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PubMed2002

Effects of recombinant human IGF-I and oral contraceptive administration on bone density in anorexia nervosa.

Over 90% of women with anorexia nervosa demonstrate osteopenia, and almost 40% demonstrate osteoporosis at one or more skeletal sites. In addition to estrogen deficiency causing an increase in bone resorption, nutritional effects on the GH-IGI-I axis may contribute to the severe bone loss in this population by decreasing bone formation. We tested the hypothesis that recombinant human IGF-I (rhIGF-I) would increase bone density in women with anorexia nervosa and furthermore assessed the effects of combined rhIGF-I and oral contraceptive administration (OCP) in this population. Sixty osteopenic women with Diagnosis and Statistical Manual of Mental Disorders IV Revised confirmed anorexia nervosa [age (25.2 +/- 0.7 yr, range 18-38 yr), body mass index (17.8 +/- 0.3 kg/m(2) ), spinal bone mineral density T score (-2.1 +/- 0.1 SD) were randomized to one of four treatment groups [rhIGF-I (30 microg/kg sc twice daily) and a daily oral contraceptive (Ovcon 35, 35 microg ethinyl estradiol and 0.4 mg norethindrone], rhIGF-I alone (30 microg/kg sc twice daily), oral contraceptive alone, or neither treatment for 9 months. All subjects received calcium 1500 mg/d and a standard multivitamin containing 400 IU of vitamin D. Administration of rhIGF-I was placebo controlled and blinded to subjects. The rhIGF-I was titrated to maintain IGF-I levels within the age-adjusted normal range for each patient and was well tolerated. The effects of rhIGF-I and OCP were analyzed simultaneously among all subjects in a factorial analysis and in an analysis of the four individual treatment groups. Anteroposterior spinal bone density increased significantly in response to rhIGF-I (1.1% +/- 0.5% vs. -0.6% +/- 0.8%, P = 0.05, all rhIGF-I vs. all placebo treated, respectively, by analysis of covariance). In contrast, OCP did not result in increased bone density (0.8% +/- 0.6% vs. -0.4% +/- 0.8%, P = 0.21, all OCP vs. all non-OCP treated, respectively, by analysis of covariance). However, bone density increased to the greatest extent in the combined treatment group (rhIGF-I and OCP), compared with control patients receiving no active therapy (1.8% +/- 0.8% vs. 0.3% +/- 0.6% vs. -0.2% +/- 0.8% vs. -1.0% +/- 1.3%, rhIGF-I and OCP vs. rhIGF-I alone vs. OCP alone vs. no active therapy, P < 0.05 for rhIGF-I and OCP vs. no active therapy). These data demonstrate that osteopenic women with anorexia nervosa treated with rhIGF-I showed more beneficial changes in bone density, compared with patients not treated with rhIGF-I. Antiresorptive therapy with OCP is not sufficient to improve bone density in undernourished patients, but such therapy may augment the effects of rhIGF-I in a combined treatment strategy. Further long-term studies are needed to investigate the effects of rhIGF-I and combined anabolic/antiresorptive strategies on bone in women with anorexia nervosa.

Adult↗
PubMed2006

The role of olanzapine in the treatment of anorexia nervosa.

OBJECTIVE: To evaluate the role of olanzapine in the treatment of anorexia nervosa. DATA SOURCES: Literature was obtained through searches of MEDLINE (1966-December 2006), EMBASE (1980-4th Quarter 2006), and PsycINFO (1985-December 2006) and a bibliographic review of published articles. Key terms used in the searches included anorexia nervosa, antipsychotics, eating disorders, olanzapine, and Zyprexa. STUDY SELECTION AND DATA EXTRACTION: All English language articles that were identified from the search were evaluated. All primary literature was included in the review. DATA SYNTHESIS: In several case reports and most clinical trials, patients with anorexia nervosa successfully gained weight while being treated with olanzapine. Moreover, many patients treated with olanzapine achieved a healthy body weight. Case reports and trials identified additional benefits of olanzapine, including reduction in delusional thinking; improvement in body image, sleep, depressive symptoms, adherence to treatment, and eating-disorder symptoms; and decreased agitation and premeal anxiety. CONCLUSIONS: Preliminary evidence supports the use of olanzapine for treatment of anorexia nervosa by demonstrating that olanzapine 2.5-15 mg daily promotes weight gain and has positive effects on associated psychological symptoms. Limitations of the reported data include small sample size, low completion rate in clinical trials, and open-label trial design. Although olanzapine appears to have a potential role in the treatment of anorexia nervosa that has been unresponsive to other therapy, randomized, placebo-controlled studies with larger sample sizes are necessary to establish its role in therapy.

