The eating disorder (ED) are anorexia nervosa, bulimia and unspecified eating disorder behavior according to ICD-10. Currently the ED have become a social and health problem of the first kind that require specialized and interdisciplinary approach to the response of such disorders.

The growing demand observed in different assistive devices is associated with increased incidence of eating disorders in recent decades.

She is a woman of 23 years old, single. It is the small two brothers. He lives with his parents and brother 25 years. It is fourth-year student of law. It is derived from primary care by their GP after significant weight loss by decreasing the intake of foods high in calories and low mood. It is defined as a very responsible person, controller and is always looking for perfection in every activity performed. He began to try to lose weight about a year that relates to start time of stress ago. She speaks that had many exams and wanted to get top marks in all. With good adherence to psychotherapy and monitoring by nurses. Aspects of body image as well as traits such as perfectionism work.

These clinical conditions are characterized by their complexity and diversity symptomatology, which involves a significant interference in their functioning in different vital areas and clinically significant distress. After the psychotherapeutic approach, a significant reduction in the clinic that she had at the beginning and an improvement in mood was observed.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Several reviews have reported the incidence of schizophrenia in patients with eating disorders (ED) to be between 3–10% and the incidence of transient psychotic episodes to be 10–15%. On the other hand, anorexia nervosa appears to affect 1 to 4% of schizophrenia patients. Reports of psychosis and ED occurring in the same patient have led to various views as to the nature of the relationship between the two.

Analysis of the literature illustrated by different clinical cases in which appears to be a relationship between ED and psychosis.

Critical reflection about the hypothesis that could underlie the comorbidity of psychotic illness and ED.

Non-systematic review of a literature search using the keywords: eating disorders; psychosis; comorbidity.

There is no consistent sequence in the co-occurrence of the two conditions – ED sometimes precede and sometimes follows the onset of psychosis. ED patients can develop psychotic symptoms, most frequently transient in the course of the disorder, while others are subsequently diagnosed with a chronic psychotic disorder. On the other hand, patients with a primary psychotic illness can develop an eating disorder. The connection between the two, however, remains speculative, considering the hypothesis that ED and psychosis can be entirely separate disorders that can, by chance, occur in the same person.

The area of comorbidity and overlapping symptoms in psychiatry requires more deep research. Despite evidence from case series, the comorbidity between ED and psychosis is poorly understood, and firm conclusions cannot be drawn from this analysis.

The authors have not supplied their declaration of competing interest.

Several studies have proved that people who suffer from Anorexia Nervosa (AN) experience higher levels of anxiety, stress and depression than general population; while controversial results have been found among obese people (OB); the purpose of this study is to compare levels of anxiety, stress, and depression in AN sample, in OB sample and in Healthy Control Group (HC).

AN sample: 27 anorexic inpatient women in an eating disorder unit. OB sample: 27 obese women evaluated for elegibility of bariatric surgery intervention. HC group: 27 women from different countries had been recruited. DASS 21 and STAI-Y questionnaires had been subministred to evaluate anxiety, stress and depression. The questionnaires had been scores and statistical analysis had been held to determine whether the differences founded in the 3 populations were significant or not (P-value < 0.05).

Table 1. The differences founded were significant.

Anxiety and stress (DASS21, STAI): AN have reported higher levels than OB and HC that present similar levels. Depression (DASS21): AN have reported higher levels than OB and HC; OB higher levels than HC.

The authors have not supplied their declaration of competing interest.

Night Eating Syndrome (NES) was described in 1955 in a subset of patients resistant to weight loss. It is characterized by morning anorexia, evening hyperfagia and sleep disturbances. It is also more prevalent among patients with another eating disorder (ED), particularly binge-eating disorder (BED) or bulimia nervosa (BN).

Review of the literature about the relationship between NES and another EDs and to present a case report of a patient with a long-standing purgative anorexia nervosa (AN-BP) and comorbid NES.

review of the literature using the database Medline through Pubmed, with the keywords: “night eating syndrome” and “eating disorder”.

NES is highly prevalent among patients with EDs, with an estimated prevalence of about 5–44%. However, most of the existent literature explores the relationship between NES and BED or BN, and it is not consensual if NES is a subtype of another ED. There is still scarce evidence about NES and AN comorbidity.

In this case report, we present a patient with a history of AN-BP, in which the recovery of lost weight and the increase of body mass index (BMI) occurred simultaneously with a period of worsening NES symptoms, which leads the authors to question if the psychopathology of NES has contributed to the recovery of BMI at the expense of maintaining a dysfunctional eating pattern.

The authors have not supplied their declaration of competing interest.

