Anorexia in cancer patients has a variety of causes and impairs patients’ quality of life. However, there have been few reports of thiamine deficiency (TD) playing a role in anorexia during palliative care. The objective of this report was to describe such a case.

An 82-year-old woman with advanced cervical cancer was admitted for palliative care because of progressive disease. One month after admission, she developed myoclonus on the left side, difficulty speaking, slurred speech, and drooping of the left corner of the mouth, with no consciousness disturbance. She also developed nausea and complained of decreased dietary intake for more than 2 weeks.

The patient’s thiamine level, which had been measured 2 weeks earlier, was 27 ng/ml, which was below the normal range, and 100 mg of thiamine was administered intravenously. After 2 hours, the patient’s neurological findings resolved, and her dietary intake improved from 30% to 40% of meals to 90% to 100%. Subsequently, the patient did not experience similar symptoms, and her clinical course was stable. Based on the patient’s clinical course, gastrointestinal beriberi was diagnosed.

This case shows that TD may cause anorexia. Many patients who receive palliative care have decreased dietary intake. Consequently, such patients may present with gastrointestinal beriberi, as in the present case. Appropriate diagnosis and treatment may contribute to increasing such patients’ quality of life. It may be necessary to differentiate TD from other conditions as a cause of anorexia in patients receiving palliative care.

Anorexia nervosa is an eating behavior disorder that is often related to various personality factors. The relationship between obsessive compulsive disorder and eating Disorders has been highlighted.

To present a clinical case of a patient with eating disorder and gastric bezoar, secondary to compulsive hair ingestion.

Bibliographic review of articles published in relation to the comorbidity of these disorders, based on articles published in the last 5 years in Pubmed.

26-year-old female. Diagnosis of restrictive anorexia nervosa. She was admitted to the hospital on two occasions for nutritional disorders. In the last admission, she reported greater anxiety and significant weight loss. She reports that she has limited her food intake, but she does feel thin and is unable to eat for fear of gaining weight. Ruminative thoughts about her body image. During admission, the patient expressed a sensation of fullness, nausea and vomiting, later observing in abdominal X-ray and gastroscopy, the presence of a gastric trichobezoar, which was finally resolved conservatively.

Trichotillomania is observerd in 1 in 2000 people, trichophagia is even less frequent. According to DSM- V, these disorders are grouped within obsessive-compulsive spectrum disorders. A Trichobezoar is a conglomerate that can be found in the stomach or intestine, composed mainly of hair, previously ingested. Trichotillomania can be associated with anorexia nervosa, especially in patients with obsessive personality traits, which occurs frequently. The gastric slowing that patients with anorexia often present is a factor that favors the formation of the bezoar

No significant relationships.

Anorexia nervosa has an important burden on both patients and families, with important comorbidities such as depression and obsessive symptoms. These are more resistant to pharmacological treatment than in non-anorexia patients, due to both biological and psychological mechanisms. Electroconvulsive therapy is the best available therapy for treatment resistant depression making it a treatment to consider in treatment resistant depression in anorexia though only case reports exist.

To review the current evidence for electroconvulsive therapy of depression in patients with anorexia nervosa as well as it’s ethical challenges

Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “electroconvulsive therapy”, “anorexia nervosa”.

Electroconvulsive therapy in anorexia has no controlled trials with mostly case reports available on scientific databases. It presents important challenges due to patient age, medical status and ethical challenges. Even less evidence exist for electroconvulsive therapy in children and adolescents than for adults, anorexia can complicate medical status presenting an anesthetic and life-support challenge and it’s egosyntonicity can place a legal and ethical challenge when patient refuses treatment.

Anorexia has a dramatic burden on patients and families affected, with integrated evidence-based treatment being necessary both for treating the current episode and for remission prevention. Case-reports show that electroconvulsive therapy can play a role on treatment resistant depression in anorexia.

No significant relationships.

Hepatic ones are some of the most described somatic complications in anorexia nervosa (AN) affected patients. They can be due to malnutrition, which is the more usual thing, or due to re-feeding. The first one can lead to more marked elevations of the hepatic enzymes, especially alanine-aminotransferase (ALT). It’s been also described the relation between a sharply decreased body mass index (BMI) and this kind of complications, but there are still to determine more predictors.

Identifying clinical predictors of hepatic complications in AN.

We analysed data from 71 AN affected patients hospitalized at Bellvitge Hospital from January 2016 to October 2021. We used IBM SPSS Statistics 22 to do all the statistics in this work.

The medium age of the sample was 27.66 years with 10.8 years of evolution of AN. The medium BMI was 13.88. 33.80% of them had some sort of hepatic enzymes elevation, two of them a several one. AST, ALT and ALP were significantly more elevated in those patients with lower BMI. GGT was significantly more elevated in patients with more years of disorder development. We didn’t identify correlation between any purgative method and hepatic alterations.

The elevation of ALT, AST and ALP seems to be related with the BMI of the patients, while the elevation of the GGT turns out to be related to the time of evolution of the eating disorder. Purgative methods don’t seem to be related to the development of hepatic alterations in AN.

No significant relationships.

Anorexia of females adolescents has a high mortality rate and heavy health, psychological, family consequences even in case of survival.

