Home Remedies for Anorexia

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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Anorexia-Bulimia Home Treatment Program

The best way to treat Anorexia Bulimia is at home with an individual program. This gives people a chance to control their behavior by themselves and not be dependent on a group or a therapist. The Positive Energy Treatment is the anorexia and bulimia selfhelp method discovered by Karen Phillips. This method is based on the belief that recovering from bulimia requires you to change your subconscious mind. You need to change negative feelings and thoughts into positive ones. You need to change a negative identity into a positive one.

AnorexiaBulimia Home Treatment Program Overview

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Empirical Status Of Therapy For Bulimia Nervosa

The efficacy of CBT for BN has been evaluated in nearly 30 controlled studies. The percentage reduction in binge eating and purging across all clients receiving CBT is typically 80 or more compared to virtually 0 reduction in wait-list controls. Approximately 50 of those treated with CBT report complete cessation of all binge eating and purging at treatment termination. Large effect sizes for CBT are found for both behavioral symptoms (e.g., binge frequency 1.28) and cognitive symptoms (e.g., eating attitudes 1.35) (Whittal, Agras, & Gould, 1999 see also Lewandowski, Gebing, Anthony, & O'Brien, 1997). Furthermore, symptom reduction and cessation are fairly well-maintained across time with the majority of clients retaining therapeutic changes 1 year after treatment. The study with the longest follow-up period found that two-thirds of clients treated with CBT had no eating disorder at a 5-year posttreatment assessment (Fairburn et al., 1995). Furthermore, CBT has effects on the...

Classification of Eating Disorders Obesity

Obesity can be classified as an eating disorder since, primarily or secondarily, obese patients eat Figure 1 Classification of eating disorders based on the interaction between the preoccupation with food and body weight and the self-control of hunger. 1999 Academic Press. Figure 1 Classification of eating disorders based on the interaction between the preoccupation with food and body weight and the self-control of hunger. 1999 Academic Press. inappropriately for their increased weight and because obese individuals tend to suffer also from the other eating disorders. Anorexia Nervosa Anorexia nervosa is usually seen in younger women who restrict their food intake and increase exercise, causing a voluntary, stubborn malnutrition. Bulimia People who cannot control their hunger over a long period of time tend to have secret binging episodes. This is followed by an overwhelming feeling of guilt and depression, which frequently leads to self-induced vomiting. For this reason, the terms...

Hypothalamic Control of Hunger in Anorexia Nervosa

In normal individuals fasting and weight loss increase hunger by multiple mechanisms (decreased serum levels of leptin, insulin, and blood glucose and increased levels of ghrelin). At the level of the hypothalamus there is an increase in the potent orexigenic neuropeptide Y and other changes in neurotransmitters secondary to the fasting state. Some of these neurotransmitter changes may be the cause or a mechanism of anorexia nervosa, and for this reason they have received considerable attention in the past several years. It is important to understand that appetite control is a very complex hypothalamic function that involves many local and systemic neuropeptides, amines, and hormones. Abnormal serotonin activity has been found in the brain of women with anorexia nervosa. An area in the chromosome 1 (p36.3-34.3) that contains genes for the serotonin 1D receptor and for the opioid delta receptor was associated with patients with anorexia nervosa by linkage analysis. One polymorphism in...

Dbt Model Of Eating Disorders

DBT for ED is based on a broadly defined affect regulation model of eating disorders. The basic premise of the theory is that disordered eating serves to regulate intolerable affective states in individuals with few or no other adaptive strategies for regulating affect. Bingeing or bulimic behavior is explained as a result of trying to escape or block primary or secondary aversive emotions that may be triggered by thoughts regarding food, body image, perfectionism, the self, or interpersonal situations. Bingeing functions to quickly narrow attention and cognitive focus from these thoughts and to provide immediate escape from physiological responses and feelings. Over time, bingeing, as an escape behavior, becomes reinforced, especially if there are no more adaptive emotion regulation skills present. Eventually bingeing becomes an overlearned dysfunctional response to dysregulated emotions. The longer-term effects of bingeing or bulimic behaviors are secondary emotions such as feeling...