Anorexia Nervosa↗
PubMed2001

Attachment in anorexia nervosa: a transgenerational perspective.

Both clinical and empirical studies suggest that insecure attachment is common in eating disordered populations. Clinical studies have addressed mother-daughter interactions, but there has been little empirical research into the mother's own attachment patterns and whether there might be intergenerational transmission of these patterns. We aimed to examine the attachment status of patients with severe anorexia nervosa and their mothers, using the 'gold standard' Adult Attachment Interview (AAI). We predicted: (1) a high level of insecurity among the patients (women with anorexia nervosa with or without bulimic behaviours); (2) that the mothers would show a higher rate of insecurity than predicted by population norms; and (3) that there might be attachment style associations within mother-daughter pairs. Twenty consecutive in-patients with a DSM-IV diagnosis of anorexia nervosa were interviewed using the AAI, as were 12 of their mothers. The mental state of daughters was rated by experienced clinicians, and that of mothers by the Clinical Interview Schedule (Revised). AAIs were transcribed and rated by expert raters. Nineteen (95%) daughters and 10 (83%) mothers were rated insecure on the AAI. Of these, 15 (79%) daughters and seven (70%) mothers were dismissive in type. We did not find an association between mothers' and daughters' attachment style. The incidence of unresolved loss was high among the mothers (67%). Idealization scores were high and reflective functioning scores low in both mother and daughter groups. Women with anorexia nervosa and their mothers commonly have a dismissive attachment style. Low levels of reflective functioning and high idealization scores are found in both groups, and may be learned (or transmitted) from mother to daughter. A difficulty in emotional processing, exemplified by unresolved loss, may be transmitted to daughters, and act as a risk factor for the development of anorexia nervosa.

Adolescent↗
PubMed2000

Differential environmental factors in anorexia nervosa: a sibling pair study.

OBJECTIVES: Previous studies have explored differences in psychosocial and familial factors between women who develop anorexia nervosa and those who do not. However, these studies have generally used between-group comparisons. This study looks at the environmental factors which may be antecedents of anorexia nervosa looking at sister pairs where one had anorexia nervosa and the other did not. DESIGN: A paired design was used to compare anorexic women with an unaffected sister on a number of background variables, including sibling interaction, parental care, peer group characteristics and other events unique to the individual. METHODS: The Sibling Inventory of Differential Experience (SIDE) was used to determine non-shared environment. Out of an initial sample of 148 women with past or current anorexia nervosa, 28 were identified who had sisters with no reported history of eating disorders and who also consented to complete the questionnaire. RESULTS: Anorexic sisters perceived more maternal control and reported more antagonism towards and jealousy of their sisters than did unaffected sisters. In addition, anorexic women reported having had fewer friends and boyfriends than their sisters. CONCLUSIONS: These results confirm the perceived differences in background environment between women with and women without anorexia nervosa. These issues are discussed in relation to behavioural genetics, family dynamics and psychosexual development.

Adolescent↗
PubMed1982

The role of sex hormones in the mechanism of inhibited LH release in female patients with anorexia nervosa.

