Az anorexia nervosa leginkább gyermekkorban vagy fiatal felnőttkorban jelentkező krónikus, az életminőséget jelentősen rontó betegség. A szerzők kurrens szakirodalmi adatokra támaszkodva mutatják be a kórkép heterogenitását, a korai kezdetű formák speciális diagnosztikus megfontolásait. Az elmúlt évtized tudományos kutatásai arra világítottak rá, hogy korábban az etiopatogenezis szempontjából dominánsnak gondolt pszichológiai, családi, társadalmi tényezők (soványság iránti kulturális preferencia, kedvezőtlen családi működés, perfekcionizmus) mellett a genetikai-neurobiológiai tényezők legalább azonos súllyal esnek latba. Az evészavarok heritabilitása olyan kórképekéhez közelít, amelyeket klasszikusan biológiailag meghatározottnak gondolunk. Jelen dolgozat összefoglalást ad az utóbbi években leginkább vizsgált neurobiológiai, neuropszichológiai kockázati tényezőkről, amelyek a vulnerabilitás biológiai alapját képezhetik. Bár eddig nem sikerült egyetlen közös kockázati tényezőt találni, több olyan eltérés is ismert, amelyek az anorexiás betegek jól elkülöníthető alcsoportjaihoz köthetők. Az endo- és szubfenotípusokban való gondolkodás több betegségben eredményezett célzottabb és hatékonyabb terápiás lehetőségeket, a referátum utolsó részében ennek lehetőségét mutatják be a szerzők az anorexia nervosára vonatkoztatva. Orv. Hetil., 2014, 155(4), 124–131.
Pászthy, B.: Medical complications in children and adolescents with anorexia nervosa. [A gyermek- és serdülőkorban kezdődő anorexia nervosa szomatikus szövődményei.] Orv. Hetil., 2007, 148, 405–412. [Hungarian]
Pászthy B. , 'Medical complications in children and adolescents with anorexia nervosa. [A gyermek- és serdülőkorban kezdődő anorexia nervosa szomatikus szövődményei.] ' (2007 ) 148 Orv. Hetil. : 405 -412 .
Fisher, M.: Treatment of eating disorders in children, adolescents and young adults. Pediatr. Rev., 2006, 27, 5–16.
Fisher M. , 'Treatment of eating disorders in children, adolescents and young adults ' (2006 ) 27 Pediatr. Rev. : 5 -16 .
Nicholls, D., Chater, R., Lask, B., et al.: Children into DSM don’t go: a comparison of classification systems for eating disorders in childhood and early adolescence. Int. J. Eat. Disord., 2000, 28, 317–324.
Lask B. , 'Children into DSM don’t go: a comparison of classification systems for eating disorders in childhood and early adolescence ' (2000 ) 28 Int. J. Eat. Disord. : 317 -324 .
Pászthy, B., Major, M.: Eating disorders in childhood and adolescence. In: Túry, F., Pászthy, B. (eds.): Disorders of eating and body image perception. [Gyermek- és serdülőkori evészavarok. In: Túry, F., Pászthy, B. (szerk.): Evészavarok és testképzavarok.] Pro Die Kiadó, Budapest, 2008, 25–40. [Hungarian]
Major M. , '', in Disorders of eating and body image perception. [Evészavarok és testképzavarok.] , (2008 ) -.
Casiero, D., Frishman, W. H.: Cardiovascular complications of eating disorders. Cardiol. Rev., 2006, 14, 227–231.
Frishman W. H. , 'Cardiovascular complications of eating disorders ' (2006 ) 14 Cardiol. Rev. : 227 -231 .
Steinhausen, H. C.: The outcome of anorexia nervosa in the 20th century. Am. J. Psychiatry, 2002, 159, 1284–1293.
Steinhausen H. C. , 'The outcome of anorexia nervosa in the 20th century ' (2002 ) 159 Am. J. Psychiatry : 1284 -1293 .
Crisp, A.: Death, survival and recovery in anorexia nervosa: a thirty five year study. Eur. Eat. Disorders Rev., 2006, 14, 168–175.
Crisp A. , 'Death, survival and recovery in anorexia nervosa: a thirty five year study ' (2006 ) 14 Eur. Eat. Disorders Rev. : 168 -175 .