Is Toxic Anorexia Likely to Occur in Practise

LOEC data for toxic anorexia from some toxicants derived from the experiments in Chap. 3 are reviewed in Table 5.1. The LOEC is compared to concentrations of the selected substances in sewage water and effluent from a waste water treatment plant. Discharge of untreated sewage water may yield concentrations sufficiently high in order to stimulate occurrences of toxic anorexia, due to e.g. copper. The pesticide concentration in agricultural polder ditches can incidentally exceed the LOECs for toxic anorexia. A further comparison is made with water quality standards. From the table, it can be concluded that, for most of the substances, the LOEC for toxic anorexia is well below the quality standard used for surface waters in the Netherlands. These MPC's (Maximum Permissible Concentrations) are calculated from the principle that 95 of the species in the ecosystem must be protected. One exception, however, is dimethoate, where the LOEC for toxic anorexia (18 g l) is comparable with the...

Conclusion Toxic Anorexia a Factor to Be Considerd

In Chaps. 2 and 3, toxic anorexia has been demonstrated as a mechanism that can act as a forward switch, inducing a shift from a clear water state towards a eutro-phied state in small, artificial water bodies (80 laboratory cultures, and 5 m3 outdoor mesocosms). The concentrations of the toxic substances that induce this shift (such as metals and pesticides) are generally lower than the value at which toxic effects such as mortality or growth reduction occur. Despite this, the LOECs for toxic anorexia are sufficiently high for environmental quality standards to be safe. Thus, toxic anorexia is not expected to occur on a large scale in natural waters. In specific regional waters, however, environmental quality standards may be exceeded. An example is areas with intensive agriculture, where pesticide concentrations as high as 100 times the prescribed quality standard or more are observed. Toxic anorexia may well occur at these concentrations. It was demonstrated for an agricultural area...

TABLE 2832 Signs and Symptoms of Bulimia in Adolescents and Young Adults

A diagnosis of bulimia3 is suggested by the following A third diagnosis3 to be considered is eating disorder not otherwise specified. It is characterized by 1. For females, all criteria for anorexia except still menstruating 2. All criteria for anorexia except normal weight 3. All criteria for bulimia but lower frequency or duration 6. Binge-eating disorder The diagnosis of an eating disorder should be considered in a premenarchal patient who engages in potentially unhealthy weight-control practices and or demonstrates obsessive thinking about food, weight, and height, especially if there is a delay in the maturation for gender and age. Families of patients with eating disorders tend to be outwardly orderly, respectable, and conventional. However, the inner dynamics of the family involve a rigid adherence to secret obligations and stifling prohibitions. Honesty and spontaneity are discouraged, and true autonomy and self-gratification are submerged beneath the adolescent's desire to...

Case Examples A Anorexia Nervosa

Patsy was a 17-year-old high school student who had been suffering from anorexia nervosa since the age of 13. She was characterized by her family as a tenacious and diligent student, and she had been an excellent athlete in middle school and earlier in high school. Starting at ages 9 and 10 she clearly excelled in track and appeared to be headed for the State championship team. However, at age 13, shortly after she first started to menstruate, she started to diet severely in response to a casual remark by a friend at practice concerning her weight. At first her parents thought little of it, but within a few months she had lost considerable weight and the family took her to her pediatrician, who diagnosed anorexia nervosa and referred her to a child psychologist. The pediatrician also thought she was depressed and obsessional and started to treat her with paroxetine (Paxil), a selective serotonin reuptake inhibitor used to treat depression and obsessive-compulsive disorder. maintained...

Anorexia Nervosa And Bulimia Nervosa

Anorexia nervosa and bulimia nervosa have reached epidemic proportions in the last 15 years. These diseases were once viewed as purely psychological in nature. However, increasing evidence has confirmed that both disorders involve physical complications, and knowledge of and ability to treat the medical complications of eating disorders are crucial for the patient's well-being. Eating disorders affect between 5 and 10 percent of adolescent girls and young women, and up to 0.10 percent of males. Originally regarded as rich girls' diseases, they are now recognized across all socioeconomic and racial groups and in patients between the ages of 8 and 80. The onset of anorexia is usually between 12 years of age and the mid-thirties, with a bimodal distribution at ages 13 to 14 and 17 to 18. Bulimia usually begins between the ages of 17 and 25. The onset of both disorders has been reported in older persons.12 Anorexia, with its resulting starvation syndrome, is more likely to be recognized...

