Starving for independence. Anorexia nervosa in an adolescent with type 1 diabetes / Önállóságra éhezve. Az 1-es típusú diabetes mellitus és az anorexia nervosa együttes elofordulása egy serdülo leányban.

Összefoglaló. Az 1-es típusú diabetes mellitus (T1DM-) betegek körében az evészavarok elofordulása az átlagpopulációhoz képest körülbelül kétszeresre teheto. Ez a komorbiditás különösen veszélyes mind a magas mortalitási rizikó, mind a súlyos szövodmények lehetosége miatt. Az evészavarban szenvedo, T1DM-mel élo gyermekek és fiatalok hatékony kezelése a diabetológusok, pszichiáterek, pszichológusok, novérek és dietetikusok összehangolt munkájával valósítható meg. Közleményünkben egy 14,5 éves, T1DM-mel élo, anorexia nervosával diagnosztizált páciensünk multidiszciplináris terápiáját mutatjuk be, kiemelve a különbözo szakemberek együttmuködésének fobb metszéspontjait. A szoros diabetológiai gondozással párhuzamosan az anorexia nervosa terápiájában a protokollok ajánlásaival megegyezoen családterápiát és kognitív viselkedésterápiás elemekkel bovített egyéni terápiát alkalmaztunk. A terápiás folyamat összesen 18 hónapig tartott. Esetünk korábban le nem írt diabetológiai érdekessége, hogy a számottevo súlycsökkenéssel párhuzamosan betegünk inzulinigénye a töredékére csökkent, ami jelentos mértékben érintette a bazálisinzulin-szükségletet is. Orv Hetil. 2021; 162(33): 1341-1346. Summary. The incidence of eating disorders is approximately twice as high in type 1 diabetes mellitus (T1DM) compared to the general population. Comorbidity is related to potentially severe organ complications and consequently higher mortality risk. The effective treatment of eating disorders in T1DM is provided by the teamwork of diabetologists, psychiatrists, psychologists, nurses and dietitians. The purpose of this paper is to present the multidisciplinary treatment of a 14.5-year-old adolescent with T1DM and diagnosed with anorexia nervosa, focusing on the cooperation of the professionals. In line with the current guidelines, both family therapy and cognitive behavioral therapy-informed individual psychotherapy were applied beside the strict diabetes control. Her therapy process lasted 18 months. The unusual diabetological aspect of our case is that the significant weight loss was associated with highly decreased insulin requirement affecting also the basal insulin requirements. Orv Hetil. 2021; 162(33): 1341-1346.

[The continuum hypothesis of eating disorders, the evolution of a model from 1970's to the present]. / Az evészavarok kontinuum hipotézise, egy modell alakulása az 1970-es évektol napjainkig.

Classification and definition of criteria for eating disorders (ED) have been modified in the last decades due to changing theories about these disorders. The academic approach has been transformed from time to time by results from studies with increasing number of subjects and updated psychological tools. Investigation of EDs means a great challenge for researchers since they constitute a heterogeneous group and exhibit a dynamically variable manifestation and chronological progress. The author provides an overview on the different theories and related most significant results. Despite the intensively developing research in this field, further investigations are needed for the exact determination of subclusters of EDs and to develop successful treatment protocols.

[Body image and body image distortion]. / A testképtol a testképzavarig.

The aim of this literature review is to integrate the results of various studies regarding body image and body image distortion into a unified framework. The concept of body image is complex and can be interpreted from multiple points of view. The first part of the study touches upon different age characteristics, attentional focus on the body, the early and important role of the body in identity formation, specific features in adolescence, gender differences, and the often-observed stability of body image (distortion), which may be present as a (trait) marker throughout the lifespan. The second part focuses on the organization of body image. The results of different studies on cognitive information processing are reviewed, the question of perceptual accuracy is addressed and the concepts of embodiment are examined. The third topic is body image distortion. First, the concept is contextualized along different continua, then discussed in a clinical sense along with the complexity of diagnostic methods, as well as the state and trait aspects of body image distortion. Orv Hetil. 2017; 158(19): 723-730.

Taste reactivity deficit in anorexia nervosa.

AIM: Anorexia nervosa is a complex psychiatric disorder posing a rapidly increasing burden on modern societies. Our purpose was to clarify perceptual-motivational aspects of gustatory disturbances in the disease. METHODS: A taste reactivity test, with the use of all five primary qualities in two concentrations, was performed in restrictive-type anorexic patients, and their hedonic evaluations were compared to those of age-matched healthy control subjects. RESULTS: The patients gave significantly lower pleasantness scores for pleasant taste stimuli compared with controls. The differences were the greatest for the lower concentration sucrose, umami and sodium chloride. Ratings given for the aversive taste stimuli were similar in both experimental groups. CONCLUSION: Our findings contribute to a better understanding of complex symptoms of anorexia nervosa, and may also help to develop more effective cognitive-behavioral therapies.

[The role of gene-environment interaction in the development of eating disorders]. / A gén-környezet interakció szerepe az evészavarok kialakulásában.

The biological research predominant in the last decades have not brought a solution in the discovery of risk factors contributing to the development of eating disorders, and elaborating a more effective therapy. The large amount of molecular genetic studies, however, by showing the various genetic vulnerability, contributed significantly to recognizing a more specific effect of the environmental factors. The authors evaluate the genetic studies of eating disorders and present environmental factors having a role in the development of eating disorders. They report about recently published data of gene-environment interaction and conclude from the data clinically applicable consequences.

[Dreams and imaginations in the therapy of eating disordered patients.]

