DBS for treatment-refractory anorexia nervosa

Section of Eating Disorders, Institute of Psychiatry, King's College London, London SE5 8AF, UK. Electronic address: .
The Lancet (Impact Factor: 39.21). 03/2013; 381(9875). DOI: 10.1016/S0140-6736(13)60057-4
Source: PubMed
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    ABSTRACT: Brainstem and hypothalamic "orexigenic/anorexigenic" networks are thought to maintain body weight homeostasis in response to hormonal and metabolic feedback from peripheral sites. This approach has not been successful in managing over-and underweight patients. It is suggested that concept of homeostasis has been misinterpreted; rather than exerting control, the brain permits eating in proportion to the amount of physical activity necessary to obtain food. In support, animal experiments have shown that while a hypothalamic "orexigen" excites eating when food is abundant, it inhibits eating and stimulates foraging when food is in short supply. As the physical price of food approaches zero, eating and body weight increase without constraints. Conversely, in anorexia nervosa body weight is homeostatically regulated, the high level of physical activity in anorexia is displaced hoarding for food that keeps body weight constantly low. A treatment based on this point of view, providing patients with computerized mealtime support to re-establish normal eating behavior, has brought 75% of patients with eating disorders into remission, reduced the rate of relapse to 10%, and eliminated mortality.
    Frontiers in Neuroscience 08/2014; 8. DOI:10.3389/fnins.2014.00234
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    ABSTRACT: This clinical practice guideline for treatment of DSM-5 feeding and eating disorders was conducted as part of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guidelines (CPG) Project 2013-2014.
    Australian and New Zealand Journal of Psychiatry 11/2014; 48(11):977-1008. DOI:10.1177/0004867414555814 · 3.77 Impact Factor
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    ABSTRACT: Extremes of eating disorders (ED) have become prevalent in both developed and developing countries. Available therapies, though largely effective, fail in a substantial number of patients and carry considerable side effects. Morbid obesity and anorexia nervosa (AN) represent important causes of morbidity and mortality among young adults. Morbid obesity affects disproportionate numbers of children. AN is also important for its high mortality in young adults. The challenges of effectively treating AN are well recognized. In this article, important aspects of ED are reviewed in detail and novel approaches to the treatment of ED are proposed.
    Neurosurgery clinics of North America 01/2014; 25(1):147-157. DOI:10.1016/ · 1.54 Impact Factor