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Anorexia nervosa and hysteria are two entities whose concepts have evolved through the ages, from "hysterical anorexia" to become distinct both in their presentations and in the representations within the community. Today, the psychiatric approach has been enriched by the contribution of neuroscience. Hospital treatment of anorexia nervosa allows intervention on the symptoms of the disease, but also takes into account the associated needs and disorders.

Refeeding in anorexia nervosa is a collaborative enterprise involving multidisciplinary care plans, but clinicians currently lack guidance, as treatment guidelines are based largely on clinical confidence rather than more robust evidence. It seems crucial to identify reproducible approaches to refeeding that simultaneously maximize weight recovery and minimize the associated risks, in addition to improving long-term weight and cognitive and behavioral recovery and reducing relapse rates. We discuss here various approaches to refeeding, including, among others, where, by which route, how rapidly patients are best refed, and ways of choosing between them, taking into account the precautions or the potential effects of medication or of psychological care, to define better care plans for use in clinical practice.Conclusion: The importance of early weight gain for long-term recovery has been demonstrated by several studies in both outpatient and inpatient setting. Recent studies have also provided evidence to support a switch in current care practices for refeeding from a conservative approach to higher calorie refeeding. Finally, the risks of undernutrition/"underfeeding syndrome" and a maintenance of weight suppression are now better identified. Greater caution should still be applied for more severely malnourished 70% average body weight and/or chronically ill, adult patients. What is Known: • Refeeding is a central part of the treatment in AN and should be a multidisciplinary and collaborative enterprise, together with nutritional rehabilitation and psychological support, but there are no clear guidelines on the management of refeeding in clinical practice. • The risk of a refeeding syndrome is well known and well managed in severely malnourished patients ("conservative approaches"). What is New: • There is evidence that early weight restoration has an impact on outcome, justifying an aggressive approach to refeeding in the early stages of the illness. • The risks of "underfeeding syndrome" and of a maintenance of weight suppression are now better identified and there is sufficient evidence to support a switch in current care practices for refeeding from a conservative approach to higher calorie refeeding. Graphical abstract.

Background Early-onset anorexia nervosa (EO-AN) represents a significant clinical burden to paediatric and mental health services. The impact of EO-AN on bone mineral abnormalities has not been thoroughly investigated due to inadequate control for pubertal status. In this study, we investigated bone mineral abnormalities in girls with EO-AN regardless of pubertal development stage. Method We conducted a cross-sectional study of 67 girls with EO-AN (median age = 12.4 [10.9–13.7 years]) after a median duration of disease of 1.3 [0.6–2.0] years, and 67 healthy age-, sex-, pubertal status- matched control subjects. We compared relevant bone mineral parameters between groups: the total body bone mineral density [TB-BMD], the lumbar spine BMD [LS-BMD], the total body bone mineral content [TB-BMC] and the ratio of the TB-BMC to lean body mass [TB-BMC/LBM]. Results TB-BMD, TB-BMC, LS-BMD and TB-BMC/LBM were all significantly lower in patients with AN compared to controls. In the EO-AN group, older age, later pubertal stages and higher lean body mass were associated with higher TB-BMC, TB-BMD, and LS-BMD values. Discussion Girls with EO-AN displayed deficits in bone mineral content and density after adjustment for pubertal maturation. Age, higher pubertal stage and lean body mass were identified as determinants of bone maturation in the clinical population of patients with EO-AN. Bone health should be promoted in patients, specifically in those with an onset of disorder before 14 years old and with a delayed puberty.

Puberty is a critical risk period for eating disorders, especially in girls. Previous reports showed that the association between puberty and eating disorders is mainly due to genetic factors, but the nature of these factors is unclear. To identify these genetic factors, we carried out exome analysis in 10 girls with anorexia nervosa compared to 10 unaffected women controls and identified low-frequency variants in genes among a list of 185 puberty-associated genes. After filtering data, 9 controls and 9 affected girls had at least one potential pathogenic rare (PPR) variant. In controls, 35 PPR variants were identified located (in 31 genes) whereas 52 PPR variants (in 38 genes) were identified in patients with AN. Among the genes identified only in the AN patients, we found a significant enrichment as compared to the general population and the control sample, in variants previously identified as associated with age at menarche (TNRC6A, LAMB2 and FAAH2). Two AN patients presented at least one rare missense variant in these genes. Moreover, nine patients with AN carried out missense/frameshift variants in puberty-associated genes previously identified by GWAS studies. Our results suggest that rare variants in genes involved in the timing of puberty such as TNRC6A, LAMB2 and FAAH2 may predispose to anorexia nervosa susceptibility during puberty.

Autism Spectrum Disorders subjects (ASD) are well known to have deficits in social interaction. We recorded simultaneously eye movements and postural sway during exploration of emotional faces in children with ASD and typically developing children (TD). We analyzed several postural and ocular parameters. The results showed that all postural parameters were significantly greater in children with ASD; ASD made significantly fewer saccades and had shorter fixation time than TD, particularly in the eyes, and especially for unpleasant emotions. These results suggest that poor postural control of ASD and their impaired visual strategies could be due to a lack of interest in social cognition, causing a delay in the development of the cortical areas, and thus could have an effect on their postural control.

