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Philip S Mehler - One of the best experts on this subject based on the ideXlab platform.
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medical complications of Anorexia Nervosa and bulimia
The American Journal of Medicine, 2016Co-Authors: Patricia Westmoreland, Mori J Krantz, Philip S MehlerAbstract:Anorexia Nervosa and bulimia Nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of Anorexia Nervosa, as well as from the purging behaviors that characterize bulimia Nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as Anorexia Nervosa and bulimia Nervosa become more severe and chronic. We review the medical complications that are associated with Anorexia Nervosa and bulimia Nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders.
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predictors of hypophosphatemia during refeeding of patients with severe Anorexia Nervosa
International Journal of Eating Disorders, 2015Co-Authors: Jennifer L Gaudiani, Carrie A Brown, Allison L Sabel, Philip S MehlerAbstract:Objective Hypophosphatemia of refeeding is one of the most dangerous complications seen during the treatment of patients with Anorexia Nervosa. Although easily detectable and treatable, hypophosphatemia is under-recognized as a complication of refeeding. Specific risk factors for the development of hypophosphatemia are likely to exist among patients with severe Anorexia Nervosa. The purpose of this study was to identify clinically useful markers that may predict the development of or protection from hypophosphatemia during refeeding. Methods We conducted a retrospective case-control study of 123 patients with severe Anorexia Nervosa admitted for medical stabilization at the ACUTE Center for Eating Disorders between October 1, 2008 and December 31, 2013. Risk factors for refeeding hypophosphatemia were determined by multivariate logistic regression from clinical parameters and laboratory values measured at the time of admission. Results The prevalence of hypophosphatemia was 33.3% (41 of 123 patients). Higher hemoglobin was the only risk factor associated with a higher odds of developing hypophosphatemia (adjusted odds ratio [aOR], 1.56 [95% confidence interval [CI], 1.12–2.18]). Statistically significant protective factors against the development of hypophosphatemia were observed with higher body mass index (aOR, 0.54 [95% CI, 0.39–0.75]), higher serum potassium (aOR, 0.29 [95% CI, 0.14–0.62]), and higher serum prealbumin (aOR, 0.91 [95% CI, 0.84–0.99]). Discussion Four independent factors associated with refeeding hypophosphatemia were identified. Identification of findings which correlate with hypophosphatemia, or the lack thereof, has the potential to facilitate appropriate triage of patients with Anorexia Nervosa for closer monitoring during refeeding. © 2015 Wiley Periodicals, Inc (Int J Eat Disord 2015; 48:898–904).
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exercise electrocardiography extinguishes persistent junctional rhythm in a patient with severe Anorexia Nervosa
The Cardiology, 2011Co-Authors: Mori J Krantz, Jennifer L Gaudiani, Victor W Johnson, Philip S MehlerAbstract:Among psychiatric conditions, Anorexia Nervosa carries the highest mortality, in part due to the propensity for rhythm disturbances among patients with advanced disease. Patients with Anorexia Nervosa are prone to both bradycardia and tachyarrhythmias, though mortality has not been associated with the former. To date, only one case of junctional rhythm in the setting of Anorexia Nervosa has been previously described, which was unremitting and required prolonged hospitalization. We report a case of persistent accelerated junctional rhythm where a formal exercise electrocardiography study demonstrated rapid reversion to sinus rhythm with graded exercise. Despite a 22-day hospitalization the patient never reverted permanently to sinus rhythm. This underscores the heightened vagal tone that may be seen among patients with severe Anorexia Nervosa. Despite this, it may be rapidly extinguished with sympathetic overdrive during exercise. In this context, exercise electrocardiography appears to be a safe, noninvasive means of assessing cardiac conduction and chronotropic reserve in this population.
