Catecholamine metabolism in anorexia nervosa

Studies are reviewed that address the question of whether anorexia nervosa is associated with abnormalities in central nervous system catecholamine metabolism. There is some support for the hypothesis that norepinephrine and dopamine metabolism are altered in this disorder.     

Brain metabolism alterations in patients with anorexia nervosa observed in 1H-MRS

The causes of metabolic brain changes in patients with anorexia nervosa are still not fully explained. The purpose of this study was to use the 1H-MRS method in investigating metabolic changes in the brain of patients with anorexia nervosa. We studied 10 patients for visible alternations in brain metabolism and compared the results to healthy controls. 1H-MRS was acquired by the method of single voxels in white and grey matter. Proton MRS was performed after image guided localization using stimulated echo acquisition mode (STEAM) sequence with a short echo time of 20 ms. For data evaluation we used standard Siemens software and the additional PC. Choosing of the MRS sequences was related with particular interest in metabolites of short time echo: myoinositol and lipids. Besides this we evaluated peaks of: N-acetylaspartate (NAN), creatine (Cr) and choline (Cho). The results show significant differences in the levels of metabolites connected with fatty metabolism. In white matter we observed the reduction of lip-peak. The data was evaluated approximately and presented as lip:Cr. We did not observe any differences in other metabolites. As far as we know similar results had been reported and our study confirmed significant disorders in metabolism of these chemicals in patients with anorexia nervosa.     

Differences in brain serotonergic metabolism between nonbulimic and bulimic patients with anorexia nervosa

CSF concentrations of serotonin and dopamine metabolites in 16 patients with anorexia nervosa were measured before and after probenecid administration, and the patients were studied before and at intervals after weight recovery. After probenecid administration, the weight-recovered nonbulimic anorexic patients had a higher concentration of the serotonin metabolite, 5-hydroxyindoleacetic acid, than the weight-recovered bulimic patients but no significant differences in CSF homovanillic acid. This finding is consistent with evidence that suggests a role for brain serotonin metabolism in carbohydrate and mood regulation.     

Altered norepinephrine metabolism following long-term weight recovery in patients with anorexia nervosa

This study evaluated the relationship between noradrenergic function and long-term weight recovery in patients with anorexia nervosa. Eleven patients with long-term weight maintenance (6 to 72 months) had lower plasma and cerebrospinal fluid concentrations of norepinephrine and 3-methoxy-4-hydroxy-phenylglycol than did healthy controls. Reduced noradrenergic activity may be associated with long-term stability of weight recovery in patients with anorexia nervosa.     

Altered energy metabolism in anorexia nervosa

Optimal nutritional rehabilitation of anorexia nervosa requires more information concerning actual energy and substrate requirements. To this end, indirect calorimetry was performed in female patients (n=34, age 20.9+/-1.2 yr, body mass index [BMI] 15.6+/-0.2 kg/m(2); mean+/-SEM) soon after commencement of refeeding and at the time of discharge from hospital (n=18, BMI 19.0+/-0.3 kg/m(2)). Healthy female controls (n=18, age 24.6+/-1.3 yr, BMI 21.6+/-0.6 kg/m(2)) were also tested. Resting energy expenditure (REE) and respiratory quotient (RQ) were measured in the fasting state, followed by diet-induced thermogenesis (DIT) and RQ over a 4 h period following a 100 g oral glucose load. Compared with post-refeeding patients and controls, pre-refeeding patients had a high basal RQ and a low REE, with a paradoxically higher DIT (13.2+/-0.9% of REE vs. 8.3+/-1.2% and 8.6+/-0.9% in post-refeeding patients and controls, respectively). RQ values in pre-refeeding patients exceeded unity following the glucose load, probably reflecting net lipogenesis, whereas in the post-refeeding patients, post-glucose RQ was similar to that of controls, suggesting premature curtailment of lipogenesis. These data demonstrate energy wasting in emaciated patients with anorexia nervosa. Biological repair processes could account for disproportionate energy loss early in refeeding and there may be some later impediment to full restoration of fat stores.     

