21,511 research outputs found
The role of drug therapies in the treatment of anorexia and bulimia nervosa: a review of the literature
No full textBackground
The present review summarizes published papers reporting the results of both open-label and double-blind studies, which explored the potential efficacy of antidepressants, antipsychotics and mood stabilizers in the treatment of anorexia nervosa (AN) and bulimia nervosa (BN).
Methods
The literature was sourced from recent searches on Pubmed updated to January 2013 using the terms “eating disorders”, “pharmacotherapy”, “anorexia nervosa”, “bulimia nervosa”, “therapy” or “treatment”. Studies were selected for inclusion if they met a level of evidence that minimized the risk of bias such as randomized controlled trials (RCTs) or systematic review of RCTs.
Results
This critical review seems to suggest that selective serotonin reuptake inhibitors (SSRI) have a proven efficacy in BN. Antipsychotics seem to be potentially promising options in the treatment of severe adult and adolescent AN patients, revealing positive psychopathological effects and good tolerability. Other treatments, such as the anticonvulsant topiramate in BN, may be promising.
Conclusion
Even if there have been useful researches on the efficacy of pharmacotherapy in the treatment of BN, there are still many unsolved issues regarding the optimal management of other EDs. Future directions for pharmacological treatment researches in EDs should include randomized controlled trials with different medications, inpatient versus outpatient trials and the assessment of medication effects for relapse prevention in recovered patients
Gastroenteric hormone responses to hedonic eating in healthy humans.
No full textHedonic eating differentiates from homeostatic eating on two main aspects: the first one is that eating occurs when there is no need for calorie ingestion and the second one is that the food is consumed exclusively for its gustatory and rewarding properties. Gastroeneteric hormones such as ghrelin, colecystokinin-33 (CCK) and peptide YY(3-36) (PYY(3-36)) are known to play a pivotal role in the homeostatic control of food intake. To the contrary, their role in hedonic eating has been never investigated. Here we report peripheral responses of CCK, PYY(3-36) and ghrelin to the consumption of food for pleasure in well-nourished satiated healthy subjects. Plasma levels of CCK, PYY(3-36) and ghrelin were measured in 7 satiated healthy subjects before and after ad libitum consumption of both a highly pleasurable food (hedonic eating) and an isoenergetic non-pleasurable food (non-hedonic eating). The consumption of food for pleasure was associated to a significantly increased production of the hunger hormone ghrelin and a significantly decreased secretion of the satiety hormone CCK. No significant changes in plasma PYY(3-36) levels occurred in the two eating conditions. These preliminary data demonstrate that in hedonic eating the peripheral hunger signal represented by ghrelin secretion is enhanced while the satiety signal of CCK production is decreased. This could be responsible for the persistence of peripheral cues allowing a continued eating as well as for the activation of endogenous reward mechanisms, which can drive food consumption in spite of no energy need, only for reward
Flattened cortisol awakening response in chronic patients with schizophrenia onset after cannabis exposure.
No full textCannabis may play a causal role in the onset of some schizophrenia cases; however, the biological vulnerability that predisposes some individuals to develop schizophrenia after exposure to cannabis is not known. According to the diathesis-stress pathogenetic model, it is likely that the endogenous stress response system, including the hypothalamus-pituitary-adrenal (HPA) axis, could be involved. Therefore, we investigated the saliva cortisol awakening response (CAR) of 16 patients with schizophrenia onset after the exposure to cannabis (Can+) as compared to 12 patients with schizophrenia onset without cannabis exposure (Can-) and to 15 healthy controls. The CAR was assessed by collecting saliva samples at awakening and after 15, 30 and 60min. As compared to healthy controls, Can+ schizophrenia patients exhibited significantly enhanced baseline saliva cortisol levels and a flattened CAR. No significant abnormality in both baseline cortisol levels and CAR was detected in Can- schizophrenia patients. These findings demonstrate a dysregulation of the HPA axis in chronic schizophrenic patients whose illness started after cannabis exposure but not in those with an illness onset without cannabis exposure. Further studies need to clarify whether this HPA dysregulation is a part of the biological background underlying the increased risk to schizophrenia after exposure to cannabis
Central and peripheral peptides regulating eating behaviour and energy homeostasis in anorexia nervosa and bulimia nervosa: a literature review
No full textA large body of literature suggests the occurrence of a dysregulation in both central and peripheral modulators of appetite in patients with anorexia nervosa (AN) and bulimia nervosa (BN), but at the moment, the state or trait-dependent nature of those changes is far from being clear. It has been proposed, although not definitively proved, that peptide alterations, even when secondary to malnutrition and/or to aberrant eating behaviours, might contribute to the genesis and the maintenance of some symptomatic aspects of AN and BN, thus affecting the course and the prognosis of these disorders. This review focuses on the most significant literature studies that explored the physiology of those central and peripheral peptides, which have prominent effects on eating behaviour, body weight and energy homeostasis in patients with AN and BN. The relevance of peptide dysfunctions for the pathophysiology of eating disorders is critically discussed
Hedonic Eating Is Associated with Increased Peripheral Levels of Ghrelin and the Endocannabinoid 2-Arachidonoyl-Glycerol in Healthy Humans: A Pilot Study
No full textEndocannabinoid and Gastroenteric Hormone Responses to Hedonic Eating in Healthy Humans: Implications for Eating Disorders
No full textAbnormal diurnal patterns of salivary alpha-amylase and cortisol secretion in acute patients with anorexia nervosa
No full text"OBJECTIVES: The evidence that the activity of the sympathetic nervous system (SNS) is decreased in acute anorexia nervosa (AN) is not consistent. Therefore, we aimed to assess the SNS basal activity in malnourished AN patients through the measurement of diurnal salivary levels of α-amylase, whose secretion is regulated by the SNS. As secondary aim, we measured also salivary cortisol.. . METHODS: Eight symptomatic female patients with restrictive AN and eight age-matched healthy women underwent saliva sample collection at awakening and over the day. α-amylase and cortisol were assayed by ELISA method.. . RESULTS: In both patients and controls, saliva α-amylase levels significantly decreased during 60 min after awakening and then progressively rose towards the afternoon\/evening. AN patients exhibited significantly reduced levels of the salivary enzyme with a significant decrease in its overall diurnal secretion and a dysregulated secretory pattern. As compared to control women, AN patients exhibited significantly enhanced levels of salivary cortisol at awakening, an enhanced and advanced cortisol secretion after awakening but no significant change in the overall diurnal secretion of the salivary hormone.. . CONCLUSIONS: These results suggest that the activity of the SNS, evaluated through the assessment of the diurnal secretion of salivary α-amylase, is impaired in the acute phase of AN whereas the cortisol awakening response is enhanced.
