MORTALITY AND SUDDEN-DEATH IN ANOREXIA-NERVOSA

Objective: Mortality rates of anorexia nervosa (AN) are generally assu med to rise with increasingly protracted follow-up periods. Reports ar e highly variable, with rates ranging between 5 and 20%. A rate of 5.9 % resulted from very recent meta-analyses. Causes of death of AN patie nts ranged from suicide to sudden death. Method: Findings so far publi shed on clinical course, follow-up, outcome, prognosis, mortality, and sudden death in AN cases were systematically analyzed with the view t o checking on divergent definitions of mortality rate, crude mortality rate, mortality death rate, and methodological problems of recording which may be causes of variability of data and evaluations. The same v ariability applied to descriptions of causes of death in AN. While sui cide data usually are precise, most of all deaths resulted from inadeq uately defined complications of eating disorder, and in some cases the cause of death, including sudden death, is reported as unknown. Resul ts: The crude mortality rate due to all causes of death of AN patients was found to be 5.9% by means of linear regression in a meta-analysis . However, no absolute, precise data were given on causes of death, in cluding sudden death in AN. Reference is made to the great variety of somatic alterations as well as to the role played by cardiac arrhythmi a and acute circulatory failure in the context of sudden death. Discus sion: Any AN death should be fully reported for proper elucidation of the causes. Neuroanatomic, neuropathological, and neurohistological st udies should be conducted, primarily into the right brain hemisphere f or accurate determination of etiological relationships between cerebra l function, brain alterations, and AN. An account is given in this pap er of preliminary results obtained from a quantitative-neurohistologic al investigation of the brain of a female AN patient aged 13.5 years w ho died a sudden death. (C) 1997 by John Wiley & Sons, Inc.