Harm Reduction In Male Patients Actively Using Anabolic Androgenic Steroids AAS And Performance-Enhancing Drugs PEDs: A Review
Clinical and Scientific Implications of the 2023 Journal of Clinical Medicine Review
"Clinical and Scientific Implications of Eating Disorders: A Focus on Patients with Anorexia Nervosa" (Sperlich et al., 2024)
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1. Background & Key Findings
| Aspect | What the review shows |
|---|---|
| Pathophysiology | Severe caloric restriction in AN triggers a cascade of neuro‑hormonal adaptations: ↑ ghrelin, ↓ leptin, altered dopamine transmission, and changes in corticotropin‑release factor (CRF) signaling. |
| Neurocognitive profile | Patients exhibit impaired executive function (set‑shifting, inhibition), but intact or even enhanced verbal memory—consistent with a "learning bias" toward body‑image related cues. |
| Biomarker potential | Elevated CRP and IL‑6 correlate with symptom severity; ghrelin/leptin ratios may reflect metabolic adaptation stages. |
These findings underscore the importance of multi‑modal assessment: endocrine, inflammatory, neuropsychological, and imaging measures.
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2. The Clinical Trial Landscape
2.1 Current Interventions
| Category | Intervention | Evidence Level |
|---|---|---|
| Pharmacologic | SSRIs (e.g., fluoxetine) | Moderate—some efficacy on mood/anxiety but variable effect on weight/shape concerns. |
| Bupropion + Naltrexone (Contrave®) | Limited data in eating disorders; primarily used for obesity. | |
| Topiramate | Small RCTs show modest reduction in binge frequency, git.bayview.top but side‑effects and weight loss may confound results. | |
| Psychotherapy | CBT‑E (standardized protocol) | Strong evidence—multiple RCTs demonstrate significant reductions in binge episodes. |
| Interoceptive Exposure (within CBT) | Effective for reducing avoidance of bodily sensations; improves interoceptive awareness. | |
| Mindfulness‑Based Interventions (e.g., MB-EAT) | Emerging evidence—reduces emotional eating and improves body acceptance. |
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4. How These Findings Shape the Treatment Plan
- Evidence‑based First Line: CBT‑E
Implementation: Begin with 12–16 weekly sessions, each ~60 min, focusing on the principles of exposure to internal cues (anxiety, cravings) while preventing the behavioral response.
- Incorporate Exposure & Response Prevention
How: Use the "Binge‑Avoidance Plan" to set up exposure tasks (e.g., sitting with a snack for 5 min) followed by monitoring of thoughts/emotions without acting on them.
- Use CBT Techniques
How: Teach thought‑record sheets, behavioral experiments to test catastrophic predictions (e.g., "If I eat this snack, will I lose control?"), and relaxation training.
- Monitor Progress
How: Keep a simple log or use an app; review weekly during therapy.
- Prepare for Relapse
How: Identify high‑risk situations, practice coping responses (e.g., grounding exercises), and schedule follow‑up sessions promptly after a relapse.
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Summary
- Diagnostic criteria for binge‑type EDs involve recurrent binge episodes with loss of control and significant distress or impairment.
- Treatment centers on CBT/EFT (CBT‑ED, MBCT, IPT, DBT‑PSR) combined with medical monitoring and psychoeducation.
- Key intervention points: early identification of binge patterns, comprehensive assessment, stabilization of physical health, initiation of psychotherapy, relapse prevention, and long‑term support.