TABLE 2833 Physiologic Changes Associated with Eating Disorders

Self-induced vomiting results in various disorders. Dental problems are caused by gastric acid regurgitation into the oral cavity. In addition, the oral hygiene of most anorexics is poor, and the vigorous brushing often done by bulimics aggravates dental problems. This poor oral hygiene, together with dietary deficiencies and dehydration of the soft tissue of the mouth, can cause gingivitis and dental erosion. Osteoporosis is common in anorexics. It usually affects the femur, radius, and spine, in order of decreasing frequency. Estrogen deficiency is not a major causative factor. Any patient with an eating disorder who has been amenorrheic and low in weight for more than a year should undergo bone-density studies. A femur fracture has been reported in a young anorexic who tripped on a rug.6 Adolescent diabetics induce ketosis by skipping insulin for a day or two to lose weight sometimes they overeat and increase insulin in compensation. The abuse of insulin and food can lead to severe...

Binge Eating Disorder

Psychotherapy research involving binge eating disorder has been largely based on treatments for bulimia nervosa and, because substantial numbers of binge eating disorder patients are overweight or obese, on psychotherapy treatment research for obesity. Because obesity is a common comorbid condition, researchers have been concerned with how to relate treatments designed to reduce binge eating behavior with those designed to enhance weight loss. Based on available studies, most experts agree that initial therapeutic aims should focus on reducing binge eating episodes. Once binge eating has been controlled weight loss programs may be more effective. Nevertheless, when results are examined at 5 years after treatment the enduring impact of weight loss programs is not very impressive. For obese patients, non-diet approaches that stress self-acceptance, improving body image, and improving health and fitness through exercise and better nutrition, are being developed as alternatives to...

Early Detection Of Eating Disorders

The value of early detection of a disorder is generally undisputed in medicine. Foremost among the benefits of early detection is the chance for early treatment, enhancing the likelihood for a shorter duration of illness and a full recovery. Commonly, heightened public awareness about medical disorders facilitates early diagnosis however, so far this has not happened in the eating disorders. Certainly one reason is that the public finds it difficult to distinguish between widespread and perhaps justified dieting efforts that often lead to disordered eating and the restrictive eating habits seen in the eating disorders. Since in the early phase the signs and symptoms of intractable dieting - e.g. refusal to eat, weight loss, sense of loss of control over eating - can overlap with the symptoms in AN or BN, physicians and health care personnel need to be cognizant of the differences in the signs associated with temporary dieting and the symptoms of an eating disorder. The DSM-IV...

Empirical Status Of Cbt For Anorexia Nervosa

Empirical investigations of the efficacy of CBT for AN are just beginning to appear in the literature. Currently, only two controlled trials of CBT for AN have been published. Serfaty, Turkington, Heap, Ledsham, and Jolley (1999) randomized 35 persons with AN to either CBT or nutritional counseling. After 6 months of treatment, dropout rates were 8 for CBT and 100 for nutritional counseling. Those receiving CBT showed significant increases in body mass index, and significant decreases in eating disorder symptomatology and depression. Of those who completed CBT, 70 no longer met diagnostic criteria for AN. Adding to these findings, Vitousek (2002) described an unpublished study comparing CBT to nutritional counseling with medical management in the treatment of AN. Similar to Serfaty et al. (1999), fewer patients in the CBT condition dropped out (27 versus 53 ) and more met criteria for good outcome at the end of treatment (44 versus 6 ). One recent study examined the efficacy of CBT...

Anorexia Nervosa

Few controlled trials of psychotherapy for anorexia nervosa have been published, in part due to the tremendous difficulties of conducting such trials with this population, especially during phases when the patients are seriously underweight. Consequently, recommendations regarding the role of psychotherapy in early phases of treatment rely strongly on consensus opinions of experienced clinicians and clinical researchers. Investigators increasingly appreciate just how much malnutrition in anorexia nervosa contributes significantly to cognitive impairment and to increases in many characteristic psychopathological features including obsessional thinking, perfectionism, and other eating-disorder related attitudes, as well as symptoms of anxiety, depression, and emotional lability. With nutritional rehabilitation alone, many of these psychopathological features improve significantly. Accordingly, current views suggest that the initial treatment of the undernourished patient with anorexia...

