Bakgrund: Anorexia Nervosa är en sjukdom som innebär att patienten har en onormalt låg kroppsvikt och en extrem rädsla för att gå upp i vikt. Sjukdomen påverkar stora delar av kroppen och medför ofta olika komplikationer som i värsta fall leder till döden. Sjuksköterskans omvårdnad är till för att lindra lidande och främja hälsa. Då sjukdomsbilden ofta är komplex hos patienter med Anorexia Nervosa är omvårdnadsbehovet många gånger stort.  Syfte: Syftet med litteraturstudien var att belysa patientens erfarenhet av att vårdas till följd av Anorexia Nervosa. Metod: En litteraturstudie med integrerad analys och induktiv ansats baserad på sju kvalitativa artiklar och de kvalitativa delarna av en studie med mixad metod användes för att besvara syftet. Artiklarna är inhämtade från databaserna Cinahl och Psycinfo.  Resultat: Analysen grundade ett resultat bestående av tre huvudkategorier samt sex underkategorier. Huvudkategorierna var: erfarenhet av vårdmötet, vikten av delaktighet och autonomi samt vikten av stöd. Huvudkategorierna innefattade fem underkategorier, dessa var: vårdpersonalens förståelse och kunskap, individanpassad vård, kontinuitet i vården, betydelsen av en god relation samt vägledning & struktur.  Slutsats: Patienterna erfor många gånger att vården de fick var bristande. Den bristande vården berodde ofta på kunskapsbrist hos vårdpersonal. Det var viktigt att bli behandlad med respekt, empati och känsla av förståelse. Individanpassad vård var positivt för tillfrisknandet.

Background: Eating disorders are defined as serious psychiatric conditions that in many cases have psychological and physical consequences. In Sweden 190 000 people between the age of 15 and 60 estimated to suffer from an eating disorder. Anorexia nervosa is one of the most serious psychiatric disorders and the mortality rate for these patients is higher than any other mental illness. The care of eating disorders is often experienced as complicated by both healthcare professionals and patients. The nurse has a profession which requires care with a focus on each patient as unique. It’s important that the nurse sees the person behind the eating disorder. Purpose: The purpose of this study was to synthesize experiences of care and support within clinics specialized in eating disorders among patients with anorexia nervosa. Method: For this work, a qualitative literature study has been used as a study design. A qualitative content analysis was applied. Results: Four categories were identified with fifteen associated subcategories. The categories were individualized care, the importance of good communication, the importance of the environment and extended treatment. Conclusion: A personcentered and individual care and treatment proved to be of greatest importance for patients to recover. That the patients were allowed to feel involved, where they were seen as a person not their ilness and had a good collaboration with healthcare staff was decisive.

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Eating disorders fall within the top nine health ailments affecting young people today. These illnesses such as Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified affect a large number of people, particularly female adolescents. The disorders can further cause complications in one’s health, systemically and orally, sometimes resulting in death. The purpose of this paper is to closely examine published studies examining the link between eating disorders and oral health. Multiple studies have found that patients suffering from eating disorders are more likely to develop tooth erosion. Behaviors often found in eating disorder patients such as self-induced vomiting and ingestion of highly acidic diets can lead to such enamel loss, a condition that is irreversible. Other researchers disagree about whether eating disorders can lead to an increase in dental caries, with some finding amplification and others finding no significant results. Parotid gland swelling is another side effect of eating disorders but this complication often recedes once the unhealthy behavior is halted. Most studies have not yet found a link between these illnesses and increased periodontal disease. However, they do seem to lead to decreased unstimulated salivary flow rates. Furthermore, it also appears that the disorders lead to augmented levels of S. mutans and Lactobacilli. One’s oral mucosa can also be affected via angular cheilitis and oral candidiasis. Additionally, eating disorders may serve as a risk factor for bone and joint disorders such as osteoporosis and temporomandibular joint disorders, respectively. The illnesses may show effect outside the oral cavity through Russell’s sign on one’s knuckles and oral function may be impaired. With all these possible oral complications being some of the first to indicate the presence of an eating disorder, dentists may be integral to identifying and stopping the progression of the disease. However, it has been suggested that eating disorder patients may have greater dental anxiety keeping them from visiting the dentist in the first place, let alone divulging their disease to their dentist. Furthermore, oral health professionals may not be adequately prepared to notice the presence of an eating disorder. Dental schools must do more to teach future oral health professionals about eating disorders, especially in the clinic, as simple suggestions like avoiding brushing one’s teeth immediately after participating in self-induced vomiting may help to reduce the likelihood of enamel erosion. Through this analysis it was determined that while sufficient baseline research has been done, there is still a great deal more to learn about how eating disorders affect one’s oral health. There are multiple forms of diagnostic criteria that could possibly prevent patients from receiving the best treatment possible. Furthermore, more research needs to be done on disorders other than Anorexia Nervosa and Bulimia Nervosa as not every patient falls under these two categories. Since it has been shown that certain types of medication can decrease one’s salivary flow rate, future studies need to also consider any medication that patients may be on. In order to really aid those affected by eating disorders, men should be considered as future subjects too, since most studies have currently only focused on women. By completing more research on eating disorders and their consequences on oral health, health care professionals will be better able to serve those affected.