In order to elucidate the mechanism of impaired LH secretion, 60 female patients with anorexia nervosa were investigated. A control group consisted of 14 women of the same age, examined in the follicular phase of the menstrual cycle. The serum LH, FSH, prolactin, TSH, testosterone, dihydrotestosterone, dehydroepiandrosterone, delta 4-androstenedione, oestrone, oestradiol, oestriol, progesterone, thyroxine, triiodothyronine, reverse T3 and serum sex hormone binding globulin (SHBG) concentrations were measured. The results showed a significant increase in serum dehydroepiandrosterone, testosterone, oestriol and reverse T3 concentrations. However, oestrone, oestradiol, progesterone, SHBG and triiodothyronine levels were significantly lower than those of the control group. The mean serum LH concentration in patients with anorexia nervosa before and after LRH stimulation was significantly lower than that in the control group, but FSH secretion in response to LRH was normal. All hormonal changes in anorexia nervosa disappeared after weight gain during cyproheptadine treatment. Dramatically increased dehydroepiandrosterone levels suggest that the high testosterone in women with anorexia nervosa is derived from adrenal rather than from gonadal steroids. There was no correlation between serum testosterone, dehydroepiandrosterone, oestriol and LH concentrations indicating that steroid hormone disturbances do not cause impaired LH release in anorexia nervosa.

Adolescent↗
PubMed2004

Failure to thrive and cognitive development in toddlers with infantile anorexia.

OBJECTIVE: The goal of this study was to examine the relative contributions of growth deficiency and psychosocial factors to cognitive development in toddlers with infantile anorexia. METHODS: Eighty-eight toddlers, ranging in age from 12 to 33 months, were enrolled in this study. Toddlers were evaluated by 2 child psychiatrists and placed into 1 of 3 groups: infantile anorexia, picky eater, and healthy eater. All 3 groups were matched for age, race, gender, and socioeconomic status (SES). Toddlers underwent nutritional evaluations and cognitive assessments with the Bayley Scales of Infant Development. Toddlers and their mothers were also videotaped during feeding and play interactions, which later were rated independently by 2 observers. RESULTS: On average, toddlers with infantile anorexia performed within the normal range of cognitive development. However, the Mental Developmental Index (MDI) scores of the healthy eater group (MDI = 110) were significantly higher than those of the infantile anorexia (MDI = 99) and picky eater (MDI = 96) groups. Within the infantile anorexia group, correlations between MDI scores and the toddlers' percentage of ideal body weight approached statistical significance (r =.32). Across all groups, the toddlers' MDI scores were associated with the quality of mother-child interactions, SES level, and maternal education level. Collectively, these variables explained 22% of the variance in MDI scores. CONCLUSIONS: This study demonstrated that psychosocial factors, such as mother-toddler interactions, maternal education level, and SES level, are related to the cognitive development of toddlers with feeding problems and explain more unique variance in MDI scores than nutritional status.

Anorexia↗
PubMed2003

Candidate gene analysis of the Price Foundation anorexia nervosa affected relative pair dataset.

The eating disorders are severe psychiatric illnesses with significant morbidity and mortality that exhibit statistically significant familial risk and heritability, providing support for a molecular genetic approach toward defining etiological factors. An emerging candidate gene literature has concentrated on serotinergic and dopaminergic candidates. With the financial support of the Price Foundation, a group of investigators initiated an international multi-center collaboration (Price Foundation Collaborative Group) in 1995 to study the genetics of anorexia and bulimia nervosa by collecting and analyzing phenotypes and genotypes of individuals and their relatives affected with eating disorders. The first sample of families collected by this collaborative group, known as the Price Foundation Anorexia Nervosa Affected Relative Pair (AN-ARP) dataset, was ascertained on an proband affected with Anorexia Nervosa (AN), with relative pairs affected with the eating disorders AN, Bulimia Nervosa or Eating Disorders Not Otherwise Specified [1]. Biognosis U.S., Inc. was founded to identify and characterize candidate susceptibility genes for anorexia and bulimia nervosa phenotypes in the Price Foundation eating disorder datasets. During 2000-2001, Biognosis U.S., Inc. developed and implemented a research program with a focus on the analysis of candidate genes nominated by neurochemical characteristics of eating disorder patients [2], serotonergic and dopaminergic candidate gene polymorphisms [3], neuroendocrine regulation of appetite [4], and by a positional hypothesis from a linkage analysis of the AN-ARP dataset [5]. This report reviews the anorexia nervosa candidate gene literature through 2001, the candidate gene research program implemented at Biognosis U.S., Inc. and selected candidate gene findings in the AN-ARP dataset derived from that research program.