Recently the integrative approach has been applied in the treatment of eating disorders with multicausal origin. In order to achieve long-term therapeutic effect, the psychodynamic interpretation is often needed and favoured as a part of the personal, multimodal therapeutic strategy. The present paper focuses on body image distortion as one of the most decisive and least influenceable symptom of the disorder. The symptom is interpreted along the body image distortion-body boundaries-self boundaries-autonomy line. With illustrative therapy details of dreams, imaginations, the authors aim to demonstrate the therapeutic use of dynamically oriented therapy and dynamically oriented hypnotherapy.

[Dreams and imaginations in the therapy of eating disordered patients]. / Almok és imaginációk az evészavaros betegek terápiájában.

Recently the integrative approach has been applied in the treatment of eating disorders with multicausal origin. In order to achieve long-term therapeutic effect, the psychodynamic interpretation is often needed and favoured as a part of the personal, multimodal therapeutic strategy. The present paper focuses on body image distortion as one of the most decisive and least influenceable symptom of the disorder. The symptom is interpreted along the body image distortion-body boundaries-self boundaries-autonomy line. With illustrative therapy details of dreams, imaginations, the authors aim to demonstrate the therapeutic use of dynamically oriented therapy and dynamically oriented hypnotherapy.

[Leptin and glucose metabolism in eating disorders]. / A leptin és glukóz metabolizmus evészavarokban.

AIM: Leptin, which was discovered only a decade ago, is a peptide that informs hypothalamic areas about the energy balance of the body. New research findings, has suggested a possible role of leptin in eating disorders as well. Few data are available about the relationship between leptin, insulin and glucose metabolism in the pathomechanism of eating disorders. The authors were searching for answers to these relationships in their investigations. METHODS: The study groups included 56 patients with eating disorders and 22 healthy subjects served as controls. The diagnosis was based on DSM-IV criteria. For measuring leptin, insulin and C-peptide serum concentrations a radioimmunoassay method was applied, and serum glucose concentrations were detected by spectrofluorimetry. Detailed statistical analysis of the results was carried out. RESULTS: A correlation between BMI and serum leptin concentration could be proved only in anorectic patients. In contrast to former findings, there was no correlation between BMI and leptin concentration in the bulimia group, and the leptin concentrations were significantly higher in bulimic patients than in the control group. During the glucose tolerance test, leptin levels showed a significant decrease in the anorexia group. CONCLUSION: The results raise the possibility of a direct effect of central regulatory mechanisms of food intake in the pathomechanism of anorexia nervosa.

[Genetic markers and personality traits in eating disorders--preliminary results]. / Genetikai és személyiségfaktorok vizsgálata evészavarokban.

INTRODUCTION: The multidimensional approach of the ethiopathogenesis of eating disorders include the genetic, biologic, psychosocial effects, and premorbid personality markers. AIM/METHOD: To determine the potential relation between genetic and personality trate and state factors, and also to investigate the connection of clinical symptoms and diagnostic subgroups. The serotonin transporter gene (VNTR) polymorphism was investigated by polymerase chain reaction (PCR) technology, the personality factors were determined by the Temperament and Character Inventory (TCI) inventory. RESULTS: Among patients with bulimia nervosa (BN) the short allele of serotonin transporter gene was more frequent than in anorexia nervosa (78% vs. 67%), and in both groups it was more common than in the general population (43%). Patients with anorexia nervosa (AN) have higher scores in the scale of harm avoidance (61,2 vs. 51.4), but in bulimia nervosa the novelty seeking (54.5 vs. 44.2) and the reward dependence factors (53.2 vs. 46.5) were more significant. In the self-directedness (BN: 42.7; AN: 44.3) and the cooperativeness scales (BN: 51.2; AN: 44.6) both groups show lower scores, which could implicate personality disorder in the background of the eating disorders. Anorexic patients with the 10 allele show similar personality factors like patients with bulimia nervosa, while with the 12 allele (homozygotes), their factors were more likely the factors of patients with classic anorexic symptoms. CONCLUSION: Our data strength the role of specific personality factors in the background of the symptoms of eating disorders. Among patients with bulimia nervosa the 10 allele were more frequent, which could indicate the role of the serotonin system in developing eating disorders. Two subgroups were differentiated among patients with anorexia nervosa in relation with personality factors; the factors of patients with the 12 allele homozygotes were similar to the classical factors of anorexia nervosa, while patients with the 10 allele were like bulimic patients. Our results could improve our knowledge with newer aspects concerning the etiology of eating disorders, that might be used in broadening our preventive and therapeutic facilities in the future.

[Psychiatric sequelae of interferon-alpha therapy]. / Az interferon-alpha-terápia pszichiátriai következményei.

INTRODUCTION: Psychopathologic conditions commonly complicate the treatment with the interferon-alpha. The most important among them is depression, which can induce suicidal attempt. The outcome of mental side effects of interferon-alpha necessitate the discontinuation of therapy and, in more severe cases, psychiatric treatment. AIM AND METHOD: A brief literature review presents the biology of interferon-alpha with emphasis on the central nervous system effects which are probably closely related to mental side effects. Three case reports demonstrate the interdisciplinary nature of interferon induced psychiatric conditions. RESULTS: The appearance of neuropsychiatric side effects of interferon-alpha are frequent, the consequences of which can prove dramatic: involvement of the vital prognosis, psychiatric morbidity, especially depressions, and suicidal risk. CONCLUSION: The close collaboration of clinical practitioners and psychiatrists, from the pre-therapeutical evaluation to the follow up care is required.