Bakgrund: Anorexia Nervosa är en psykisk sjukdom som innebär en förvrängd kroppssyn,där patienten upplever sig överviktig trots undervikt. Kvinnor insjuknar oftare än män.Prevalensen för AN i Sverige är 1–2 procent av den svenska befolkningen. Bantning är alltidförsta steget in i AN.Syfte: Syftet med litteraturstudien var att beskriva patienters upplevelse av tillfrisknande frånanorexia nervosa.Metod: En litteraturstudie med systematisk sökning. För att sammanställa resultatet ilitteraturstudien har en integrerad analys använts. Efter bearbetning av artiklarna resulteradedet i tio artiklar som användes i litteraturstudien.Resultat: Depressioner, ångest, stress och utmattning är vanligt vid AN. Västerländskaskönhetsidealet är en riskfaktor för att insjukna i AN. AN kan upplevas som en vän och entrygghet, vilket kan skapa en identitetskris vid tillfrisknandet. Stöd från anhöriga är viktigt förtillfrisknandet.Slutsats: AN är en komplicerad sjukdom med en lång återhämtningsprocess som krävermotivation och tålamod av patienten. Det behövs mer forskning på män med AN, då denmesta forskningen är på kvinnor med sjukdomen.

Note:

Anorexia nervosa is a serious problem that affects over one million males yearly. It is often misdiagnosed and overlooked completely in clinical, medical and school settings because of the misperception that it is a disorder exclusively present in females. The DSM-IV largely contributes to this misnomer due to the gender-biased criteria. The purpose of this exploratory study was to identify the etiology and clinical characteristics of male anorexia and devise a more comprehensive definition of anorexia nervosa that encompasses both males and females. An additional purpose was to develop an instrument that identifies risk factors associated with anorexia nervosa in males and aid mental health and medical practitioners in making this diagnosis. A review of literature illuminated unique features of the male anorexic as well as characteristics shared with females. The Assessment of Anorexia Nervosa in Males Questionnaire (AANMQ) was developed for this study to assess an expert panel's clinical observations regarding potential misdiagnosis and treatment gaps among males with anorexia nervosa. This panel included one male anorexic, one parent of an anorexic male, and eight mental health and medical practitioners who were selected based on personal and clinical experiences working with male anorexics. Data were collected via face-to-face and telephone interviews. A compilation of literature and the expert panel's responses to the AANMQ resulted in the content suggested for the Assessment of Male Anorexia Nervosa (AMAN), a diagnostic inventory that provides a comprehensive profile specific to male anorexics. This instrument is to be used by mental health and medical practitioners for the diagnosis of this disorder. Even when anorexia nervosa is correctly diagnosed, services for males are selective and inadequate due to treatment models being geared toward a female population. The AMAN compensates for the missing elements and gender-biased nature of DSM-IV and permits accurate assessment and diagnosis of male anorexia. / Ph. D.

