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Anorexia nervosa [keywords]
- A systematic review of the frequency, duration, type and effect of involuntary treatment for people with anorexia nervosa, and an analysis of patient characteristics. [JOURNAL ARTICLE]
- J Eat Disord 2014; 2(1):29.
Involuntary treatment of anorexia nervosa is controversial and costly. A better understanding of the conditions that determine involuntary treatment, as well as the effect of such treatment is needed in order to adequately assess the legitimacy of this model of care. The aim of the present study was to investigate the frequency and duration of involuntary treatment, the characteristics of this group of patients, the kind of involuntary actions that are applied and the effect of such actions.Relevant databases were systematically searched for studies investigating the involuntary treatment of individuals diagnosed with anorexia nervosa.The studies included in the review contained people treated in an inpatient setting for severe or severe and enduring anorexia nervosa. People that were treated involuntarily were characterised by a more severe psychiatric load. The levels of eating disorder pathology between involuntary and voluntary groups were similar and the outcome of involuntary treatment was comparable in terms of symptom reduction to that of voluntary treatment.Despite inconsistent findings, the comparable levels of eating disorder pathology observed between involuntary and voluntary patient-groups together with findings of higher co-morbidity, more preadmissions, longer duration of illness and more incidences of self-harm for involuntary patients suggest that involuntary treatment is not a reaction to the severity of eating disorder symptoms alone, but is most likely a response to the complexity of the patient's situation as a whole.
- The multifactorial etiology of eating disorders outlined in a case of anorexia nervosa and complicated by psychiatric co-morbidities. [Journal Article]
- Psychiatr Danub 2014 Nov.:250-5.
This article outlines a case of anorexia nervosa within the context of its multifactorial etiology and complex neurobiology. Additionally, it also highlights that in this case there were several co-morbid personality traits and other psychiatric co-morbidites such as OCD and bipolar disorder.
- The Process of Help-Seeking in Anorexia Nervosa: Patients' Perspective of First Contact With Health Services. [JOURNAL ARTICLE]
- Eat Disord 2014 Nov 20.:1-17.
In this study we explored circumstances, reflections, and reactions to first treatment contact in 34 women (aged 18-51) diagnosed with anorexia nervosa (AN) (DSM-IV). Using methods from grounded theory we identified how the meeting came about, what motivated the patients, and how they reacted to the conversation. The results suggest that (a) health care professionals need to demonstrate effective professional communication skills and proficient knowledge about eating disorders in early contacts; (b) treatment goals other than recovery from AN should be explored; and (c) patients' view of AN as a strategy for increased control and mastery in life may be a topic for discussion in the early contacts.
- The Effectiveness of an Individualized Form of Day Hospital Treatment. [JOURNAL ARTICLE]
- Eat Disord 2014 Nov 20.:1-15.
The traditional group format of day hospital treatment for eating disorders restricts individual tailoring of treatment, which is challenging when complex cases are referred. In 2007 we introduced a new program that included individual sessions. Patients referred to this program were older, had longer illness duration, and more pre-treatment symptoms than the original group program. These clients also had more psychopathology, and were more likely to have a diagnosis of anorexia nervosa binge/purge subtype. Weight gain and abstinence from symptoms were less likely for patients in this new program. However, premature discharge, rapid response, symptom frequencies, and relapse rates did not differ.
- [Deep Brain Stimulation: New Frontier in the Treatment of CNS Disorders.] [REVIEW]
- Acta Med Port 2014 Sep-Oct; 27(5):641-648.
Introduction: The author reviews the present indications of deep brain stimulation, its progress and outcomes, its targets and techniques, the main neurosurgeons and medical centers involved.Material and Methods: This review is based on the experience of the Functional Neurosurgery group of the Hospital Santa Maria (Centro Hospitalar de Lisboa Norte) since 1995 and on the bibliography published since 1980 indexed on PubMed.Results and Discussion: The deep brain stimulation applications in the different functional neurosciences fields are presented and discussed: Movement disorders, including Parkinson'€™s disease, dystonia and tremor, Gilles de la Tourette, chronic pain, epilepsy and psychosurgery with its different aims: Obsessive-compulsive disorder, severe resistant depression, resistant aggressiveness with disruptive behavior, eating behavior disorders (anorexia nervosa, morbid obesity) and drug addiction (alcohol, opioids, cocaine).Conclusions: In most of these clinical situations, deep brain stimulation is a safe and useful therapeutic resource that must be considered whenever the usual therapies are useless or not enough; in the other cases a greater experience is needed to make it a regular indication.
- Decreasing the duration of untreated illness for individuals with anorexia nervosa: study protocol of the evaluation of a systemic public health intervention at community level. [JOURNAL ARTICLE]
- BMC Psychiatry 2014 Nov 18; 14(1):300.