Animals↗
PubMed2004

Effect of Cryptobia salmositica-induced anorexia on feeding behavior and immune response in juvenile rainbow trout Oncorhynchus mykiss.

At 10 degrees C, rainbow trout Oncorhynchus mykiss (n = 13 per group) infected with Cryptobia salmositica Katz, 1951 became anorexic at 3 wk post-infection (w.p.i.), with feed-intake decreasing significantly from 1.33 to 0.94% body weight (b.w.). Anorexia was most severe at 4 w.p.i. (0.80% b.w.), coinciding with peak parasitemia (9.2 x 10(6) parasites ml blood(-1)) and anemia. At 8 w.p.i., fish had recovered their appetite although they still had contained detectable parasites (6.8 x 10(5) parasites ml(-1)) and were anemic (pack cell volume, PCV, of 24.4%). However at 5 degrees C, anorexia occurred at 5 w.p.i. (0.81% b.w.), and was most severe at 7 w.p.i. (0.40% b.w.). At 8 w.p.i. (0.43% b.w.), fish displayed high parasitemia (4.6 x 10(6) parasites ml(-1)) and low PCV (10.8%). Fish at 5 degrees C had lower gastric evacuation (GE) rates (GE48h) than 10 degrees C fish, however there were no differences between infected and naive fish at both temperatures. Before anorexia, there was no significant correlation between mean share of meal (MSM, a measure of how food was partitioned within a group) and coefficient of variation in feeding but this became significant during anorexia (p = 0.02 and p = 0.0002 at 10 and 5 degrees C respectively). Significant correlations were detected between b.w. and MSM before onset of anorexia at 10 degrees C (p = 0.005) and 5 degrees C (p = 0.02); this was maintained at 10 degrees C (p = 0.001) but not at 5 degrees C (p = 0.98). Fish on an anorexic diet (0.93% b.w.) responded well at 10 degrees C to a live C. salmositica vaccine; this could partly be due to constant antigenic stimulation by the live vaccine.

Analysis of Variance↗
PubMed2003

Long-term survival of patients with anorexia nervosa: a population-based study in Rochester, Minn.

OBJECTIVE: To estimate long-term survival of unselected patients with anorexia nervosa from Rochester, Minn. PATIENTS AND METHODS: In this population-based retrospective cohort study, all 208 Rochester residents who presented with anorexia nervosa (193 women and 15 men) for the first time from 1935 through 1989 were monitored for up to 63 years. Subsequent survival was compared with that expected for Minnesota white residents of similar age and sex, and standardized mortality ratios were determined on the basis of age- and sex-specific death rates for the US population in 1987. RESULTS: Survival was not worse than expected in this cohort (P = .16). The estimated survival 30 years after the initial diagnosis of anorexia nervosa was 93% (95% confidence interval, 88%-97%) compared with an expected 94%. During 5646 person-years of follow-up (median, 22 years per patient), 17 deaths occurred (14 women and 3 men) compared with an expected 23.7 deaths (standardized mortality ratio, 0.71; 95% confidence interval, 0.42-1.09). One woman died of complications of anorexia nervosa, 2 women committed suicide, and 6 patients (5 women and 1 man) died of complications of alcoholism. Other causes of death were not increased. CONCLUSIONS: Long-term survival of Rochester patients with anorexia nervosa did not differ from that expected. This finding suggests that overall mortality was not increased among the spectrum of cases representative of the community.