Kohls, E., Túry, F.: Long-term outcome of anorexia nervosa and bulimia nervosa. In: Túry, F., Pászthy, B. (eds.): Disorders of eating and body image perception. [Az anorexia nervosa és a bulimia nervosa hosszú távú kimenetele. In: Túry, F., Pászthy, B. (szerk.): Evészavarok és testképzavarok.] Pro Die Kiadó, Budapest, 2008, 485–493. [Hungarian]
Túry F. , '', in Disorders of eating and body image perception. [Evészavarok és testképzavarok.] , (2008 ) -.
Keski-Rahkonen, A., Hoek, H. W., Susser, E. S., et al.: Epidemiology and course of anorexia nervosa in the community. Am. J. Psychiatry, 2007, 164, 1259–1265.
Susser E. S. , 'Epidemiology and course of anorexia nervosa in the community ' (2007 ) 164 Am. J. Psychiatry : 1259 -1265 .
Gorwood, P., Kipman, A., Foulon, C.: The human genetics of anorexia nervosa. Eur. J. Pharmacol., 2003, 480, 163–170.
Foulon C. , 'The human genetics of anorexia nervosa ' (2003 ) 480 Eur. J. Pharmacol. : 163 -170 .
Scherag, S., Hebebrand, J., Hinney, A.: Eating disorders: The current status of molecular genetic research. Eur. Child Adolesc. Psychiatry, 2010, 19, 211–226.
Hinney A. , 'Eating disorders: The current status of molecular genetic research ' (2010 ) 19 Eur. Child Adolesc. Psychiatry : 211 -226 .
Bulik, C. M., Slof-Op’t Landt, M. C. T., van Furth, E. F., et al.: The genetics of anorexia nervosa. Annu. Rev. Nutr., 2007, 27, 263–275.
Furth E. F. , 'The genetics of anorexia nervosa ' (2007 ) 27 Annu. Rev. Nutr. : 263 -275 .
Bulik, C. M., Tozzi, F.: The genetics of bulimia nervosa. Drugs Today (Barc.), 2004, 40, 741–749.
Tozzi F. , 'The genetics of bulimia nervosa ' (2004 ) 40 Drugs Today (Barc.) : 741 -749 .
Strober, M., Freeman, R., Lampert, C., et al.: Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmisson of partial syndromes. Am. J. Psychiatry, 2000, 157, 393–401.
Lampert C. , 'Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmisson of partial syndromes ' (2000 ) 157 Am. J. Psychiatry : 393 -401 .
Brewerton, T. D., Jimerson, D. C.: Studies of serotonin function in anorexia nervosa. Psychiatr. Res., 1996, 62, 31–42.
Jimerson D. C. , 'Studies of serotonin function in anorexia nervosa ' (1996 ) 62 Psychiatr. Res. : 31 -42 .
Weltzin, T. E., Fernstrom, M. H., Kaye, W. H.: Serotonin and bulimia nervosa. Nutr. Rev., 1994, 52, 399–408.
Kaye W. H. , 'Serotonin and bulimia nervosa ' (1994 ) 52 Nutr. Rev. : 399 -408 .
Kaye, W. H.: Anorexia nervosa, obsessional behavior and serotonin. Psychopharmacol. Bull., 1997, 33, 335–344.
Kaye W. H. , 'Anorexia nervosa, obsessional behavior and serotonin ' (1997 ) 33 Psychopharmacol. Bull. : 335 -344 .
Steiger, H.: Eating disorders and the serotonin connection: state, trait and developmental effects. J. Psychiatry Neurosci., 2004, 29, 20–29.
Steiger H. , 'Eating disorders and the serotonin connection: state, trait and developmental effects ' (2004 ) 29 J. Psychiatry Neurosci. : 20 -29 .
Hinney, A., Remschmidt, H., Hebebrand, J.: Candidate gene polymorphisms in eating disorders. Eur. J. Pharmacol., 2000, 410, 147–159.
Hebebrand J. , 'Candidate gene polymorphisms in eating disorders ' (2000 ) 410 Eur. J. Pharmacol. : 147 -159 .
Kaye, W., Strober, M., Jimerson, D.: The neurobiology of eating disorders. In: Charney, D., Nestler, E. (eds.): The Neurobiology of Mental Illness. Oxford University Press, New York, 2004, 1112–1128.
Jimerson D. , '', in The Neurobiology of Mental Illness , (2004 ) -.
Nakazato, M., Hashimoto, K., Shimizu, E., et al.: Decreased levels of serum brain-derived neurotrophic factor in female patients with eating disorders. Biol. Psychiatry, 2003, 54, 485–490.
Shimizu E. , 'Decreased levels of serum brain-derived neurotrophic factor in female patients with eating disorders ' (2003 ) 54 Biol. Psychiatry : 485 -490 .