BackgroundAnorexia nervosa (AN) is a mental disorder with grave burdens for affected individuals as well as for the healthcare system. One of the strongest predictors of a poor outcome is a long Duration of Untreated Illness (DUI), which is defined as the time between the onset of the disease and treatment initiation. Reducing the DUI is an important step to optimize care of individuals with AN. In order to achieve this aim, systemic public health interventions are necessary. Objective of this study is to evaluate a systemic public health intervention at Community level aiming to reduce the DUI in individuals with AN.Methods/designThe intervention includes the establishment of a network of health care professionals within the area of eating disorders (EDs), the development of an internet-based treatment guide, the presentation of informative short-films about EDs in cinemas and a corresponding poster campaign as well as a special outpatient clinic. For the evaluating study a pre-post between-subject design is chosen. The DUI, and the duration until first contact (DUC) with a health care professional, ED pathology as well as comorbidity are assessed before and after the systemic intervention is carried out.DiscussionThe study attempts to provide evidence of the effectiveness of an ED-related systematic public health intervention. Additionally, the study will lead to a better understanding of the DUI, which is essential in order to improve care of individuals with AN.Trial registrationCurrent Controlled Trials ISRCTN44979231; Registered 11 November 2011.
- [Depressive states at the stage of broad clinical presentations of anorexia nervosa in adolescents.] [JOURNAL ARTICLE]
- Zh Nevrol Psikhiatr Im S S Korsakova 2014; 114(9):9-14.
Objective. To specify psychopathological features and dynamics of depression developed at the stage of broad clinical presentations of anorexia nervosa (AN) in adolescent patients. Materials and methods. Authors studied 61 young women, aged from 14 to 18 years, mean age 16.6±0.9 years. Depressive states manifested during the first year of AN in all patients. Results. Two variants of depressive episodes were described. The first variant was characterized by asthenic/depressive, somatic and autonomic presentations, with the leading role of exogenous/organic and somatogenic factors. In the second variant, affective disorders were characterized by the anxiety affect concomitant with adynamia, dysphoria and melancholia that most probably may be caused by endogenous constitutional/biological factors. The follow-up data (0,5-6 years) indicated that most of the patients with the second variant of depressive episodes had recurrent depressive states. During the course of disease, eating disorders acquired an atypical character and gradually decreased while the affective pathology became dominating. Conclusion. Depressive symptomatology in AN patients of pubertal age corresponded to main mechanisms of development of the clinical picture and dynamics of adolescent depression as atypical depressive triad, predominance of anxiety and asthenic/adynamic affect, a trend towards protracted course and substantial frequency of dysmorphophobic symptoms and overvalued ideas.
- [Criteria for admitting patients with anorexia nervosa as inpatients to a general hospital; survey among internists]. [English Abstract, Journal Article]
- Tijdschr Psychiatr 2014; 56(11):708-16.
Anorexia nervosa (an) is associated with a number of life-threatening complications. Sometimes there are good reasons for admitting an anorexia nervosa patient to a general hospital for treatment as an inpatient. Therefore, there needs to be optimal collaboration between psychiatrists treating the patient and the medical staff at the general hospital.<br/>To obtain insight into the admission criteria and other possible factors that play a role in the physician's decision to admit a patient with anorexia nervosa for inpatient treatment in a general hospital.<br/>Internists and residents-internal medicine completed a questionnaire about admission criteria and, where applicable, about threshold values for these criteria. The physicians were also asked to judge two case vignettes. In addition, they were questioned about other factors that influenced their views on the admission of patients with anorexia nervosa to a general hospital and about their attitude to this patient-group, their experience of treating patients with anorexia nervosa and their awareness of a need for a guideline. The data were collected at the annual Dutch congress for internists at Maastricht.<br/>In total 78 congress attendees responded to the questionnaire; 47% were internist and 53% were resident-in-training. Agreement was greatest with regard to the following admission criteria (top 5): 1. serum potassium (threshold value <2.5 mmol/l was the criterion selected most); 2. arrhythmia; 3. hypoglycemia; 4. heart rate (threshold value <40 bpm was chosen most); 5. prolonged qt interval on an ECG. According to the two fictitious cases, the reason for admitting a patient with anorexia nervosa with milder symptoms was influenced by 'attitude'. Half of the respondents pointed out that the patient's cooperation plays a role in the decision to admit a patient with an eating disorder.<br/>Respondents reached a consensus regarding several admission criteria but the threshold values they gave varied substantially. Attitude towards the patient-group can sometines influence the decision to admit a patient with anorexia nervosa to a general hospital. Internists and residents-in-training indicated they require detailed, carefully compiled guidelines which take into consideration the expected results and which emphasise the importance of obtaining the patient's cooperation.