Hubertus Himmerich

By Julia Weschenfelder, Jessica Bentley and Hubertus Himmerich

Obesity and overweight are major health concerns and the leading preventable cause of death in developed and developing countries. Obesity affects men and women differently due to biological, socioeconomic, cultural and country-specific gender-related disparities. This book chapter outlines obesity as a risk factor for physical diseases and mental health disorders in women. Obesity has been shown to contribute to the risk of certain types of cancer, including breast, endometrial, gallbladder, oesophageal and renal cancer. In terms of reproductive health, obesity negatively affects both fertility and contraception. In addition, obesity is associated with early miscarriage, higher rates of caesarean section and high-risk obstetrical conditions, in addition to higher maternal and neonatal mortality rates, and congenital malformations. In terms of mental health, obesity is closely linked to depression, anxiety disorders, neurodegenerative diseases and sleep disorders. Socioeconomic, psychosocial and behavioural factors, factors associated with ageing, mechanisms related to the microbiome, gastrointestinal and vascular system, intracellular pathophysiology and metabolism in the body, hormones, adipocytokines and problems associated with medical treatment are important factors linking obesity with its negative consequences on physical and mental health.

Part of the book: Adipose Tissue

By Amabel Dessain, Jessica Bentley, Janet Treasure, Ulrike Schmidt and Hubertus Himmerich

In clinical practice, patients with anorexia nervosa (AN), their carers and clinicians often disagree about psychopharmacological treatment. We developed two corresponding questionnaires to survey the perspectives of patients with AN and their carers on psychopharmacological treatment. These questionnaires were distributed to 36 patients and 37 carers as a quality improvement project on a specialist unit for eating disorders at the South London and Maudsley NHS Foundation Trust. Although most patients did not believe that medication could help with AN, the majority thought that medication for AN should help with anxiety (61.1%), concentration (52.8%), sleep problems (52.8%) and anorexic thoughts (55.6%). Most of the carers shared the view that drug treatment for AN should help with anxiety (54%) and anorexic thoughts (64.8%). Most patients had concerns about potential weight gain, increased appetite, changes in body shape and metabolism during psychopharmacological treatment. By contrast, the majority of carers were not concerned about these specific side effects. Some of the concerns expressed by the patients seem to be AN-related. However, their desire for help with anxiety and anorexic thoughts, which is shared by their carers, should be taken seriously by clinicians when choosing a medication or planning psychopharmacological studies.

Part of the book: Anorexia and Bulimia Nervosa

By Ralf F. Tauber, Carola Nisch, Mutahira M. Qureshi, Olivia Patsalos and Hubertus Himmerich

In Germany, inpatient therapy for depression mainly takes place in either health insurance-financed psychiatric hospitals, or in pension insurance-financed, psychotherapy-focused, psychosomatic rehabilitation hospitals. In psychiatric hospitals, the diagnosis is made according to the International Classification of Diseases (ICD), and therapeutic attempts are made to achieve remission, whereas in rehabilitation hospitals, the International Classification of Functioning, Disability and Health (ICF) plays an essential diagnostic role. Accordingly, the main German pension insurance, Deutsche Rentenversicherung, has developed a rehabilitation therapy standard for depressive disorders. In this chapter, we focus on the psychotherapeutic inpatient rehabilitation for patients with depression based on an example of a specialized psychotherapeutic hospital. This example illustrates how psychotherapeutic inpatient rehabilitation can be tailored to the individual’s needs and may include any of the following therapeutic modalities: Cognitive Behavior Therapy (CBT), Schema Therapy, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), pharmacotherapy, group therapy for comorbid conditions, skills training, psychoeducation, occupational therapy (OT), movement therapy, physiotherapy, music therapy, social work, family work, and self-help groups. People with depression may benefit from this service model of psychosomatic inpatient rehabilitation beyond symptom remission, as it focuses on increasing people’s functional level as well as their quality of life.