According to the most widely influential treatment guidelines from the National Institute for Health and Clinical Excellence and the American Psychiatric Association, existing evidence for adult AN treatment is weak, and more treatment studies are needed.

The primary objective of this project is to gain knowledge about the effectiveness of CBT-E in the treatment of Anorexia Nervosa (AN). Secondary objectives are to prospectively examine baseline predictors of treatment outcome/drop-out and to examine variables related to treatment process and patient engagement as predictors of outcome/drop-out. Thirdly, in a multidisciplinary approach, to focus on selected pathophysiological mechanisms including disturbed neuropsychological functioning, changes in the gut microbiota, immunological and genetic measures in patients with severe AN in different stages of the disease, and further to investigate to what extent they are related to treatment outcome.

The sample consists of patients aged ≥ 16 years with AN admitted to outpatient treatment (CBT-E) at Section for Eating Disorders, Haukeland University Hospital, Bergen, Norway. Outcome measures include BMI, self-reported eating disorder symptoms (EDE-Q), depression (BDI), anxiety (BAI) general psychiatric symptomatology (SCL-90-R, M.I.N.I 6.0), health related quality of life (CIA, RAND-36), physical activity (accelerometers) and neuropsychological functioning. The main measurement points are at the start of treatment, 3 months, end of treatment and one year follow-up. Baseline predictors of treatment outcome and drop-out will be examined as well as the association between early adherence, behavioral change, therapeutic alliance and treatment outcome. In addition biochemical, genetic and bacteriological assessments will be conducted.

The authors have not supplied their declaration of competing interest.

Stress exposure is a risk factor for both the onset and the maintenance of Eating Disorders (EDs). The attachment theory may provide a framework to explain the relationship between social stress and EDs, since secure attachment promotes the seeking for support in order to help people to face stressful events. The endogenous stress response system, including the hypothalamus-pituitary-adrenal (HPA) axis, is likely involved in mediating the role of attachment in the subjects’ coping with stressful situations.

We explored cortisol responses to the Trier Social Stress Test (TSST) of patients with EDs in order to evaluate possible associations between subjects’ attachment styles and HPA axis functioning.

Twenty-one adult patients with EDs (7 with secure attachment and 14 with insecure attachment) filled in the Experience in Close Relationship (ECR) questionnaire, which assesses the adult attachment style, and were exposed to the TSST. Saliva samples were collected before and after the stress in order to measure cortisol levels.

As compared to ED patients with secure attachment, those with insecure attachment showed a significant different pattern of the HPA response to the stress test.

Present findings suggest that attachment style may influence the HPA response to stress in patients with EDs and this effect may have relevant implications for the pathophysiology of EDs.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

To describe the main characteristics of male patients suffering from anorexia in a specialized unit for eating disorders management.

As a result of a more prevalent diagnosis of eating disorders in women (including anorexia among others), male patients characteristics have been less described in current literature.

The authors retrospectively reviewed the clinical history of all male patients attending our unit of Eating Disorders in a period of one year (2015). The recorded characteristics were analyzed and classified as demographic, clinical and biographical. Finally a bibliographic review was also performed and correlated with our results.

During our review (currently being performed) we have found that, even if in much less numbers than in women, the characteristics of male patients suffering anorexia have recognizable patterns and for instance can be used for the better understanding of this pathology in this population.

The authors have not supplied their declaration of competing interest.

‘Dar Kenn Ghal Sahhtek’ is a residential service for patients suffering from eating disorders, namely Bulimia Nervosa, Anorexia Nervosa and Obesity (Binge Eating and Non Binge Eating type). The focus will be made on the obesity services.

1. To show that Dar Kenn Ghal Sahhtek has proved to be an effective therapeutic intervention towards obesity (with or without binge eating). 2. To show that from a recruitment of 30 obese subjects a substantial proportion met the DSM-5 criteria for Binge Eating Disorder.

1. To show that by means of questionnaires and physical testing a marked improvement was made following the therapeutic interventions offered at DKGS. 2. To highlight the high incidence of binge eating disorder in a sample of 30 obese subjects recruited via DKGS.

1. Interviewing the patient for the DSM-5 criteria of binge eating. 2. Comparing scores of questionnaires before admission and prior to discharge. 3. Evaluating the response to various treatment modalities.

On interviewing the group of 30 patients, 47.6% of the patients were found to be the diagnostic criteria of Binge Eating Disorder according to DSM-5 (Table 1).

Firstly, a considerable proportions of obese subjects proved to meet the DSM-5 criteria for binge eating while Dar Kenn Ghall Sahhtek has proved to be an effective therapeutic intervention towards obesity (with and without binge eating).

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Case report of a patient with Anorexia Nervosa and bizarre behavior.