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polydipsia and hyponatremia in a woman with Anorexia Nervosa
International Journal of Eating Disorders, 2010Co-Authors: Amit Bahia, Philip S MehlerAbstract:Objective: Hyponatremia is infrequently reported in the constellation of metabolic abnormalities in patients with eating disorders. We sought to identify the etiology and describe the management of a patient with Anorexia Nervosa and hyponatremia. Method: We report the case of a 23-year-old woman with Anorexia Nervosa who suffered with severe hyponatremia. Results: The etiology of hyponatremia in this case, as in most patients with eating disorders, was multifactorial, encompassing both hypovolemic and euvolemic categories of hyponatremia. Multiple impairments in the ability to clear free water are responsible for a heightened risk for hyponatremia in patients with Anorexia Nervosa. Discussion: This case underscores the importance of careful scrutiny of fluid intake, an awareness of medications that lead to hyponatremia, and the need for regular monitoring of serum electrolytes, even in patients with Anorexia Nervosa, to allow for an early diagnosis and to assist in the formulation of an effective treatment and prevention strategy. © 2010 by Wiley Periodicals, Inc.
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liver function test abnormalities in Anorexia Nervosa cause or effect
International Journal of Eating Disorders, 2009Co-Authors: Vignesh Narayanan, Jennifer L Gaudiani, Robert Hill Harris, Philip S MehlerAbstract:Objective: Two females with severe Anorexia Nervosa (BMI of 10) were seen with marked abnormalities in their liver function tests before the initiation of refeeding. These paradoxically resolved with progressive refeeding and weight restoration. Method: Clinical observation during regimented medical stabilization and refeeding of two patients with severe Anorexia Nervosa with frequent monitoring of liver function tests. Results: Normalization of liver function tests ensued as caloric intake increased and weight gain progressed. Discussion: Although classically liver function test elevations occur during refeeding, as a manifestation of excessive calories and fat deposition in the liver, they may also be elevated due to severe malnutrition before refeeding has commenced and improved as refeeding occurs. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010
Janet Treasure - One of the best experts on this subject based on the ideXlab platform.
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process evaluation of the maudsley model for treatment of adults with Anorexia Nervosa trial part ii patient experiences of two psychological therapies for treatment of Anorexia Nervosa
European Eating Disorders Review, 2014Co-Authors: Anna Lose, Janet Treasure, Charlotte Davies, Beth Renwick, M Kenyon, Ulrike SchmidtAbstract:Objective This study is the second part of a process evaluation, embedded in the MOSAIC study, a large randomised controlled trial comparing two different psychological therapies, the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) and Specialist Supportive Clinical Management (SSCM). The study adopted a qualitative approach to examine patient experiences of the two treatments. Method Seventeen semi-structured interviews were conducted with Anorexia Nervosa and Eating Disorder Not Otherwise Specified-Anorexia Nervosa type patients, and transcripts were analysed thematically. Results Patient responses yielded five main themes: positive and helpful aspects, beneficial outcomes, less helpful aspects, possible improvements to the treatments, and the therapeutic and external environment. The findings show clear differences and some overlaps between patients' views on MANTRA and SSCM. Discussion Both therapies were experienced by patients as credible and largely helpful, albeit in different ways. These results are in agreement with those of therapists' views on these treatments. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
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the socio emotional processing stream in Anorexia Nervosa
Neuroscience & Biobehavioral Reviews, 2011Co-Authors: Anna Oldershaw, Janet Treasure, David Hambrook, Kate Tchanturia, Daniel Stahl, Ulrike SchmidtAbstract:The significance of socio-emotional factors in development and maintenance of Anorexia Nervosa (AN) has been noted, but the literature is poorly integrated without clear models guiding research or treatment. This systematic review retrieved experimental studies of social-cognitive or affective processing in AN and categorised them using Ochsner's "Social-Emotional Processing Stream." Ochsner's "Processing Stream", based on healthy data, comprises five constructs: (1) acquisition of and (2) recognition and response to social-affective stimuli, (3) low-level and (4) high-level mental state inference and (5) context-sensitive emotion regulation. Thirty-seven experimental studies in Anorexia Nervosa were identified, mapping on to four of the five constructs (not Construct 3). A meta-analysis of nine affect recognition studies was conducted. AN patients demonstrated impairments in each of the four domains with preliminary reports that some difficulties are trait-like, and others ameliorate following recovery. Socio-emotional data was integrated with previous reports of neural abnormalities to generate an AN specific model of socio-emotional processing. Additional research is required for further definition and to translate experimental findings into clinical practice.
