UPCL, ED symptoms, BMI, and studied impulsive behaviours show a substantial improvement during hospital treatment. These changes seem to be long lasting, still being effective through one-year post-hospitalization follow-up.

Managing Stigma: Disclosure-Response Communication Patterns in Pro-Anorexic Websites

Pro-anorexic websites are a popular online venue for individuals with anorexia, but recent research suggests that they play a role of "online negative enabling support groups" because they can undermine recovery and encourage negative behaviors by validating pro-anorexic views. By analyzing 22,811 messages from 5,590 conversations from the Pro-Ana Nation online discussion board forum, this study examines communicative mechanisms of online negative enabling support through language analysis of disclosure-response sequences, changes in the language of the initial discloser within an interaction exchange, and the role of responses in eliciting those changes. The findings show that initiating disclosures containing stigma-related emotion words, anorexia-specific content, and sociorelational content are typically met with negatively valenced responses from other members of the pro-anorexic community. Moreover, although the act of revealing stigmatized information has some cathartic effects, disclosers use more, not fewer, stigma-related emotion words when they receive negatively valenced responses. These results provide insight into communicative dynamics and effects of online negative enabling support through validation of the pro-anorexic identity and the dangerous cycle of stigma escalation in disclosure-response exchanges on pro-anorexic online communities.

[Caring for teenagers with anorexia]

Anorexia mainly affects young girls, although more and more boys and adults are also concerned. The consequences of eating disorders have a significant impact on young people's health. Nurses play a key role in the therapeutic contract set up during the hospital treatment.

An innovative solid oral nutritional supplement to fight weight loss and anorexia: open, randomised controlled trial of efficacy in institutionalised, malnourished older adults

BACKGROUND AND OBJECTIVE

To evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults>70 years with protein-energy malnutrition. The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients (Protibis®, Solidages, France).

DESIGN

An open, multicentre, randomised controlled trial.

SETTING

Seven nursing homes.

PARTICIPANTS

One hundred and seventy-five malnourished older adults, aged 86±8 years.

INTERVENTION

All participants received the standard institutional diet. In addition, Intervention group participants received eight cookies daily (11.5 g protein; 244 kcal) for 6 weeks (w0-w6).

MEASUREMENTS

Five visits (w-4, w0, w6, w10 and w18).

MAIN OUTCOME

Percentage of weight gain from w0 to w6 (body mass in kg).

SECONDARY OUTCOMES

Appetite, rated using a numerical scale (0: no appetite to 10: extremely good appetite); current episodes of pressure ulcers and diarrhea.

RESULTS

Average weight increased in Intervention group (n=88) compared with Control group (n=87) without cookies supplementation (+1.6 versus -0.7%, P=0.038). Weight gain persisted 1 month (+3.0 versus -0.2%, P=0.025) and 3 months after the end of cookies consumption (+3.9 versus -0.9%, P=0.003), with diarrhea reduction (P=0.027). There was a synergistic effect with liquid/creamy dietary supplements. Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase (P=0.024), appetite increase (P=0.009) and pressure ulcers reduction (P=0.031).

CONCLUSION

The trial suggested that, to fight against anorexia, the stimulation of touch (finger food; chewing, even on edentulous gums) and hearing (intra-oral sounds) could be valuable alternatives to sight, smell and taste alterations.

Taking control of anorexia together

Many people with anorexia receive inadequate treatment for what is a debilitating, relentless and life-threatening illness. In Lincolnshire an innovative nurse-led day programme is helping people stay out of hospital and take back control from the illness. Peer support is crucial to the programme's success.

"I am a waste of breath, of space, of time": metaphors of self in a pro-anorexia group

According to recent research on eating disorders, heavy users of pro-anorexia (pro-ana) sites show higher levels of disordered eating and more severe impairment of quality of life than non-heavy users. A better understanding of how pro-ana members self-present in the virtual world could shed some light on these offline behaviors. Through discourse analysis, I examined the metaphors the members of a pro-ana group invoked in their personal profiles on a popular social networking site, to talk about the self. I applied the Metaphor Identification Procedure to 757 text profiles. I identified four key metaphorical constructions in pro-ana members' self-descriptions: self as space, self as weight, perfecting the self, and the social self. These four main metaphors represented discourse strategies, both to create a collective pro-ana identity and to enact an individual identity as pro-ana. In this article, I discuss the implications of these findings for the treatment of eating disorders.