Adolescent↗
PubMed1999

Distinct patterns of neuropeptide gene expression in the lateral hypothalamic area and arcuate nucleus are associated with dehydration-induced anorexia.

We have investigated the hormonal and hypothalamic neuropeptidergic substrates of dehydration-associated anorexia. In situ hybridization and hormone analyses of anorexic and paired food-restricted rats revealed two distinct profiles. First, both groups had the characteristic gene expression and endocrine signatures usually associated with starvation: increased neuropeptide Y and decreased proopiomelanocortin and neurotensin mRNAs in the arcuate nucleus (ARH); increased circulating glucocorticoid but reduced leptin and insulin. Dehydrated animals are strongly anorexic despite these attributes, showing that the output of leptin- and insulin-sensitive ARH neurons that ordinarily stimulate eating must be inhibited. The second pattern occurred only in anorexic animals and had two components: (1) reduced corticotropin-releasing hormone (CRH) mRNA in the neuroendocrine paraventricular nucleus (PVH) and (2) increased CRH and neurotensin mRNAs in the lateral hypothalamic (LHA) and retrochiasmatic areas. However, neither corticosterone nor suppressed PVH CRH gene expression is required for anorexia after dehydration because PVH CRH mRNA in dehydrated adrenalectomized animals is unchanged from euhydrated adrenalectomized controls. We also showed that LHA CRH mRNA was strongly correlated with the intensity of anorexia, increased LHA CRH gene expression preceded the onset of anorexia, and dehydrated adrenalectomized animals (which also develop anorexia) had elevated LHA CRH gene expression with a distribution pattern similar to intact animals. Finally, we identified specific efferents from the CRH-containing region of the LHA to the PVH, thereby providing a neuroanatomical framework for the integration by the PVH of neuropeptidergic signals from the ARH and the LHA. Together, these observations suggest that CRH and neurotensin neurons in the LHA constitute a novel anatomical substrate for their well known anorexic effects.

Adrenalectomy↗
PubMed2000

[Mental anorexia in aging. Report of a case].

Elderly subjects who refuse to eat, and thus develop malnutrition, can be observed both in institutional and community settings. Causes include physiological changes related to the aging process, mental disorders and environmental factors. Most cases of anorexia nevrosa begin in adolescence but a sizeable number may develop at a later age. The term anorexia nevrosa in the elderly is proposed to describe this clinical entity observed in a woman who developed anorexia nevrosa at the age of 76 years. This entity is examined in comparison with prolonged earlier-onset anorexia nevrosa and late-onset anorexia.

Age Factors↗
PubMed2000

[Serum leptin levels and soluble leptin receptors in female patients with anorexia nervosa].

BACKGROUND: Leptin action in peripheral tissues is enabled by an interaction with specific transmembrane receptors. Several of leptin receptor isoforms were identified, including soluble leptin receptor isoform structurally identical to extracellular domain of the the long leptin receptor isoform. The soluble receptor isoform is released to the circulation and acts probably as leptin-binding factor. The aim of our study was to measure serum concentrations of the soluble leptin receptor in patients with anorexia nervosa and in the control group of healthy women. Relationships of soluble leptin receptor levels to body mass index (BMI), body fat content, serum leptin, TNF-alpha and insulin levels were also studied. METHOD AND RESULTS: 16 patients with anorexia nervosa and 16 age-matched lean healthy women were included into the study. All of the subjects were measured and weighed, the body fat content was estimated from the skinfold thickness measurement. The blood for the determination of leptin, soluble leptin receptor and other hormonal parameters was obtained from all subjects after the overnight fasting. BMI, body fat content, serum leptin and insulin levels in patients with anorexia nervosa were significantly lower than in the control group (BMI: 14.98 +/- 2.32 vs. 22.21 +/- 2.48, p < 0.01, % fat content: 16.43 +/- 4.56 vs. 27.19 +/- 4.59, p < 0.01, leptin: 1.37 +/- 1.85 ng.ml-1 vs. 7.19 +/- 3.49 ng.ml-1, p < 0.01, insulin: 12.97 +/- 2.89 mU.l-1 vs. 17.09 +/- 5.57 mU.l-1, p < 0.05). Serum soluble leptin receptor levels in patients with anorexia nervosa were significantly higher compared the to control group (24.67 +/- 8.3 U.ml-1 vs. 15.71 +/- 2.79 U.ml-1, p < 0.01). No significant differences in serum TNF-alpha levels between the groups studied were found. Serum leptin levels in both groups correlated positively with BMI and body fat content. Serum soluble leptin receptor levels in both groups correlated negatively with BMI only. No statistically significant relationships between serum soluble leptin receptor levels and the rest of parameters studied were found in any of the groups studied. CONCLUSIONS: Serum soluble leptin receptors levels in patients with anorexia nervosa were significantly higher in comparison with the healthy subjects. Except of the negative correlation between serum soluble leptin receptor levels and BMI no statistically significant relationships between serum soluble leptin receptor and the rest of parameters studied were found.