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neural correlates of impaired cognitive behavioral flexibility in Anorexia Nervosa
American Journal of Psychiatry, 2009Co-Authors: Arne Zastrow, Janet Treasure, Kate Tchanturia, Stefan Kaiser, Christoph Stippich, Stephan Walther, Wolfgang Herzog, Aysenil Belger, Matthias Weisbrod, Hanschristoph FriederichAbstract:OBJECTIVE: Impaired cognitive-behavioral flexibility is regarded as a trait marker in Anorexia Nervosa patients. The authors sought to investigate the neural correlates of this deficit in executive functioning in Anorexia Nervosa. METHOD: Fifteen women with Anorexia Nervosa and 15 age-matched healthy comparison women underwent event-related functional MRI while performing a target-detection task. The task distinguished between shifts in behavioral response and shifts in cognitive set. It involved infrequent target and non-target distractor stimuli embedded in a sequence of prepotent standard stimuli. RESULTS: Relative to comparison subjects, Anorexia Nervosa patients showed a significantly higher error rate in behavioral response shifting, independent of whether those runs also involved cognitive set shifting. During behavioral response shifting, patients showed reduced activation in the left and right thalamus, ventral striatum, anterior cingulate cortex, sensorimotor brain regions, and cerebellum that differed significantly from the comparison group but showed dominant activation in frontal and parietal brain regions. These differential activations in patients and comparison subjects were specific to shifts in behavioral response: except for thalamic activation, they were not observed in response to non-target distractor trials that required no alteration in behavioral response. CONCLUSION: Impaired behavioral response shifting in Anorexia Nervosa seems to be associated with hypoactivation in the ventral anterior cingulate-striato-thalamic loop that is involved in motivation-related behavior. In contrast, Anorexia Nervosa patients showed predominant activation of frontoparietal networks that is indicative of effortful and supervisory cognitive control during task performance.
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is impaired set shifting an endophenotype of Anorexia Nervosa
American Journal of Psychiatry, 2005Co-Authors: Joanna Holliday, David A Collier, Kate Tchanturia, Sabine Landau, Janet TreasureAbstract:OBJECTIVE: Set-shifting difficulties have been reported in subjects with Anorexia Nervosa and appear to persist after recovery; therefore, they may be endophenotypic traits. The goals of this study were to investigate whether set-shifting difficulties are familial by examining discordant sister-pairs in comparison with healthy unrelated women and to replicate, with a broader battery, the lack of influence of an acute illness state on neuropsychological performance. METHOD: Forty-seven pairs of sisters discordant for Anorexia Nervosa and 47 healthy unrelated women who were comparable in age and IQ completed neuropsychological tasks selected to assess set-shifting ability. Analyses of variance with standard errors that are robust against correlations within family clusters were used to compare the groups. Results were adjusted for obsessive-compulsive, anxiety, and depression symptoms. Subjects with acute (N=24) and fully remitted (N=23) Anorexia Nervosa were compared to assess state versus trait effects. R...
