Lege Artis Medicinae

[The role of intergenerational stress in the background of anorexia nervosa]

TÚRY Ferenc1, PÁSZTHY bea2

APRIL 23, 2021

Lege Artis Medicinae - 2021;31(03-04)

DOI: https://doi.org/10.33616/lam.31.008

Case Reports

[In childhood and adolescence, family therapy is a crucial therapeutic method in the treatment of anorexia nervosa. Among the family stress factors there are the tensions often too obvious between the parental and grandparental generations. Three case reports are presented, where the transgenerational tensions played an important role in the family of a young patient, suffering from anorexia nervosa. During the family therapy, the treat­ment of interrelated family stress factors and focusing on transgenerational relations proved to be crucial in the successful outcomes. While treating anorexia nervosa by family therapy there are not only important the recognition and treatment of tensions within the nuclear family, but also those of stressed relations emerging from grandparental generation through multigenerational transfer mechanisms. This treatment may be successful either with the grandparent’s inclusion, or exclusion. ]

AFFILIATIONS

  1. Semmelweis Egyetem, Magatartástudományi Intézet
  2. Semmelweis Egyetem, I. Sz. Gyermekgyógyászati Klinika

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Benefits of SGLT-2 inhibitors: beyond glycemic control]

BALOGH Zoltán, SIRA Lívia

[In the recent years, according to international and Hungarian guidelines, in addition to lifestyle modification, metformin is the preferred initial glucose-lowering drug for most people with type 2 diabetes, if not contraindicated. Sodium glucose co­transporter-2 inhibitors have been shown to reduce progression of chronic kidney disease, or kidney failure, as well as the risk of hospitalizations for congestive heart failure and (mainly in secondary prevention) cardiovascular death in patients with type 2 diabetes. For major adverse cardiovascular events and for the renoprotection, there seems to be no class effect. On the other hand, a class effect of sodium glucose co­transporter-2 inhibitors is evident for hospitalization for heart failure. In this review the authors summarize novel data about sodium glucose cotransporter-2 inhibitors, and about their new perspectives in the near future.]

Lege Artis Medicinae

[Tobacco use habits and cessation support tasks in Hungary. PART 1.]

CSELKÓ Zsuzsa, FÉNYES Márta, CSÁNYI Péter, BOGOS Krisztina, KISS Judit, DEMJÉN Tibor

[Today, non-communicable diseases and their underlying main risk factors, namely tobacco use, physical inactivity, excessive alcohol intake and unhealthy diet are responsible for almost 70% of the mortality worldwide. The Global Ac­tion Plan issued for the preven­tion and control of non-communicable diseases aims among others to reduce smoking rates by 30% as compared to the 2010 prevalence. The aim of the World Health Or­ga­ni­zation (WHO) in ac­cor­dance with the United Nations Sus­tai­nable Development Goals (UN SDG 2030) proposes to achieve a 23% target rate in Hun­gary by 2025. Based on the current smo­king prevalance (29%) and preliminary estimates this goal will not be accomplished. It is highly concerning that while the con­sumption of traditional tobacco products does not decrease at the expected rate in Hungary, novel nicotine and tobacco products are spreading worldwide and in Hungary as well. Thus in order to curb tobacco use, more ro­bust actions are needed in Hungary. More emphasis should be laid on the provisions of the WHO Fra­mework Con­vention on Tobacco Control (FCTC). This document re­com­mends to in­crease the tax rate of to­bacco products, declares to halt the spread of novel nicotine and tobacco products, and urges health care requirements to support smokers in quit­ting. The present summary describes the smoking cessation support related tasks of the health care in­dust­ry, taking into ac­count current national smoking habits. ]

Lege Artis Medicinae

[Commemorating the Lipótmező. Part 1.]

RIHMER Zoltán

[“What did Lipótmező mean to you?” My friends and acquaintances asked frequently this question in the past decades, concerning the National Institute for Psychiatry and Neurology or well known as the Lipótmező my past workplace and the role it played in my life thus far. It is difficult to give a short answer, but the three and a half decades I have spent there were certainly of decisive importance in my professional and private life as well. Since I was banned from tobacco smoking due to my disease ten years ago, I cannot keep my pipe in my mouth any more. Thus, I decided to recollect the dearest stories kept in my memory, which had the deepest impact on me during my 35 years in Lipótmező both as a doctor and as a man. ]

Lege Artis Medicinae

[30 years in diabetology reflected on the pages of Lege Artis Medicinae – 1990-2020]

WINKLER Gábor

[Commemorating the 30th anniversary of foundation the journal Lege Artis Me­di­cinae, the author endeavours to review the main developments of diabetology in the same period and arranges their reflections on the journal’s pages. He points out that similar to many other disciplines, the history of development has extremely been rich in the past three decades, thus he focused only on a few issues. The author analyses the changes in the treatment of type 2 diabetes and highlights specific aspects like the importance of early metabolic control, individualized treatment choices, a risk-oriented approach instead of a glucocentric direction, and the role of patient education and a health-conscious lifestyle, which have resulted in the holistic approach of our therapeutic strategy. While using relevant quotes, the author shows that the readers of the journal were also able to keep pace with all events and they were always provided with relevant information by au­thentic specialists of diabetology. ]

Lege Artis Medicinae

[Who should initiate SGLT-2-inhibitors?]