Part of the book: Psychosomatic Medicine

By Briana Applewhite, Aishwarya Krishna Priya, Valentina Cardi and Hubertus Himmerich

Anorexia nervosa (AN) is an eating disorder associated with a high mortality and an often chronic and disabling course. Thus, novel treatment options should be explored. We performed two focus groups with a total of six people with AN on their use of music and their thoughts about music as an additional therapeutic option. Interviews were transcribed and analyzed in-depth using the NVivo 12 software package. The most prevalent theme throughout the focus groups involved positive expressions, emotions and memories related to music. This theme occurred in ~25% of the data. The importance of music was the second most common theme. Negative feelings and memories associated with music accounted for only ~10% of all references. All six patients expressed that they see benefit in using music therapy as an adjunct to their current treatment. Our analysis shows that people with AN connect music mainly with positive emotions and memories. Therapists might think about applying music more frequently during their sessions with AN patients and consider adding music therapy to their overall treatment concept. However, the results also suggest that music can influence mood not only positively but negatively as well. Quantitative research in bigger patient samples and randomized clinical trials will be necessary to verify these results.

Part of the book: Weight Management

By Anna Carr, Kate Tchanturia, Emmanuelle Dufour, Mary Cowan and Hubertus Himmerich

Anorexia nervosa (AN) is a serious and often highly persistent psychiatric disorder, whereby sufferers struggle to maintain a healthy weight. Its complexity creates challenges regarding treatment, however psychological therapy is recommended by the National Institute for Heath and Care Excellence (NICE). There are four major evidence-based psychotherapies recommended for treating adults – enhanced cognitive behavioural therapy (CBT-E), the Maudsley model of anorexia nervosa treatment for adults (MANTRA), specialist supportive clinical management (SSCM) and focal psychodynamic therapy (FPT)—and three main psychotherapies recommended for treating adolescents with anorexia-family therapy for anorexia nervosa (FT-AN), enhanced cognitive behavioural therapy (CBT-E) and adolescent focused therapy for anorexia nervosa (AFP-AN). Additionally, several novel adjunct treatments are under examination, two of which—cognitive remediation therapy (CRT) and cognitive remediation and emotion skills training (CREST)—are also discussed in this chapter. Other relevant areas regarding psychological treatment include: combinations of medication or occupational therapy and psychotherapy, treating individuals with comorbidities, the challenges of studying psychological treatment for anorexia and future directions of psychotherapies for anorexia, and are also discussed.

Part of the book: Weight Management

By Marie Hehl, Gemma Peachey, Ivana Picek, Camilla Day, Georgia Faulkner, Alexandra Harvey, Janet Treasure and Hubertus Himmerich

Diagnostic criteria for anorexia nervosa (AN) include significantly low body weight, fear of weight gain, and body image disturbance. Being severely underweight is associated with physical health risks, for example, electrolyte disturbances, epileptic seizures, cardiac arrhythmias, organ failure, and sudden death. It is also a perpetuating factor of AN. Therefore, the correct measurement of body weight is necessary for safe clinical management of AN. In clinical practice, there may be a requirement to attain a certain target weight before discharge from inpatient treatment or to prevent hospital admission. Schools, universities, and employers sometimes require a minimum body weight depending on the physical demands of the tasks at hand. Understandably, people with AN are therefore tempted to falsify their weight, for example, by water loading or using weights, to circumvent these restrictions and avoid disadvantages resulting from their mental health condition. In this chapter, we consider how to obtain an accurate assessment of body weight in the best possible collaborative, therapeutic, and motivating way.

Part of the book: Weight Loss

By Jessica McMahon, Ines Green, Titilope Omitogun, Ivana Picek, Gemma Peachey, Camilla Day, Janet Treasure and Hubertus Himmerich

Whilst no medication has yet been approved for the treatment of anorexia nervosa (AN), clinicians often prescribe psychopharmacological and physical health medication to help with low mood, anxiety, obsessive-compulsive symptoms, sleep problems and pain. However, shared decision-making (SDM) requires an informed patient who feels confident to make the decision on their medication together with the medical doctor. We have therefore designed an intervention that consisted of a leaflet and two seminars, one on psychopharmacological agents and one on physical health medication, and we have measured the patients’ own perception of their knowledge about medication before and after this intervention. A total of 11 patients with AN, 10 females and one gender-fluid person between 19 and 37 years of age who were currently treated in our inpatient or daycare service, agreed to participate in the quality improvement project. After the intervention, patients felt significantly better informed in four different domains: medications for eating disorders, mental health and physical health medication, and pro re nata (PRN) medication. The latter is medication that is given as required. Thus, a psychoeducational activity consisting of written information and seminars seems feasible to improve knowledge and SDM in people with AN. However, the small sample size limits the generalizability of our findings.

Part of the book: Weight Loss