Clinical observation in hospital.

Woman with 43 years old, with a peace of 65 years, who was hospitalized in Psychiatric Service – Eating Disorders, in August 2015, because of its extreme thinness, with difficulty to walk and with severe edema of the feet, ankles and legs. At the entrance, she weighed 29 kg, after 4 days her weight reduced to 23 kg, reaching a BMI of 8.5 kg/m2. In the first week, she showed a high cognitive impairment, confusional state and detailed and ruminative speech about food. She had developed multiple techniques to hide food and to hide and take dietary supplements for weight loss. Furthermore, she had a bizarre behavior and marked social isolation, not interacting with other patients.

Although the low prevalence of EDs, these have a high morbidity, and are one of the psychiatric disorders that most often leads to a fatal outcome. Treatment is lengthy and cumbersome, requiring serious investments under the personal point of view, family and clinical, yet still, these patients can have a full life and quality.

The authors have not supplied their declaration of competing interest.

The level of express emotion (EE) is a measure of the attitude of close relatives towards a patient and include dimensions as critical comments, hostility and emotional over-involvement. Anger and impulsivity may lead to self-injurious and aggressive behaviours, and often represent an obstacle to treatment.

To compare anger expression, impulsivity and expressed emotion in ED and SCHZ, and to explore the different level of caregivers’ EE in the two groups.

Twenty-five female with ED diagnosis and 25 patients with schizophrenia, were recruited at the Psychiatry Ward and outpatient Service of AOU – Novara, during one year period. Patient's assessment included Global Assessment of Functioning (GAF), Structured Clinical Interview (SCID 1-2), Level of Expressed Emotion Scale (LEE), Paykel scale, State and Trait Anxiety Inventory (STAY 1-2), State-Trait Anger Expression Inventory (STAXY), Barratt Impulsiveness Scale (BIS-11).

Levels of anxiety (both state and trait) are higher in the ED group than in SCHZ. As far as the STAXY is concerned, SCHZ patients score higher than ED ones on control over anger, while general index of anger expression was higher in ED patients. We did not find significant differences in EE between two groups, except for the patient's emotional response of the patient to the disease, which was greater among SCHZ. Both SCHZ and ED patients scored higher on the LEE, Paykel and STAY than their caregivers.

SCHZ and ED patients show different patterns of anxiety and anger, but similar profile as far as EE is concerned. Implications for treatment will be discussed.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Eating disorders often have serious medical complications, including the highest mortality rates of any psychiatric disorder. The search for an optimal therapeutic strategy during the last decades has been difficult and it has included antidepressants, antipsychotics, anticonvulsants, benzodiazepines and mood stabilisers.

To review the medical literature related to the treatment of eating disorders with atypical antipsychotics.

Medline search and ulterior review of the related literature. Keywords: “eating disorders”; “anorexia nervosa”; “bulimia nervosa”; “binge eating disorder”; “antypsychotic agents”.

To the date, most of the studies have been with olanzapine. Olanzapine has shown effects, not only on weight gain, but also on management of other psychological features such as obsessive-compulsive symptoms, depression, aggression, persistence and interpersonal distrust. However, most of these studies have been compared to placebo, and binge-eating behaviour has also been described when using olanzapine (not with aripiprazole or ziprasidone). Recently, Marzola et al, when comparing olanzapine + SSRIs versus aripiprazol + SSRIs, described that aripiprazole (compared to olanzapine) is significantly more effective in reducing purging episodes, eating preoccupations and rituals.

So far, aripiprazol and olanzapine have been proved to be the most effective atypical antypsichotics in eating disorders, especially in anorexia nervosa. However, most of studies were placebo-controlled and in quite small samples. Further investigation is needed.

The authors have not supplied their declaration of competing interest.

Anorexia nervosa (AN) is characterized by self-induced starvation coupled with fear of gaining weight and a distorted body image. Its treatment is complex and challenging, and sometimes hospitalization is needed.

Santa Maria Hospital's Eating Disorders Unit (SMH-EDU) is a multidisciplinary team, formed in 1989, that provides both outpatient and inpatient treatment.

To present and discuss SMH-EDU's AN treatment and its results.

Revision and statistical analysis of all hospitalized AN’ patients’ clinical files, from 1 January 2014 to 31 December 2014. Treatment outcome was assessed by BMI variation.

