A Perspective on Chronic and Long-Lasting Anorexia Nervosa

Anorexia Nervosa (AN) is a severe eating disorder which typically develops in younger females. Many studies focus on this specific population, a majority of which will eventually partially or fully recover. A minority will become chronic despite extensive treatment. These patients are treatment-resistant and may not necessarily benefit from usual treatment. In this article we will reflect on possible mechanisms which may explain the maintenance of disease, and especially on the possible role of affective and anxiety disturbances. We will use, due to the lack of large-scale studies, data from risk and prognostic factors, treatment options and neurobiological correlates in chronic AN patients. Lastly, we will propose how these elements may advise further research and treatments.

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Prognostic factors of infantile spasms: Role of treatment options including a ketogenic diet

Brain and Development ◽

10.1016/j.braindev.2013.06.014 ◽

2013 ◽

Vol 35 (8) ◽

pp. 821-826 ◽

Cited By ~ 13

Author(s):

Jeehun Lee ◽

Jun Hwa Lee ◽

Hee Jun Yu ◽

Munhyang Lee

Keyword(s):

Prognostic Factors ◽

Ketogenic Diet ◽

Treatment Options ◽

Infantile Spasms

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Associations between Blood Metabolic Profile at 7 Years Old and Eating Disorders in Adolescence: Findings from the Avon Longitudinal Study of Parents and Children

Metabolites ◽

10.3390/metabo9090191 ◽

2019 ◽

Vol 9 (9) ◽

pp. 191 ◽

Cited By ~ 1

Author(s):

Diana Santos Ferreira ◽

Christopher Hübel ◽

Moritz Herle ◽

Mohamed Abdulkadir ◽

Ruth Loos ◽

...

Keyword(s):

Fatty Acids ◽

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Fatty Acid ◽

Binge Eating ◽

Binge Eating Disorder ◽

Metabolic Factors ◽

Lower Odds

Eating disorders are severe illnesses characterized by both psychiatric and metabolic factors. We explored the prospective role of metabolic risk in eating disorders in a UK cohort (n = 2929 participants), measuring 158 metabolic traits in non-fasting EDTA-plasma by nuclear magnetic resonance. We associated metabolic markers at 7 years (exposure) with risk for anorexia nervosa and binge-eating disorder (outcomes) at 14, 16, and 18 years using logistic regression adjusted for maternal education, child’s sex, age, body mass index, and calorie intake at 7 years. Elevated very low-density lipoproteins, triglycerides, apolipoprotein-B/A, and monounsaturated fatty acids ratio were associated with lower odds of anorexia nervosa at age 18, while elevated high-density lipoproteins, docosahexaenoic acid and polyunsaturated fatty acids ratio, and fatty acid unsaturation were associated with higher risk for anorexia nervosa at 18 years. Elevated linoleic acid and n-6 fatty acid ratios were associated with lower odds of binge-eating disorder at 16 years, while elevated saturated fatty acid ratio was associated with higher odds of binge-eating disorder. Most associations had large confidence intervals and showed, for anorexia nervosa, different directions across time points. Overall, our results show some evidence for a role of metabolic factors in eating disorders development in adolescence.

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The Anorexia Nervosa Genetics Initiative: Overview and Methods

10.1101/234013 ◽

2017 ◽

Author(s):

Laura M Thornton ◽

Melissa A Munn-Chernoff ◽

Jessica H Baker ◽

Anders Juréus ◽

Richard Parker ◽

...