Pharmacological manipulations in animal models of anorexia and binge eating in relation to humans

Eating disorders, such as anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorders (BED), are described as abnormal eating habits that usually involve insufficient or excessive food intake. Animal models have been developed that provide insight into certain aspects of eating disorders. Several drugs have been found efficacious in these animal models and some of them have eventually proven useful in the treatment of eating disorders. This review will cover the role of monoaminergic neurotransmitters in eating disorders and their pharmacological manipulations in animal models and humans. Dopamine, 5-HT (serotonin) and noradrenaline in hypothalamic and striatal regions regulate food intake by affecting hunger and satiety and by affecting rewarding and motivational aspects of feeding. Reduced neurotransmission by dopamine, 5-HT and noradrenaline and compensatory changes, at least in dopamine D2 and 5-HT(2C/2A) receptors, have been related to the pathophysiology of AN in humans and animal models. Also, in disorders and animal models of BN and BED, monoaminergic neurotransmission is down-regulated but receptor level changes are different from those seen in AN. A hypofunctional dopamine system or overactive α2-adrenoceptors may contribute to an attenuated response to (palatable) food and result in hedonic binge eating. Evidence for the efficacy of monoaminergic treatments for AN is limited, while more support exists for the treatment of BN or BED with monoaminergic drugs.

Rodent model of activity-based anorexia

Activity-based anorexia (ABA) consists of a procedure that involves the simultaneous exposure of animals to a restricted feeding schedule, while free access is allowed to an activity wheel. Under these conditions, animals show a progressive increase in wheel running, a reduced efficiency in food intake to compensate for their increased activity, and a severe progression of weight loss. Due to the parallelism with the clinical manifestations of anorexia nervosa including increased activity, reduced food intake and severe weight loss, the ABA procedure has been proposed as the best analog of human anorexia nervosa (AN). Thus, ABA research could both allow a better understanding of the mechanisms underlying AN and generate useful leads for treatment development in AN.

Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis

Eating disorders in dancers are thought to be common, but the exact rates remain to be clarified. The aim of this study is to systematically compile and analyse the rates of eating disorders in dancers. A literature search, appraisal and meta-analysis were conducted. Thirty-three relevant studies were published between 1966 and 2013 with sufficient data for extraction. Primary data were extracted as raw numbers or confidence intervals. Risk ratios and 95% confidence intervals were calculated for controlled studies. The overall prevalence of eating disorders was 12.0% (16.4% for ballet dancers), 2.0% (4% for ballet dancers) for anorexia, 4.4% (2% for ballet dancers) for bulimia and 9.5% (14.9% for ballet dancers) for eating disorders not otherwise specified (EDNOS). The dancer group had higher mean scores on the EAT-26 and the Eating Disorder Inventory subscales. Dancers, in general, had a higher risk of suffering from eating disorders in general, anorexia nervosa and EDNOS, but no higher risk of suffering from bulimia nervosa. The study concluded that as dancers had a three times higher risk of suffering from eating disorders, particularly anorexia nervosa and EDNOS, specifically designed services for this population should be considered.

Evaluation of the psychometric characteristics of the Spanish version of the Anorectic Behaviour Observation Scale

AIMS

The Anorectic Behaviour Observation Scale (ABOS) was designed to obtain information from relatives about behaviours and attitudes of patients with eating disorders (ED). The aim of this study was to validate the ABOS into Spanish.

METHODS

We evaluated the psychometric characteristics of the Spanish version of the ABOS in a clinical ED sample (239 caregivers of 143 ED patients). Instrument reliability (internal consistency), validity (construct, convergent and discriminant, known groups), responsiveness and goodness-of-fit were measured.

