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: 45.22). 03/2013; 381(9875). DOI: 10.1016/S0140-6736(13)60057-4
Source: PubMed
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    • "base for anorexia nervosa treatment is meager considering the extent to which this disorder erodes quality of life and takes far too many lives prematurely " (Lipsman et al., 2013; Treasure and Schmidt, 2013; Attia, 2014; Bulik, 2014; Editorial, 2014; Herpertz- Dahlmann et al., 2014; Zipfel et al., 2014). The same outcome was described 20 years earlier (Bergh and Södersten, 1998). "
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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(8). DOI:10.3389/fnins.2014.00234 · 3.66 Impact Factor
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    ABSTRACT: This review summarizes recent evidence on psychological treatments for eating disorders. Eating disorders are serious psychiatric conditions requiring evidence-based intervention. Treatments have been evaluated within each eating disorder diagnosis and across diagnoses. For adults with anorexia nervosa, no one specialist treatment has been shown to be superior. Cognitive behavioral therapy and interpersonal psychotherapy remain the most established treatments for bulimia nervosa and binge eating disorder, with stepped-care approaches showing promise and new behavioral treatments under study. Enhanced cognitive behavioral therapy has improved symptoms in adults and youth. Maudsley family-based therapy is the most established treatment for youth with anorexia nervosa and may be efficacious for youth with bulimia nervosa. Interpersonal psychotherapy for the prevention of excess weight gain may be efficacious for reducing loss of control eating and weight gain in overweight youth. Significant advances in treatments have been made, including evaluation of long-term outcomes, novel approaches, and tailored extension for specific patient profiles. However, widespread access to effective eating disorder treatments remains limited. Increasing the potency and expanding the implementation of psychological treatments beyond research settings into clinical practice has strong potential to increase access to care, thereby reducing the burden of eating disorders.
    Current opinion in psychiatry 09/2013; 26(6). DOI:10.1097/YCO.0b013e328365a30e · 3.94 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/ · 1.44 Impact Factor
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