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Large Scale ◽

Eating Behaviors ◽

Clinical Information ◽

The United States ◽

Sample Collection ◽

Present Sample ◽

Link Type ◽

Dsm Iv

AbstractBackground:Genetic factors contribute to anorexia nervosa (AN); and the first genome-wide significant locus has been identified. We describe methods and procedures for the Anorexia Nervosa Genetics Initiative (ANGI), an international collaboration designed to rapidly recruit 13000 individuals with AN as well as ancestrally matched controls. We present sample characteristics and the utility of an online eating disorder diagnostic questionnaire suitable for large-scale genetic and population research.Methods:ANGI recruited from the United States (US), Australia/New Zealand (ANZ), Sweden (SE), and Denmark (DK). Recruitment was via national registers (SE, DK); treatment centers (US, ANZ, SE, DK); and social and traditional media (US, ANZ, SE). All cases had a lifetime AN diagnosis based on DSM-IV or ICD-10 criteria (excluding amenorrhea). Recruited controls had no lifetime history of disordered eating behaviors. To assess the positive and negative predictive validity of the online eating disorder questionnaire (ED100K-v1), 109 women also completed the Structured Clinical Interview for DSM-IV (SCID), Module H.Results:Blood samples and clinical information were collected from 13,364 individuals with lifetime AN and from controls. Online diagnostic phenotyping was effective and efficient; the validity of the questionnaire was acceptable.Conclusions:Our multipronged recruitment approach was highly effective for rapid recruitment and can be used as a model for efforts by other groups. High online presence of individuals with AN rendered the Internet/social media a remarkably effective recruitment tool in some countries. ANGI has substantially augmented Psychiatric Genomics Consortium AN sample collection. ANGI is a registered clinical trial: clinicaltrials.gov NCT01916538; https://clinicaltrials.gov/ct2/show/NCT01916538?cond=Anorexia+Nervosa&draw=1&rank=3.

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ANGI — Anorexia Nervosa Genetics Initiative

Twin Research and Human Genetics ◽

10.1017/thg.2020.24 ◽

2020 ◽

Vol 23 (2) ◽

pp. 135-136

Author(s):

Cynthia Bulik ◽

Martin Kennedy ◽

Tracey Wade

Keyword(s):

Anorexia Nervosa ◽

Genetic Variants ◽

Large Scale ◽

Genome Wide Association Study ◽

Genetic Correlations ◽

Genome Wide Association ◽

Life Threatening Illness ◽

Genome Wide ◽

Life Threatening

AbstractIdentification of genetic variants associated with eating disorders is underway. The Anorexia Nervosa Genetics Initiative, an initiative of the Klarman Family Foundation, has contributed to advancing the field, yielding a large-scale genome-wide association study published in Nature Genetics. Eight genetic variants significantly associated with anorexia nervosa were identified, along with patterns of genetic correlations that suggest both psychiatric and metabolic origins of this serious and life-threatening illness. This article details the role of Professor Nick Martin in contributing to this important collaboration.

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Galantamine in the Treatment of Vascular Dementia

International Psychogeriatrics ◽

10.1017/s1041610203009189 ◽

2003 ◽

Vol 15 (S1) ◽

pp. 187-193 ◽

Cited By ~ 5

Author(s):

H. Robert Brashear

Keyword(s):

Vascular Dementia ◽

Large Scale ◽

Controlled Trial ◽

Treatment Options ◽

Treatment Strategies ◽

Acetylcholinesterase Inhibitors ◽

Symptomatic Therapy ◽

Cognitive Benefits ◽

And Behavior

Vascular dementia (VaD) is a disorder with no cure and limited treatment options. Similarities between VaD and Alzheimer's disease (AD) arise on a number of levels. Both involve progressive decline in cognition, functional ability, and behavior, and there is evidence for a central role of reduced cholinergic neurotransmission in the two illnesses. Treatment strategies in VaD have historically focused on prevention, although evidence of cognitive benefits with preventative treatment is scarce. Acetylcholinesterase inhibitors represent a rational treatment possibility for symptomatic therapy of patients with VaD. A recent large-scale trial of galantamine in patients with VaD or AD with cerebrovascular disease (AD + CVD) represents the first placebo-controlled trial showing clinically relevant benefits in these important patient populations.