RESULTS

Data from the Spanish population revealed a three-factor structure similar to that of the original ABOS, although the composition of subscales differed somewhat from the original. An ABOS cut-point of 21 was identified. The Cronbach's alpha coefficient for the total ABOS score was 0.81. Correlations with other instruments demonstrated convergent and divergent validity. Among caregivers, the total ABOS score and Factor scores significantly discriminated between anxiety, depression and health-related quality of life, while among ED patients they discriminated between diagnosis, severity and level of ED symptoms - evidence of known-groups validity.

CONCLUSION

These findings suggest that the ABOS can be reliably and validly used in Spain in a number of different clinical contexts, by researchers and clinicians alike.

Increased hypothalamic-pituitary-adrenal drive is associated with decreased appetite and hypoactivation of food-motivation neurocircuitry in anorexia nervosa

OBJECTIVE

Corticotrophin-releasing hormone (CRH)-mediated hypercortisolemia has been demonstrated in anorexia nervosa (AN), a psychiatric disorder characterized by food restriction despite low body weight. While CRH is anorexigenic, downstream cortisol stimulates hunger. Using a food-related functional magnetic resonance imaging (fMRI) paradigm, we have demonstrated hypoactivation of brain regions involved in food motivation in women with AN, even after weight recovery. The relationship between hypothalamic-pituitary-adrenal (HPA) axis dysregulation and appetite and the association with food-motivation neurocircuitry hypoactivation are unknown in AN. We investigated the relationship between HPA activity, appetite, and food-motivation neurocircuitry hypoactivation in AN.

DESIGN

Cross-sectional study of 36 women (13 AN, ten weight-recovered AN (ANWR), and 13 healthy controls (HC)).

METHODS

Peripheral cortisol and ACTH levels were measured in a fasting state and 30, 60, and 120 min after a standardized mixed meal. The visual analog scale was used to assess homeostatic and hedonic appetite. fMRI was performed during visual processing of food and non-food stimuli to measure the brain activation pre- and post-meal.

RESULTS

In each group, serum cortisol levels decreased following the meal. Mean fasting, 120 min post-meal, and nadir cortisol levels were high in AN vs HC. Mean postprandial ACTH levels were high in ANWR compared with HC and AN subjects. Cortisol levels were associated with lower fasting homeostatic and hedonic appetite, independent of BMI and depressive symptoms. Cortisol levels were also associated with between-group variance in activation in the food-motivation brain regions (e.g. hypothalamus, amygdala, hippocampus, orbitofrontal cortex, and insula).

CONCLUSIONS

HPA activation may contribute to the maintenance of AN by the suppression of appetitive drive.

[Anorexia and corporal mediations]

The body, the central point of expression of the anorexic symptom, is an important therapeutic lever.The young anorexic girl protects herself through corporal hypertonicity. This tension is consistent with her fears of seeing her body becoming that of an adult and to feel emotions and sensations with too much force. Corporal mediation consists in helping the young girls get to grips with this body.

[Anorexia in adolescents, the experience of caregivers and team supervision]

The hospital treatment of anorexic adolescents is complex, multidisciplinary and often long.The psychopathological functioning of these young patients places the caregivers in a difficult position. The team of the adolescent crisis and hospitalisation unit at Caen general hospital benefits from the support of a psychologist from outside the unit.

Does the opinion of the therapeutic team match with psychometric measures during the course of eating disorders?

INTRODUCTION

Is there a group of psychometric variables, which correlates with the criteria of an interdisciplinary team about the course of ED?

OBJECTIVES

The aim of this study was to analyse the correlation between the clinic criteria of an interdisciplinary team with respect to the course of eating disorders (ED) and different psychometric criteria.

METHODS

The course was analysed in a final sample of 30 ED outpatients during their six first months of treatment. A scale of clinical criteria of the course of ED (therapeutic team's opinion) and different questionnaires on psychological, psychopathological and eating-related variables were used. The statistical analysis comprised of a discriminant analysis in order to find the variables with a discriminant function to distinguish between a fair-bad course and a good course.

RESULTS

Perceived stress, self-esteem, the variables of the SCL-90-R, depression, thought-shape fusion, anxiety, food craving and the score on body shape questionnaire were found to have discriminant function. Comparing the therapeutic team's criteria and the results of the questionnaires a 10% of patients were misclassified.

