Outcome, comorbidity and prognosis in anorexia nervosa. / Przebieg choroby, wspólchorobowosc i czynniki rokownicze w jadlowstrecie psychicznym.

Anorexia nervosa (AN) is a relatively common disorder, especially in adolescent and young adult women. The lifetime prevalence of AN in females ranges from 1.2 to 2.2%. The prevalence in males is 10-times lower. The condition is associated with a high risk of chronic course and poor prognosis in terms of treatment and the risk of death. Longer follow-up periods seemed to correspond with increased improvement rates and increased mortality. Onset of the disorder during adolescence is associated with better prognosis. It is reported that as much as 70% to over 80% of patients in this age group achieve remission. Worse outcomes are observed in patients who required hospitalization and in adults. Recent studies indicate improved prognosis for cure and lower mortality rates than previously reported. However, the recovery can take several years and AN is associated with high risk of developing other psychiatric disorders during the patients' lifetime, even after recovery from AN (mainly: affective disorders, anxiety disorders, obsessive-compulsive disorders, substance abuse disorders). Studies indicate that bulimic symptoms often occur in the course of anorexia nervosa (especially within 2-3 years from the onset of AN). The authors present a review of literature on the course, comorbidity, mortality, and prognostic factors in AN. Better knowledge of the course of anorexia can contribute to more realistic expectations of the pace of symptomatic improvement, as well as to a creation of therapeutic programs which are better adapted to the needs of the patients.

Bone mineralization and densitometric evaluation of vertebral fractures in women 6-21 years after the onset of anorexia nervosa symptoms. / Mineralizacja kosci i ocena densytometryczna zlaman kregoslupa u kobiet po uplywie 6­21 lat od pojawienia sie objawów jadlowstretu psychicznego.

OBJECTIVES: We attempted to assess bone mineralization and the frequency of fractures occurrence in women with a history of treatment of anorexia nervosa (AN) in adolescence. METHODS: 47 women (age 20-36.8 years) were re-examined 6.33-21,2 years after the onset of AN symptoms. Bone mineral density (BMD) of total body, lumbar spine, femoral neck, total hip (DXA) and densitometric Vertebral Fracture Assessment (VFA) were performed on 46 of women and BAP, P1NP, CTX, estradiol, testosterone, cortisol, IGF-1, leptin, DHEA-S on 45 of women entered for the current study. Current BMD results were compared with available baseline results from the time of hospitalization. RESULTS: Currently BMD Z-score <-1 examined at any location occurred in 28 from 46 women (including Z-score <-2 in 5 women). In 11 from 12 women with reduced BMD at the time of hospitalization current total body BMD was within the normal range. Lumbar spine BMD was normalized or improved respectively in 5 and 6 from 15 women. Currently increased levels/activity of bone formation markers: P1NP in 27 (60%) and BAP in 28 women (62.2%) were observed. In 7 women (15.6%) increased values of bone formation markers with increased marker of bone resorption (CTX) occurred. Osteoporotic fractures and fractures in the spine in VFA were not observed during the observation period. CONCLUSIONS: Despite early treatment of adolescent-onset AN and good outcomes of the treatment, decreased BMD was currently present in 60.9% of women. During follow-up normalization or significant improvement in BMD results (total body, lumbar spine) were observed in majority of cases.

Bone mineralization disorders as a complication of anorexia nervosa - etiology, prevalence, course and treatment. / Zaburzenia mineralizacji kosci jako powiklanie jadlowstretu psychicznego - etiologia, rozpowszechnienie, przebieg i leczenie.