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cognitive flexibility in Anorexia Nervosa and bulimia Nervosa
Journal of The International Neuropsychological Society, 2004Co-Authors: Kate Tchanturia, Marija Anderluh, Robin G Morris, S Rabehesketh, David A Collier, Patricia Sanchez, Janet TreasureAbstract:The aim of this study was to determine if there are differences in cognitive flexibility in Anorexia Nervosa and bulimia Nervosa. Fifty-three patients with an eating disorder (34 with Anorexia Nervosa and 19 with bulimia Nervosa) and 35 healthy controls participated in the study. A battery of neuropsychological tests for cognitive flexibility was used, including Trail Making B, the Brixton Test, Verbal Fluency, the Haptic Illusion Test, a cognitive shifting task (CatBat) and a picture set test. Using exploratory factor analysis, four factors were obtained: 1: Simple Alternation; 2: Mental Flexibility; 3: Perseveration; and 4: Perceptual Shift. Patients with Anorexia Nervosa had abnormal scores on Factors 1 and 4. Patients with bulimia Nervosa showed a different pattern, with significant impairments in Factors 2 and 4. These findings suggest that differential neuropsychological disturbance in the domain of mental flexibility0rigidity may underlie the spectrum of eating disorders. ( JINS, 2004, 10, 513‐520.)
Kate Tchanturia - One of the best experts on this subject based on the ideXlab platform.
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characteristics of autism spectrum disorder in Anorexia Nervosa a naturalistic study in an inpatient treatment programme
Autism, 2019Co-Authors: Kate Tchanturia, James Adamson, Jenni Leppanen, Heather WestwoodAbstract:Previous research has demonstrated links between Anorexia Nervosa and autism spectrum disorder however, few studies have examined the possible impact of symptoms of autism spectrum disorder on clinical outcomes in Anorexia Nervosa. The aim of this study was to examine the association between symptoms of autism spectrum disorder and eating disorders, and other psychopathology during the course of inpatient treatment in individuals with Anorexia Nervosa. Participants with Anorexia Nervosa (n = 171) completed questionnaires exploring eating disorder psychopathology, symptoms of depression and anxiety, and everyday functioning at both admission and discharge. Characteristics associated with autism spectrum disorder were assessed using the Autism Spectrum Quotient, short version. Autism spectrum disorder symptoms were significantly positively correlated with eating disorder psychopathology, work and social functioning, and symptoms of depression and anxiety, but not with body mass index. Autism Spectrum Quotie...
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alterations in brain structure in adults with Anorexia Nervosa and the impact of illness duration
Psychological Medicine, 2014Co-Authors: Leon Fonville, Vincent Giampietro, Steven Williams, Andrew Simmons, Kate TchanturiaAbstract:Background Brain structure alterations have been reported in Anorexia Nervosa, but findings have been inconsistent. This may be due to inadequate sample size, sample heterogeneity or differences in methodology. Method High resolution magnetic resonance images were acquired of 33 adult participants with Anorexia Nervosa and 33 healthy participants, the largest study sample to date, in order to assess whole-brain volume, ventricular cerebrospinal fluid, white matter and grey matter volume. Voxel-based morphometry was conducted to assess regional grey matter volume. Levels of depression, anxiety, obsessionality and eating disorder-related symptoms were measured and used to explore correlations with brain structure. Results Participants with Anorexia Nervosa had smaller brain volumes as well as a global decrease in grey matter volume with ventricular enlargement. Voxel-based morphometry revealed a decrease in grey matter volume spanning across the cerebellum, temporal, frontal and occipital lobes. A correlation was found between grey matter volume loss and duration of illness in the cerebellum and mesencephalon. No correlations were found with clinical measures. Conclusions Findings are in accordance with several previous studies on brain structure and match functional studies that have assessed the symptomatology of Anorexia Nervosa, such as body image distortion and cognitive bias to food. The correlation with duration of illness supports the implication of cerebellar atrophy in the maintenance of low weight and disrupted eating behaviour and illustrates its role in the chronic phase of Anorexia Nervosa. The lack of other correlations suggests that these findings are not related to the presence of co-morbid disorders.