Bulimia Nervosa

Jill came for treatment when she first met a man she really cared about, who seemed to care about her as well. She realized that the odds of getting into a serious relationship with him would be jeopardized by her disorder she feared that telling him about her bulimic symptoms would result in his dropping her, and she Jill and her therapist started by conducting a full review of her past history and current symptoms. Together they used a cognitive-behaviorally oriented treatment manual designed for individuals with bulimia nervosa. They started with twice-weekly sessions and gradually moved to weekly sessions. Highly motivated at this point, Jill dutifully completed her homework assignments, which focused on keeping a diary of her regular meals and binge eating episodes, together with records of her associated thoughts and emotions. She discovered that she was actually restricting her food intake somewhat, and that when she increased her regular meals the hunger pangs that often...

Toxic Anorexia

Reduced daphnid grazing effectiveness, or reduced feeding rate, due to toxic stress can be considered to be 'toxic anorexia'. Anorexia literally means loss of appetite. When referring to human appetite, Anorexia nervosa is a denial of nourishment by an individual to his or herself due to an, often irrational, fear of becoming fat or to bring about, often unnecessary, weight loss. In the case of toxic anorexia, the loss of appetite is induced by the presence of one or more toxic substances. This effect does not necessarily involve the binding of the toxic substance to a receptor, which results in damage to either tissue or metabolic processes.

Dietary Intake Measurement

See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors. Zinc Physiology. See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors Zinc Physiology. See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Follic Acid Physiology, Dietary Sources, and...

Specific Nutrients Calcium

Decade, there is a steady decline in bone calcium. This is especially marked after menopause in women, when estrogen declines, and often leads to bone loss (osteopenia) to below a threshold that predisposes women in particular to fractures (osteoporosis). Osteoporosis is not just a disease of the elderly, and may occur in much younger patients, especially athletic young women, those with anorexia nervosa, those on steroids and other medications, and in anyone on prolonged bed rest, including astronauts experiencing long periods of weightlessness.

Recommended Readings

Anorexia Nervosa Keywords anorexia nervosa, cognitive behavioral therapy Cognitive-behavioral therapy (CBT) for anorexia nervosa (AN) is similar to that for bulimia nervosa, but, much less has been written regarding the cognitive-behavioral approach to AN. Treatment development and evaluation for AN has been slower than that for other eating disorders likely due to the ego-syntonic and intractable nature of AN. Current CBT treatments for AN draw on a cognitive-behavioral model of the precipitation and maintenance of the disorder, and are practiced with particular emphasis on the motivation and physical health of the client.

TABLE 2314 Symptoms and Signs of Hypercalcemia

A mnemonic sometimes used for the signs and symptoms of hypercalcemia is stones (renal calculi), bones (osteolysis), moans (psychiatric disorders), and groans (peptic ulcer disease and pancreatitis). The most common gastrointestinal symptoms are anorexia and constipation, but these are very nonspecific.

Hypothalamic Regulation Of Aggression

Clinical observations in humans suggest a broadly similar role for the hypothalamus in human aggression. Neoplasms that destroy the ventromedial hypo-thalamic area bilaterally are associated with attacks on caregivers reminiscent of animal aggression following ventromedial lesions. In the classic report of Reeves and Plum, a 20-year-old woman developed bulimia and obesity, amenorrhea, diabetes insipidus, and profound behavioral change. Over a 2-year period, she displayed outbursts of aggression characterized by indiscriminately scratching, hitting, or biting examiners who approached. She denied experiencing angry or vindictive internal feelings toward these individuals and expressed surprise and regret regarding her attacks. The outbursts tended to occur more frequently when she had not eaten for several hours, suggesting the emergence of predatory-like aggression. Postmortem examination revealed a hamartoma destroying the ventromedial hypothalamus. In another case report, a patient...

Biomedical and Behavioral Science

To evaluate the effectiveness of animal models, consider an example in the behavioral sciences. Bulimia is a disorder in which an individual's eating behavior becomes bizarre and his or her body image becomes distorted. In her overconcern about her body image, an adolescent female might eat large quantities of junk food and then vomit (binge-purge behavior). In the animal model of this disorder, a hole is made in the stomach wall when the animal eats, the food is siphoned off. Through this model of the condition of eating without calories,'' scientists attempt to identify and understand various environmental, dietary, and physiological causes of bulimia. Various forms of evaluation of this animal model were applied with the following results. Through examination of outcome studies of current treatments of bulimia, it was found that these treatments are only modestly and temporarily effective. Treatments reduce the frequency of binge-purge behavior but do not eliminate it, and relapse...