DISCUSSION

The results highlight the necessary and permanent checking of the relationship among the clinical criteria regarding the course of ED (members' team opinion) and different psychological, psychopathological and eating-related variables.

[Home monitoring of infants suffering from infantile anorexia]

The construction of parenthood comes under pressure when an infant suffers from anorexia nervosa. Support at home for the family can be provided by the child health nurse using Esther Bick's infant observation method. Over the course of the visits, the intrafamily relationships are appeased to create an atmosphere which is favourable to the harmonious development of the child.

Anorexia and eating patterns in the elderly

Objectives

To evaluate the change in eating habits occurring in community- dwelling and institutionalized elderly subjects with senile anorexia.

Design

Cross- sectional, observational.

Setting

Community, nursing homes and rehabilitation or acute care facilities in four Italian regions.

Participants

A random sample of 526 subjects, aged 65 years and older (217 free living individuals, 213 residents in nursing homes, and 93 patients in rehabilitation and acute wards).

Measurements

All subjects underwent a multidimensional geriatric evaluation of: nutritional status, anthropometric parameters, health and cognitive status, depression, taste, chewing and swallowing function, and some hormones related to appetite. Diet variety was assessed, considering the frequency of consumption of different food groups (milk and dairy products; meat, fish, and eggs; cereals and derivatives; fruit and vegetables).

Results

In anorexic elderly subjects the global food intake was reduced, and the eating pattern was characterized by the reduced consumption of certain food groups (“meat, eggs and fish” and “fruit and vegetables”) whereas the frequency of consumption of milk and cereals remained almost unchanged. Nutritional parameters were significantly better in normal eating subjects and correlated with diet variety.

Conclusion

Because of the high prevalence of senile anorexia in the geriatric population and its impact on the nutritional status, further research should be prompted to establish an intervention. protocol allowing the early diagnosis of anorexia of aging, aimed at identifying its causes and at optimizing treatment of anorexic patients.

Inhibition of immobilization stress-induced anorexia, behavioral deficits, and plasma corticosterone secretion by injected leptin in rats

Leptin, originally identified as an anti-obesity hormone, also has an important role in the regulation of mood and emotion. The present study was designed to monitor effects of injected leptin on immobilization stress-induced anorexia, behavioral deficits, and plasma corticosterone secretion in rats. Exposure to 2 h immobilization stress decreased food intake and body weight in saline-injected animals. Animals exposed to open field, elevated plus maze, and light-dark transition tests the day following immobilization exhibited anxiety-like behavior. Leptin injected at doses of 0.1 and 0.5 mg/kg also decreased food intake and body weight in unstressed animals and elicited anxiolytic effects at dose of 0.5 mg/kg, monitored on the following day. Immobilization-induced decreases in food intake, body weight, as well as stress-induced behavioral deficits in the open field, elevated plus maze, and light-dark transition test were reversed by exogenous leptin in a dose-dependent (0.1-0.5 mg/kg) manner. Acute exposure to 2 h immobilization produced a fourfold rise in plasma levels of corticosterone. Animals injected with leptin at a dose of 0.1 mg/kg, but not at dose of 0.5 mg/kg, exhibited a marginal increase in plasma corticosterone. Immobilization-induced increases of plasma corticosterone were reversed by leptin injected at doses of 0.1 or 0.5 mg/kg. The data suggest that exogenous leptin can reduce stress perception, resulting in an inhibition of stress effects on the activity of hypothalamic-pituitary-adrenal axis and behavior. The reported pharmacological effects of leptin represent an innovative approach for the treatment of stress-related disorders.

Role of peptide YY(3-36) in the satiety produced by gastric delivery of macronutrients in rats

