1,721,062 research outputs found
Suicide attempts in eating disorder subtypes: A meta-analysis of the literature employing DSM-IV, DSM-5, or ICD-10 diagnostic criteria
No full textBackgroundQuantification of suicidal risk in specific populations is important for the adoption of targeted prevention and harm reduction measures. Though there remains little systematic evidence, risk of suicide attempts for bulimia nervosa (BN) and binge-purging anorexia nervosa (AN-bp) appears higher than restrictive AN (AN-r); risk in binge eating disorder (BED) is still unclear. The aim of this meta-analysis was to compare proportions of suicide attempts in eating disorder (ED) subgroups.MethodsA literature search using combinations of key-words for ED and suicide attempts was performed. Studies reporting proportions of suicide attempters in at least two ED groups, diagnosed according to DSM-IV or -5 and ICD-10 diagnostic criteria were considered. ED subgroups were analyzed in pairs using a binary random effect model for proportions. Publication bias, meta-regression, and sensitivity analyses were performed.ResultsIn BN, attempted suicide was more frequent (21%) than in AN (12.5%), but the difference was statistically significant only when BN was compared with AN-r (9-10%). In BED, the proportion of suicide attempts was as high as in AN (10-12%).ConclusionsThough limited by heterogeneity across the studies in terms of methodology and aims, inability to control for relevant confounding variables, exclusion of ED not otherwise specified, this study supports suicide attempts as a major issue in EDs, especially in binge-purging subtypes, i.e. BN and AN-bp. Similar suicidal proportions were observed in AN and BED. The reasons for a greater proportion of attempted suicide in binge/purging subtypes need to be explored in future studies
Metabolic Syndrome, Mild Cognitive Impairment, and Dementia: A Meta-Analysis of Longitudinal Studies
No full textObjective: A systematic review and a meta-analysis of both clinical and population-based studies was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to clarify whether Metabolic Syndrome (MetS) is a risk or a protective factor for incident dementia, Alzheimer disease (AD), and vascular dementia (VaD), and whether it's involved in progression to dementia in patients affected by mild cognitive impairment (MCI). Methods: Search terms included (“metabolic syndrome” OR “syndrome x” OR “plurimetabolic syndrome”) AND (“dementia” OR “Alzheimer disease” OR “vascular dementia” OR “mild cognitive impairment” OR “MCI”). Research was restricted to articles published in English between January 1, 2000 and August 31, 2018. No age limit was set. Results: At the end of the selection procedure, nine longitudinal studies were selected for the meta-analysis: six studies enrolled cognitively well-functioning participants and three studies involved MCI patients. A total of 18,313 participants aged older than 40 years with mean MetS prevalence of 22.7% were followed on average for 9.41years. A fixed model was used to estimate pooled hazard ratios and 95% confidence intervals. Conclusion: No statistically significant pooled association emerged between MetS and incident dementia and AD. MetS increased the incidence of pure VaD. MetS increased the risk of progression from MCI to dementia. Follow-up length might be a key factor in investigating these associations further. Because MetS is constituted by a set of potentially modifiable factors, further studies with longer follow-up and repeated assessment of both MetS and cognitive status are desirable to draw definite conclusions
Epigenetic basis of psychiatric disorders: a narrative review
No full textBackground: Psychiatric disorders are complex, multifactorial illnesses with a demonstrated biological component in their etiopathogenesis. Epigenetic modifications, through the modulation of DNA methylation, histone modifications and RNA interference, tune tissue-specific gene expression patterns and play a relevant role in the etiology of psychiatric illnesses. Objective: This review aims to discuss the epigenetic mechanisms involved in psychiatric disorders, their modulation by environmental factors and their interactions with genetic variants, in order to provide a comprehensive picture of their mutual crosstalk. Methods: In accordance with the PRISMA guidelines, systematic searches of Medline, EMBASE, PsycINFO, Web of Science, Scopus, and the Cochrane Library were conducted. Results: Exposure to environmental factors, such as poor socio-economic status, obstetric complications, migration, and early life stressors, may lead to stable changes in gene expression and neural circuit function, playing a role in the risk of psychiatric diseases. The most replicated genes involved by studies using different techniques are discussed. Increasing evidence indicates that these sustained abnormalities are maintained by epigenetic modifications in specific brain regions and they interact with genetic variants in determining the risk of psychiatric disorders. Conclusion: An increasing amount of evidence suggests that epigenetics plays a pivotal role in the etiopathogenesis of psychiatric disorders. New therapeutic approaches may work by reversing detrimental epigenetic changes that occurred during the lifespan
AN UNUSUAL CASE OF FOOD HOARDING: THE WEIGHT OF ANOREXIA NERVOSA IN HOARDING DISORDERS
Full text linkAnorexia Nervosa (AN) is a severe eating disorder which typically develops in younger
females. Many studies focus on this specific population, a majority of which will eventually
partially or fully recover. A minority will become chronic despite extensive treatment.