To reduce the mortality rate and the consequences of anorexia by providing a theory that allows us to have early or even predictive diagnosis

25 years ago I found blood type (O, A, B, AB) difference between an anorexic patient and her mother. Pregnancy had been with placental detachment and birth was traumatic, presumed causes of a mother/daughter blood contact. From that day on, I checked, in the case of Anorexia of the Female Adolescent, the blood types of the anorexic girl and her mother.

In my collection of data (more than 100 cases in 25 years): only the girls who have a different blood type (O, A, B, AB) from the mother are anorexic and from the patient’s history, we could think of a mother/daughter blood contact during the pregnancy. There are no exceptions in my data. My new theory is that Anorexia of the Female Adolescent, in addition to the girl’s psychological causes, needs a “conditio sine qua non” (a necessary but not sufficient condition): Different mother/daughter blood types (O,A,B,AB) and traumatic contact between the two blood types during pregnancy and/or birth”.

My theory facilitates early diagnosis (Preventive Medicine) by limiting observation, for Anorexia risk, to only daughters with a different blood type than that of the mother. Recognizing this “conditio sine qua non” for Anorexia of the Female Adolescent allows us an early diagnosis and a predictive hypothesis.

No significant relationships.

We present the case of a patient with schizophrenia who presents with restriction of intake, fear of gaining weight and alteration in the way of perceiving herself in which we ask ourselves if these behavioral alterations are secondary to her diagnosis of schizophrenia to an anorexia nervosa independent of previous diagnosis.

We propose to carry out a differential diagnosis of alterations in the perception of self-image in a patient with a diagnosis of schizophrenia. We suggest that these alterations may be secondary to alterations in the experience of the self present due to their psychosis.

In the differential diagnosis of the cause of alterations in self-image and fear of gaining weight, we rely on the psychiatric interview, the study of previous history and different scales: - Eating Disorders Inventory (EDI) - Gardner Body Image Assessment - Weight, body image and self-esteem scale E-PICA - IPASE scale

In this patient in whom the differential diagnosis of the cause of her dietary restrictions and weight loss is proposed, there does not seem to be any psychotic symptoms that produce these alterations.

In the alterations in self-image in those psychotic patients, there is a doubt as to whether these could be secondary to alterations in the perception of the self typical of psychotic diseases or, on the contrary, be secondary to the spectrum of Eating Disorders.

Anorexia nervosa has a prevalence of 0.5–3% in adolescents, placing this population at increased risk of cardiac anomalies including arrhythmias, pericardial effusion, and myocardial dysfunction. Our objective is to describe cardiovascular anomalies observed by tissue Doppler imaging in patients with anorexia nervosa.

We retrospectively reviewed electrocardiogram, Holter, and echocardiography findings in 28 patients diagnosed with anorexia nervosa.

Electrocardiogram was abnormal in 71% of patients with sinus bradycardia observed in 57%. Holter confirmed sinus bradycardia without significant pauses. Prolonged QTc, low voltage, and ectopic beats were each seen in 14% of patients. Wenckebach atrioventricular block was observed in one patient. Supraventricular or ventricular tachycardia was not observed. Echocardiography showed structurally normal heart in all patients. Pericardial effusion was seen in 7.1% of patients and left ventricular mass was decreased in 10.7%. Mean ejection fraction was 0.73 and mean fractional shortening was 38.4%. Tissue Doppler imaging revealed systolic or diastolic dysfunction in four patients with e’, a’, and s’ velocities in the lateral and septal basal segments more than two standard deviations below the mean. Two patients had decreased left ventricular mass but no significant difference in disease duration from the group. Basal segment velocities below one standard deviation were also observed in an additional seven patients.

A trend for decreased tissue Doppler imaging velocities was seen in 25.0% of patients, while significant systolic and diastolic dysfunction was seen in 14.3% of patients, associated with a significant reduction in left ventricular mass and independent of disease duration.

The presence of subthreshold psychotic symptoms in adolescents with eating disorders is poorly described. This study provides a detailed characterization of adolescents affected by eating disorders in the absence or presence of subthreshold psychotic symptoms, taking into account a wide set of sociodemographic, psychological, and clinical variables.

Ninety-four adolescents diagnosed with eating disorders were interviewed, focusing on clinical anamnesis and sociodemographic data collection. The Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to assess the presence (HR+) or absence (HR−) of subthreshold psychosis. The clinicians completed a questionnaire on eating disorders severity, whereas patients provided self-report measures of global social functioning and psychological symptoms associated with eating disorders.

Attenuated psychotic symptoms were highly frequent (84% of subjects). HR+ patients experienced more frequently purging behaviors and dysmorphophobia and received a greater amount of antipsychotic drugs. Compared to HR− counterparts, HR+ patients reported higher eating disorders severity and psychological symptoms (i.e., ineffectiveness, interpersonal and affective problems) associated with eating disorders. Finally, a significant correlation between global social functioning and eating disorders severity emerged only for HR− subjects.

These descriptive data are warranted to identify a potential psychotic core in eating disorders, mainly concerning body image and weight as well as specific psychological features. The availability of reliable and valid markers of risk can further increase our capacity to detect the early emergence of psychosis in adolescents with eating disorders, whose outcome might be worsened by the presence of psychotic symptoms.