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the socio emotional processing stream in Anorexia Nervosa
Neuroscience & Biobehavioral Reviews, 2011Co-Authors: Anna Oldershaw, Janet Treasure, David Hambrook, Kate Tchanturia, Daniel Stahl, Ulrike SchmidtAbstract:The significance of socio-emotional factors in development and maintenance of Anorexia Nervosa (AN) has been noted, but the literature is poorly integrated without clear models guiding research or treatment. This systematic review retrieved experimental studies of social-cognitive or affective processing in AN and categorised them using Ochsner's "Social-Emotional Processing Stream." Ochsner's "Processing Stream", based on healthy data, comprises five constructs: (1) acquisition of and (2) recognition and response to social-affective stimuli, (3) low-level and (4) high-level mental state inference and (5) context-sensitive emotion regulation. Thirty-seven experimental studies in Anorexia Nervosa were identified, mapping on to four of the five constructs (not Construct 3). A meta-analysis of nine affect recognition studies was conducted. AN patients demonstrated impairments in each of the four domains with preliminary reports that some difficulties are trait-like, and others ameliorate following recovery. Socio-emotional data was integrated with previous reports of neural abnormalities to generate an AN specific model of socio-emotional processing. Additional research is required for further definition and to translate experimental findings into clinical practice.
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neural correlates of impaired cognitive behavioral flexibility in Anorexia Nervosa
American Journal of Psychiatry, 2009Co-Authors: Arne Zastrow, Janet Treasure, Kate Tchanturia, Stefan Kaiser, Christoph Stippich, Stephan Walther, Wolfgang Herzog, Aysenil Belger, Matthias Weisbrod, Hanschristoph FriederichAbstract:OBJECTIVE: Impaired cognitive-behavioral flexibility is regarded as a trait marker in Anorexia Nervosa patients. The authors sought to investigate the neural correlates of this deficit in executive functioning in Anorexia Nervosa. METHOD: Fifteen women with Anorexia Nervosa and 15 age-matched healthy comparison women underwent event-related functional MRI while performing a target-detection task. The task distinguished between shifts in behavioral response and shifts in cognitive set. It involved infrequent target and non-target distractor stimuli embedded in a sequence of prepotent standard stimuli. RESULTS: Relative to comparison subjects, Anorexia Nervosa patients showed a significantly higher error rate in behavioral response shifting, independent of whether those runs also involved cognitive set shifting. During behavioral response shifting, patients showed reduced activation in the left and right thalamus, ventral striatum, anterior cingulate cortex, sensorimotor brain regions, and cerebellum that differed significantly from the comparison group but showed dominant activation in frontal and parietal brain regions. These differential activations in patients and comparison subjects were specific to shifts in behavioral response: except for thalamic activation, they were not observed in response to non-target distractor trials that required no alteration in behavioral response. CONCLUSION: Impaired behavioral response shifting in Anorexia Nervosa seems to be associated with hypoactivation in the ventral anterior cingulate-striato-thalamic loop that is involved in motivation-related behavior. In contrast, Anorexia Nervosa patients showed predominant activation of frontoparietal networks that is indicative of effortful and supervisory cognitive control during task performance.
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is impaired set shifting an endophenotype of Anorexia Nervosa
American Journal of Psychiatry, 2005Co-Authors: Joanna Holliday, David A Collier, Kate Tchanturia, Sabine Landau, Janet TreasureAbstract:OBJECTIVE: Set-shifting difficulties have been reported in subjects with Anorexia Nervosa and appear to persist after recovery; therefore, they may be endophenotypic traits. The goals of this study were to investigate whether set-shifting difficulties are familial by examining discordant sister-pairs in comparison with healthy unrelated women and to replicate, with a broader battery, the lack of influence of an acute illness state on neuropsychological performance. METHOD: Forty-seven pairs of sisters discordant for Anorexia Nervosa and 47 healthy unrelated women who were comparable in age and IQ completed neuropsychological tasks selected to assess set-shifting ability. Analyses of variance with standard errors that are robust against correlations within family clusters were used to compare the groups. Results were adjusted for obsessive-compulsive, anxiety, and depression symptoms. Subjects with acute (N=24) and fully remitted (N=23) Anorexia Nervosa were compared to assess state versus trait effects. R...
Mori J Krantz - One of the best experts on this subject based on the ideXlab platform.
