Littérature scientifique sur le sujet « Disturbi dell’Alimentazione »

I disturbi della nutrizione e dell’alimentazione rappresentano una problematica significativa all’interno della salute pubblica. Un importante approfondimento teorico sui trattamenti è fornito dalle linee guida regionali e nazionali, quali l’allegato 1 alla delibera 668 del 2017 della Regione Friuli-Venezia Giulia e il documento “Appropriatezza clinica, strutturale e operativa nella prevenzione, diagnosi e terapia dei disturbi dell’alimentazione” pubblicato nel 2013 dal Ministero della Salute. Lo scopo del seguente articolo è descrivere la progettazione e l’esecuzione di un intervento educativo, svolto su un singolo caso con diagnosi di bulimia nervosa, finalizzato l’aumento della motivazione al cambiamento. Il lavoro ha previsto una prima fase per l’individuazione delle aree di intervento e il successivo progetto educativo ha previsto l’utilizzo del Modello Transteorico del Cambiamento di Prochaska e Diclemente con attività per l’aumento della motivazione al cambiamento della persona presa in carico. Il progetto realizzato e i risultati positivi ottenuti hanno dimostrato che tramite l’applicazione del Modello Transteorico del Cambiamento è possibile lavorare sull’importante aspetto motivazionale con l’utilizzo di schemi specifici sul cambiamento, di aspetti psicologici e comportamentali.

I titoli del mese: L’uomo (… il neonatologo) non separi ciò che la natura unisce! - Il caso del neonato da madre Covid-positiva - Diagnosi e diete maledette - Sempre gli oppioidi? O bastano i FANS? Il caso del trauma muscoloscheletrico - “Mah…, forse sì…, forse no…, più no che sì... ovvero: l’esitazione vaccinale - Bambini in terapia con antiepilettici: non dimenticatevi della vitamina D - Bambini con disturbo dell’alimentazione: una piccola epidemia

INTRODUCTION: After treatment, a large proportion of patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) shows only a partial remission of their eating disorder psychopathology, frequent relapses and a persistence of psychiatric comorbidities. The aim of this study was to evaluate the possible role of childhood abuse on long-term outcomes and its relationship with cortisol levels and HPA-axis alteration. METHODS: One hundred thirty-three Eating Disorder (EDs) patients (61 AN, 72 BN) were studied by means of the Structured Clinical Interview for DSM-IV and psychometric tests, at baseline, at the end of individual Cognitive Behavioral Therapy, and three years after the end of treatment. Seventy-two age and gender matched healthy control (HC) were also recruited. Blood samples were drawn in the morning (8 a.m.) after an overnight fast for determination of cortisol levels. All the patients and HC were asked to provide their written informed consent. The study protocol was approved by the Ethics Committee of the Institution. RESULTS: Patients reporting childhood abuse (overall:24.8%; physical abuse:24.1%; sexual abuse:13.5%) showed lower age onset, higher impulsivity, and a greater rate of psychiatric comorbidity than other patients. At follow-up, a full recovery from any Axis I diagnosis was observed in 4 (12.1%) patients with abuse (vs 31 [31%] of the other patients). This different rate was mainly associated with the persistence of unipolar depression in abused patients (77.8% vs 26.7%). Linear mixed models showed a reduction of depressive symptoms in non-abused patients, but not in those reporting abuse. Patients with abuse showed a higher diagnostic cross-over rate (39.4% vs 13.0%), as compared to the other patients. Patients with abuse showed a lower morning cortisol levels at the baseline as compared with other patients and HC with p<0.001 and non-abused patients showed higher cortisol levels respect to HC. At the follow-up non-abused patients showed a significant reduction of morning cortisol levels with p<0.001, while abused patients maintained the lower levels reported at the baseline. Finally, survival analysis showed that patients with abuse had a higher probability of drop-out during treatment. DISCUSSION: Patients with EDs reporting a history of childhood abuse represent a group of persons with more complex psychopathological features, a dysregulation of HPA-axis activity, a different response to treatment and worse long-term outcomes, thus requiring specific treatment strategies.