ARTICLE | doi:10.20944/preprints202305.1023.v1
Subject: Public Health And Healthcare, Public Health And Health Services Keywords: Atypical anorexia nervosa; anorexia nervosa; Asian adolescents; eating disorders
Online: 15 May 2023 (10:33:45 CEST)
Atypical Anorexia Nervosa (AAN) had been found to have significant physical and psychological complications at presentation but has not been described in a multi-ethnic Asian population. This retrospective cohort analysis aimed to characterize the baseline presentation of adolescents with Anorexia nervosa (AN) (N=317) and AAN (N=141) in an Asian cohort that presented to a specialist paediatric eating disorder program between January 2010 to October 2020 for assessment. In patients with AAN, there were increased proportions of males (16% vs 7%) and of Malay ethnicity (11% vs 4%) compared to AN. Adolescents with AAN had lower admission rates (61% vs 81%) as well as lower rates of bradycardia (45% vs 75%) and hypotension (7% vs 21%) but higher rate of syncope (13% vs 7%) compared to adolescents with AN. However, adolescents with AAN had higher frequency of psychological complications including self-harm and drug overdose (14% vs 1.5%) requiring admission as well as higher rates of purging (45.1% vs 14.8%) and for Eating Disorder Questionnaire score in the shape domain was more severe. Asian adolescents with AAN manifest with physical complications of malnutrition and had worse eating disorder psychopathology with higher frequency of other psychological co-morbidities underlining the severity of the illness.
ARTICLE | doi:10.20944/preprints202201.0213.v1
Subject: Medicine And Pharmacology, Psychiatry And Mental Health Keywords: anorexia; aged; intensive care; depression
Online: 14 January 2022 (13:52:25 CET)
Abstract: Appetite loss is common in older patients and an independent risk factor for sarcopenia, which is associated with high mortality. However, few studies have explored the phenomenon of appetite loss after discharge from the intensive care unit (ICU). Therefore, we aimed to describe the prevalence of appetite loss and the relationship between appetite loss and depression in patients living at home 12 months after intensive care. We conducted a post hoc analysis, which was a published ambidirectional study examining post-intensive care syndrome at 12 months after discharge. We included patients aged > 65 years. The Short Nutritional Assessment Questionnaire (SNAQ) and Hospital Anxiety Depression Scale (HADS) were used for the analysis. Descriptive statistics and a multilevel generalized linear model were used to clarify the relationship between appetite loss and depression. Data from 468 patients were analyzed. The defined appetite loss was 25.4% (95%CI, 21.5–29.4). High severity of depression was an independent factor for high probability of appetite loss (OR, 1.2; 95%CI, 1.14–1.28; p=0.00). Poor appetite is common 12 months after intensive care and is associated with the severity of depression.
ARTICLE | doi:10.20944/preprints202206.0029.v1
Subject: Medicine And Pharmacology, Immunology And Allergy Keywords: Anorexia; adolescents; pediatric; liver injury; aminotransferase; renal injury; refeeding
Online: 2 June 2022 (07:58:28 CEST)
Background: Only few pediatric reports exist regarding the prevalence, cause and evolution of liver and renal injury in patients with anorexia nervosa (AN). The aim of this study is to describe the prevalence and the risk factors of hepatic and renal failure at admission and during hospitalization, especially during refeeding in a cohort of hospitalized adolescents with AN.Methods: In a retrospective cohort study of adolescents with AN in a single hospital of Marseille from 2013 to 2019, we compared four groups on admission: elevated aminotransferases (AT)/normal AT and renal injury/no renal injury to analyze the differences between them (demographic factors, anthropometric factors, disease duration, initial prescribed calories, speed of refeeding, aminotransferase level, glomerular filtration rate). We observed the evolution of AT and renal injury for these four groups during refeeding (by the increase of kilocalories). Results: A total of 29 subjects with AN met eligibility criteria (age: 14.2 years, female (86.2%), BMI at admission (Z-score= -2.8 standard deviation (SD)) with elevated AT (20.7 %) and renal injury (13.8 %) on admission. Lower Z-score BMI (-4.05 vs -2 SD, p = 0.013), lower expected weight for height (69% vs 76%, p = 0.034) and longer disease duration (2.1 vs 0.9 years, p =0,032) were significantly associated with elevated liver enzymes at admission. Lower Z-score BMI (-3.35 vs -2.5 SD, p = 0.002), lower expected weight for height at admission (69% vs 74,5%, p = 0.002) and loss of weight before admission (0.66 vs à 0.20 kg per day, p = 0.002) were associated with renal injury at admission. Time nadir BMI (13.5 vs 6.5 days, p = 0.034) and duration of hospitalization (55 vs 41 days, p = 0.036) were longer in elevated enzymes on admission group. During refeeding, liver enzymes (95% confidence interval (CI), odds ratio (OR) aspartate aminotransferase: -0.07 [-0.11; -0.03] and OR alanine aminotransferase: -0.16 [-0.27; -0.06]) and renal injury (95% CI, OR creatinine: -0.013 [-0.017; -0.008]) have normalized with the increase of calories, with significant association.Conclusions: The results of this study suggest that degree of malnutrition is associated with liver and renal injury on admission. Theses failures disappeared with refeeding. In the future, prospective multicentric studies could examine evolution of renal and hepatic failure undergoing refeeding in large pediatric cohort of AN.
