[Transcranial magnetic stimulation for comorbid depression in anorexia]

A 24-year-old anorexic patient with cormobid symptoms of depression was treated for depression with repetitive transcranial magnetic stimulation (rTMS) rather than with psychopharmacotherapy, due to her poor physical condition. The depressive symptomatology significantly improved in correlation with two rTMS cycles but occurred again within 2 weeks. A third successful cycle was then followed by a maintenance rTMS protocol with the patient going into remission from depression. This case illustrates that rTMS may be considered as a therapeutic option for comorbid depression in anorectic patients.

Personality traits after recovery from eating disorders: do subtypes differ?

OBJECTIVE

We compared individuals recovered from anorexia (AN) and bulimia nervosa (BN) to determine characteristics that are shared by or distinguish eating disorder (ED) subtypes.

METHOD

Sixty women recovered for > or = 1 year from AN or BN were compared with 47 control women (CW). Assessments included the Yale-Brown-Cornell Eating Disorder Scale, the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory, the Yale-Brown Obsessive Compulsive Scale, the Temperament and Character Inventory, and Structured Clinical Interviews for DSM-IV.

RESULTS

Individuals recovered from an ED had similar scores for mood and personality variables that were significantly higher than the scores for CW. Few recovered subjects had Cluster B personality disorder. Most individuals recovered within 6 years of their ED onset. A latent profile analysis identified an "inhibited" and "disinhibited" cluster based on personality traits.

CONCLUSION

A wide range of symptoms persist after recovery and do not differ between subtypes of ED. These findings may aid in identifying traits that create vulnerabilities for developing an ED.

Gender differences in the progression of co-morbid psychopathology symptoms of eating disordered patients

This study examined the utility of the Personality Assessment Inventory (PAI) in screening for comorbid psychopathology in eating disordered males and females undergoing residential treatment. The PAI, a self-administered screening tool containing 344 items to provide information on 11 clinical constructs, was administered at admission and discharge to 181 patients, 154 females and 27 males. Average age was 26.88 years (SD=9.35) and average length of stay was 58.31 days (SD=39.94). The results showed that both male and female patients exhibit several comorbid disorders at admission to residential treatment and the severity of these symptoms was statistically significantly reduced over the course of treatment. When comparing differences among genders, the results show that females present with more psychopathology symptoms at the start of treatment but make better progress than males in reducing these symptoms over time. When comparing patients across eating disorder diagnoses, subjects with bulimia displayed more severe comorbid symptomatology as compared to those with anorexia or other eating disorders. A thorough clinical assessment of eating disordered patients including comorbid psychopathology disorders is relevant for clinical diagnosis, treatment planning, and perhaps ultimately the outcome of treatment.

Nutritional rehabilitation of anorexia nervosa. Goals and dangers

Nutritional rehabilitation of adolescents with anorexia nervosa is both a science and an art. The goals are to promote metabolic recovery; restore a healthy body weight; reverse the medical complications of the disorder and to improve eating behaviors and psychological functioning. Most, but not all of the medical complications are reversible with nutritional rehabilitation. Refeeding patients with anorexia nervosa results in deposition of lean body mass initially, followed by restoration of adipose tissue as treatment goal weight is approached. The major danger of nutritional rehabilitation is the refeeding syndrome, characterized by fluid and electrolyte, cardiac, hematological and neurological complications, the most serious of which is sudden unexpected death. The refeeding syndrome is most likely to occur in those who are severely malnourished. In such patients, this complication can be avoided by slow refeeding with careful monitoring of body weight, heart rate and rhythm and serum electrolytes, especially serum phosphorus. This paper reviews our clinical experience.