Anorexia nervosa (AN) most often has its onset in adolescence, which is a crucial period to achieve peak bone mass. The hormonal abnormalities (hypoestrogenism, hypercortisolism, decreased secretion of dehydroepiandrosterone, testosterone, insulin-like growth factor) and malnutrition are associated with profound bone mineralization disorders. Densitomertic bone mineral density (BMD) values for osteopenia and osteoporosis were found respectively in 35-98% and 13-50% of women with AN. Prospective studies indicate a further decline in BMD at the beginning of treatment and a crucial importance of weight gain and return of spontaneous menses for its growth. Due to frequent chronic and relapsing course of AN densitometric assessment of BMD is recommended in all patients with AN and amenorrhea lasting around twelve months. In order to establish standards for the treatment of osteoporosis in AN, studies on pharmacological treatment are conducted. There are promising results indicating the improvement in BMD after treatment with physiologic oestrogen replacement treatment and sequential administration of medroxyprogesterone in teenage girls and bisphosphonates in adult women. Supplementation of vitamin D and adequate consumption of calcium from diet are recommended. Further studies on the effectiveness of long-term treatment of osteoporosis with regard to the possibility of increase in BMD and reducing the risk of osteoporotic fractures are needed.

Obsessive-compulsive symptoms and physical activity in patients with anorexia nervosa - possible relationships.

OBJECTIVES: The aim of the study was to find relationship between obsessive-compulsive symptoms and level and characteristic of physical activity among patients with anorexia nervosa (AN). METHODS: Material and methods. 76 female patients, aged 14.8 +/ - 1.8 years with AN completed the Polish version of the Leyton Obsessional Inventory-Child Version (LOI-CV). In order to assess the level and type of physical activity, Physical Activity Questionnaire was developed. RESULTS: 35 (46%) subjects were qualified to HR group (Obsessive-Compulsive Disorder "High-risk group") (25 or more points on the Interference Score of LOI-CV) and 41 (54%) to nHR group (no "High-risk group"). nHR patients spent less studying in a standing position, significantly more often used elevators rather than stairs and, according to their parents, devote less time for physical activity. Positive correlation between the caregiver's perception of patient's weekly activity and the number of "YES" answers in LOI-CV, positive trend between Patient's Activity Index or summarised Activity Index and the number of "YES" answers in LOI-CV were found. We also found negative correlation between the time spent studying at school and the number of "YES" answers in LOI-CV. CONCLUSIONS: The results show that there is a connection between obsessive-compulsive symptoms and the hyperactivity in AN patients.

Gastrointestinal motility disorders in patients with anorexia nervosa - a review of the literature.

Anorexia nervosa is a disease carrying havoc on many levels of the body functioning. The presence of numerous somatic complications as a consequence of starvation is an important part of the clinical picture of this disease. Symptoms of the gastrointestinal tract are one of the most common complaints reported by patients, especially in the initial period of realimentation. Most common symptoms are associated with gastrointestinal motility disorders. The available data show that as many as half of patients suffering from anorexia nervosa manifest significant gastrointestinal motility disorders (incomplete relaxation of the upper and lower oesophageal sphincter, impaired compliance of the stomach, delayed gastric emptying, intestinal transit extension, decreased motility of the rectum and anus). These disorders along with gastrointestinal tract ailments may impede the restoration of proper diet, if not detected early and treated. There are relatively few studies on gastrointestinal motility disorders in patients suffering from anorexia nervosa, which do not clearly answer the question whether these disorders are genetic, or result from cachexia and whether they disappear along with the restoration of the normal body weight. No reference of research results to the clinical practice, and the lack of standard procedures for diagnosis and treatment of gastrointestinal disorders in patients with anorexia nervosa are significant problems for specialists in the field of psychiatry and gastroenterology.

[The influence of obsessive compulsive symptoms on the course of anorexia nervosa]. / Wplyw objawów obsesyjno-kompulsyjnych na przebieg jadlowstretu psychicznego.

OBJECTIVE: to assess the prevalence of obsessive-compulsive disorder (OCD) or OC symptoms in patients with anorexia nervosa (AN) and to find a possible relationship between the presence of OC symptoms and the course of AN. METHOD: 137 adolescent female patients with AN, aged 14.8 +/- 1.8 years, completed the Polish version of the LOI-CV. Two groups, High-risk (HR) and no High-risk (nHR), were defined according to the cut-off score of LOI-CV. The diagnosis of OCD was confirmed with the Polish version of K-SADS-PL. The relationship between the number and intensity of OC symptoms and the following data were analyzed: age of onset and on admittance to a psychiatric facility, weight loss, BMI on admittance and its changes, age of first menstruation, time of amenorrhea and of restitution of menses, length of treatment and number of relapses. RESULTS: OCD was not diagnosed in any subject, but 25% of the examined patients had OC symptoms which qualified them to High-risk group. Differences in HR and nHR groups were found between duration of AN before hospitalization, age and body mass after release from hospital. Negative correlation was found between "Yes" Score and Interference Score in LOI-CV and the age of patient at the time of release from hospital. CONCLUSIONS: the results of our study do not support the observations about a high co-occurrence of AN and OCD, but indicate the frequent co-occurrence of OK symptoms.