BENCZÚR Béla

All articles in the issue

Related contents

Clinical Neuroscience

[Hungarian adaptation of a short eating disorder questionnaire (SCOFF)]

DUKAY-SZABÓ Szilvia, SIMON Dávid, VARGA Márta, SZABÓ Pál, TÚRY Ferenc, RATHNER Günther

[Aim - Eating disorders are becoming an increasingly relevant health issue, therefore the fast and accurate screening of people at risk is of great practical importance. The aim of SCOFF questionnaire is to assess this risk and the extent to which a person is affected, by using five simple yes or no questions. The objective of our study was to assess the validity of the Hungarian version of the test Methods - 777 medical students (210 men, 567 women, mean age 22.3±2.33 years) participated in the survey. The online questionnaire contained anthropometric data, the Eating Behaviour Severity Scale and, beside the SCOFF, the Eating Disorder Inventory (EDI). Results - The SCOFF is excellent at screening clinical eating disorders. Its sensitivity was 100% and specificity 85.1%. It is less efficient at detecting subclinical cases, but it does not show worse results than EDI. According to the data SCOFF is better at identifying more serious cases. Applying on the same sample SCOFF had higher sensitivity and lower specificity than EDI. Discussion - SCOFF is suitable for primary screening of eating disorders with a non-diagnostic purpose, taken two “yes” answers out of five as the critical margin, specified by the authors.]

Clinical Neuroscience

[Eating disorders and pregnancy - a review of literature]

DUKAY-SZABÓ Szilvia, VARGA Márta, TÚRY Ferenc

[Eating disorders are psychosomatic disorders affecting primarily women, and influence reproductive functions as well. They have an impact on ovarial cyclem fertility, course of pregnancy, process of delivery, post partum period. Moreover, some data show that they can influence the adult health status. Extensive research from the last three decades call the attention to the fact that besides the classical eating disorders (anorexia nervosa and bulimia nervosa) the newer types (e.g., orthorexia nervosa), and subclinical disorders also occur in a subgroup of pregnant women. For this reason it is of key importance that the personnel working in the territory of obstetrics and gynecology have a solid knowledge about the symptoms, screening and therapeutical opportunities, and outcome of these disorders. The review summarizes the recent research data about the relationship of eating disorders and pregnancy.]

Lege Artis Medicinae

[The role of fathers in the family therapy of eating disorders, with special regard to mosaic families]

TÚRY Ferenc, SZENTES Annamária

[Eating disorders (anorexia nervosa, bulimia nervosa) are the typical forms of modern disorders of civilization. In the therapy of young (below age of twenty years) patients the family therapy can play a decisive role. During family therapy, in the case of mosaic families (newly organized families after divorce and second marriage) it is a frequent question, which family members should be involved into the therapeutical sessions: the biological parents, or the members of the actual families. In this paper two cases are reported where mosaic families were consulted. In the family therapy the new distribution of parental roles, the strengthening of the paternal responsibility of the foster-father were crucial in the families. In both cases a full remission occurred. As a conclusion we can state that during family therapy of eating disordered patients - and supposedly in other psychosomatic disorders - in the case of mosaic families the involvement of the actual family members, and the strengthening of the parental role can be an important factor in the therapeutical efficacy.]

Lege Artis Medicinae

[The value of the SCOFF questionnaire in the screening of eating disorders]

DUKAY-SZABÓ Szilvia, VARGA Márta, TÚRY Ferenc

[Having become an increasingly relevant health issue from the second half of the 20th century, eating disorders have presented the need for screening, carried out in the simplest possible way, by a short questionnaire. Morgan and his colleagues identified this necessity and in 1999 created the SCOFF test to screen eating disorders with five yes or no questions. The questionnaire promptly became popular due to its briefness and easy adaptability. It was translated into several languages, its validity was measured on numerous populations. According to the results SCOFF is suitable for primary screening of eating disorders with a non-diagnostic purpose, taken two “yes” answers out of five as the critical margin, specified by the authors. Our objective was to give a review of the history of the SCOFF questionnaire.]

Clinical Neuroscience

[Changes of the immune functions in patients with eating disorders]

PÁLI Anikó Andrea, PÁSZTHY Bea

[Aims - In this study we investigated whether calorie restriction or redundant food intake influences the function of regulatory T cells (Tregs), and their main regulators (dendritic cells and macrophages), or the targets of Tregs, CD4+ lymphocytes. Patients and methods - We investigated 11 white adolescents (10 girls and 1 boy) with anorexia nervosa, 12 obes adolescents and 10 healthy controlls. With flow cytometry we determined the prevalence of Tregs, myeloid and plasmacytoid dendritic cells. We applied intracellular staining to investigate TNF-alpha and IL-12 production of macrophages, moreover IL-2, IL-4, and IFN-gamma production of CD4+ cells. We also determined calcium flux kinetics upon activation in CD4+ cells. Results - We did not find any difference between obese, anorectic and control individuals in the prevalence of Tregs, dendritic cells, TNF-alpha and IL-12 positive macrophages, IL-4 and IFN-gamma positive CD4+ lymphocytes. We found that the prevalence of IL-2 positive lymphocytes after activation was lower in anorectic than in control subjects [median (range): 11.50 (7.60-15.30) vs. 13.50 (12.00-22.00), p=0.023], and in obese patients, too [12.50 (8.50-15.50) vs. 13.50 (12.00-22.00), p=0.028]. IFN-gamma/IL-4 ratio in CD4+ cells was higher in obese patients compared with control (p=0.046). The calcium flux characteristics of lymphocytes upon activation differed markedly in anorectic and healthy subjects as maximal calcium levels developed later in anorectic patients [86 (45- 232) vs. 215 (59-235) second, p<0.05]. We also tested the association between lymphocyte activation parameters and patients' clinical status, but did not find any association between the variables. Discussion - Our results suggest that the antigen presenting cell - regulatory T cell - CD4+ lymphocyte axis might be affected by calorie and nutritional disturbances, further studies are needed to elucidate the underlying processes.]