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All rights reserved" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:16 [ "pii" => "S1134593424000691" "issn" => "11345934" "doi" => "10.1016/j.psiq.2024.100509" "estado" => "S250" "fechaPublicacion" => "2024-10-01" "aid" => "100509" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Trabajos académicos</span>" "titulo" => "Risk of hospital readmission in patients with psychotic symptoms and a history of drug use" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Riesgo de reingreso hospitalario en pacientes con síntomas psicóticos y antecedentes de consumo de drogas" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "f0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 586 "Ancho" => 948 "Tamanyo" => 32098 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Survival analysis of the risk of hospital readmission by history of cannabis use.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paula Mollà Roig" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Paula" "apellidos" => "Mollà Roig" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1134593424000691?idApp=UINPBA00004N" "url" => "/11345934/0000003100000004/v7_202410110611/S1134593424000691/v7_202410110611/en/main.assets" ] "itemAnterior" => array:16 [ "pii" => "S1134593424000551" "issn" => "11345934" "doi" => "10.1016/j.psiq.2024.100495" "estado" => "S250" "fechaPublicacion" => "2024-10-01" "aid" => "100495" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión</span>" "titulo" => "Efectos terapéuticos de las plantas medicinales en los trastornos de ansiedad. 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Scoping review" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "f0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2569 "Ancho" => 2368 "Tamanyo" => 368600 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Figura " "rol" => "short" ] ] "descripcion" => array:1 [ "es" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Diagrama de flujo PRISMA para la selección de los estudios.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jose Luis Estela-Zape, Diana Carolina Libreros-Chica, Lizeth Dayana Noreña-Buitrón, Jose Miguel Sierra-Olea" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Jose Luis" "apellidos" => "Estela-Zape" ] 1 => array:2 [ "nombre" => "Diana Carolina" "apellidos" => "Libreros-Chica" ] 2 => array:2 [ "nombre" => "Lizeth Dayana" "apellidos" => "Noreña-Buitrón" ] 3 => array:2 [ "nombre" => "Jose Miguel" "apellidos" => "Sierra-Olea" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1134593424000551?idApp=UINPBA00004N" "url" => "/11345934/0000003100000004/v7_202410110611/S1134593424000551/v7_202410110611/es/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Case report. Pregnancy in women with an eating disorder" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Belén Resa-Pérez, Andrea Jiménez-Mayoral, Vanessa Gladys Velasquez-Acebey, Filip Damian Budny, Georgina Badia i Realp, Salvador Miret-Fallada, María Irigoyen-Otiñano" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Belén" "apellidos" => "Resa-Pérez" "email" => array:1 [ 0 => "bresa@gss.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] ] ] 1 => array:4 [ "nombre" => "Andrea" "apellidos" => "Jiménez-Mayoral" "email" => array:1 [ 0 => "ajimenezm@gss.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "af0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cr0005" ] ] ] 2 => array:4 [ "nombre" => "Vanessa Gladys" "apellidos" => "Velasquez-Acebey" "email" => array:1 [ 0 => "vvelasquez@gss.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] ] ] 3 => array:4 [ "nombre" => "Filip Damian" "apellidos" => "Budny" "email" => array:1 [ 0 => "fbudny@gss.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] ] ] 4 => array:4 [ "nombre" => "Georgina" "apellidos" => "Badia i Realp" "email" => array:1 [ 0 => "gbadia@gss.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "af0015" ] ] ] 5 => array:4 [ "nombre" => "Salvador" "apellidos" => "Miret-Fallada" "email" => array:1 [ 0 => "smiret@gss.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] ] ] 6 => array:4 [ "nombre" => "María" "apellidos" => "Irigoyen-Otiñano" "email" => array:1 [ 0 => "mirigoyen@gss.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "af0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "PC_afffvrvbyWOGV" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Psychiatry Service, University Hospital Santa Maria, Avinguda Rovira Roure, 44, 25198 Lleida, Spain" "etiqueta" => "a" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Group of Biological Functionings of Mental Disorders, Institute for Biomedical Research in Lleida (IRB), 25198 Lleida, Spain" "etiqueta" => "b" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Psychology Service, University Hospital Santa Maria, Avinguda Rovira Roure, 44, 25198 Lleida, Spain" "etiqueta" => "c" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "CIBERSAM Group 10, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain" "etiqueta" => "d" "identificador" => "PC_afffvrvbyWOGV" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Servicio de Psiquiatría del Hospital Universitario Santa María, Institut de Recerca Biomèdica (IRB) de Lleida (España), Avinguda Rovira Roure, 44, 25198 Lleida, Spain." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Embarazo en mujeres con trastorno de conducta alimentaria. A propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "f0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 653 "Ancho" => 945 "Tamanyo" => 40518 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">BMI evolution.