Hypothalamus and adipose tissue are essential central and peripheral sites regulating energy homeostasis. Disruption of energy homeostasis can lead to diseases like anorexia and obesity in humans and reduced productivity in animals. Therefore, integrating knowledge in hypothalamic appetite regulation and adipose tissue metabolism is essential to maintain homeostasis. The aim of this dissertation was to elucidate molecular and cellular mechanisms of energy homeostasis in birds. We determined adipose tissue physiological changes during the first two weeks post-hatch in chickens from lines selected for low (LWS) and high (HWS) body weight. LWS was more dependent on yolk and subcutaneous fat mobilization for growth from hatch to day 4 post-hatch, with hyperplasia-predominated replenishment of the reservoir. In contrast, HWS was more dependent on feed for growth and maintained depot mass through hyperplasia and hypertrophy. From day 4 to 14 post-hatch, compared to maintenance of depot weight and adipocyte size in LWS, HWS accumulated clavicular and abdominal fat with minimal lipolysis. There was greater expression of precursor and proliferation markers in LWS with more apoptotic cells in the abdominal stromal vascular fraction on day 14 post-hatch, suggesting that apoptosis contributed to lower adipogenic potential and lack of abdominal fat in LWS. Exposure to thermal and nutritional stressors at hatch impaired growth by reducing yolk utilization and lowering body weight, lean and fat masses in LWS. Stress exposure resulted in increased global DNA methylation and DNA methyltransferase activity in the arcuate nucleus of the hypothalamus in LWS. Moreover, there was decreased binding to methyl-CpG-binding domain protein 2 in the promoter of corticotropin-releasing factor (CRF) because of hypomethylation in one CpG site at its core binding site in stressed LWS, which explains the increased CRF expression in the paraventricular nucleus of the hypothalamus. We next determined effects of nutritional status on adipose tissue physiology in Japanese quail, a less-intensively selected avian species. Six-hour fasting promoted lipolysis and gene expression changes in 7-day old quail with some changes restored to original levels within 1 hour of refeeding. Overall, our results reveal novel cellular and molecular mechanisms regulating appetite and adiposity in birds early post-hatch. / Doctor of Philosophy / Hypothalamus and adipose tissue are essential for regulating energy homeostasis in central and peripheral body sites, respectively. Disruption of energy homeostasis can lead to diseases like anorexia and obesity in humans and reduced productivity in animals. Therefore, integrating knowledge in hypothalamic appetite regulation and adipose tissue metabolism is essential to maintain energy homeostasis in both humans and animals. The aim of this dissertation was to elucidate molecular and cellular mechanisms of energy homeostasis in birds. We first determined adipose tissue physiological changes in chickens during the first two weeks post-hatch from lines selected for low (LWS) and high (HWS) body weight. These chickens have been selected for juvenile body weight for over 60 generations. The LWS are lean and anorexic, while HWS eat compulsively and develop obesity and metabolic syndrome. Such characteristics make the body weight line chickens good animal models to study physiological changes under anorexia and obesity. We found that LWS was more dependent on yolk reserves and subcutaneous fat mobilization for growth from hatch to day 4 post-hatch, with replenishment of the fat reservoir by increases in cell number. By contrast, HWS was more dependent on feed for growth and maintained depot mass through increased cell number and cell size. From day 4 to 14 post-hatch, HWS accumulated fat throughout the body, with less fat breakdown as compared to LWS. There was greater expression of cellular precursor and proliferation markers in LWS, with more dying cells in their abdominal fat on day 14 post-hatch, suggesting that programmed cell death is responsible for the lack of fat cell development in LWS. Exposure to thermal and nutritional stressors at hatch impaired growth by reducing yolk utilization and lowering body weight, lean and fat masses in LWS. There were many molecular changes in the hypothalamus, including changes in DNA that led to increased activation of corticotropin-releasing factor (CRF), a signaling molecule that is known to regulate the body's stress and appetite responses. Stress exposure increased global DNA methylation and DNA methyltransferase activity in the arcuate nucleus of the hypothalamus in LWS. Moreover, there was less methylation at the core binding site of methyl-CpG-binding domain protein 2 (MBD2), a protein that binds to methylated DNA to repress gene expression, in the CRF gene, in stressed LWS. In response to stress, there was decreased binding of MBD2 to the promoter region of CRF, which may explain increased expression of CRF in the paraventricular nucleus of LWS. These results demonstrate that early-life stressful events can cause epigenetic changes (like DNA methylation) that lead to alterations in physiology and behavior that persist to later in life. We next determined effects of nutritional status on adipose tissue physiology in Japanese quail, which have undergone less artificial selection than chickens and are more representative of a wilder-type bird. Six-hour fasting promoted lipolysis and gene expression changes in 7-day old quail with some changes restored to original levels within 1 hour of refeeding. Overall, our results provide novel perspectives on cellular and molecular mechanisms regulating appetite and adiposity in birds during early post-hatch development.

