Objective: Recent studies describe refeeding in anorexia nervosa (AN) using various methods to deliver higher calorie loads than is currently recommended. We systematically examined approaches to refeeding in hospitalized patients with AN Methods: Systematic review of PubMed, PsycINFO, Scopus, and Clinical Trials databases from 1960–2015 using the terms refeeding, weight restoration, hypophosphatemia, anorexia nervosa, anorexia, and anorexic. Results: 948 abstracts were retrieved using the search criteria and were included if they described a refeeding protocol in hospitalized patients with AN with sufficient detail to allow replication. Twenty-two papers were included in the final review. Most studies were in adolescents and were observational or retrospective; the majority of studies since 2010 have reported on refeeding approaches beginning with higher calories or advancing caloric prescriptions faster than current treatment recommendations. Discussion: The available evidence supported seven conclusions, summarized here: 1) In moderately malnourished patients with AN, higher calorie feeding is feasible; 2) Meal-only approaches or combined nasogastric plus meal-feeding approaches can deliver higher calorie feeds in hospital; 3) In severely malnourished patients with AN, there is insufficient evidence to support any change to current standards of care for refeeding hospitalized patients; 4) Higher calorie approaches to refeeding appear safe under close medical supervision and with correction of electrolyte abnormalities; 5) The impact of differing approaches to refeeding on long-term outcomes is unknown; 6) TPN is not recommended unless no other form of refeeding is possible; and 7) Meals and liquid formulas with nutrient compositions within recommended ranges are appropriate for refeeding.

Refeeding patients with AN using a hospital-based, behavioral protocol may be accomplished safely and more rapidly than generally recognized, weight restoring most patients by discharge. Helpful elements may include the program's integrated, step-down structure; multidisciplinary team approach emphasizing group therapy to effect behavior change; and close medical monitoring for those with BMI < 15.

This study identified differential impairments underlying IGT performance in AN and BN. Findings suggest that impaired decision making in AN might involve impaired memory functions. Impaired decision making in BN might involve altered reward and punishment sensitivity.

Huntington’s Disease (HD) is a neurodegenerative disease caused by a CAG triplet-repeat expansion-mutation in the Huntingtin gene. Subjects at risk for HD can be identified by genetic testing in the prodromal phase. Structural changes of basal-ganglia nuclei such as the caudate nucleus are well-replicated findings observable early in prodromal-HD subjects and may be preceded by distinct functional alterations of cortico-striatal circuits. This study aims to assess functional integrity of the motor system as a cortico-striatal circuit with particular clinical relevance in HD. Ten subjects in the prodromal phase of HD and ten matched controls were administered blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) at rest (3 Tesla). Functional connectivity was measured as synchrony of BOLD activity between the caudate nucleus and thirteen cortical brain regions (seeds). Basal-ganglia volumes were assessed as established markers of disease progression in prodromal-HD. Linear regression analysis was performed to test for a relationship between structural changes and group differences in functional connectivity. Prodromal-HD subjects showed reduced BOLD synchrony between two seeds in the premotor cortex (BA6) and the caudate nucleus. While similar effect sizes could be observed for reduced basal-ganglia volumes and differences in functional connectivity, coefficients of determination indicate a moderate relationship between functional connectivity and striatal atrophy. Our data show reduced cortico-striatal functional connectivity at rest in prodromal-HD and suggest a relation to early structural brain changes. Additional longitudinal studies are necessary to elucidate the temporal relationship between functional alterations and earliest structural brain changes in prodromal-HD.