Hypothalamic-pituitary-gonadal function in anorexia nervosa and bulimia

Patients with anorexia nervosa (AN) exhibit neuroendocrine abnormalities that may result solely from emaciation or may reflect defective endocrine mechanisms which are intrinsic to disordered eating even in the absence of starvation. To distinguish these possibilities, we have studied indices of hypothalamic-pituitary-gonadal (HPG) function in 9 patients with AN, 12 normal weight patients with bulimia and recent or current oligomenorrhea, and 8 normal weight controls. Measurement of 24-hour luteinizing hormone (LH) secretion with 30-min sampling revealed significantly fewer LH secretory spikes and a trend toward lower mean 24-hour LH levels in both bulimic and anorectic patients than in controls. Stimulation with gonadotropin releasing hormone produced elevated LH responses in the bulimic group and blunted LH responses in the anorectic group. Stimulation with estradiol revealed diminished LH augmentative responses and a trend toward diminished follicle stimulating hormone augmentative responses among bulimic as well as AN patients compared to controls. In each instance, the bulimic group tended to show within-group heterogeneity, with some individuals falling within the AN range. These findings suggest that HPG axis abnormalities in eating disordered patients cannot entirely be attributed to emaciation and that factors other than subnormal weight contribute to disturbed hypothalamic-pituitary functioning in these patients.     

Asymmetric cognitive function in anorexia nervosa

Three anorexics, one at normal weight, were examined, with a neuropsychological battery including the Halstead-Reitan tests. Their data were contrasted with that of 24 psychiatric controls matched for age, sex and IQ. Individually and as a group the anorexics showed above average verbal/academic scores and impaired spatial skills, whereas visual-motor and problem solving skills were equivalent to controls. Somatosensory recognition was impaired bilaterally in all three patients, and motor skills were low in the two emaciated patients. Other sensory tests and intermanual comparisons of sensory and motor skills were not impaired relative to controls. The findings suggest that a spatial reasoning deficit may be a predisposing or maintaining factor in this disorder. High verbal skills, in contrast, may reflect substantial left hemisphere contributions to the anorexic's cognitive style.     

Hypnotizability in patients with anorexia nervosa and bulimia

Hypnotizability was assessed with the use of three standardized hypnosis scales in 86 patients with eating disorders. All diagnoses were made according to DSM-III criteria. Sixty-five patients had anorexia nervosa and 21 had bulimia. The anorectic patients were divided into subgroups of 19 abstainers and 46 vomiters and purgers. Bulimic patients were highly hypnotizable, significantly more so than the patients with anorexia nervosa and age-matched populations. There was also a trend for the purging subgroup of anorectics to have higher hypnotic capacity than abstaining anorectics.     

Autonomic nervous system function in women with anorexia nervosa

Clinical Autonomic Research - Abnormalities in autonomic function have been observed in people with anorexia nervosa. However, the majority of investigations have utilised heart rate variability as...     

Cerebral atrophy and vigilance performance in patients with anorexia nervosa and bulimia nervosa

The relationship between ventricular size, as a measure of brain atrophy, and performance on a vigilance task was investigated in 39 patients with anorexia or bulimia nervosa during the acute stage of their illness. Compared to normal controls, the patients performed significantly more poorly in the cognitive task. Half of the patients displayed enlarged ventricles. However, the patients with ventricular dilatation did not perform worse in the cognitive test than patients with normally sized ventricles. Other clinical characteristics, such as symptom severity or duration of illness, were also not correlated with ventricular size. These results support the interpretation that cerebral atrophy per se does not have severe consequences on the neuropsychological or psychopathological status in eating disorder patients.     

Insulin sensitivity in patients with anorexia nervosa and bulimia

Insulin sensitivity was studied using the euglycemic insulin clamp technique in 5 female patients with anorexia nervosa and 4 females with bulimia. The results were compared with those of 15 male patients with non-insulin-dependent diabetes mellitus. Euglycemic insulin clamp is performed for 2 h using the Biostator, during which time insulin was infused at a rate of 0.77 mU kg-1 min-1. Fasting plasma glucose and immunoreactive insulin tended to be lower in patients with anorexia nervosa than in those with bulimia (69.8 +/- 6.7 vs 75.9 +/- 7.7 mg/dl, and 5.9 +/- 2.0 vs 9.8 +/- 3.4 U/ml). The mean metabolic clearance rate (MCR) was 9.2 +/- 3.9 ml kg-1 min-1 for patients with anorexia nervosa, 5.1 +/- 2.2 ml kg-1 min-1 for patients with bulimia, and 3.8 +/- 0.3 ml kg-1 min-1 for patients with diabetes mellitus. However, one anorectic had a significantly high MCR. One anorectic and 3 bulimics had a significantly low MCR. These results suggest that insulin sensitivity varied in patients with anorexia nervosa, whereas it tended to decrease in some patients with bulimia but not to the same degree as in patients with diabetes mellitus.     