Att leva med barn som insjuknat i anorexia nervosa - En litteraturstudie om familjens upplevelser Abstrakt (Sv) Bakgrund: I Sverige är de ca 1 % av alla kvinnor som fått diagnosen anorexia nervosa. När ett barn insjuknat i anorexia nervosa påverkas hela familjen av denna livssituationsförändring. Familjens inflytande är en viktig del i behandlingen av anorexia nervosa, genom att sjukdomen har en okänd orsak upplever familjen sig som den bidragande faktorn till insjuknandet. Syfte: Belysa familjemedlemmars upplevelse av att leva med ett barn som insjuknat i anorexia nervosa. Metod: En litteraturstudie baserad på elva artiklar med en kvalitativ ansats. Resultatet från varje artikel har granskat, analyserat och sammanställts. Resultat: Resultatet redovisades i två kategorier och sju underkategorier. Huvudkategorierna är att leva i vanmakt och att leva under förändrade livsförhållanden. Konklusion: Att leva med ett barn som insjuknat i anorexia nervosa upplevs av familjen som påfrestande på grund av att sjukdomen bidrog till stora livsförändringar. Utifrån denna studies resultat kan sjuksköterskan anpassa sitt bemötande och ge god omvårdnad till alla familjemedlemmar. Nyckelord: Familj, barn, upplevelse, anorexia nervosa / Living with a child diagnosed with anorexia nervosa - A literature review of the family's experiences Abstract (En) Background: Approximately 1 % of all women in Sweden is diagnosed with anorexia nervosa. When a child is diagnosed with anorexia nervosa the whole family is affected by the life change the dieses brings. The family's influence is an important part of the treatment of anorexia nervosa. Since the disease has an unknown cause, the family often blame themselves as the contributing factor to the onset. Aim: The aim of the study is to highlight the family members' experience of living with a child suffering from anorexia nervosa. Method: A literature study was conducted based on eleven articles using a qualitative approach. The results from each article has been reviewed, analysed and compiled. Results: The results were presented in two categories and seven subcategories. The main categories are to live in powerlessness and to live under lifechanging conditions. Conclusion: Living with a child suffering from anorexia is experienced by the family as stressful because the disease contributed to major life changes. Based on the result of this study, the nurse can adjust attitude and provide good care for all family members. Keywords: Family, child, experience, anorexia nervosa

Background: Anorexia Nervosa is a mental illness of which the result is a will-controlled weight loss. It is an illness that affects the entire body and can become life-threatening. The illness is most common in young women and is often developed because of a stressful life event, stressful family relationships or sexual abuse. The disease also has a heredity of 50-90% in all cases. Aim: The aim of this study is to describe how nurses can involve the family in the care of a patient with Anorexia Nervosa. Method: The method used in this study was a literary survey based on ten articles of both qualitative and quantitative type. The articles were analysed using the method of Friberg (2012b). Result: Three main themes were created: Building relationships, providing education and preparing for home. Conclusion: The result of this study shows that the involvement of the family in the care of a patient with Anorexia Nervosa has improved conditions of recovery. Nurses have a crucial role in this process by creating relationships, having an educational role and preparing both patient and family for the return home.