These patients are treatment-resistant and may not necessarily benefit from usual
treatment. In this article we will reflect on possible mechanisms which may explain the
maintenance of disease, and especially on the possible role of affective and anxiety
disturbances. We will use, due to the lack of large-scale studies, data from risk and
prognostic factors, treatment options and neurobiological correlates in chronic AN
patients. Lastly, we will propose how these elements may advise further research
and treatments
The missing link between philosophy and psychopathology
No full textINTRODUCTION: The uncertainty regarding the scientific status of psychiatry arises from psychiatry's involvement with some unsolved problems, or put in another way, from its enmeshment in certain points of transition of contemporary science. There is, in primis, the unsolved problem of the relationship between the mind and the body and, moreo- ver, the intricate relationship of connection/disjunction among biology, social science, anthropology, philosophy, etc. To speak about what psychopathology can expect from philosophy is, above all, to immerse oneself in a debate about the conditions of possibility of psychiatry as a science. This debate is especially concerned with the models of knowledge that have, until now, been proposed to psychiatry. Those models oscillate between the Dilthey's paradigms of the "Science of Nature" and the "Science of Spirit".METHODS: It is certain that psychopathology, as already indicated by Jaspers, is a discipline which is among the most involved regard- ing the use of the two different cognitive strategies. The first strategy concerns the concept of "explanation" and its rigid approach to the objective and ultimate cause of the phenomenon. The second strategy is the "comprehensive" approach. This model, which the hermeneutic thought defines "interpretative", theorizes the provisional character, the subjectiveness and the finiteness of every cognitive project.RESULTS: The interest of the authors is orientated towards the hermeneutic side (comprehensive-interpretative) of psychiatry, that which deals with the specificity of every clinical history, with the continuity of sense, and with intrinsic narrative intelligibility of every human event, psychopathological or not.CONCLUSIONS: This approach to psychopathology is based on the statement: "a clinical history is a text which must be interpreted". From this perspective, every clinical history should be perceived as a text to decipher but, above all, as a "text" to listen to, in the persevering expectation that it could disclose its particular "project of world". When speaking about psychiatry, we always face a problem which dominates all the others: the unsolved problem of the relation- ship between typicalness and singularity of subjective events. B.B. Mandelbrot, theorist of "fractals", sums this dilemma up clearly. He suggests that the innumerable variety of the configurations of Nature is a challenge to investigate the morphology of that which is "irregu- lar" in order to discover in it, as far as possible, a rule
Psychiatric hospitalization during the two SARS-CoV-2 pandemic waves: New warnings for acute psychotic episodes and suicidal behaviors
Full text linkBACKGROUNDThe subsequent waves of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic have represented a dramatic health emergency characterized by significant consequences on mental health. Diachronic variations in the incidence rates of acute relapse of psychiatric disorders may represent significant "sentinel events " for assessing the mental health response to an unprecedented stressful event.AIMTo investigate the variation in psychiatric hospitalization rates and differences in sociodemographic and clinical-psychopathological peculiarities at Bologna "Maggiore " General Hospital Psychiatric Ward (GHPW) between the first two waves SARS-CoV-2 pandemic and the same periods of the previous 3 years. The secondary purpose of the study was to suggest a diachronic response pathway to stress by reporting additional literature data on coping strategies.METHODSThis observational and retrospective study collected information on admission to the GHPW at the "Maggiore " Hospital in Bologna in the index periods defined as follows: the first period between February 24, 2020 and April 30, 2020 (first epidemic wave) and the second period between October 8, 2020, and January 7, 2021 (second pandemic wave). Absolute numbers and proportion of admitted patients, their sociodemographic and clinical-psychopathological characteristics were compared with the same parameters recorded in the two same periods of the previous 3 years. No strict inclusion or exclusion criteria were provided in the data collection to collect information on all patients requiring acute psychiatric hospitalization.RESULTSDuring the first wave, there was a significant reduction in hospitalization rates, although there was a simultaneous increase in compulsory hospitalizations and the acute relapse of schizophrenia spectrum and other psychotic disorders. During the second wave, hospitalization rates reached those recorded during the same period of the previous 3 years, mainly due to the rise of bipolar and related disorders, depressive disorders, anxiety disorders, trauma- and stressor-related disorders and suicidal behaviors.CONCLUSIONThe coping strategies adopted during the first wave of the SARS-CoV-2 pandemic protected the vulnerable population from the general risk of clinical-psychopathological acute relapse, even if they increased the susceptibility to run into schizophrenia spectrum and other psychotic disorder relapses. In the medium-long term (as in the second pandemic wave), the same strategies do not play protective roles against the stress associated with the pandemic and social restriction measures. Indeed, during the second wave of the SARS-CoV-2 pandemic, an increase in total hospitalization rate, suicidal behaviors and the incidence rate of bipolar and related disorders, depressive disorders, anxiety disorders, trauma- and stressor-related disorders was observed
Late-life body mass index and dementia incidence: nine-year follow-up data from the Kungsholmen Project
No full textOBJECTIVES: To describe the association between late-life body mass index (BMI) and dementia development with a time perspective and to investigate the effect of weight changes on dementia incidence.