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medical complications of Anorexia Nervosa and bulimia
The American Journal of Medicine, 2016Co-Authors: Patricia Westmoreland, Mori J Krantz, Philip S MehlerAbstract:Anorexia Nervosa and bulimia Nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of Anorexia Nervosa, as well as from the purging behaviors that characterize bulimia Nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as Anorexia Nervosa and bulimia Nervosa become more severe and chronic. We review the medical complications that are associated with Anorexia Nervosa and bulimia Nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders.
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exercise electrocardiography extinguishes persistent junctional rhythm in a patient with severe Anorexia Nervosa
The Cardiology, 2011Co-Authors: Mori J Krantz, Jennifer L Gaudiani, Victor W Johnson, Philip S MehlerAbstract:Among psychiatric conditions, Anorexia Nervosa carries the highest mortality, in part due to the propensity for rhythm disturbances among patients with advanced disease. Patients with Anorexia Nervosa are prone to both bradycardia and tachyarrhythmias, though mortality has not been associated with the former. To date, only one case of junctional rhythm in the setting of Anorexia Nervosa has been previously described, which was unremitting and required prolonged hospitalization. We report a case of persistent accelerated junctional rhythm where a formal exercise electrocardiography study demonstrated rapid reversion to sinus rhythm with graded exercise. Despite a 22-day hospitalization the patient never reverted permanently to sinus rhythm. This underscores the heightened vagal tone that may be seen among patients with severe Anorexia Nervosa. Despite this, it may be rapidly extinguished with sympathetic overdrive during exercise. In this context, exercise electrocardiography appears to be a safe, noninvasive means of assessing cardiac conduction and chronotropic reserve in this population.
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Resting tachycardia, a warning sign in Anorexia Nervosa: case report
2004Co-Authors: Mori J Krantz, Philip S MehlerAbstract:© 2004 Krantz and Mehler; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL. Anorexia Nervosabradycardiatachycardiamalnutrition Background: Among psychiatric disorders, Anorexia Nervosa has the highest mortality rate. During an exacerbation of this illness, patients frequently present with nonspecific symptoms. Upon hospitalization, Anorexia Nervosa patients are often markedly bradycardic, which may be an adaptive response to progressive weight loss and negative energy balance. When Anorexia Nervosa patients manifest tachycardia, even heart rates in the 80–90 bpm range, a supervening acute illness should be suspected. Case presentation: A 52-year old woman with longstanding Anorexia Nervosa was hospitalized due to progressive leg pain, weakness, and fatigue accompanied by marked weight loss. On physical examination she was cachectic but in no apparent distress. She had fine lanugo-type hair over her face and arms with an erythematous rash noted on her palms and left lower extremity. Her blood pressure was 96/50 mm Hg and resting heart rate was 106 bpm though she appeared euvolemic
Hans W. Hoek - One of the best experts on this subject based on the ideXlab platform.
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incidence prevalence and mortality of Anorexia Nervosa and bulimia Nervosa
Current Opinion in Psychiatry, 2021Co-Authors: Annelies E Van Eeden, Hans W. Hoek, Daphne Van HoekenAbstract:PURPOSE OF REVIEW To review the recent literature on the epidemiology of Anorexia Nervosa and bulimia Nervosa in terms of incidence, prevalence and mortality. RECENT FINDINGS Although the overall incidence rate of Anorexia Nervosa is considerably stable over the past decades, the incidence among younger persons (aged <15 years) has increased. It is unclear whether this reflects earlier detection or earlier age of onset. Nevertheless, it has implications for future research into risk factors and for prevention programs. For bulimia Nervosa, there has been a decline in overall incidence rate over time. The lifetime prevalence rates of Anorexia Nervosa might be up to 4% among females and 0.3% among males. Regarding bulimia Nervosa, up to 3% of females and more than 1% of males suffer from this disorder during their lifetime. While epidemiological studies in the past mainly focused on young females from Western countries, Anorexia Nervosa and bulimia Nervosa are reported worldwide among males and females from all ages. Both eating disorders may carry a five or more times increased mortality risk. SUMMARY Anorexia Nervosa and bulimia Nervosa occur worldwide among females and males of all age groups and are associated with an increased mortality risk.