Wade, T. D., Gordon, S., Medland, S., et al.: Genetic variants associated with disordered eating. Int. J. Eat. Disord., 2013, 46, 594–608.
Medland S. , 'Genetic variants associated with disordered eating ' (2013 ) 46 Int. J. Eat. Disord. : 594 -608 .
Bacanu, S. A., Bulik, C. M., Klump, K. L., et al.: Linkage analysis of anorexia and bulimia nervosa cohorts using selected behavioral phenotypes as quantitative traits or covariates. Am. J. Med. Genet. B Neuropsychiatr. Genet., 2005, 139B, 61–68.
Klump K. L. , 'Linkage analysis of anorexia and bulimia nervosa cohorts using selected behavioral phenotypes as quantitative traits or covariates ' (2005 ) 139B Am. J. Med. Genet. B Neuropsychiatr. Genet. : 61 -68 .
Campbell, I. C., Mill, J., Uher, R., et al.: Eating disorders, gene-environment interactions and epigenetics. Neurosci. Biobehav. Rev., 2011, 35, 784–793.
Uher R. , 'Eating disorders, gene-environment interactions and epigenetics ' (2011 ) 35 Neurosci. Biobehav. Rev. : 784 -793 .
Levenson, J. M., Sweatt, J. D.: Epigenetic mechanisms in memory formation. Nat. Rev. Neurosci., 2005, 6, 108–118.
Sweatt J. D. , 'Epigenetic mechanisms in memory formation ' (2005 ) 6 Nat. Rev. Neurosci. : 108 -118 .
Tsankova, N., Renthal, W., Kumar, A., et al.: Epigenetic regulation in psychiatric disorders. Nat. Rev. Neurosci., 2007, 8, 355–367.
Kumar A. , 'Epigenetic regulation in psychiatric disorders ' (2007 ) 8 Nat. Rev. Neurosci. : 355 -367 .
Reichenberg, A., Mill, J., MacCabe, J. H.: Epigenetics, genomic mutations and cognitive function. Cogn. Neuropsychiatry, 2009, 14, 377–390.
MacCabe J. H. , 'Epigenetics, genomic mutations and cognitive function ' (2009 ) 14 Cogn. Neuropsychiatry : 377 -390 .
Van Kuyck, K., Gérard, N., Van Laere, K., et al.: Towards a neurocircuitry in anorexia nervosa: evidence from functional neuroimaging studies. J. Psychiatr. Res., 2009, 43, 1133–1145.
Laere K. , 'Towards a neurocircuitry in anorexia nervosa: evidence from functional neuroimaging studies ' (2009 ) 43 J. Psychiatr. Res. : 1133 -1145 .
Sonnevend, M., Pászthy, B.: The neurobiologic backgrounds of eating disorders. In: Túry, F., Pászthy, B. (eds.): Disorders of eating and body image perception. [Az evészavarok idegrendszeri háttere. In: Túry, F., Pászthy B. (szerk.): Evészavarok és testképzavarok.] Pro Die Kiadó, Budapest, 2008, 183–195. [Hungarian]
Pászthy B. , '', in Disorders of eating and body image perception. [Evészavarok és testképzavarok.] , (2008 ) -.
Kaye, W. H., Wagner, A., Fudge, J. L., et al.: Neurocircuitry of eating disorders. In: Adan, R. A. H., Kaye, W. H. (eds.): Behavioral neurobiology of eating disorders. Springer, 2011, 37–58.
Fudge J. L. , '', in Behavioral neurobiology of eating disorders , (2011 ) -.
Friederich, H. C., Herzog, W.: Cognitive and behavioral flexibility in anorexia nervosa. In: Adan, R. A. H., Kaye, W. H. (eds.): Behavioral neurobiology of eating disorders. Springer, 2011, 111–124.
Herzog W. , '', in Behavioral neurobiology of eating disorders , (2011 ) -.
Gottesman, I. I., Gould, T. D.: The endophenotype concept in psychiatry: etymology and strategic intentions. Am. J. Psychiatry, 2003, 160, 636–645.
Gould T. D. , 'The endophenotype concept in psychiatry: etymology and strategic intentions ' (2003 ) 160 Am. J. Psychiatry : 636 -645 .
Bulik, C. M., Hebebrand, J., Keski-Rahkonen, A., et al.: Genetic epidemiology, endophenotypes and eating disorder classification. Int. J. Eat. Disord., 2007, 40 (Suppl. 3), S52–S60.