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Pregnancy and postpartum period are physiological stages with greater energy requirements, due to the increase in blood volume that entails the creation of new tissues such as the placenta, the amniotic fluid, or breast milk.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> From the second trimester of pregnancy, it is necessary to increase intakes around 300 kcal daily which makes it essential to follow a healthy, balanced, and supplemented diet.<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">Authors have studied the impact of an eating disorder (ED) on pregnancy. It is generally associated with a decrease in eating symptoms and psychopharmacological medication during pregnancy and the first 9 months after childbirth.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">The main problem is women's fear of weight gain before, during, and after pregnancy. In fact, in women diagnosed with ED, it is common to associate the term “pregorexia”, which refers to the attempt to lose weight and maintain a low weight during the pregnancy period.<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> It has been observed that up to 92% of women with ED reported difficulties adjusting to pregnancy, compared to 13% of women who reported these difficulties and who did not have a psychiatric diagnosis.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">Another key factor to take into account at this stage is vomiting. Although it is typical of pregnancy, it has been described as a tool to promote or justify a compensatory mechanism, or trigger an ED, during pregnancy.</p><p id="p0025" class="elsevierStylePara elsevierViewall">Regarding weight gain throughout pregnancy, the usual figures are determined by the mother's previous weight, with an increase between 11.5 and 16 kg considered physiological in women with a body mass index (BMI) in normal range. For women with a previous BMI less than 18.5, it is considered that the weight gain should be greater, between 12.5 and 18 kg.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a></p><p id="p0030" class="elsevierStylePara elsevierViewall">Generally, women with ED type AN associate lower BMI figures prior to pregnancy compared to women with ED type BN or non-specific eating disorder (NSED). On the other hand, women with ED type AN or BN associate a greater increase in BMI during pregnancy than women with NSED..<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> However, malnutrition or malnutrition, which can easily occur in ED situations, are risk factors described for adverse events during childbirth and in the newborn.<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a> Management of pregnancies in women with active AN requires regular and multidisciplinary monitoring of obstetricians, pediatricians, and psychiatrists.<a class="elsevierStyleCrossRefs" href="#bb0030"><span class="elsevierStyleSup">6–8</span></a></p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Methods</span><p id="p0035" class="elsevierStylePara elsevierViewall">The authors present a case of a 33-year-old woman who is diagnosed with an ED during adolescence, and after intensive follow-up until the age of 30, she becomes pregnant on 2 occasions. Emphasis is placed on eating symptoms during pregnancy and the postpartum period and a bibliographic review is carried out in this regard. As an observational clinical case (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1), the patient's IQ was obtained and no evaluation was requested by the institutional ethics committee, although this work complies with the agreements of the Declaration of Helsinki.</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Case report</span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Patient identification and background</span><p id="p0040" class="elsevierStylePara elsevierViewall">The patient is a 33-year-old woman, currently married, with a daughter aged 1 year and 8 months. She has a good relationship with her parents. Her father passed away when she was 28, which may have increased her restrictive behaviors. She completed a degree in social education.</p><p id="p0045" class="elsevierStylePara elsevierViewall">She had good academic performance but experienced some difficulties in group relationships and reported bullying in high school, identifying this event as a triggering factor for her restrictive behaviors. Regarding romantic relationships, she exhibited high emotional dependence and a need for approval.</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Analysis of the reason for consultation</span><p id="p0050" class="elsevierStylePara elsevierViewall">She began follow-up in the Eating Disorders Unit in 2009 due to worsening of restrictive symptoms and started clinical psychology follow-up in 2010 at the Adult Mental Health Center for Anorexia Nervosa.</p><p id="p0055" class="elsevierStylePara elsevierViewall">Initially, the patient reported significant mood reduction, high anxiety, difficulty managing emotions, frustration, and rumination about her food intake and body image.