A total of 45 admissions (41 patients) were analysed: 75.65% had AN restricting type and 24.45% had AN purging type. All patient were females, with median age of 27 years old (range 12–57 years). Average admission BMI was 14.51 kg/m2 (ranging from 11.19 to 17.77 kg/m2). The mean lengths of stay were 39 days. Thirty-six percent of the patients had at least one previous hospitalization. Only 2 patients were readmitted at SMH-EDU: triple readmissions. The mean time between the beginning of the disorder and the admission was 111 months (ranging 2 to 408 months). Average discharged BMI was 16.32 kg/m2 (ranging from 13.24 to 19.11 kg/m2).

Inpatient treatment for AN at SMH-EDU is considered only for those patients whose disorder has not improved with appropriate outpatient treatment. Therefore, most inpatients at SMH-EDU have disorders of high severity, as demonstrated in our results.

The authors have not supplied their declaration of competing interest.

Orthorexia nervosa (ON) is an excessive fixation on the consumption of healthy food and an obsession with its biological purity. The aim of this study was to assess the prevalence of ON in a population of Polish urban adolescents and some possible contributory factors.

Validation and adaptation of the ORTO-15 Questionnaire was made in the group of 399 participants (15–21 years old). The validation procedure incorporated three basic methods to be applied in the reliability analysis. The reliability analysis of the ORTO-15 Questionnaire based on repeatability of the responses presents a very good (kappa: 0.81–1.00 for 5 items) and a good repeatability (kappa: 0.61–0.80 for 10 items). The reliability analysis based on the value of the Cronbach's α reached a satisfactory level (0.7–0.9). The ORTO-15 questionnaire was considered a reliable tool to identify the risk of ON in population studies in the group of urban youth aged 15–21. Assessment was made among 1899 high school students, 992 girls, and 907 boys, aged 15–21 years.

The mean value of the ORTO-15 was 39.2 ± 3.6 points, with no sex difference. The main factors connected with orthorexia, according to the “Orthorexia 35” definition were excess weight, sporting activities, out-of-school activities, smoking status, working parents and a high family income.

This study, of a large number of adolescents, showed a prevalence of ON similar to that recorded in adult populations. This is a first assessment of orthorexia among adolescent population.

The authors have not supplied their declaration of competing interest.

There is a low prevalence of eating disorders among men. In many cases, the disorder arises as a means of avoiding psychosocial maturation. Various psychiatric comorbidities such as depression or obsessive-compulsive disorder are frequently found in these patients.

To analyze psychiatric symptoms in relation to a case of anorexia nervosa.

Pubmed revision on clinical presentation of anorexia nervosa in male. Review of patient medical records.

A 23-years-old male with diagnosis of restricting anorexia nervosa was treated and followed since 2012. In July 2015, the patient, who was clinically stabilized for a year, had decreased gradually intake. Suddenly he showed a decreased consciousness, followed by an absence of response and mutism that motivated hospital admission. The diagnosis was dissociative stupor. A research in women with eating disorders shows a prevalence of pathological dissociation between 4.8 and 48.6%. After recovering a normal consciousness, he presented clinical features of anorexia nervosa according DSM 5 criteria. The patient remained two months until he reached his previous BMI (17) to continue an outcome treatment. Despite of several years of specific treatment for anorexia nervosa, both parents and patient still did not accept the diagnosis. Cultural constructions of eating disorders as a “women's illness” mean that men may fail to recognise their disorder.

There is a delay of diagnosis of anorexia nervosa in men. The lack of research on men's experiences and the cultural construction of anorexia nervosa as a female problem may contribute to underdiagnose eating disorders in men.

The authors have not supplied their declaration of competing interest.

Anorexia nervosa (AN) is severe and debilitating psychiatric illness characterized by destructive weight loss behaviour, refusal to maintain body weight at or above minimal normal weight for age and height, intense fear of weight gain and disturbance in experience of body shape and weight.

The purpose of this review is to investigate the state of art concerning the use of atypical antipsychotics (SGA) in the treatment of anorexia nervosa, comparing the efficacy and tolerability in female patients not selected by age.

A Medline enquiry of published articles from 2005 to October 2015 was performed using the following Keywords: “anorexia nervosa; pharmacological treatment; atypical antipsychotics; olanzapine; risperidone; paliperidone; aripiprazole; quetiapine”. Reviews and RCT were also analyzed.

No strong evidence of beneficial effects was found in using SGA in adults. The majority of studies focused on olanzapine, which seems to have, in some studies, only positive effect on body mass index, eating disorder symptoms and functional impairment. Risperidone doesn’t seem to have effect on body mass index. Olanzapine and risperidone increase the mean fasting glucose and insulin levels. In a recent study the main finding is represented by the positive effects of the adjunct of aripiprazole to antidepressants on eating-related obsessive-compulsive symptomatology.

In conclusion, in our review we observed that research in treatment with SGA of AN is still far away from finding univocal conclusions.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.