Keski-Rahkonen A. , 'Genetic epidemiology, endophenotypes and eating disorder classification ' (2007 ) 40 Int. J. Eat. Disord. : S52 -S60 .
Steiger, H., Bruce, K. R.: Personality traits and disorders associated with anorexia nervosa, bulimia nervosa and binge eating disorder. In: Brewerton, T. D. (ed.): Clinical handbook of eating disorders – an integral approach. Marcel Dekker Inc., New York, 2004, 209–310.
Bruce K. R. , '', in Clinical handbook of eating disorders – an integral approach , (2004 ) -.
Lopez, C., Tchanturia, K., Stahl, D., et al.: An examination of the concept of central coherence in women with anorexia nervosa. Int. J. Eat. Disord., 2008, 41, 143–152.
Stahl D. , 'An examination of the concept of central coherence in women with anorexia nervosa ' (2008 ) 41 Int. J. Eat. Disord. : 143 -152 .
Tchanturia, K., Morris, R. G., Brecelj Anderluh, B. M., et al.: Set shifting in anorexia nervosa: an examination before and after weight gain, in full recovery and relationship to childhood and adult OCPD traits. J. Psychiatr. Res., 2004, 38, 545–552.
Brecelj Anderluh B. M. , 'Set shifting in anorexia nervosa: an examination before and after weight gain, in full recovery and relationship to childhood and adult OCPD traits ' (2004 ) 38 J. Psychiatr. Res. : 545 -552 .
Holliday, J., Tchanturia, K., Landau, S., et al.: Is impaired set-shifting an endophenotype of anorexia nervosa? Am. J. Psychiatry, 2005, 162, 2269–2275.
Landau S. , 'Is impaired set-shifting an endophenotype of anorexia nervosa? ' (2005 ) 162 Am. J. Psychiatry : 2269 -2275 .
Zucker, N. L., Losh, M., Bulik, C. M., et al.: Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes. Psychol. Bull., 2007, 133, 976–1006.
Bulik C. M. , 'Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes ' (2007 ) 133 Psychol. Bull. : 976 -1006 .
Gillberg, I. C., Råstam, M., Wentz, E., et al.: Cognitive and executive functions in anorexia nervosa ten years after onset of eating disorder. J. Clin. Exp. Neuropsychol., 2007, 29, 170–178.
Wentz E. , 'Cognitive and executive functions in anorexia nervosa ten years after onset of eating disorder ' (2007 ) 29 J. Clin. Exp. Neuropsychol. : 170 -178 .
Oldershaw, A., Treasure, J., Hambrook, D., et al.: Is anorexia nervosa a version of autism spectrum disorders? Eur. Eat. Disord. Rev., 2011, 19, 462–474.
Hambrook D. , 'Is anorexia nervosa a version of autism spectrum disorders? ' (2011 ) 19 Eur. Eat. Disord. Rev. : 462 -474 .
Anckarsäter, H., Hofvander, B., Billstedt, E., et al.: The sociocommunicative deficit subgroup in anorexia nervosa: autism spectrum disorders and neurocognition in a community-based, longitudinal study. Psychol. Med., 2012, 42, 1957–1967.
Billstedt E. , 'The sociocommunicative deficit subgroup in anorexia nervosa: autism spectrum disorders and neurocognition in a community-based, longitudinal study ' (2012 ) 42 Psychol. Med. : 1957 -1967 .
Oldershaw, A., Hambrook, D., Tchanturia, K., et al.: Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients. Psychosom. Med., 2010, 72, 73–79.
Tchanturia K. , 'Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients ' (2010 ) 72 Psychosom. Med. : 73 -79 .
Nilsson, E. W., Gillberg, C., Gillberg, I. C., et al.: Ten-year follow-up of adolescent-onset anorexia nervosa: personality disorders. J. Am. Acad. Child Adolesc. Psychiatry, 1999, 38, 1389–1395.
Gillberg I. C. , 'Ten-year follow-up of adolescent-onset anorexia nervosa: personality disorders ' (1999 ) 38 J. Am. Acad. Child Adolesc. Psychiatry : 1389 -1395 .
Berkman, N. D., Lohr, K. N., Bulik, C. M.: Outcomes of eating disorders: a systematic review of the literature. Int. J. Eat. Disord., 2007, 40, 293–309.
Bulik C. M. , 'Outcomes of eating disorders: a systematic review of the literature ' (2007 ) 40 Int. J. Eat. Disord. : 293 -309 .