ABSTRACT
New therapeutic approaches in anorexia nervosa. Anorexia nervosa is characterized by nutritional, somatic and psychiatric symptoms that require multidisplinary approaches. New therapeutic approaches have the increase the quality of the alliance between the patient and the therapist, and therefore facilitate the commitment process (such as with to motivational therapy); these therapies also aim at facilitating mental flexibility, increase central coherence, elaborate new strategies to resolve problems (such as with cognitive remediation and mindfulness based cognitive therapy), and reinforcement of family ressources (during marriage and family therapy).
Nouvelles approches de la prise en charge de l'anorexie mentale. L'anorexie mentale se caractérise par des symptômes alimentaires, somatiques et psychiatriques nécessitant des soins multidisciplinaires nutritionnels, psychologiques et corporels. Les nouvelles approches thérapeutiques renforcent l'alliance avec le patient et l'adhésion au soin (thérapies motivationnelles), l'assouplissement du fonctionnement cognitif et l'émergence de nouvelles stratégies de résolution de problèmes (remédiation cognitive et thérapie cognitive fondée sur la pleine conscience), l'activation des ressources familiales, la communication interne, la réduction du sentiment de solitude et de stigmatisation (thérapies multifamiliales).
Subject(s)
Anorexia Nervosa , Anorexia Nervosa/therapy , Cognitive Behavioral Therapy , Family Therapy , HumansABSTRACT
BACKGROUND: A number of characteristics associated with Autism Spectrum Disorders (ASD) are over-represented among patients with Anorexia Nervosa (AN) as well as among relatives of these patients. Yet the co-occurrence of autistic traits in AN has not been fully explored and no previous study has directly compared self-reported evaluations of cognitive and socio-affective skills in AN and ASD. METHODS: We aimed to determine the degree of overlap between AN and ASD from scores on questionnaires classically used to measure ASD impairments. Fifteen AN participants, 15 ASD participants and two groups of matched controls completed a battery of self-reports measuring: autistic traits (Autism-Spectrum Quotient), empathy (Empathy Quotient-short and Interpersonal Reactivity Index), systemizing (Systemizing Quotient-short) and alexithymia (Bermond-Vorst Alexithymia Questionnaire-B). Univariate comparisons of mean totalled scores were performed on each measure (patients vs. controls, and AN vs. ASD), and a Principal Component Analysis was used to study subject proximities in a reduced-factor space constructed from AQ, BVAQ-B and IRI subscales. RESULTS: These analyses revealed similarities in a few cognitive domains (Attention Switching, Perspective Taking and Fantasy, lack of emotional introspection) and in some nonspecific affective dimensions (depression and feelings of distress), but also marked dissimilarities in social skills (the ability to communicate emotions to others, empathizing). CONCLUSION: The AN and ASD participants reported similar needs for sameness, and similar difficulties understanding their emotions and taking the perspective of another, but contrasting abilities to feel concerned in interpersonal situations. Our mixed findings encourage further exploration of transdiagnostic similarities and associations between these disorders.
Subject(s)
Affective Symptoms/complications , Anorexia Nervosa/complications , Autistic Disorder/complications , Depression/complications , Adolescent , Adult , Affective Symptoms/diagnosis , Autistic Disorder/diagnosis , Depression/diagnosis , Diagnostic Self Evaluation , Empathy , Female , Humans , Male , Psychiatric Status Rating Scales , PsychometricsABSTRACT
BACKGROUND & AIMS: Body weight changes do not reflect the respective changes of body compartments, namely fat-free mass (FFM) and fat mass (FM). Both bioelectrical Impedance Analysis (BIA) and the Dual X-ray absorptiometry (DXA) measure FFM and FM. This study in underweight patients with anorexia nervosa (AN) aims to compare measurements of FM and FFM done by DXA and BIA using 5 different BIA equations already validated in healthy population and to identify the most suitable BIA equation for AN patients. METHODS: Fifty female patients with AN (BMI=14.3 ± 1.49, age=19.98 ± 5.68yrs) were included in the study. Body composition was measured by DXA (Delphi W, Hologic, Bedford, MA) and by 50 kHz BIA (FORANA, Helios) using 5 different BIA equations validated in healthy population (Sun, Geneva, Kushner, Deurenberg and Roubenoff equations). Comparison between the DXA and the 5 BIA equations was done using the sum of the squares of differences and Bland-Altman plots. RESULTS: The Deurenberg equation gave the best estimates of FFM when compared to the measurements by DXA (FFM(dxa)=35.80 kg versus FFM(deurenberg)=36.36 kg) and very close estimates of FM (FM(dxa)=9.16 kg and FM(deurenberg)=9.57 kg) The Kushner equation showed slightly better estimates for FM (FM(kushner)=9. 0kg) when compared to the DXA, but not for FFM. Sun equation gave the broadest differences for FM and FFM when compared with DXA. CONCLUSION: The best available BIA equation to calculate the FFM and the FM in patients with AN is the Deurenberg equation. It takes into account the weight, height and age and is applicable in adults and adolescents AN patients with BMI of 12.8-21.0, and for ages between 13.4 and up to 36.9 years.