[Assessment of neuropeptide Y, leptin and leptin-receptor concentrations in teenagers suffering from anorexia nervosa]. / Ocena wartosci stezen neuropeptydu Y, leptyny oraz receptora leptyny u nastolatek chorych na anoreksje.

INTRODUCTION: Anorexia nervosa (AN) is the third most common chronic disorder affecting adolescents and is associated with high mortality risk. The predominant symptom of anorexia nervosa is persistent and intentional striving to achieve weight loss initiated and/or sustained by the patient, leading to cachexia. Until now the cause of the condition remains unknown, but seems to be multifactoral. Patients with AN develop multi-organ complications and endocrine disorders affecting multiple disturbances of energy metabolism. Neuropeptide Y and leptin can be found between chemical substances regulating feelings of hunger and satiety. Neuropeptide Y plays the main role in the regulation of energetic homeostasis of the organism, feeding customs, sexual and reproductive functions. Concentration of neuropeptide Y increases during starvation and decreases after feeding. In anorexia nervosa the concentration of neuropeptide Y increases and, by doing that, decreases the excrection of gonadoliberines and gonadotropines. Leptin influences the feeling of hunger and its synthesis takes part, among others, in adiposal tissue. It also influences the menstruation disturbances. Rising leptin concentrations, with accompanying increasing adiposity is known to be the main factor influencing the puberty and the reverse of the malfunction of hypothalamic-pituitary-gonadal axis in malnourished persons. During hunger and low calorie intake, leptin concentration decreases, independently of adiposity. AIM: The main aim of the study was to assess concentrations of neuropeptide Y, leptin and leptin receptor in teenagers treated for anorexia nervosa. MATERIALS AND METHODS: The study was conducted between 2007- 2011 in a group of 45 female teenagers with anorexia nervosa and a control group consisting of 59 healthy regularly menstruating female age peers. Concentrations of leptin, leptin receptor and neuropeptide Y (NPY) have been determined by using immunoenzymatic tests. Blood samples were obtained in fasting state. The Ethics Committee of the Medical University of Lodz approved of the study. RESULTS: There were statistically significant differences between mean values of BMI (14.6 vs. 19.83), median value of leptin concentration (3.79 vs. 12.09), proportions of LEP/BMI (0.1986 vs. 0.5701) in the study group when compared to controls. Higher values were found in the study group if compared to the percentage of body mass insufficiency--(23.09 vs. 3.97), neuropeptide Y concentration--(0.33 vs. 0.19), proportions of NPY/BMI--(0.023 vs. 0.0095), concentration of leptin receptor--(30.25 vs. 19.45), proportions of LR/BMI--(2.1048 vs. 0.9744). CONCLUSIONS: Low concentrations of leptine correlate to high concentrations of leptin receptor. A positive correlation between low body mass index and leptin receptor concentration and proportions of LR to BMI was found. A negative correlation was found between body mass loss and leptin concentration. The increasing concentration of neuropeptide Y, correlated to body mass deficency with existing high concentrations of leptin, could suggest disturbances of their regulatory axis.

[Menstrual dysfunction in anorexia nervosa]. / Zaburzenia miesiaczkowania w jadlowstrecie psychicznym.

One of the symptoms of anorexia nervosa (a.n.) is cessation of pubescence or secondary amenorrhea. Their origin in anorexia nervosa is multifactorial, partly resulting from starvation-induced hipogonadism. Amenorrhea in a.n. may persist despite weight recovery and is often related to osteoporosis. The authors' present causes of amenorrhea and its persisting in a.n., pointing to the factors influencing prognosis according to resumption of menses. They also review reports of hormonal replacement therapy in this group of patients.