[Clinical mentorship as a bridge to life in the treatment of eating disorders]

The aim of this article is to describe a community-based multi-modality intensive treatment program, which demonstrates a significant reduction in symptoms of eating disorders while providing an opportunity to deal with the functional and social skills. Treatment is delivered through a multidisciplinary team. The uniqueness of the team is in the inclusion of clinical mentors. These are social workers, art therapists and graduate level psychology students who are trained to connect with clients in an informal, intensive manner (10-40 hours a week). The mentors focus on legitimizing healthy attitudes to food, eating and life, while highlighting the pain and loss associated with the disorder. The mentors serve as meal companion and calming figure, representing the healthy self-caring voice. The relationship established during the many hours spent together becomes a powerful experience, completely different from the isolation of the disorder. The treatment intervenes in most areas of life, focusing on an active search for possibilities, in contrast to the emptiness associated with the disorder. This article presents the results and principles of a 2.5-year practice. Seventeen patients, ill for 6 years and more, completed this program more than a year ago. An assessment of their BMI and their general outcome using Eckert scales was performed. One year after completing the program, 76% of the patients were defined as recovered and 12% were almost recovered with only a few remaining symptoms. All of these patients function satisfactorily in the community, both in social and occupational aspects. Six percent were partially recovered and 6% suffered from regression during the first year of follow-up. This treatment provides the intensity required in hospitalizations, while enabling patients to stay in the community and maintain those activities that survive the disorder. This program has proven to work well with chronic patients. Further data, not analyzed as yet, also indicates the efficacy of this treatment in acute cases.

Frames of reference utilized in the rehabilitation of individuals with eating disorders

An occupational therapist's role with clients diagnosed with eating disorders, both anorexia nervosa and bulimia nervosa, has been described throughout the literature. However, the frames of reference and treatment approaches that occupational therapists implement have not been clearly established or validated. This paper outlines the symptomatology of anorexia nervosa and bulimia nervosa, and critically reviews the current literature concerning the frames of reference and treatment approaches used by occupational therapists when intervening with this population. The literature reviewed indicates that therapists are using a variety of frames of reference and treatment approaches. There appears to be an emphasis on the psychoanalytical and cognitive-behavioural frames of reference, although there is a lack of empirical evidence in regards to all frames of reference and treatment approaches. Reasons for the lack of current research with this population, and possible future areas of research are suggested.

Nutritional assessment of drug addicts

OBJECTIVE

To discern if factors such as organic pathology, sex, duration and/or intensity of drug addiction, alcohol abuse, hepatitis B infection, anorexia with poor food and drink consumption, or disturbance of social and familial networks, are related to an impaired nutritional status in hospitalized drug addicts.

DESIGN

Cross-sectional prospective study.

SETTING

Detoxication unit and internal medicine unit of a university hospital.

PATIENTS

140 drug addicts without acute organic pathology and 18 with acute organic pathology related to drug addiction. The immunological study was compared with a control group composed of 50 healthy and well-nourished individuals (26 women and 24 men), age-matched with our patients.

RESULTS

Drug addicts without organic pathology were under-nourished: 92.4% weighed under the mean weight for the population and 55.7% had had a weight loss above 5%. The distribution of mid-upper arm circumference (MUAC), triceps skinfold (TSF) measurement and mid-arm muscle area (MAMA) compared with the percentiles for the population showed a shift towards lower values. We found a high percentage of patients with a high lymphocyte count (55%). Despite the high lymphocyte count, delayed hypersensitivity was depressed in our patients. Of our patients, 66.4% exhibited anorexia at admission. The mean calorific intake was 978 +/- 89 kcal/day in females and 1265 +/- 64 kcal/day in males. However, in most cases, malnutrition (usually marasmus-like malnutrition) was not very severe; only 30% of the drug addicts weighed less than 80% of the mean weight for the population, or admitted to a weight loss above 10%, and by subjective nutritional assessment, only 18% were deeply malnourished. Otherwise, the nutritional status was very poor in drug addicts with acute organic pathology. We also found a worse nutritional status in our patients related to female sex, intensity of drug addiction, anorexia with poor food and drink consumption, and disturbance of the social and familial networks.

CONCLUSIONS

Many drug addicts suffer from calorie and protein malnutrition. This mainutrition is related to female sex, intensity of drug addiction, anorexia and poor food and drink consumption, and disturbance of the social and familial links. Acute organic pathology leads to a significant worsening of the nutritional status of drug addicts.