Hippocampal volume and cognitive function in anorexia nervosa

We hypothesised that hippocampal volume would be reduced in underweight anorexia nervosa (AN) and associated with impaired hippocampus-dependent cognitive function. Hippocampal and whole brain volumes were measured in 16 women with AN and 16 matched healthy women using magnetic resonance imaging (MRI) and a manual tracing method. Participants also completed the Doors and People Test of hippocampus-dependent memory and an IQ test. After adjustment for total cerebral volume, there was significant bilateral reduction in hippocampal volume in the AN group (8.2% right; 7.5% left). There was no evidence of impaired hippocampus-dependent cognitive function and no evidence of a relationship between hippocampal volume and clinical features of AN. The reduced hippocampal volume in anorexia nervosa is not associated with changes in cognitive function. To understand the cause and consequence of hippocampal size and function, it will be important to integrate endocrine, neuropsychological and neuroimaging studies.     

Measures of serotonin metabolism in anorexia nervosa.

Thirty-five consecutive attenders at a clinic specializing in anorexia nervosa were studied. All conformed to a DSM-III-R diagnosis for anorexia nervosa. In addition, 3 cases suffered from major depressive disorder and 9 from dysthymia. Blood from all patients was analysed for monoamine oxidase, serotonin (5-HT), 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), tryptophan and platelet paroxetine binding. Findings showed that blood 5-HT was higher than normal in all patient groups, and was highest in those having affective disorder with anorexia nervosa. However, of the patients with anorexia nervosa alone, a subgroup having greatest weight loss had blood 5-HT levels significantly below all other groups. Lack of significant changes in other parameters compared with normal subjects points to the possibility of abnormal 5-HT storage or release.     

Adaptation of psychodrama in psychotherapy of patients with anorexia nervosa and bulimia nervosa

The aim of the article was an attempt to present selected theoretical motifs and moreover self experience in the adaptation of elements of psychodrama by Moreno in psychodynamic psychotherapy (individual and group psychotherapy) in a group of people with anorexia and bulimia nervosa. Psychodrama through own creativity, spontaneity and taking action on the "here and now" stage helps to attain and intensify therapeutic aims which concern the consciousness of inner conflict of persons with anorexia and bulimia nervosa, which is translocated on their body.     

Neuropsychological assessments before and after treatment in patients with anorexia nervosa and bulimia nervosa

In psychiatric patients the identification of cognitive deficits which predict a poor clinical outcome is important for the development of specific treatment strategies aimed at the amelioration of these impaired cognitive functions to increase the likelihood of full clinical remission. However, such attempts are absent in bulimia nervosa (BU), are scarce in anorexia nervosa (AN) and, furthermore, provide conflicting results. In the present prospective study we investigated the neuropsychological demands in 12 patients with AN and in 14 patients with BU before, during, and after a treatment period. At the initial testing session, both patients samples showed similar and impaired performance levels on tasks measuring attentional demands and problem solving abilities, while their mnemonic functions were preserved. At the final testing session, which took place 7 months thereafter, the impaired cognitive functions had improved to a similar degree in the AN and the BU subgroups. However, although the eating disorder symptomatology had ameliorated in parallel, no direct associations could be established with the initial neuropsychological demands and their rectification, respectively. On an individual level, 11 patients initially showed obvious cognitive deficits. However, the clinical characteristics of this subgroup differed not from that found in the 15 'good performers'. These findings indicate that the cognitive functions in the acute AN and BU are similarly impaired, but also ameliorate in a similar manner with clinical remission. Because no associations were obvious between cognitive and clinical rectifications, significant contributions of mediating factors (e.g., changes in metabolic brain turnover and in steroid hormones) are suggested.