Anorexia Nervosa↗
PubMedDate not supplied

Uremic anorexia: a consequence of persistently high brain serotonin levels? The tryptophan/serotonin disorder hypothesis.

Anorexia is a frequent part of uremic syndrome, contributing to malnutrition in dialysis patients. Many factors have been suggested as responsible for uremic anorexia. In this paper we formulate a new hypothesis to explain the appetite disorders in dialysis patients: "the tryptophan/serotonin disorder hypothesis." We review current knowledge of normal hunger-satiety cycle control and the disorders described in uremic patients. There are four phases in food intake regulation: (1) the gastric phase, during which food induces satiety through gastric distention and satiety peptide release; (2) the post absorptive phase, during which circulating compounds, including glucose and amino acids, cause satiety by hepatic receptors via the vagus nerve; (3) the hepatic phase, during which adenosine triphosphate (ATP) concentration is the main stimulus inducing hunger or satiety, with cytokines inhibiting ATP production; and (4) the central phase, during which appetite is regulated through peripheral (circulating plasma substances and neurotransmitters) and brain stimuli. Brain serotonin is the final target for peripheral mechanisms controlling appetite. High brain serotonin levels and a lower serotonin/dopamine ratio cause anorexia. Plasma and brain amino acid concentrations are recognized factors involved in neurotransmitter synthesis and appetite control. Tryptophan is the substrate of serotonin synthesis. High plasma levels of anorectics such as tryptophan (plasma and brain), cholecystokinin, tumor necrosis factor alpha, interleukin-1, and leptin, and deficiencies of nitric oxide and neuropeptide Y have been described in uremia; all increase intracerebral serotonin. We suggest that brain serotonin hyperproduction due to a uremic-dependent excess of tryptophan may be the final common pathway involved in the genesis of uremic anorexia. Various methods of ameliorating anorexia by decreasing the central effects of serotonin are proposed.

Amino Acids↗
PubMed2000

[Digital necrosis in a patient with anorexia nervosa. Association of vasculopathy and radial artery injury].

BACKGROUND: Patients with anorexia nervosa can develop distal vasculopathy sometimes leading to severe Raynaud's phenomenon or acrocyanosis. We report a cas of anorexia nervosa-related vasculopathy associated with iatrogenic injury to the radial artery that led to digital necrosis. CASE REPORT: An 18-year-old woman, with a history of severe anorexia nervosa of 5 years duration and who acknowledged regular use of tobacco and cannabis, was hospitalized for necrosis of the left index and thumb that had occurred shortly after left radial artery puncture for blood gas analysis. Acrocyanosis of the 4 limbs had been present since the onset of anorexia nervosa. Arteriography of the upper limbs showed major spasm of the left radial and cubital arteries and thromboses in the left interdigital arteries of the left index and thumb. The distal portions of the arteries were then on the left and on the right. The nectrotic lesions healed after intravenous administration of ilomedine and interruption of tobacco and cannabis. Acrocyanosis of the four limbs persisted. DISCUSSION: We report a case of digital necrosis occurring after arterial puncture for blood gas analysis in a patient with a vascular bed weakened by tobacco and cannabis intoxication but also by anorexia nervosa-related vasculopathy. This observation underlines the potentially dangerous nature of invasive intravascular procedures in this context. Indications for vessel puncture must be assessed with prudence.