Peptide YY(3-36) [PYY(3-36)] is postulated to act as a hormonal signal from gut to brain to inhibit food intake. PYY(3-36) potently reduces food intake when administered systemically or into the brain. If action of endogenous PYY(3-36) is necessary for normal satiation to occur, then pharmacological blockade of its receptors should increase food intake. Here, we determined the effects of iv infusion of Y1, Y2, and Y5 receptor antagonists (BIBP 3226, BIIE 0246, CGP 71683) during the first 3 h of the dark period on food intake in non-food-deprived rats. Our results showed that 1) Y2 receptor blockade reversed the anorexic response to iv infusion of PYY(3-36) but did not increase food intake when administered alone; 2) Y1 and Y5 receptor antagonists neither attenuated PYY(3-36)-induced anorexia nor altered food intake when given alone; and 3) Y2 receptor blockade attenuated anorexic responses to gastric infusions of casein hydrolysate and long-chain triglycerides, but not maltodextrin. Previous work showed that Y2 antagonist BIIE 0246 does not penetrate the blood-brain barrier. Together, these results support the hypothesis that gut PYY(3-36) action at Y2 receptors peripheral to the blood brain barrier plays an essential role in mediating satiety responses to gastric delivery of protein and long-chain triglycerides, but not polysaccharide.

The theatricalization of death

The essay analyzes anorexia as a theatrical performance, complete with its chosen acting school and particular dramatic features (plot, acting style, suspense-establishing mechanisms and motifs).

Neurobiology driving hyperactivity in activity-based anorexia

Hyperactivity in anorexia nervosa is difficult to control and negatively impacts outcome. Hyperactivity is a key driving force to starvation in an animal model named activity-based anorexia (ABA). Recent research has started unraveling what mechanisms underlie this hyperactivity. Besides a general increase in locomotor activity that may be an expression of foraging behavior and involves frontal brain regions, the increased locomotor activity expressed before food is presented (food anticipatory behavior or FAA) involves hypothalamic neural circuits. Ghrelin plays a role in FAA, whereas decreased leptin signaling is involved in both aspects of increased locomotor activity. We hypothesize that increased ghrelin and decreased leptin signaling drive the activity of dopamine neurons in the ventral tegmental area. In anorexia nervosa patients, this altered activity of the dopamine system may be involved not only in hyperactivity but also in aberrant cognitive processing related to food.

How to develop patient trust in anorexia treatment

Anorexia nervosa is a serious and commonly fatal psychological condition. It is essential that nurses develop positive relationships with patients to enable successful treatment. However, these relationships are often difficult to form. This article discusses how the features of anorexia affect creating and sustaining effective nurse-patient relationships.

Effect of management of patients with Anorexia and Bulimia nervosa on symptoms and impulsive behavior

The aim of the study was to provide further and up to date information on the evaluation of the management of Anorexia and Bulimia nervosa at the Eating Disorders Unit (EDU) of the Ljubljana Psychiatric Clinic, based upon detailed assessment of the eating disorders specific and non specific symptoms of impulsive behaviors, highly correlated with these entities. 34 female patients with anorexia (restrictive or purgative type) and 38 female patients with Bulimia nervosa (purgative or non-purgative type) undergoing hospital treatment at the EDU were evaluated upon admission, as well as upon discharge and three and six months after discharge, using the Eating Disorder Questionnaire. Upon discharge a marked decrease in the overall symptoms was noted. The differences in symptoms incidences between the two groups were significantly specific for the individual form of eating disorder, especially upon admission, and were more pronounced in anorexia group. In later measurements, performed during the period of three and six months after discharge, a mild trend of increase in the disorder specific symptoms was detected in both groups, but was not statistically significant. In addition to binging on food, striking, quarreling and spending sprees are characteristics of patients with eating disorders, which in particular apply to the Bulimia nervosa group. Apart from the disorder specific symptoms, impulsive behavior was also reduced during study period, while the difference in its occurrence between the two groups gradually became non-significant. The management of patients with eating disorders at the EDU was successful in both groups, confirmed by an intense reduction of the disorder specific symptoms, impulsive behavior and increased stability recorded three and six months after discharge. The study strongly suggests that the effect of treatment regime for eating disorders can be predicted by careful assessment of the relevant symptoms and impulsive behavioral patterns.

[Deterioration of social relationships at home and lack of appetite]

The search for food, the need to "eat to live", was for a long time man's main concern. But through the centuries, the meal has come to represent a moment of conviviality, exchange, social rituals and codes which go beyond the simple pleasure of satiation. Meals and the art of living therefore go hand in hand. What happens, though, as people get older and relationships wane? How can elderly people regain the desire to eat and an interest in other people?