</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">History of the problem</span><p id="p0060" class="elsevierStylePara elsevierViewall">The patient began experiencing restrictive symptoms during adolescence at the age of 15, identifying bullying in high school and language problems as possible triggers. Since then, she reported increased weight control, anxiety, and body dissatisfaction. She described emotional instability, a need for external approval, high emotional dependence, and low self-esteem.</p><p id="p0065" class="elsevierStylePara elsevierViewall">In this context, she explained using substances such as cannabis for its anxiolytic effect, which led to increased appetite and consequently to binge eating and purging due to fear of weight gain. As a result, she began follow-up at the Child and Adolescent Mental Health Center to control her eating symptoms.</p><p id="p0070" class="elsevierStylePara elsevierViewall">At 16, she reported using laxatives and toxic substances like speed and amphetamines as anorexigenic agents. The patient reached a BMI of 17.5 and was eventually admitted to the Child and Adolescent Psychiatry Unit due to decompensation of her psychopathology, began psychopharmacological treatment, and was diagnosed with anorexia nervosa (AN).</p><p id="p0075" class="elsevierStylePara elsevierViewall">At 18, she was referred to the Eating Disorders Unit, adopting restrictive behaviors, occasional vomiting, and minor self-harm for anxiolytic purposes. She had close follow-up for several years with both psychology and psychiatry and was prescribed multiple psychotropic medications with irregular treatment adherence.</p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0095">Analysis and description of problem behaviors</span><p id="p0080" class="elsevierStylePara elsevierViewall">The patient became pregnant at the age of 30. She maintained stability regarding eating behaviors 5 months before pregnancy, with a BMI of 18.5. At the beginning of pregnancy, the patient experienced increasing anxiety and fear of weight gain but did not exhibit risky eating behaviors, trying to follow a balanced diet. She decided to discontinue psychopharmacological treatment (bupropion 150 mg, lormetazepam 1 mg, and diazepam 2.5 mg) on her own.</p><p id="p0085" class="elsevierStylePara elsevierViewall">She had monthly follow-ups with psychology and psychiatry to control symptoms. At 8 weeks of pregnancy, the patient suffered a miscarriage but did not resume pharmacological treatment, continuing mental health follow-up every 1–2 months.</p><p id="p0090" class="elsevierStylePara elsevierViewall">A year later, the patient became pregnant again. At the beginning of pregnancy, she weighed 53.7 kg and had a BMI of 17.6. She reported nausea and vomiting until the fifth month of gestation, which made her feel better. She denied purging and restrictive behaviors, claiming to have a balanced diet with small portions. The patient gained 6.5 kg during pregnancy.</p><p id="p0095" class="elsevierStylePara elsevierViewall">During the postpartum period, she reported anxious-depressive symptoms. Two months after delivery, she experienced some negative thoughts about her body and weight, with some dissatisfaction with her body image, but she managed to cope with it (<a class="elsevierStyleCrossRef" href="#f0005">Fig. 1</a>).</p><elsevierMultimedia ident="f0005"></elsevierMultimedia></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0100">Establishment of treatment goals</span><p id="p0100" class="elsevierStylePara elsevierViewall">The objective from psychology and psychiatry was to address factors that increased anxiety and body dissatisfaction, emphasizing self-esteem, body acceptance, and obsessive weight control.</p><p id="p0105" class="elsevierStylePara elsevierViewall">After the first miscarriage, psychotherapy sessions were increased, with monthly follow-ups by both psychology and psychiatry to work through grief, pregnancy loss, and family planning. Subsequently, the importance of resuming appropriate food intake and avoiding relapses were emphasized by working on illness awareness.</p><p id="p0110" class="elsevierStylePara elsevierViewall">In the second pregnancy, the patient remained more stable, did not engage in anorexic or purgative behaviors, and maintained a balanced diet. After pregnancy, postpartum body dissatisfaction and the importance of self-care were addressed.</p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0105">Study of therapeutic objectives</span><p id="p0115" class="elsevierStylePara elsevierViewall">Close follow-up aimed to reduce the intensity of anxiety symptoms, improve emotion management, decrease depressive symptoms, and reduce obsession with weight control. The goal was to establish a structured eating pattern based on acceptance.</p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0110">Evolution of treatment efficacy</span><p id="p0120" class="elsevierStylePara elsevierViewall">The patient is currently still under mental health follow-up. Psychotropic medications were not reintroduced as the patient remained stable.</p><p id="p0125" class="elsevierStylePara elsevierViewall">Her progress has been slow but evident. Notable improvements in insight are observed, with no restrictive behaviors, better control of anxiety, and fear of weight gain, structured eating with 3 meals a day, and no excessive physical exercise or weight control.</p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0115">Follow-up</span><p id="p0130" class="elsevierStylePara elsevierViewall">The patient is currently still under Mental Health follow-up, with visits every 2 months with psychology and every 2–3 months with psychiatry. Significant improvement in ED is evident, and discharge is even being considered.