[Pediatric aspects of anorexia nervosa care]. / Aspekty pediatryczne opieki nad chorym na jadlowstret psychiczny.

The paper summarizes basic information concerning diagnostic criteria and clinical picture of anorexia nervosa (AN) and medical complications of this potentially fatal disease. The authors stressed out guidelines for hospitalization and recommended laboratory tests.

[Eating disorders of infancy and early childhood]. / Zaburzenia odzywiania u niemowlat i malych dzieci.

Feeding problems are frequently observed among the population of infants and small children. This problems include food refusal, overeating, selective eating and bizarre food habits. That problems might be transient, but they may last for many years among some of children. They could lead to poor weight gain, specific nutritional deficiencies and even failure to thrive. In ICD-10 classification two diagnostic categories regarding eating disorders during this life period have been proposed (Eating disorders and Pica of infancy and early childhood). That criteria are too general though, they don't tell much about etiology and they don't allow to make decision about using specific therapy for the disorder as well. The author presents American authors' propositions regarding more specific categories of feeding problems differentiation in this particular age group and presents casuistic descriptions.

Pellagra: a rare complication of anorexia nervosa.

Pellagra is a potentially fatal, nutritional disease with cutaneous, gastrointestinal, and neuropsychiatric manifestations. Because of the diversity of pellagra's signs and symptoms, diagnosis is difficult without an appropriate index of suspicion. A case of pellagra in a 14-year-old girl with anorexia nervosa is presented. Signs and symptoms of pellagra were resolved after niacin therapy and dietary treatment.

[Bone metabolism disturbances in anorexia nervosa]. / Zaburzenia metabolizmu kostnego w jadlowstrkcie psychicznym.

Osteoporosis is a frequent complications of anorexia nervosa (AN). The etiology of osteoporosis in AN is multifactorial. Multiaxial hormonal disturbances and chronic undernutrition cause decrease or the lack of increase of bone mineral density (BMD), expected in adolescence. Both processes result from increased resorption and insufficient bone formation and/or mineralization. Decreased BMD persist in adult patients with a history of AN in the adolescence. There are no guidelines concerning treatment of osteoporosis in AN. The authors present review of the literature concerning bone metabolism in AN.

[Surgical complications occurring during hospitalization of patients with anorexia nervosa--literature review and a discussion of three cases]. / Powiklania chirurgiczne w trakcie szpitalnego leczenia jadlowstretu psychicznego--przeglad pismiennictwa i omówienie trzech przypadków.

Anorexia nervosa (a.n.) is a mental disorder connected with the high mortality coming up to 18%. The death causes are suicide and somatic complications resulting from cachexy, laxatives and diuretics abuse, which occurs in some patients and from vomiting provocation. The digestive tract complications are considered to be the death causes in a.n, as well. Among the surgical complications, which usual occur in the initial period of the intensive nutrition the most serious and frequent ones are oesophageal rupture in the course of vomiting provocation (Boerhaave's syndrome) and the syndrome of compression of the horizontal part of the duodenum, by the mesentery (superior mesenteric artery syndrome) leading to the gastrectasia and possible gastric necrosis and perforation. In this paper the review of the current literature concerning the digestive tract complications in a.n. has been made. Also, the courses of the diseases and the complications requiring surgical intervention in 3 patients treated between 1998 and 2000 in the Department of Child Psychiatry and the Department of Cardiosurgery of the Medical University of Warsaw have been discussed. The patients developed segmental enteritis, gastrectasia caused by the superior mesenteric artery syndrome and small intestine strangulation. The early surgical intervention in the latter case and the proper maintenance treatment in two other ones allowed to avoid more serious complications. The authors postulate profound analysis of the abdominal complaints from the point if view of surgical complications in anorectic patients in the initial period of their hospital treatment and consideration of the complete parenteral hyperalimentation in the extremely debilitated to avoid life threatening digestive tract complications.