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Possible role of the gut microbiota in the pathogenesis of anorexia nervosa

BioPsychoSocial Medicine ◽

10.1186/s13030-021-00228-9 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Nobuyuki Sudo

Keyword(s):

Eating Disorders ◽

Weight Loss ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Weight Gain ◽

Gut Microbiota ◽

Psychosocial Factors ◽

Biological Factors ◽

Fear Of Weight Gain

AbstractAnorexia nervosa (AN), an eating disorder, is characterized by extreme weight loss and fear of weight gain. Psychosocial factors are thought to play important roles in the development and progression of AN; however, biological factors also presumably contribute to eating disorders. Recent evidence has shown that the gut microbiota plays an important role in pathogenesis of neuropsychiatric disorders including AN. In this article, we describe the possible role of the gut microbiota in the development and persistence of AN, based on the latest research works, including those of our group.

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Characterizing Treatment-Resistant Anorexia Nervosa

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.542206 ◽

2021 ◽

Vol 11 ◽

Author(s):

Sarah Smith ◽

D. Blake Woodside

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Depressive Symptoms ◽

Treatment Resistance ◽

Treatment Resistant ◽

Eating Disorder Treatment ◽

Duration Of Illness ◽

Eating Disorder Psychopathology ◽

Significant Difference ◽

Disorder Treatment

Background: The issue of treatment resistance in eating disorder care is controversial. Prior research has identified multiple failed treatment attempts as a common criterion for severe and enduring anorexia nervosa, but little is known about patients who have multiple failed treatment attempts. This study was designed to compare the clinical and demographic characteristics of eating disorder patients with multiple, incomplete inpatient admissions to those with good outcomes. Understanding if these patient populations differ at initial admissions has implications for the prediction and characterization of inpatient eating disorder treatment resistance.Methods: This study analyzed existing data from a specialist inpatient eating disorder program at a large Canadian teaching hospital collected between 2000 and 2016. Treatment resistance was defined as two or more incomplete admissions and no complete admissions in the study period. Data were available on 37 patients who met this criteria, and 38 patients who had completed their first admission and remained well (defined as a BMI > 18.5 with no binging or purging behavior) 1 year after discharge. Variables of interest included age, weight, diagnoses, duration of illness, eating disorder psychopathology, eating disorder behavioral frequencies and depressive symptoms at the time of index inpatient admissions. Statistical analyses consisted of Mann–Whitney U tests, Chi-square tests, and a logistic regression.Results: In our main bivariate analyses, patients with multiple incomplete admissions were characterized by more severe eating disorder psychopathology and depressive symptoms at admission as well as an increased prevalence of the binge purge subtype of anorexia nervosa. In our exploratory multivariate analyses controlling for diagnostic subtype and depressive symptoms, severity of eating disorder psychopathology did not remain significant. No statistically significant difference in body mass index (BMI) or frequencies of eating disorder behaviors were found. A trend toward a longer duration of illness did not meet statistical significance.Conclusions: This study found that patients considered resistant to inpatient eating disorder treatment differ from those with good outcomes at initial admission. These results suggest that while treatment-resistant anorexia nervosa may be related to severe and enduring anorexia nervosa, it may also be a different concept that warrants additional research.

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Carers’ views on autism and eating disorders comorbidity: qualitative study

BJPsych Open ◽

10.1192/bjo.2020.36 ◽

2020 ◽

Vol 6 (3) ◽

Cited By ~ 1

Author(s):