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mental capacity to consent to treatment in Anorexia Nervosa explorative study
British Journal of Psychiatry Open, 2016Co-Authors: Isis F F M Elzakkers, Unna N. Danner, Hans W. Hoek, Annemarie A. Van ElburgAbstract:BACKGROUND: Mental capacity to consent to treatment in Anorexia Nervosa is a neglected area in clinical decision-making. AIMS: To examine clinical and neuropsychological parameters associated with diminished mental capacity in Anorexia Nervosa. METHOD: An explorative study was conducted in 70 adult female patients with severe Anorexia Nervosa. Mental capacity to consent to treatment was assessed by experienced psychiatrists. Further measurements included the MacCAT-T (to assess mental capacity status), a range of clinical measures (body mass index (BMI) and comorbidity) and neuropsychological tests assessing decision-making, central coherence and set-shifting capacity. RESULTS: Diminished mental capacity occurs in a third of patients with severe Anorexia Nervosa and is associated with a low BMI, less appreciation of illness and treatment, previous treatment for Anorexia Nervosa, low social functioning and poor set shifting. CONCLUSIONS: Assessment of diminished mental capacity in Anorexia Nervosa requires careful evaluation of not only BMI, but also the degree of appreciation of illness and treatment, history and the tendency to have a rigid thinking style. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Epidemiology of Anorexia Nervosa in Men: A Nationwide Study of Finnish Twins
2009Co-Authors: Anu Raevuori, Hans W. Hoek, Ezra Susser, Jaakko Kaprio, Aila Rissanen, Anna KeskiAbstract:Background: To examine the epidemiology of Anorexia Nervosa in men, we screened Finnish male twins born in 1975–79. Methods and Findings: Men (N = 2122) from FinnTwin16 birth cohorts were screened for lifetime eating disorders by a questionnaire. The screen positives (N = 18), their male co-twins (N = 10) and those with lifetime minimum BMI#17.5 (N = 21) were administered the Structured Clinical Interview for DSM-IV Anorexia Nervosa. The incidence rate of Anorexia Nervosa for the presumed peak age of risk (10–24y) was 15.7 per 100 000 person-years; its lifetime prevalence was 0.24%. All probands had recovered from eating disorders, but suffered from substantial psychiatric comorbidity, which also manifested in their co-twins. Additionally, male co-twins displayed significant dissatisfaction with body musculature, a male-specific feature of body dysmorphic disorder. Conclusions: Anorexia Nervosa in males in the community is more common, transient and accompanied by mor
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incidence prevalence and mortality of Anorexia Nervosa and other eating disorders
Current Opinion in Psychiatry, 2006Co-Authors: Hans W. HoekAbstract:Purpose of review The purpose of this review is to evaluate the recent literature on the incidence and prevalence of and mortality associated with eating disorders. Recent findings General-practice studies shove that the overall incidence rates of Anorexia Nervosa remained stable during the 1990s, compared with the 1980s. Some evidence suggests that the occurrence of bulimia Nervosa is decreasing. Anorexia Nervosa is a common disorder among young white females; but is extremely rare among black females. Recent studies confirm previous findings of the high mortality rate within the Anorexia Nervosa population. Summary The incidence of Anorexia Nervosa is around eight per 100 000 persons per year. An upward trend has been observed in the incidence of Anorexia Nervosa in the past century till the 1970s. The most substantial increase was among females aged 15-24 years, for whom a significant increase was observed from 1935 to 1999. The average prevalence rates for Anorexia Nervosa and bulimia Nervosa among young females are 0.3 and 1%, respectively. Only a minority of people with eating disorders, especially with bulimia Nervosa, are treated in mental healthcare.