</p></span></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0120">Results</span><p id="p0135" class="elsevierStylePara elsevierViewall">Finally, an eutocic delivery was carried out without incidents. Maternal BMI during childbirth was 22.3 and fetal weight was 2900 g at birth.</p><p id="p0140" class="elsevierStylePara elsevierViewall">Currently, the baby is 5 months old. It presents weight adjusted to its age and its neurodevelopment is normal.</p><p id="p0145" class="elsevierStylePara elsevierViewall">The patient reports good maternal–child bonding and breastfeeding without complications. Although she denies restrictions or purgative behaviors, she has lost weight in postpartum and has recovered her pre-pregnancy BMI. In psychological visits, she verbalizes body dissatisfaction and negative content ruminations about motherhood and the parental figure she exerts over the baby. No major affective symptoms have been observed in this period.</p></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0125">Discussion/Conclusions</span><p id="p0150" class="elsevierStylePara elsevierViewall">The case illustrates the complex evolution of pregnant women with EDs.</p><p id="p0155" class="elsevierStylePara elsevierViewall">In the example of our patient, during pregnancy, a stabilization of symptoms was observed, with a decrease in dietary restrictions.</p><p id="p0160" class="elsevierStylePara elsevierViewall">Likely, protective factors such as the desire to ensure the baby's safety, perception of fetal movements, and concern for fetal well-being contributed to this improvement.<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a></p><p id="p0165" class="elsevierStylePara elsevierViewall">In the postpartum period to the present, the patient has maintained clinical stability, without significant restrictions or purgative behaviors, although there persists a focus on body image and strict control of eating. However, in the consulted literature, a high risk of ED symptom exacerbation in the postpartum stage has been observed, related to difficulties in adapting to postpartum body changes, increased susceptibility to postpartum depression,<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a> and resistance in establishing maternal–fetal bonding and breastfeeding,<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> among other factors.</p><p id="p0170" class="elsevierStylePara elsevierViewall">Increased risk of miscarriage, preterm birth, and low birth weight have been documented in women with EDs.<a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a> Specifically, women with AN have a higher risk of postpartum hemorrhage and a greater likelihood of low birth weight in the newborn. Conversely, in women with bulimia nervosa, the risk of miscarriage and preeclampsia is highlighted, as well as gestational diabetes and the need for induction of labor. Newborns of women with this condition have lower Apgar scores at 1 min after birth.<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a> In the case presented, the patient experienced a miscarriage at 8 weeks of gestation in her first pregnancy. This adverse outcome is possibly related to the patient's difficulty in adjusting to pregnancy, which increased her anxiety and fear of weight gain.</p><p id="p0175" class="elsevierStylePara elsevierViewall">It is noteworthy that, during the patient's second pregnancy, although there was weight gain, it was very limited, only 6 kg. According to literature, the patient, who had a pre-pregnancy BMI of 18.5, should have gained approximately 11.5–16 kg.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> Our hypothesis is that pregnancy-related vomiting was used to compensate the weight gain, behavior related to the term “pregorexia” mentioned earlier. The limited weight gain and the patient's description of nausea and vomiting until the fifth month of pregnancy, which provided her with some relief, support this possible explanation.</p><p id="p0180" class="elsevierStylePara elsevierViewall">Although many studies have observed high rates of difficulties in mother–child attachment in patients with EDs,<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> our patient did not experience difficulties in establishing a bond with her child, so specific parental support therapies were not necessary in this case.</p><p id="p0185" class="elsevierStylePara elsevierViewall">Regarding the use of psychotropic medications, in our case, the treatment with an antidepressant and 2 benzodiazepines was discontinued after the miscarriage in the first pregnancy, and intensive follow-up by both psychology and psychiatry was initiated. According to guidelines, cognitive-behavioral therapy is the first-line recommendation in pregnant women with EDs, and if pharmacotherapy is necessary, attempts should be made to use monotherapy and the minimum effective dose.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> Therefore, the change in the therapeutic plan for our patient does not seem inappropriate.</p><p id="p0190" class="elsevierStylePara elsevierViewall">The literature has frequently associated EDs with high impulsivity, substance use, and self-harm behaviors.