James Adamson ◽

Emma Kinnaird ◽

Danielle Glennon ◽

Madeleine Oakley ◽

Kate Tchanturia

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Structured Interview ◽

Autism Spectrum ◽

Current Treatment ◽

Autism Diagnosis ◽

Interview Schedule ◽

Loved One ◽

The Impact

Background Patients with co-occurring anorexia nervosa and autism respond differently to eating disorder treatments. Previous interviews with patients with both conditions and clinicians working in eating disorder services has highlighted service and treatment adaptations might be beneficial and could improve outcomes for these individuals. Aims The aim of this study was to explore carers’ experiences of current treatment approaches for people with autism who have anorexia nervosa, and their views on how these can be improved. Method Ten carers of a loved one diagnosed with autism and anorexia nervosa were interviewed using a semi-structured interview schedule and the transcripts were analysed with thematic analysis. Results Four key themes emerged from the interviews: the role of autism in anorexia nervosa, carers’ problems with clinical services, the impact on carers and suggestions for future improvements. Conclusions Carers agreed that autism played a significant role in the development and maintenance of their daughters’ anorexia nervosa. However, this comorbidity does not appear to be appropriately addressed in current treatment provisions. They described several difficulties, including problems getting an autism diagnosis and the perception that eating disorder services did not accept or adapt around the condition. This resulted in feelings of frustration and isolation for families, a scenario exacerbated by a perceived lack of support or specific resources for carers of individuals on the autism spectrum. Clinical recommendations on the basis of the current and previous studies are outlined.

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Successful Treatment of Vitiligo with Crisaborole 2% Ointment

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.3.2.47 ◽

2019 ◽

Vol 3 (2) ◽

pp. 111-113 ◽

Cited By ~ 1

Author(s):

William Tausend ◽

Paige Hoyer ◽

Morgan Arnold ◽

Keith Wagner ◽

Lindy Ross ◽

...

Keyword(s):

Atopic Dermatitis ◽

Successful Treatment ◽

Systemic Treatment ◽

Treatment Options ◽

Skin Pigmentation ◽

Treatment Resistant ◽

Common Disorder ◽

Autoimmune Destruction ◽

Destruction Of Melanocytes

Vitiligo is a common disorder of skin pigmentation resulting from autoimmune destruction of melanocytes. A variety of topical and systemic treatment options have been tried with varying success. Here we describe the case of a man with refractory vitiligo successfully treated with topical crisaborole ointment.Crisaborole ointment is a topical phosphodiesterase (PDE)-4 inhibitor recently FDA-approved for the treatment of atopic dermatitis. Previous literature has discussed the possible role of systemic PDE-4 inhibitors in vitiligo; herein, we discuss the ability of topical crisaborole to accelerate repigmentation in treatment-resistant vitiligo.

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The prevalence and correlates of haematological abnormalities in adult inpatients with anorexia nervosa

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.031 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S81-S81

Author(s):

C. Hopkins ◽

A. Bruno ◽

P. Jenkins ◽

A. Ayton

Keyword(s):

Logistic Regression ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Prospective Studies ◽

Large Scale ◽

Serum Albumin Level ◽

Binary Logistic Regression ◽

Albumin Level ◽

Competing Interest ◽

Low Serum

IntroductionThere is only limited literature concerning haematological abnormalities in anorexia nervosa (AN), with little past investigation into these abnormalities in adult AN patients admitted to inpatient eating disorder (ED) units.ObjectivesThis study sought to determine the prevalence and severity of haematological abnormalities in admitted AN patients, and to examine correlates of these abnormalities.MethodsAll adult patients with a clinical diagnosis of AN admitted to the Cotswold House specialist ED inpatient unit between November 2013 and December 2014 were included in the study. Demographic, anthropometric and haematological parameters were systematically recorded for the duration of each admission. The proportions of patients affected by haematological abnormalities (anaemia, leucocytopaenia, neutropaenia, thrombocytopaenia and pancytopaenia) were selected as primary outcomes, and binary logistic regression was performed using SPSS 22.0.ResultsA total of 37 AN patients (91.9% female; mean age: 29.7 years) were included in this study, with a mean admission BMI of 13.7 kg/m2 (SD: 1.8) and a mean admission duration of 128 days; 54.1% of patients were anaemic, 64.9% of patients experienced leucocytopaenia, 56.8% of patients developed neutropaenia, 16.2% of patients suffered thrombocytopaenia, and 8.1% of patients were pancytopaenic. Logistic regression identified low admission BMI (P = 0.009) and low serum albumin level (P = 0.017) as significant correlates of anaemia, and isolated increased age (P = 0.034) as a significant associate of leucocytopaenia.ConclusionsHaematological abnormalities occur frequently in AN inpatients. Given the frequency at which abnormalities occurred in this cohort, further large-scale and prospective studies examining haematological abnormalities in inpatient AN populations are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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