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Ghrelin: Central and Peripheral Implications in Anorexia Nervosa  [PDF]
Mathieu Méquinion,Fanny Langlet,Sara Zgheib,Bénédicte Dehouck,Christophe Chauveau,Odile Viltart
Frontiers in Endocrinology , 2013, DOI: 10.3389/fendo.2013.00015
Abstract: Increasing clinical and therapeutic interest in the neurobiology of eating disorders reflects their dramatic impact on health. Chronic food restriction resulting in severe weight loss is a major symptom described in restrictive anorexia nervosa (AN) patients, and they also suffer from metabolic disturbances, infertility, osteopenia, and osteoporosis. Restrictive AN, mostly observed in young women, is the third largest cause of chronic illness in teenagers of industrialized countries. From a neurobiological perspective, AN-linked behaviors can be considered an adaptation that permits the endurance of reduced energy supply, involving central and/or peripheral reprograming. The severe weight loss observed in AN patients is accompanied by significant changes in hormones involved in energy balance, feeding behavior, and bone formation, all of which can be replicated in animals models. Increasing evidence suggests that AN could be an addictive behavior disorder, potentially linking defects in the reward mechanism with suppressed food intake, heightened physical activity, and mood disorder. Surprisingly, the plasma levels of ghrelin, an orexigenic hormone that drives food-motivated behavior, are increased. This increase in plasma ghrelin levels seems paradoxical in light of the restrained eating adopted by AN patients, and may rather result from an adaptation to the disease. The aim of this review is to describe the role played by ghrelin in AN focusing on its central vs. peripheral actions. In AN patients and in rodent AN models, chronic food restriction induces profound alterations in the ? ghrelin ? signaling that leads to the development of inappropriate behaviors like hyperactivity or addiction to food starvation and therefore a greater depletion in energy reserves. The question of a transient insensitivity to ghrelin and/or a potential metabolic reprograming is discussed in regard of new clinical treatments currently investigated.
Psychological characteristics of mothers of patients with anorexia nervosa: implications for treatment and prognosis
Campos, Lia Keuchguerian Silveira;Sampaio, Anna Beatriz Ribeiro Ferreira;Garcia Junior, Celso;Magdaleno Junior, Ronis;Battistoni, Maria Marta de Magalh?es;Turato, Egberto Ribeiro;
Trends in Psychiatry and Psychotherapy , 2012, DOI: 10.1590/S2237-60892012000100004
Abstract: introduction: the complexity of factors involved in anorexia nervosa (an) and the recommendations of prominent health organizations underscore the importance of reflecting on therapeutic interventions aimed at patients' family members. objective: to expand knowledge about the mother-daughter relationship in an, with a focus on developing a conceptual framework that is able to improve the treatment of the disorder, reduce factors that perpetuate it and improve prognosis. method: a clinical method, anchored by psychodynamic references, was employed in a group of family members of patients with eating disorders. the group met weekly, and sessions were led by psychologists from the eating disorder outpatient clinic of a university hospital. results and discussion: common characteristics in the mother-daughter relationship in cases of an were identified. the issue of mutual control, the dialectic between omnipotence and impotence, and the relationship of devotion, passion and annihilation between mothers and daughters are phenomena that form the basis of an, with a direct influence on the severity of each case and on treatment success. conclusion: our findings allowed us to identify important aspects in the mother-daughter relationship in an, which may improve the clinical interventions aimed at treating the disorder.
Current treatment for anorexia nervosa: efficacy, safety, and adherence  [cached]
Lindsay P Bodell,Pamela K Keel
Psychology Research and Behavior Management , 2010,
Abstract: Lindsay P Bodell, Pamela K KeelDepartment of Psychology, Florida State University, Tallahassee, FL, USAAbstract: Anorexia nervosa (AN) is a serious psychiatric illness associated with significant medical and psychiatric morbidity, psychosocial impairment, increased risk of death, and chronicity. Given the severity of the disorder, the establishment of safe and effective treatments is necessary. Several treatments have been tried in AN, but few favorable results have emerged. This paper reviews randomized controlled trials in AN, and provides a synthesis of existing data regarding the efficacy, safety, and adherence associated with pharmacologic and psychological interventions. Randomized controlled trials for the treatment of AN published in peer-reviewed journals were identified by electronic and manual searches. Overall, pharmacotherapy has limited benefits in the treatment of AN, with some promising preliminary findings associated with olanzapine, an antipsychotic agent. No single psychological intervention has demonstrated clear superiority in treating adults with AN. In adolescents with AN, the evidence base is strongest for the use of family therapy over alternative individual psychotherapies. Results highlight challenges in both treating individuals with AN and in studying the effects of those treatments, and further emphasize the importance of continued efforts to develop novel interventions. Treatment trials currently underway and areas for future research are discussed.Keywords: anorexia nervosa, treatment, pharmacotherapy, psychotherapy, randomized controlled trials
Leptina e anorexia nervosa Leptin and anorexia nervosa  [cached]
Roberta de Oliveira Corrêa,Silvia Cristina da Silva Pimentel,Célia Martins Cortez
Psicologia Clínica , 2012, DOI: 10.1590/s0103-56652012000100011
Abstract: Estudos recentes comprovam a importancia da leptina no comportamento alimentar. A diminui o das concentra es séricas desse horm nio está diretamente relacionada com a varia o da taxa de gordura corporal e provoca altera es em eixos neuroendócrinos, levando à amenorreia e à hiperatividade, entre outras consequências. Neste trabalho estamos apresentando uma revis o bibliográfica dos principais focos de estudo que relacionam a LEP com a ANN, bem como dos efeitos do excesso e da deficiência desse horm nio sobre o comportamento alimentar. Trata-se de um esfor o para converter uma grande gama de conhecimentos obtidos da literatura em um texto, objetivando prover uma vis o de como a LEP, funcionando como um sinal periférico de disponibilidade de energia, pode influenciar a atividade de circuitos neuronais que controlam mecanismos associados à regula o da homeostasia energética. Recent studies demonstrate the importance of leptin in feeding behavior. The decreasing of the serum concentration of this hormone is directly related to the body fatty amount and provokes alterations in neuroendocrine axis, causing amenorrhea and hyperactivity, among others consequences. In this paper, a review of the main aspects interconnecting leptin and anorexia nervosa is made, as well as of the effects of excess and deficiency of this hormone on feeding disease. It was an effort to convert a large amount of knowledge obtained from literature into a condensed text, aiming to provide an updated view, how leptin functioning as a peripheral signal of energy availability to central nervous system influences on the neural activity involved in regulation of body weight and energy homeostasis.
The genetic and neurobiological etiology of anorexia nervosa
Tetyana Pekar
University of Toronto Journal of Undergraduate Life Sciences , 2009,
Abstract: Anorexia nervosa (AN) is a life-threatening eating disorder (ED) characterized by restrictive eating, the pursuit of thinness and an obsessive fear of being fat. The lifetime prevalence of AN is 0.3-1% with morality rates approximately 8-15%, higher than in any other mental illness. Unfortunately, treatment therapies have remained generally unsuccessful. Relapse is common, disordered eating patterns persistent in majority of the cases and as many as 20% remaining chronically ill. Despite the severity and chronicity of the disorder, the etiology of AN is largely unknown. Multiple theories have been developed outlining the biological, psychological and cultural factors contributing to AN pathogenesis. However, there is a growing consensus that understanding the predisposing genetic and neurobiological factors leading to AN is critical in order to improve treatment outcomes. The purpose of this mini-review is to summarize the current evidence pointing to alterations in serotonin (5-HT) and dopamine (DA) function in AN pathology. Disturbances in these neurotransmitter systems may explain the underlying genetic component and common psychiatric traits and comorbid disorders present in AN.
Anorexia nervosa: uma revis?o
Schmidt, Eder;Mata, Gustavo Ferreira da;
Fractal : Revista de Psicologia , 2008, DOI: 10.1590/S1984-02922008000200006
Abstract: the authors present a review of some points regard to anorexia nervosa. classificatory, historic, clinical and therapeutic aspects are reported. recognized as the basis for some mystical occurrences at the middle ages, it was seen as a hysterical presentation in the seventeenth century, to become object of freudian questions. it discusses the anorexia as a presentation of the hysterical structure, here boarded from the freud's concepts on hysteria, oedipus and femininity, and considering the physical body like a mere support for symbolic articulations. about to freud, anorexia nervosa is a symptom by which hysterical patient expresses his aversion to sexuality.
Processo de Enfermagem para pacientes com Anorexia Nervosa
Toledo, Vanessa Pellegrino;Ramos, Natália Amorim;Wopereis, Flávia;
Revista Brasileira de Enfermagem , 2011, DOI: 10.1590/S0034-71672011000100029
Abstract: experience report on the application of the nursing process (np) to a female patient with anorexia nervosa patient, using patient history, diagnoses, nursing interventions and outcomes. the interventions were based on the nursing diagnoses: body image disturbance, altered nutrition less than body requirements, anxiety, chronic low self-esteem, activity intolerance, ineffective management of therapeutic regimen, risk for infection, fluid volume deficit and social isolation. based on the application of the nursing process, the planned results were achieved, favoring a better quality of life during the patient's hospitalization time. mental, neurological, endocrine and immunological factors, which are peculiar in anorexia nervosa cases, permitted the elaboration of an nursing process, which positively contributed to complement the patient's health rehabilitation
The occupational roles of women with anorexia nervosa
Quiles-Cestari, Leila Maria;Ribeiro, Rosane Pilot Pessa;
Revista Latino-Americana de Enfermagem , 2012, DOI: 10.1590/S0104-11692012000200004
Abstract: this study’s objective was to understand how occupational roles of individuals with anorexia nervosa are configured. the sample was composed of a control group and 11 adult women with anorexia nervosa being cared for by the eating disorders care group in a hospital in ribeir?o preto, sp, brazil. socio-demographic and anthropometric data were collected and the role checklist was applied. the results revealed a significant loss of roles for women with anorexia nervosa in relation to the performance of the roles worker, friend, and amateur/hobbyist, supporting the idea that psychosocial harm may arise from this eating disorder. the evaluation of occupational roles in the treatment of eating disorders is an important strategy for planning occupational therapy activities and supporting the creation of healthier spaces to enable individuals to resume occupational roles, and acquire independence and autonomy.
Psychosomatic syndromes and anorexia nervosa
Giovanni Abbate-Daga, Nadia Delsedime, Barbara Nicotra, Cristina Giovannone, Enrica Marzola, Federico Amianto, Secondo Fassino
BMC Psychiatry , 2013, DOI: 10.1186/1471-244x-13-14
Abstract: 108 AN inpatients (76 AN restricting subtype, AN-R, and 32 AN binge-purging subtype, AN-BP) were consecutively recruited and psychosomatic syndromes were diagnosed with the Structured Interview for DCPR. Participants were asked to complete psychometric tests: Body Shape Questionnaire, Beck Depression Inventory, Eating Disorder Inventory–2, and Temperament and Character Inventory. Data were submitted to cluster analysis.Illness denial (63%) and alexithymia (54.6%) resulted to be the most common syndromes in our sample. Cluster analysis identified three groups: moderate psychosomatic group (49%), somatization group (26%), and severe psychosomatic group (25%). The first group was mainly represented by AN-R patients reporting often only illness denial and alexithymia as DCPR syndromes. The second group showed more severe eating and depressive symptomatology and frequently DCPR syndromes of the somatization cluster. Thanatophobia DCPR syndrome was also represented in this group. The third group reported longer duration of illness and DCPR syndromes were highly represented; in particular, all patients were found to show the alexithymia DCPR syndrome.These results highlight the need of a deep assessment of psychosomatic syndromes in AN. Psychosomatic syndromes correlated differently with both severity of eating symptomatology and duration of illness: therefore, DCPR could be effective to achieve tailored treatments.It is known in scientific literature that anorexia nervosa (AN) is a psychosomatic condition [1-3]. Some authors have recently highlighted the role of several factors like alexithymia [4], emotion and anger dyscontrol [5], and somatization [6] in both development and maintenance of the disorder. It has also been described a psychosomatic and somatopsychic vicious circle as underpinning AN symptomatology [7-9].Moreover, poor interoceptive awareness [10,11] – the inability of discerning the difference between somatic and emotional perception (i.e. feeling “fat” ve
Malaysian Family Physician , 2011,
Abstract: This case report illustrates an adolescent with clinical presentation of moderate anorexia nervosa with no significant co-morbidities. It highlights the management of anorexia nervosa in the outpatient setting by a multi-disciplinary health care team which includes a family physician, a dietician, a psychologist and a child psychiatrist.

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