DESIGN: Three-, 6-, and 9-year follow-up study.
SETTING: The Kungsholmen Project.
PARTICIPANTS: One thousand two hundred fifty-five subjects aged 75 and older with baseline BMI data available.
MEASUREMENTS: Cox-regression models were used to estimate hazard ratios (HRs) for dementia detected at different risk periods in relation to baseline BMI. The association between BMI changes and development of dementia after 3 and 6 years was also analyzed.
RESULTS: Subjects with a BMI of 25.0 kg/m2 or higher had a lower risk of developing dementia than subjects with a BMI of 20.0 to 24.9 (HR=0.75, 95% confidence interval (CI)=0.59-0.96), even when cases occurring only during the last follow-up period (6-9 years after BMI assessment) were included (HR=0.66. 95% CI=0.40-1.07). Severe BMI loss (>10%) was related to a greater risk of dementia, but this association was present only for dementia cases detected in the subsequent 3 years (HR=2.18, 95% CI=1.27-3.74).
CONCLUSION: This study does not confirm that being overweight in late life is a risk factor for dementia, although a protective effect for a BMI greater than 25.0 is suggested. In addition, BMI loss is confirmed as a marker of incipient dementia. The findings suggest that, from a clinical perspective, the cognitive profile of elderly persons with unexplained weight loss should be considered and that being moderately overweight at older ages might be indicative of good health status
Eating Disorders and the Internet: A Descriptive Cross-sectional Study Monitoring the Pro Ana Phenomenon in an Italian Sample
No full textBackground: The Internet is a significant source of information for adolescents, affecting their life and health.
The online Pro Anorexia (Pro Ana) phenomenon is a growing danger. The purpose of this study is to evaluate the
presence of the Pro Ana phenomenon in an Italian sample of patients affected by Eating Disorders.
Methods: This study is a descriptive cross-sectional analysis that examines two different samples of patients affected
by eating disorders at different points in time, in 2017 and 2020. This study was conducted by using a seven
item anonymous questionnaire specifically developed by the authors to collect data on knowledge and visitation of
websites and Social Networks Sites related to "pro-ana" and "thinspiration" content.
Results: More than 80% of the respondents in both samples use the Internet daily. From 2017 to 2020 we observed a
rise of the phenomenon among the adolescents of our sample. In 2020, 76% of the patients knew of sites emphasizing
a marked thinness as an ideal of beauty, 60% knew of Pro Ana sites and 22% visited them.
Conclusions: Our data confirm that in Italy too, Pro Ana is a diffused phenomenon, of which clinicians need to
be consistently aware especially when treating adolescents with ED. Patients with ED mainly visit diet and nutrition
sites, and it is important to acknowledge this practice in order to prevent and address ED in early adolescence.