Bone turnover and agerelated bone loss

Age-related bone loss therefore occurs more rapidly in trabecular bone (which turns over more rapidly) and is increased by factors that promote bone turnover (transient calcium deficiency). Risk factors or disease states associated with either low peak bone mass or increased rates of loss include small body size, nulli-parity, inactivity, early natural menopause, anorexia, thyrotoxicosis, and Cushing's syndrome.

Practical Management of Eating Difficulties

Anorexia Anorexia (loss of appetite) is often associated with other eating difficulties, such as nausea, taste changes, and constipation, and addressing these problems may improve the patient's appetite. Pain may also contribute to anorexia, and regular analgesia for pain may in turn help improve appetite, as may dietary alterations (Table 2). For patients who have severe anorexia, an appetite stimulant should be considered, such as dexamethasone, medroxyproes-terone acetate, or megestrol acetate. Table 2 Dietary management of anorexia

The Potential Therapeutic Role of Vitamins

See also Cancer Epidemiology and Associations Between Diet and Cancer Epidemiology of Gastrointestinal Cancers Other Than Colorectal Cancers Epidemiology of Lung Cancer Effects on Nutritional Status. Cobalamins. Colon Nutritional Management of Disorders. Diarrheal Diseases. Eating Disorders Anorexia Nervosa. Folic Acid. Nutritional Support Adults, Enteral Adults, Parenteral Infants and Children, Parenteral. Supplementation Dietary Supplements. Vitamin B6. Vitamin D Physiology, Dietary Sources and Requirements. Vitamin E

Physiological Effects of Malignancy

Cancer cachexia is a syndrome suffered by many, but not all, patients with cancer. It is most prevalent in patients with tumors of the lung, head and neck, or gastrointestinal tract. Features of cachexia include weight loss, muscle wasting, lethargy, anorexia, early satiety, anemia of a nonspecific type, and altered host metabolism.

Clinical Features

Patients with subacute left-sided disease present with recurrent intermittent fever and constitutional symptoms such as malaise, anorexia, or weight loss. The diagnosis is frequently missed. Patients may give a history of recurrent flu or report several courses of antibiotics for presumed bacterial infections, such as bronchitis. The majority of patients with left-sided subacute disease have a murmur of aortic or mitral regurgitation or a change in their previous murmur at the time of their admission to the hospital. However, many admitted patients have been examined previously by a physician who did not detect the murmur. Patients may have Roth spots, which are retinal hemorrhages with central clearing. Peripheral evidence of endocarditis includes Osler nodes, tender nodules on the tips of the toes and fingers, and Janeway lesions, nontender plaques on the soles of the feet and palms of the hands, and clubbing. Petechiae may be seen on the conjunctiva, hard palate, neck, and upper...

Evidence for Bidirectionality

Additional evidence supporting the role of the vagus as a major pathway between the peripheral immune system and the CNS stems from the fact that the brain regions in which the vagus terminates have been found to play an important role in the various symptoms of sickness behavior. The primary area of termination for the vagus nerve is within the NTS. The NTS and the area postrema are activated in response to ip injections of IL-1 and appear to be very sensitive to low levels of this cytokine. Areas within the NTS project to the paraventricular nucleus of the hypothalamus, which controls production and secretion of CRH, one of the hormones found to be produced in response to immune activation. The hypothalamus has been found to play a major role in the production of symptoms such as anorexia and fever. In terms of the specific symptom of reduced consumption, it has been demonstrated that IL-1b suppresses the neural activity of glucose-sensitive neurons in the lateral hypothalamus and...

Clinical Description

Although some patients are asymptomatic with coincidental detection of a leukocytosis on routine medical evaluation, the chronic phase of disease typically has an insidious onset with symptoms related to hypermetabo-lism, including fatigue, anorexia, weight loss, and night sweats. Massive splenomegaly is common. With disease progression, patients typically develop worsening anemia and thrombocytopenia. Without treatment, the median survival of CML is 4-5 years from diagnosis.