Background Children with autism spectrum disorders (ASD) have poor postural stability. The objective of our study was to explore further postural capabilities in ASD children by measuring spatial as well as temporal displacement of the center of pressure using wavelet analysis. Method Thirty children with ASD (12.1 ± 2.9 years) and 30 sex-, age- and IQ-matched typically developing children participated in the study. We recorded postural control using Multitest, also called Balance Quest, Equilibre from Framiral® in three viewing conditions (eyes open, eyes closed and with perturbed vision) and in two postural conditions (stable and unstable). Results Our results show that children with ASD displayed a deficit in postural stability in comparison with typically developing children, especially when sensory inputs are not all available. Conclusion Such poor postural control in children with ASD could be due to both an impairment in using sensorial inputs appropriately and a deficit in the ability to compensate for sensorial changes.

Eating disorders (EDs) are complex and multifactorial psychiatric illnesses that induce significant and sustained pathological disruption of food intake. The Diagnostic and Statistical Manual of Mental Illnesses (DSM-5) describes the clinical criteria of major disorders including anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). The neurobiological basis of food intake is well characterized. Epidemiological studies reported a heritability about 70% in AN and 60% in BN, suggesting that genetic factors are involved in the vulnerability to EDs. The analysis of genetic regions and candidate genes identified several genes associated with AN, including the BDNF gene, encoding a neurotrophic factor and the ESR1 gene, encoding the α-receptor to estrogens. Recent genome-wide association studies (GWAS), carried out on several thousand patients versus controls, identify new candidate genes. Preliminary analyses of methylation levels, for candidate genes or on the whole methylome, suggest that epigenetic signatures are associated with EDs.

Anorexia nervosa (AN) is a complex neuropsychiatric disorder presenting with dangerously low body weight, and a deep and persistent fear of gaining weight. Up to now, four genome-wide association studies of AN have been conducted to date and identified only few significant loci. However, both previous studies focused on common variation and on rare exonic variants. Currently, de novo variants are one of the most significant risk factors for neurodevelopmental disorders and psychiatric disorders. We analyzed by whole exome sequencing a cohort of nine female AN individuals and their parents (mother and father), and focused our analysis on de novo variants. Here, we found seven de novo missense variants in potential genes in nine studied AN patients. Four of these genes (CSMD1, CREB3, PTPRD and GAB1) belong to a same signaling pathway involving neuron differentiation and dopamine pathway. This study provides a list of interesting genes such as CSDM1 and CREB3 that are candidates to be involved in the etiology of anorexia nervosa. basic research.

Anorexia nervosa (AN) is a severe debilitating eating disorder. To date, only very few genes that predispose to AN have been identified. An alternative to association studies is to characterize ultra-rare variants in familial forms of AN. Here, we have implemented this approach to identify pathways that contribute to the development of AN through the analysis of a family with three members suffering from AN by exome analysis. We identified three ultra-rare deleterious variants in three genes (DRD4, CCKAR, NMS), already connected to the reward pathway, that co-segregate with AN, suggesting that this pathway might be playing a predisposing role in AN at least in familial forms.

International audience; Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.

In all the literature about ethical dilemmas facing the accounting practitioner little attention has been paid to those which arise from the accountant's role in the process of accounting regulation. This treatment explores that role in the light of differing national modes of accounting regulation, economic impact issues in accounting regulation, some ethical principles and a number of different national illustrations. John Blake is Professor of Accounting in the Department of Accounting and Financial Services at the University of Central Lancashire, Preston PR1 2HE, in which Catherine Gowthorpe is Principal Lecturer, while Julia Clarke is a member of the Department of Business Studies, Manchester Metropolitan University, Aytoun Building, Aytoun Street, Manchester M1 3GH.

Company financial managers, when confronted with a change in accounting regulations, may face a change in their economic environment as a result of the reaction of users to the reported accounting information. In 1990 a requirement for lessees to capitalize finance leases was introduced in Spain. Reports the results of a survey in Spain of two key groups, company financial managers and bank financial analysts. The study concludes that leasing companies successfully lobbied for changes in the accounting rules which actually proved adverse to their economic interests; and company managers and bank analysts misunderstand each other′s reactions to the capitalization of finance leases. Indicates that managers can benefit from studying research on economic impact issues before determining their own response.

Recent studies support the idea that abnormalities of the reward system contribute to onset and maintenance of anorexia nervosa (AN). Next to cues coding for overweight, other research suggest cues triggering the proposed starvation dependence to be pivotally involved in the AN pathogenesis. We assessed the characteristics of the cognitive, emotional and physiologic response toward disease-specific pictures of female body shapes, in adult AN patients compared with healthy control (HC) women. Frequency and amplitude of skin conductance response (SCR) in 71 patients with AN and 20 HC were registered during processing of stimuli of three weight categories (over-, under- and normal weight). We then assessed the role of the Val66Met BDNF polymorphism as a potential intermediate factor. AN patients reported more positive feelings during processing of underweight stimuli and more negative feelings for normal- and overweight stimuli. The SCR showed a group effect (P=0.007), AN patients showing overall higher frequency of the response. SCR within patients was more frequent during processing of underweight stimuli compared with normal- and overweight stimuli. The Met allele of the BDNF gene was not more frequent in patients compared with controls, but was associated to an increased frequency of SCR (P=0.008) in response to cues for starvation. A higher positive value of starvation, rather than more negative one of overweight, might more accurately define females with AN. The Met allele of the BDNF gene could partly mediate the higher reward value of starvation observed in AN.

Surgical care has been an essential component of health care worldwide for over a century. As the incidence of traumatic injuries, cancers and cardiovascular disease continues to rise, the impact of surgical intervention on public health systems is growing. Approximately 234 million interventions are now performed every year, representing one intervention for every 25 people on earth. In the United Kingdom this equates to a ratio of one operation for every eight people (WHO 2008a).