<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a> Our patient exhibited these 3 components at some point in her life: she used THC and amphetamines during adolescence, engaged in mild self-harm behaviors in adulthood, and displayed dysfunctional personality traits. These factors are associated with a more complicated course of EDs according to the literature.</p><p id="p0195" class="elsevierStylePara elsevierViewall">In conclusion, close monitoring of pregnant women with a history of EDs is essential, as although pregnancy seems to be a period of stability in dietary symptomatology, the course and evolution of these cases are complex and pose risks for both the mother and the fetus or neonate. In this sense, the presence of active ED symptoms or a low pre-pregnancy BMI constitute poor prognostic factors due to an increased risk of miscarriage, preterm birth, and low birth weight.</p></span><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0130">Funding</span><p id="p0200" class="elsevierStylePara elsevierViewall">This article has not been funded.</p></span><span id="s0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0135">Author contributions</span><p id="p0205" class="elsevierStylePara elsevierViewall">All authors contributed to the conception and design of the case. VA and GB interviewed the patient and wrote the clinical case. AJ and SM performed the research and studied the relation between pregnancy and eating disorders. BR and MI provided relevant information about the psychopathology behind suicide and eating disorder during pregnancy. FB helped with the revision of the manuscript and its translation into English. All authors contributed to editorial changes in the manuscript and read and approved the final manuscript.</p></span><span id="s0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0140">Ethics approval and consent to participate</span><p id="p0210" class="elsevierStylePara elsevierViewall">As an observational clinical case (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1), no evaluation was requested by the institutional ethics committee, although this work complies with the agreements of the Declaration of Helsinki. This is a unique and isolated case, so informed consent was obtained from the patient, highlighting that today the data is completely anonymized, making it impossible to identify the patient, preserving the privacy of both the patient and the family.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2269804" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "as0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "as0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "as0020" "titulo" => "Discussion/Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1892486" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2269803" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "as0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "as0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "as0040" "titulo" => "Discusión/Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1892487" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "s0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "s0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "s0015" "titulo" => "Case report" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "s0020" "titulo" => "Patient identification and background" ] 1 => array:2 [ "identificador" => "s0025" "titulo" => "Analysis of the reason for consultation" ] 2 => array:2 [ "identificador" => "s0030" "titulo" => "History of the problem" ] 3 => array:2 [ "identificador" => "s0035" "titulo" => "Analysis and description of problem behaviors" ] 4 => array:2 [ "identificador" => "s0040" "titulo" => "Establishment of treatment goals" ] 5 => array:2 [ "identificador" => "s0045" "titulo" => "Study of therapeutic objectives" ] 6 => array:2 [ "identificador" => "s0050" "titulo" => "Evolution of treatment efficacy" ] 7 => array:2 [ "identificador" => "s0055" "titulo" => "Follow-up" ] ] ] 7 => array:2 [ "identificador" => "s0060" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "s0065" "titulo" => "Discussion/Conclusions" ] 9 => array:2 [ "identificador" => "s0070" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "s0075" "titulo" => "Author contributions" ] 11 => array:2 [ "identificador" => "s0080" "titulo" => "Ethics approval and consent to participate" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-07-11" "fechaAceptado" => "2024-09-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1892486" "palabras" => array:6 [ 0 => "Eating disorder" 1 => "Pregnancy" 2 => "Postpartum" 3 => "Puerperium" 4 => "Gender influence" 5 => "Risk factors" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1892487" "palabras" => array:6 [ 0 => "Trastorno de la alimentación" 1 => "Embarazo" 2 => "Posparto" 3 => "Puerperio" 4 => "Influencia del género" 5 => "Factores de riesgo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Introduction</span><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Pregnancy has been described as a period of symptomatic stability for women diagnosed with eating disorder (ED). However, a poor control of alimentary symptoms before and during pregnancy is associated with higher risk of adverse effects during childbirth and the postpartum period. A case report is presented and a bibliographic review is carried out.