Investigation of Oxytocin Secretion in Anorexia Nervosa and Bulimia Nervosa: Relationships to Temperament Personality Dimensions
No full textPublished studies suggested an implication of oxytocin in some temperament characteristics of personality. Therefore, we measured oxytocin secretion in 23 women with anorexia nervosa (AN), 27 with bulimia nervosa (BN) and 19 healthy controls and explored the relationships between circulating oxytocin and patients' personality traits. Plasma oxytocin levels were significantly reduced in AN women but not in BN ones. In healthy women, the attachment subscale scores of the reward dependence temperament and the harm avoidance (HA) scores explained 82% of the variability in circulating oxytocin. In BN patients, plasma oxytocin resulted to be negatively correlated with HA, whereas no significant correlations emerged in AN patients. These findings confirm a dysregulation of oxytocin production in AN but not in BN and show, for the first time, a disruption of the associations between hormone levels and patients' temperament traits, which may have a role in certain deranged behaviours of eating disorder patients. Copyright (c) 2015 John Wiley & Sons, Ltd and Eating Disorders Association
Asymmetry of salivary cortisol and α-amylase responses to psychosocial stress in anorexia nervosa but not in bulimia nervosa
No full textBACKGROUND:
The stress response involves the activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). As a role for stress in determining of the onset and the natural course of eating disorders (EDs) has been proposed, the study of the psychobiology of the stress response in patients with anorexia nervosa (AN) and bulimia nervosa (BN) should be helpful in understanding the pathophysiology of these disorders. The two neurobiological components of the stress response can be easily explored in humans by the measurement of salivary cortisol and α-amylase response to a stressor. Therefore, we assessed salivary cortisol and α-amylase responses to the Trier Social Stress Test (TSST) in symptomatic patients with AN and BN compared to healthy controls.MethodSeven AN women, eight BN women and eight age-matched healthy females underwent the TSST between 1530 and 1700 h. Salivary cortisol and α-amylase levels were measured by an enzyme-linked immunosorbent assay (ELISA).
RESULTS:
Compared to healthy women, AN patients showed a normal cortisol response to the TSST, although this occurred at significantly increased hormone levels, and an almost complete absence of response of α-amylase. BN women, however, exhibited enhanced pre-stress levels of salivary α-amylase but a normal response of the enzyme and cortisol to the TSST.
CONCLUSIONS:
These findings demonstrate, for the first time, the occurrence of an asymmetry between the HPA axis and SNS components of the stress response in the acute phase of AN but not in BN. The pathophysiological significance of this asymmetry remains to be determined
Beyond anorexia and bulimia nervosa: what's "new" in eating disorders?
No full textDespite the fact that awareness of eating disorders (EDs) has
grown during the past decades, the conceptualisation, psychopathological
characterisation and clinical diagnosis of EDs has
proven to be problematic for both researchers and clinicians.
Presently, diagnostic criteria employed for anorexia nervosa (AN)
and bulimia nervosa (BN) are unable to account for an exceedingly
high number of individuals with clinically significant eating
symptoms or to properly address new clinical prototypes of ED.
The aim of this paper is to describe the developments and current
limitations of EDs diagnoses, and to recapitulate the recent
literature on emerging phenotypes. Descriptions of the symptoms
and behaviours of ED patients with diabulimia, orthorexia, muscle
dysmorphia, drunkorexia and nocturnal eating disorders are
featured with special focus on psychopathological classification
and diagnostic ambiguity issues. An overview of non-specific eating
and feeding disorders (EDNOS) in the newly released DSM-5
eating and feeding disorders section is also provided. Given the
frequent transition between different phenotypes in patients with
EDs and the common occurrence of individuals with clinically
significant eating symptoms who evade diagnostic criteria, a better
understanding and categorization of emerging EDs is required
to guide psychiatric research and improve clinical outcomes
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