Adolescent↗
PubMed2002

[Anorexia nervosa and Crohn disease: diagnostic intricacies and difficulties. 3 cases].

INTRODUCTION: Diagnosis of anorexia nervosa is readily evoked in young girls who associate decreased food intake and weight loss. Among the differential diagnoses of anorexia, it is important to underline the preponderant place occupied by Crohn's disease. OBSERVATIONS: We report three cases of young 18 to 25 year-old girls, initially treated for anorexia nervosa in a psychiatric department. Diagnosis of Crohn's disease was made within 5 to 13 years. The clinical and biological characteristics are reported for each case. COMMENTS: In view of the frequency of digestive disorders concomitant to eating disorders, the distinction between anorexia and digestive disease is particularly delicate. It requires appropriate somatic and biological assessment that, when confronted with clinical and/or biological atypia, may query the initial diagnosis of anorexia.

Adolescent↗
PubMed2002

Early scurvy complicating anorexia nervosa.

Scurvy is an extremely rare complication of anorexia nervosa. Despite the poor intake of nutrients, anorexia nervosa is not commonly associated with vitamin deficiencies. We report a case of early scurvy complicating long-standing anorexia nervosa. Anorexia nervosa appears to be increasing in incidence. Although scurvy is unusual, this case shows the importance of its recognition as a nutritional consequence of anorexia nervosa.

Anorexia Nervosa↗
PubMedDate not supplied

[Anorexia nervosa in adult women].

AIM AND METHOD: The author presents the clinical picture of anorexia nervosa and comorbidity in women with serious symptoms of anorexia nervosa (diagnosed acc. to DSM-IV), which appeared in adulthood, after the age of 25 years. RESULTS: Most of these patients (25-40 years old) had mild symptoms of eating disorders (restricted anorexia nervosa), from adolescence, never diagnosed and treated, had a nondisturbed somatic state and social functioning. The worsening of psychic state and full development of anorexia nervosa symptoms occurred during stressful life event (e.g. avoidance by sexual partner). The majority of those patients had present and past (from adolescence) various anxiety and depressive disorders and personality disorders (obsessive--compulsive, borderline). In most of the women older than 40 years, anorexia nervosa comorbid with depressive disorders, less often with mixed, anxiety--depressive, disorders. The symptoms occurred during menopause, after loss of life-partner (separation or death). It was not established, which of these disorders appeared as the first one. The prognosis was better for the second group of those patients.

Adult↗
PubMed2003

[An anorexia nervosa case and an approach to this case with pharmacotherapy and psychodrama techniques].

Anorexia nervosa in an eating disorder that primarily affects female adolescents and is more commonly seen in westernized countries. Although it is a sociocultural problem of developed societies, nowadays it is also increasing rapidly in developing cultures such as Turkey. Difficulties in the treatment of anorexia nervosa have directed clinicians to understand the disorder better. Although it is well known that various factors play a role in the etiology of anorexia nervosa, psychodynamic factors also have considerable importance. In addition, social and familial interactions contribute to the development of anorexia nervosa. In the light of these facts, treatment with psychotherapy and pharmacotherapy might be used to cure this disorder. In this article, the definitive features and process of anorexia nervosa along with its psychodynamics were discussed on the basis of a case. In the treatment of the patient, psychodrama techniques with drugs were thought to be useful. The patient became aware of the unfavourable relationship and improved by the use of this method. Thus she gained emotional-cognitive insight.

Adolescent↗