REVIEW | doi:10.20944/preprints202008.0461.v1
Subject: Medicine And Pharmacology, Dietetics And Nutrition Keywords: eating disorders; anorexia nervosa; bulimia nervosa; personality traits; screening tools; Covid-19
Online: 20 August 2020 (13:11:08 CEST)
This article aims to review the screening and diagnostic tools for eating disorders (ED). Eating disorders represent a complex pathology defined by an imbalance between hunger and satiety, installed in an emotional, traumatic, or conflictive context. Recently, the emphasis regarding ED is focused on the link between genetics, mental pathology, and the somatic and metabolic phenotype and early detection. Early detection and intervention can assure a better recovery and can improve a lot the quality of life of these patients. Methods: We selected ten articles of central importance on the topic in a systematic search on eight databases, articles selected on the type of scales, and size of the study. Results: We identified eight questionnaire scales used in large trials in ED disorders in the scanned literature, choose because we consider it the most accurate and the ones that evaluate best the pathology and the elements that are important as specific traits in ED. There are interview-type scales and self-administered scales. Interview scales are characterized by assessments of symptoms and diagnosis, while self-administered assess particular traits and the possibility of further development of eating disorders. The majority of the scales evaluated were described and used in adult populations. From all the scales assessed and analyzed, only three are described at the child population – it is EAT-26 (> 16 years), EDI-3 (>13 years), and ANSOCQ (> 13 years). Conclusions: It is essential to develop specific scales for people under 18 years of age, given the increasing incidence of ED among children and the need for early detection and appropriate intervention. Early detection of ED in children implies a simple and accurate evaluation at the primary care level or in schools, as the course of the disease can be subclinical for several years. Moreover, the need for accurate scales and telemedicine testing and diagnosis is of high importance during the COVID-19 pandemic as youth are at particular risk being psychologically affected due to disrupted education and social interactions - at a critical time.
ARTICLE | doi:10.20944/preprints202211.0198.v1
Subject: Medicine And Pharmacology, Pediatrics, Perinatology And Child Health Keywords: autistic spectrum disorder; anorexia nervosa; female; prevalence; Bayes’ Theorem; diagnosis; management; generalized joint hypermobility.
Online: 10 November 2022 (11:02:35 CET)
It appears that up to 80% of females with autistic spectrum disorder (ASD) have not been diagnosed by 18 years of age. This translates to a prevalence of about 5-6%, and if true has serious implications for female mental health. One way of finding the true value is to use Bayes’ Theorem with a comorbid condition as a more easily recognizable flag. An obvious choice is anorexia nervosa (AN), but it transpires that the proportion of women with ASD who develop AN is unknown. This study uses published data in novel ways to provide two methods of estimating a range for this variable, and gives a median value of 8.3% for AN in ASD and with four other methods a median prevalence of 6% for female ASD. The clinical implications for diagnosis and management of ASD and comorbidities are discussed and a solution is provided for the rate of ASD in generalized joint hypermobility.
REVIEW | doi:10.20944/preprints202202.0156.v2
Subject: Medicine And Pharmacology, Psychiatry And Mental Health Keywords: esketamine; ketamine; ketamine assisted psychotherapy; eating disorder; anorexia nervosa; bulimia nervosa; binge eating disorder; pharmacology; psychedelics; treatment
Online: 7 March 2022 (08:34:11 CET)
Eating disorders (EDs) are serious, life-threatening psychiatric conditions associated with physical and psychosocial impairments, as well as high morbidity and mortality. Given the chronic refractory nature of EDs and the paucity of evidence-based treatments, there is a pressing need to identify novel approaches for this population. The noncompetitive N-methyl-D-aspartate receptor (NMDAr) antagonist, ketamine, has recently been approved for treatment-resistant depression, exerting rapid and robust antidepressant effects. It is now being investigated for several new indications, including obsessive-compulsive, post-traumatic, and substance use disorder; and shows transdiagnostic potential for EDs, particularly among clinical non-responders. As such, the aim of this review is to examine contemporary findings on the treatment of EDs with ketamine, whether used as a primary, adjunctive, or combination psychopharmacotherapy. Avenues for future research are also discussed. Overall, results are encouraging and point to therapeutic value, yet are limited to case series and reports on anorexia nervosa. Further empirical work is thus needed to explore ketamine efficacy across ED subgroups; establish safety profiles and optimize dosing; and develop theory-driven, targeted treatment strategies at the individual patient level.