</p></span> <span id="as0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Methods</span><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">The authors take the case of a 33-year-old woman diagnosed with anorexia nervosa during adolescence, who becomes pregnant at the age of 30. A non-systematic review was carried out using the Pubmed database using keywords [eating disorder] AND [pregnancy]. Studies of more than 5 years were excluded. The patient's informed consent was obtained. This work complies with the agreements of the Declaration of Helsinki.</p></span> <span id="as0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Results</span><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Eutocic delivery was carried out without incidents. Currently, the baby is 5 months old, his weight is adjusted to his age and his neurodevelopment is normal. Although the patient denies restrictions or purgative behaviors, she has lost weight in postpartum and has recovered her pre-pregnancy body mass index. No major affective symptoms have been observed in this period.</p></span> <span id="as0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Discussion/Conclusions</span><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Pregnancy and postpartum period constitute periods of greater vulnerability in terms of eating symptoms in patients with EDs. Emphasis should be placed on a multidisciplinary approach with the aim of avoiding the appearance of associated risk factors both for the mother and the baby.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "as0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "as0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "as0020" "titulo" => "Discussion/Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="as0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Introducción</span><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">El embarazo se ha descrito como un período de estabilidad sintomática para las mujeres diagnosticadas con trastorno de conducta alimentaria (TCA). Sin embargo, un mal control de los síntomas alimentarios antes y durante el embarazo se asocia con un mayor riesgo de efectos adversos durante el parto y el posparto. Se presenta un reporte de caso y se realiza una revisión bibliográfica.</p></span> <span id="as0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Material y métodos</span><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Los autores describen el caso de una mujer de 33 años diagnosticada de anorexia nerviosa (AN) durante la adolescencia, que queda embarazada a los 30 años. Se realizó una revisión no sistemática utilizando la base de datos Pubmed utilizando las palabras clave [trastorno alimentario] AND [embarazo]. Se excluyeron los estudios de más de 5 años. Se obtuvo el consentimiento informado del paciente. Este trabajo cumple con los acuerdos de la Declaración de Helsinki.</p></span> <span id="as0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Resultados</span><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">Finalmente, fue un parto eutócico sin incidencias. Actualmente, el bebé tiene cinco meses, con un peso está ajustado a la edad y un neurodesarrollo descrito como normal. Aunque la paciente niega restricciones o conductas purgativas, ha perdido peso en el posparto y ha recuperado su índice de masa corporal (IMC) previo al embarazo. No se han observado síntomas afectivos importantes en este período.</p></span> <span id="as0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Discusión/Conclusiones</span><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">El embarazo y el posparto constituyen períodos de mayor vulnerabilidad en cuanto a los síntomas alimentarios en pacientes con trastornos alimentarios. Se debe hacer hincapié en un abordaje multidisciplinar con el objetivo de evitar la aparición de factores de riesgo asociados tanto para la madre como para el bebé.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "as0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "as0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "as0040" "titulo" => "Discusión/Conclusiones" ] ] ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "f0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 653 "Ancho" => 945 "Tamanyo" => 40518 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">BMI evolution.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trastornos de la conducta alimentaria y obesidad" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. 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Journal Information
Case report
Case report. Pregnancy in women with an eating disorder
Embarazo en mujeres con trastorno de conducta alimentaria. A propósito de un caso
Belén Resa-Péreza, Andrea Jiménez-Mayorala,b,
, Vanessa Gladys Velasquez-Acebeya, Filip Damian Budnya, Georgina Badia i Realpc, Salvador Miret-Falladaa, María Irigoyen-Otiñanoa,b,d
Corresponding author
ajimenezm@gss.cat
Corresponding author at: Servicio de Psiquiatría del Hospital Universitario Santa María, Institut de Recerca Biomèdica (IRB) de Lleida (España), Avinguda Rovira Roure, 44, 25198 Lleida, Spain.
Corresponding author at: Servicio de Psiquiatría del Hospital Universitario Santa María, Institut de Recerca Biomèdica (IRB) de Lleida (España), Avinguda Rovira Roure, 44, 25198 Lleida, Spain.
a Psychiatry Service, University Hospital Santa Maria, Avinguda Rovira Roure, 44, 25198 Lleida, Spain
b Group of Biological Functionings of Mental Disorders, Institute for Biomedical Research in Lleida (IRB), 25198 Lleida, Spain
c Psychology Service, University Hospital Santa Maria, Avinguda Rovira Roure, 44, 25198 Lleida, Spain
d CIBERSAM Group 10, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain