scholarly journals Holistically addressing motivation and maladaptive traits in anorexia nervosa: Impact on prognosis and treatment outcomes

2019 ◽  
Vol 46 (1) ◽  
Author(s):  
Athena Milios
Keyword(s):  
Quality Of Life ◽  
Body Weight ◽  
Anorexia Nervosa ◽  
Weight Gain ◽  
Patient Outcomes ◽  
Eating Pathology ◽  
Individual Characteristics ◽  
Motivation To Change ◽  
The Impact

Anorexia Nervosa (AN) is a serious psychiatric disorder, characterized by restriction of energy intake, low body weight, intense fear of weight gain, and a disturbance in body weight self-perception. Severe and Enduring AN (SE-AN) is a long-lasting (typically 5-7 or more years and marked by several unsuccessful treatment attempts) form of AN. Traditional treatments, centering on weight restoration and core eating pathology, may be part of the reason rates of treatment dropout are high and long-term outcomes are poor, particularly in SE-AN. For SE-AN patients, who have a past marked by failed traditional treatment attempts, multidimensional treatments, addressing motivation to change and maladaptive traits, may improve a range of patient outcomes outside of eating-related symptoms, such as quality of life and interpersonal functioning.The objective of this narrative review is to briefly examine motivation-related factors (e.g., hope and readiness to change), experiential avoidance, perfectionism, and obsessive-compulsiveness, and the impact of treatment approaches incorporating these individual characteristics on various patient outcomes. In conclusion, a holistic, multidimensional, person-centred recovery approach that accounts for (a) illness severity/ chronicity, (b) individual traits, and (c) motivational factors (with a secondary focus on weight gain/eating pathology), could improve quality of life outcomes, particularly in SE-AN. Additionally, integrating patient perspectives, insights, and values into developing/testing novel person-centred interventions is paramount in order to holistically address the underlying biopsychosocial causes and perpetuating factors of AN, and to better understand the trajectory of chronicity.

scholarly journals Iron deficiency after kidney transplantation

2020 ◽  
Author(s):  
Joanna Sophia J Vinke ◽  
Marith I Francke ◽  
Michele F Eisenga ◽  
Dennis A Hesselink ◽  
Martin H de Borst
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Immune System ◽  
Iron Deficiency ◽  
Patient Outcomes ◽  
Excess Mortality ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
The Impact

Abstract Iron deficiency (ID) is highly prevalent in kidney transplant recipients (KTRs) and has been independently associated with an excess mortality risk in this population. Several causes lead to ID in KTRs, including inflammation, medication and an increased iron need after transplantation. Although many studies in other populations indicate a pivotal role for iron as a regulator of the immune system, little is known about the impact of ID on the immune system in KTRs. Moreover, clinical trials in patients with chronic kidney disease or heart failure have shown that correction of ID, with or without anaemia, improves exercise capacity and quality of life, and may improve survival. ID could therefore be a modifiable risk factor to improve graft and patient outcomes in KTRs; prospective studies are warranted to substantiate this hypothesis.

Nutritional Intervention to Prevent Weight Gain in Patients Commenced on Olanzapine: A Randomizedcontrolled Trial

2005 ◽  
Vol 39 (6) ◽  
pp. 479-486 ◽  
Author(s):  
Sherryn Evans ◽  
Richard Newton ◽  
Sally Higgins
Keyword(s):  
Quality Of Life ◽  
Body Image ◽  
Weight Gain ◽  
Treatment Group ◽  
Nutrition Education ◽  
Intervention Group ◽  
Control Group ◽  
Average Weight ◽  
The Impact

Objective: Olanzapine is the most commonly prescribed atypical antipsychotic medication in Australia. Research repor ts an average weight gain of between 4.5 and 7 kg in the 3 months following its commencement. Trying to minimize this weight gain in a population with an already high prevalence of obesity, mor tality and morbidity is of clinical and social importance. This randomized controlled trial investigated the impact of individual nutrition education provided by a dietitian on weight gain in the 3 and 6 months following the commencement of olanzapine. Method: Fifty-one individuals (29 females, 22 males) who had star ted on olanzapine in the previous 3 months (mean length of 27 days 20) were recruited through Peninsula Health Psychiatric Services and were randomly assigned to either the intervention (n = 29) or the control group (n = 22). Individuals in the intervention group received six 1 hour nutrition education sessions over a 3-month period. Weight, waist circumference, body mass index (BMI) and qualitative measures of exercise levels, quality of life, health and body image were collected at baselineat 3 and 6 months. Results: After 3 months, the control group had gained significantly more weight than the treatment group (6.0 kg vs 2.0 kg, p≤0.002). Weight gain of more than 7% of initial weight occurred in 64% of the control group compared to 13% of the treatment group. The control group's BMI increased significantly more than the treatment group's (2 kg/m2 vs 0.7 kg/m2, p ≤0.03). The treatment group reported significantly greater improvements in moderate exercise levels, quality of life, health and body image compared to the controls. At 6 months, the control group continued to show significantly more weight gain since baseline than the treatment group (9.9 kg vs 2.0 kg, p≤0.013) and consequently had significantly greater increases in BMI (3.2 kg/m2vs 0.8 kg/m2, p ≤0.017). Conclusion: Individualnutritional intervention provided bya dietitian is highly successful at preventing olanzapine-induced weight gain.

Measuring the impact of in-home vs inpatient infusion therapy on hospital re-admissions, patient outcomes and quality of life

2014 ◽  
Vol 111 (2) ◽  
pp. S112
Author(s):  
Sarah Watkins ◽  
Kim Huber ◽  
Kelly Isackson ◽  
Colleen Doyen ◽  
Carla Taylor
Keyword(s):  
Quality Of Life ◽  
Patient Outcomes ◽  
Infusion Therapy ◽  
The Impact

scholarly journals Quetiapine immediate release v. placebo for schizophrenia: systematic review, meta-analysis and reappraisal

2015 ◽  
Vol 206 (5) ◽  
pp. 360-370 ◽  
Author(s):  
Paul Hutton ◽  
Peter J. Taylor ◽  
Lee Mulligan ◽  
Sarah Tully ◽  
Joanna Moncrieff
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Weight Gain ◽  
Meta Analysis ◽  
Immediate Release ◽  
Mean Difference ◽  
Psychotic Symptoms ◽  
Controlled Trials ◽  
The Impact

BackgroundImmediate-release (IR) quetiapine has been used to treat schizophrenia since 1997, although all the principal placebo-controlled trials have >50% missing outcome data. New studies with relatively lower rates of participant withdrawal have since been published.AimsTo assess the efficacy and adverse effects of quetiapine IR for schizophrenia, with consideration of outcome quality and clinical meaningfulness of results, and to examine the potential impact of missing data on the main efficacy findings.MethodWe conducted a systematic review and meta-analysis of randomised controlled trials comparing quetiapine IR and placebo (or subtherapeutic dose in relapse prevention trials) for the treatment of schizophrenia (PROSPERO registration CRD4201100165). Primary outcomes were change in overall symptoms and response rates. We also examined whether high rates of participant withdrawal (⩾50%) attenuated effect sizes, and assessed the impact of making different assumptions about these people's outcomes.ResultsWe identified 15 relevant trials (including 2 unpublished), providing the first 12-week data for this drug and the first data on self-reported quality of life. We found quetiapine IR to have a weighted mean difference (WMD) of 6.5 points (95% CI −8.9 to −4) on Positive and Negative Syndrome Scale (PANSS) total scores, which corresponds to a standardised mean difference (SMD) of −0.33 (95% CI −0.46 to −0.21). Longer trials reported larger mean differences favouring quetiapine IR, but the overall estimate was smaller if more conservative assumptions about the outcomes of people who left the trial early were made. Approximately 21 people needed to take quetiapine IR for 1 person to experience at least a 50% improvement in PANSS score. No difference in quality of life was observed (two RCTs), although small to moderate improvements in social functioning were found (three RCTs). Quetiapine IR caused sedation and increased rates of clinically significant weight gain, but no extrapyramidal effects were observed.ConclusionsQuetiapine IR has a small beneficial effect on overall psychotic symptoms over 2–12 weeks, but also leads to weight gain and sedation.

Impressive weight gain after deep brain stimulation of nucleus accumbens in treatment-resistant bulimic anorexia nervosa

2020 ◽  
Vol 13 (11) ◽  
pp. e239316
Author(s):  
Isabel Fernandes Arroteia ◽  
Andreas Husch ◽  
Mehri Baniasadi ◽  
Frank Hertel
Keyword(s):  
Quality Of Life ◽  
Anorexia Nervosa ◽  
Weight Gain ◽  
Deep Brain Stimulation ◽  
Nucleus Accumbens ◽  
Brain Stimulation ◽  
Treatment Modalities ◽  
Durable Response ◽  
Deep Brain

Anorexia nervosa (AN) severely impacts individual’s mental and physical health as well as quality of life. In 21% of cases no durable response to conservative treatment can be obtained. The serious course of the disease in the most severely affected patients justifies invasive treatment options. One of the treatment methods increasingly used in recent years is deep brain stimulation (DBS). A 42-year-old woman suffering from chronic AN of the bulimic subtype shows a 46.9% weight gain and a subjective increase in quality of life, 12 months after bilateral nucleus accumbens (NAcc) DBS implantation. No improvement in comorbid depression could be achieved. DBS of the NAcc is a treatment option to be considered in severe AN when conventional treatment modalities recommended by evidence-based guidelines have not been able to bring lasting relief to the patient’s suffering.

scholarly journals The Severity of Menopausal Symptoms and its Relation to Obesity, Smoking, and Exercise in Middle-Aged Jordanian Women

2018 ◽  
Vol 7 (1) ◽  
pp. 41-48
Author(s):  
Ruba M Jaber ◽  
Hana H Abu Hassan ◽  
Malaak F Abuelayyan ◽  
Jailan N Yasin ◽  
Heba M Jaber
Keyword(s):  
Quality Of Life ◽  
Body Weight ◽  
Menopausal Symptoms ◽  
Sexual Problems ◽  
University Hospital ◽  
Menopausal Transition ◽  
Validated Questionnaire ◽  
Increased Risk ◽  
The Impact

Objectives: The present study aimed at finding the effect of menopausal transition, exercise, smoking, and obesity on menopausal transition. In addition, the impact of menopausal transition on women’s quality of life was investigated. Materials and Methods: This cross-sectional study was conducted at family medicine clinics of Jordan University Hospital (JUH). Totally, 359 women whose age varied from 45 to 65 years old were included, Variables including sociodemographic, smoking exercise and obesity, menopause status and its symptoms, and quality of life were assessed by self-administered and validated questionnaire. Data were analyzed using SPSS, version 16. Results: The mean age at the menopause was 49.4 years. More than 38% of the participants practiced no or irregular exercise and slightly more than 92% had abnormal body mass index (BMI) of ≥25 kg/m2 . Besides, women who practiced no or irregular exercise were significantly more likely to experience irritability, be mentally and physically exhausted, report sexual problems, and muscles and joint discomfort (P value of < 0.05). In addition, women with an abnormal waist to hip ratio were statistically at an increased risk of experiencing sexual problems. Conclusions: Based on the results, it can be concluded that normal body weight and regular and effective exercise were the key factors in alleviating menopausal symptoms during the menopausal transition, especially the psychological or mental symptoms and muscle and joint discomfort. Meanwhile, women in the midlife stage are recommended to be counseled about menopausal transition and its effect on mental and physical health. Moreover, they should be encouraged to maintain effective levels of exercise and to optimize their body weight whenever possible.

scholarly journals Study protocol of a randomized, double-blind, placebo-controlled, multi-center trial to treat antipsychotic-induced weight gain: the Metformin-Lifestyle in antipsychotic users (MELIA) trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nini de Boer ◽  
Sinan Guloksuz ◽  
Caroline van Baal ◽  
Leonie Willebrands ◽  
Jeroen Deenik ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Body Weight ◽  
Weight Gain ◽  
Lifestyle Intervention ◽  
Pragmatic Trial ◽  
Secondary Outcome ◽  
Double Blind ◽  
Major Health Problem ◽  
Link Type

Abstract Background Antipsychotic-induced Weight Gain (AiWG) is a debilitating and common adverse effect of antipsychotics. AiWG negatively impacts life expectancy, quality of life, treatment adherence, likelihood of developing type-2 diabetes and readmission. Treatment of AiWG is currently challenging, and there is no consensus on the optimal management strategy. In this study, we aim to evaluate the use of metformin for the treatment of AiWG by comparing metformin with placebo in those receiving treatment as usual, which includes a lifestyle intervention. Methods In this randomized, double-blind, multicenter, placebo-controlled, pragmatic trial with a follow-up of 52 weeks, we aim to include 256 overweight participants (Body Mass Index (BMI) > 25 kg/m2) of at least 16 years of age. Patients are eligible if they have been diagnosed with schizophrenia spectrum disorder and if they have been using an antipsychotic for at least three months. Participants will be randomized with a 1:1 allocation to placebo or metformin, and will be treated for a total of 26 weeks. Metformin will be started at 500 mg b.i.d. and escalated to 1000 mg b.i.d. 2 weeks thereafter (up to a maximum of 2000 mg daily). In addition, all participants will undergo a lifestyle intervention as part of the usual treatment consisting of a combination of an exercise program and dietary consultations. The primary outcome measure is difference in body weight as a continuous trait between the two arms from treatment inception until 26 weeks of treatment, compared to baseline. Secondary outcome measures include: 1) Any element of metabolic syndrome (MetS); 2) Response, defined as ≥5% body weight loss at 26 weeks relative to treatment inception; 3) Quality of life; 4) General mental and physical health; and 5) Cost-effectiveness. Finally, we aim to assess whether genetic liability to BMI and MetS may help estimate the amount of weight reduction following initiation of metformin treatment. Discussion The pragmatic design of the current trial allows for a comparison of the efficacy and safety of metformin in combination with a lifestyle intervention in the treatment of AiWG, facilitating the development of guidelines on the interventions for this major health problem. Trial registration This trial was registered in the Netherlands Trial Register (NTR) at https://www.trialregister.nl/trial/8440 as NTR NL8840 on March 8, 2020.

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