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The burden of losing appetite

Author of the study says anorexia remains the psychiatric disorder with the highest mortality rate. PHOTO | COURTESY | FOTOSEARCH
Author of the study says anorexia remains the psychiatric disorder with the highest mortality rate. PHOTO | COURTESY | FOTOSEARCH 

Deep brain stimulation can help patients who struggle with appetite loss to improve weight and mental health, a study has revealed.

The results of a study published in The Lancet Psychiatry says that brain stimulation might alter brain circuits that drive anorexia nervosa symptoms and as a result help improve mental and physical health.

The one year study that involved 16 people says intervention used to improve symptoms of anorexia are safe. 

The study shows it proved effective in managing treatment-resistant anorexia, which is also regarded as a psychiatric disorder with the highest mortality rate. It is estimated that 0.5 per cent of people suffer from treatment-resistant anorexia across the world, majority being teenage girls.

All the patients underwent deep brain stimulation, which involved implanting electrodes and stimulating areas of the brain that control dysfunctional behaviours.

“The study looked at how safe deep brain stimulation was for patients with anorexia, and how it affected their BMI, mood, anxiety and wellbeing. Using PET scans, the researchers also looked at how brain activity changed after one year of stimulation.”

As a result of malnutrition, chronic anorexia causes problems including weak bones, muscles, sexual problems, infertility, heart problems and seizures.

The study says the condition “can be fatal and those who become acutely ill are admitted to specialised hospital units to receive nutritional support, medical stabilisation and behavioural therapy.

The eating disorder is tied to concerns about body weight shape and size; also mood and anxiety disorders. The bulk of patients deny that they are ill and avoid seeking medical advice.

“Conventional treatment of anorexia nervosa includes behavioural modifications to improve feeding, combined with psychological therapy to address cognitive distortions related to self-esteem, eating, and body dissatisfaction. Nevertheless, after intensive treatment, nearly half of adult women with anorexia nervosa relapse within a year,” says Dr Carrie McAdams, University of Texas.
“This work shows how modern neuroscience can lead to a new treatment and simultaneously improve understanding of perpetuating factors in a complex, multifactorial disease… Difficulty in changing these factors, which are not part of the diagnostic symptoms of anorexia nervosa, could contribute to the poor outcomes seen with conventional treatments.”

There were no serious adverse events during the study, except for the five patients that experienced pain for longer than usual three to four days after the surgery. One person suffered an infection on the site of the surgery which resulted in fresh surgery to remove and do the implant all-over again.

According to the study most adverse effects were only as a result of the low sodium and potassium levels on anorexic patients.

According to the findings, mental health symptoms of the persons on study improved as mood and anxiety symptoms fell.

The patients also reported better quality life and reduced depression in 10 out of the 14 patients.

Change in weight gain was noticeable after three months, suggesting that improving mental health symptoms contribute to change in weight. The patient’s average BMI improved by 3.5 points to 17.3 while over the course six patients got to 18.5, the normal measure.

Results from scans done during the study after a year of stimulation show that there was a change in the regions linked to anorexia, an indicator “that deep brain stimulation was able to directly affect the related brain circuits.”

Notably, there was more activity in the peripheral cortical areas which are also linked to social perception and behaviour and less in areas including putamen, thalamus, cerebellum.

“Anorexia remains the psychiatric disorder with the highest mortality rate, and there is an urgent need to develop safe, effective, evidence-driven treatments that are informed by a growing understanding of brain circuitry,” said study author Andres Lozano of the University of Toronto.

“While our results show some early promise, more research will be needed before this becomes available for patients with anorexia. Our findings emphasise the need for continued research into novel neuromodulation strategies for anorexia nervosa, and for psychiatric disorders more broadly.”

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