Coulon N, Jeammet P, Godart N
Service universitaire de pédopsychiatrie, CHU de Rennes, 154, rue de Châtillon, 35000 Rennes, France.
Encephale. 2009 Dec;35(6):531-7. doi: 10.1016/j.encep.2008.09.005.
The links between anorexia nervosa (AN) and anxiety disorders, and particularly social phobia, are little known. However, social phobia occurs frequently in AN. Some studies have shown reduction in anxious and depressive symptomatology in AN with re-nutrition. But, to our knowledge, no work has examined the evolution of social phobia symptoms during re-nutrition in AN.
To specify the links between AN, nutritional state, and social phobia.
The population consisted of 2 samples and the analysis was conducted using the SPSS11.5. Sample 1 (N=24 AN) was evaluated on admission and on leaving the hospital. Our evaluation used the body mass index (BMI), the Liebowitz scale, the Mini International Neuropsychiatric Interview (MINI), and the Yale-Brown Obsessive Compulsive Scale for Eating Disorders scale (Y-BOCS-ED) respectively to evaluate or diagnose the state of malnutrition, social anxiety symptomatology, social phobia in Diagnostic and Statistical Manual-4 (DSM-IV) and anorexic symptomatology. Sample 2 (N=60) was assessed at the end of the hospitalization and then 6, 12 and 18 months later. We used the BMI, Liebowitz scale, MINI, and Eating Disorders Inventory (EDI) to assess anorexic symptomatology. In addition, the Morgan-Russell outcome assessment schedule (MR schedule) was used to assess the total clinical state of the patients.
Social anxiety symptomatology and actual diagnosis decreased throughout the treatment. However, regardless of the point at which the patient received care, there was no correlation between social phobia and nutritional state, as indicated by BMI. A correlation existed between social phobia and AN symptomatology, and between social phobia and total clinical state, during the out-patient care.
A component of AN-social phobia comorbidity is still questionable. Is it linked to the clinical state of the subjects (question of an additional effect of under nutrition and cognition), or even to AN? Others indicators of under nutrition are of interest and warrant further evaluations. We therefore feel that a diagnosis of social phobia can only be confirmed after an acute state of AN, thus allowing for preferential treatments. Others studies must be conducted in order to continue to explore the links between social phobia and AN.
神经性厌食症（AN）与焦虑症尤其是社交恐惧症之间的联系鲜为人知。然而，社交恐惧症在神经性厌食症患者中频繁出现。一些研究表明，重新营养治疗后神经性厌食症患者的焦虑和抑郁症状有所减轻。但是，据我们所知，尚无研究探讨神经性厌食症重新营养治疗期间社交恐惧症症状的演变。
明确神经性厌食症、营养状况和社交恐惧症之间的联系。
研究对象包括2个样本，分析使用SPSS11.5进行。样本1（N = 24名神经性厌食症患者）在入院时和出院时接受评估。我们分别使用体重指数（BMI）、利博维茨量表、迷你国际神经精神访谈（MINI）和耶鲁-布朗强迫症饮食障碍量表（Y-BOCS-ED）来评估或诊断营养不良状态、社交焦虑症状、《精神疾病诊断与统计手册》第4版（DSM-IV）中的社交恐惧症以及厌食症状。样本2（N = 60）在住院结束时以及之后6、12和18个月接受评估。我们使用BMI、利博维茨量表、MINI和饮食失调问卷（EDI）来评估厌食症状。此外，使用摩根-拉塞尔结局评估表（MR表）来评估患者的总体临床状态。
整个治疗过程中社交焦虑症状和实际诊断均有所下降。然而，无论患者接受治疗的时间点如何，如BMI所示，社交恐惧症与营养状况之间均无相关性。在门诊治疗期间，社交恐惧症与神经性厌食症症状之间以及社交恐惧症与总体临床状态之间存在相关性。
神经性厌食症与社交恐惧症共病的一个组成部分仍存在疑问。它是与受试者的临床状态相关（营养不良和认知的附加效应问题），甚至与神经性厌食症相关吗？其他营养不良指标也值得关注并需要进一步评估。因此，我们认为只有在神经性厌食症的急性期过后才能确诊社交恐惧症，从而进行优先治疗。必须开展其他研究以继续探索社交恐惧症与神经性厌食症之间的联系。