Although few subjects claim to visit Pro Ana websites, the majority is aware of these sites and therefore they are
potential users. Many patients assert that they are familiar with websites promoting excessive thinness as ideal
beauty, which supports the bio-psycho-social etiopathogenetic model of Anorexia Nervosa. Information sharing and
prevention work are important forms of interventions for families, teachers and clinicians, who together care for
adolescent patients with ED
The Impact of GLP-1 Receptor Agonists (GLP-1 RAs) on Mental Health: A Systematic Review
No full textPurpose Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for managing metabolic disorders such as type 2 diabetes mellitus (T2DM) and obesity. Beyond their metabolic benefits, GLP-1 RAs exhibit neuroprotective and psychotropic effects, potentially benefiting mental health conditions like depression and anxiety. This systematic review aims to synthesize existing evidence on the effects of GLP-1 RAs on mental health outcomes, including both potential thera-peutic benefits across various psychiatric disorders and the risk of associated adverse mental health effects.Methods This systematic review was conducted across PubMed/MEDLINE and Web of Science. Inclusion criteria encom-passed human and animal studies examining the impact of GLP-1 RAs on mental health. Data from 81 selected studies were extracted and analyzed, focusing on mental health outcomes and reported adverse effects.Findings GLP-1 RAs exhibit potential beneficial effects on depressive symptoms, cognitive function, and reduced risk of suicidal ideation in animal and human models through antioxidative, anti-inflammatory mechanisms, and modulation of neurotransmitter pathways. Additionally, GLP-1 RAs were effective in reducing alcohol and substance use and binge eating behaviors. Adverse psychiatric effects associated with GLP-1 RAs, including depression, anxiety, and suicidal ideation, are noted in pharmacovigilance analyses, with variations among different GLP-1 RAs.Summary GLP-1 RAs hold promise for addressing psychiatric conditions such as depression, anxiety, alcohol and substance use disorders. Despite their potential benefits, the risk of psychiatric adverse effects requires cautious administratio
Severe enduring anorexia nervosa (SE-AN) treatment options and their effectiveness: a review of literature
No full textIntroduction For nearly 20% of patients diagnosed with Anorexia Nervosa (AN), the eating disorder (ED) is prolonged and becomes long-lasting. It has been reported that patients diagnosed with Severe Enduring Anorexia Nervosa (SE-AN) have worse ED symptoms, higher rates of lifetime hospitalization, and lower psychosocial well-being compared to patients with shorter disease duration.Objectives This review aims to describe the treatments proposed to date and their effectiveness on SE-AN-related outcomes.Methods We conducted a PubMed search for studies addressing the issue of treatment approach to SE-AN adults, that were published between 2003 and 2023, peer-reviewed, written in the English language, and available in full-text. Next, we inductively created relevant macro-themes by synthesizing the data from the included articles.Results Of 251 PubMed studies, 25 articles were considered for data extraction, all published between 2003 and 2022. We identified three macro-themes. The first macro-theme, "Psychotherapy", mostly takes into consideration treatment effectiveness of cognitive behavioral therapy (CBT). Various reports determined its greater effectiveness compared to Specialist Supportive Clinical Management (SSCM), and one study proved that outpatient CBT is a valid alternative to hospitalization. The second one involves "Pharmacological Treatments". Research on dronabinol, a synthetic orexigenic cannabinoid, antipsychotics (in particular, olanzapine and haloperidol), and ketamine showed some mixed results regarding the often-complementary areas of weight gain and improvement in ED-related symptoms. Regarding the third macro-theme, "Brain Stimulation Therapies," such as Repetitive Transcranial Magnetic Stimulation (rTMS) and Deep Brain Stimulation (DBS), we found promising results in improving ED-related psychological traits (such as mood and anxiety), affective regulation, and quality of life. However, we have observed divergent results regarding outcome measures such as BMI and weight gain.Conclusions SE-AN patients are predicted to encounter both medical complications and psychological distress of increasing severity that will inevitably affect their quality of life; to our knowledge, research evidence on treatment options for SE-AN remains limited, and the methodological quality of studies is generally low. These findings denote the need to focus future research efforts on effective treatment strategies specific to long-lasting EDs.For nearly 20% of patients diagnosed with Anorexia Nervosa, the eating disorder is prolonged and becomes long-lasting. Those patients have worse ED symptoms, higher rates of lifetime hospitalization, and lower psychosocial well-being compared to patients with shorter disease duration. This review aims to describe the treatments proposed to date and their effectiveness on severe enduring anorexia nervosa related outcomes. The data obtained show how the intervention techniques primarily used in these patients are psychotherapy (in particular, cognitive behavioral therapy and Specialist Supportive Clinical Management), pharmacological treatments, and Brain Stimulation Therapies (such as Repetitive Transcranial Magnetic Stimulation and Deep Brain Stimulation). To our knowledge, research evidence on treatment options for SE-AN remains limited and these findings denote the need to focus future research efforts on effective treatment strategies specific to long-lasting eating disorders
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