Natural Infections

Although infection may be asymptomatic, symptomatic disease typically follows a predictable course. Clinical signs at the onset of disease in horses and sheep are nonspecific excited or depressed behavior, hyper-thermia, anorexia, jaundice, constipation, and colic. Classical disease becomes apparent within 1 or 2 weeks. Animals maintain an upright, wide-based stance with their heads extended. Repetitive behaviors are common and may include vacuous chewing, circular ambulation, and running into obstacles. Horses become paretic in the terminal phases of disease. A distinctive decubitus posture associated with paddling movements of the legs has been described. Frequently, in late disease, the virus migrates centrifugally along the optic nerve to cause retinopathy and visual impairment. Acute mortality may be as high as 80-100 in horses and 50 in sheep. Sheep that survive may have permanent neurologic deficits. Recurrence of acute disease has been described in sheep. Natural symptomatic...

Applications And Exclusions

Almost any behavioral therapy that is used in an individual (one-to-one) format can be implemented as a group therapy. Examples include behavioral treatments for mood disorders, anxiety disorders, eating disorders, and substance-use disorders. Group size, session duration, and session frequency can be adapted to fit the specific needs and resources of a given treatment setting. Groups typically consist of 8 to 10 patients and 1 to 2 therapists. Group sessions are typically 2 to 2.5 hours, and last from 10 to 14 weeks. Problem-specific programs treat more homogeneous groups of patients. Examples of panic disorder and social phobia programs were described earlier. Other examples include protocols specifically for depressed patients, and protocols specific for patients with bulimia nervosa. There has been little research on whether generic or specific programs are most effective. Patients with emotional disorders are likely to

Acute Mesenteric Infarction

The specific risk factors to be aware of are listed in Table.M69 2 The principal manifestation of mesenteric infarction is severe abdominal pain, often refractory to narcotic analgesics. Such severe pain combined with a relatively normal abdominal examination is considered the sine qua non of early mesenteric infarction. Despite its vascular nature, the overall spectrum of mesenteric ischemia involves a gradual onset of abdominal pain. If an embolus is the cause, sudden, severe pain may be reported.20 Prior episodes can be reported, particularly if mesenteric arterial thrombosis is the cause. Associated gastrointestinal symptoms are very common and should not lead the physician astray. Nausea, anorexia, and vomiting are common, and up to half of these patients will report diarrhea. Objective findings on physical examination are inevitable and should be considered an indication of intestinal necrosis and possible perforation. Theoretically, the stool should be guaiac-negative early on....

Morphology and Transmission

The trophozoite measures 5-15 m and pseudopodia are angular. No flagella is present. The cytoplasm is highly granular and it is characterized as having one to two nuclei without peripheral chromatin and karyosome clusters of four to eight granules. Cysts have not been identified in Dientamoebafragilis. This amoeba-flagellate does not have a cyst form and its transmission is less understood. However, transmission is suspected to be associated with helminth eggs such as Acaris and Enterobius. Higher incidences have been reported in mental institutions, missionaries, and Indians in Arizona. It has been reported in pediatric populations (Anonymous, 1993). Symptoms include fatigue, intermittent diarrhea, abdominal pain, anorexia, and nausea. It has been reported to cause noninvasive diarrheal illness. Dientamoeba colonizes the cecum and the proximal part of the colon. Reports of Dientamoeba are limited

Complex Behaviors Complex Causes

Thus, for use and abuse of alcohol, we know that the importance of genetic and environmental effects changes with sequencing in the use and abuse of alcohol, from abstinence or initiation to frequency of regular consumption, to problems associated with consumption, and ultimately, to diagnosed alcoholism and end-organ damage from the cumulative effects of alcohol. Similar stories could be told for many other behaviors of interest. Thus, for the major psychopathologies, from depression and schizophrenia in adults to attention deficit disorder in children or eating disorders in adolescents, genetic influences are invariably part of the story but never the whole story.

Ventricular Tachyarrhythmias

The long QT syndrome, in which the corrected QT interval is pathologically prolonged, is also associated with SCD. 10 Prolongation of the corrected QT interval probably represents dispersion in ventricular repolarization and can be congenital (with or without nerve deafness) or acquired (due to hypokalemia, hypomagnesemia, hypocalcemia, anorexia, ischemia, central nervous system pathology, terfenadine-ketoconazole combinations, or certain antipsychotic or antiarrhythmic drugs). The corrected QT interval can be calculated easily by the following formula

Clinical Description Of Infection

Disease in human hosts greatly depends on the condition of the host, with more severe outcomes in immunocom-promised and malnourished individuals. 4 Most patients present profuse watery diarrhea containing mucus, 7-10 days after acquisition of infection. In immunocompetent hosts, the disease is usually self-limiting with a median duration of 9-15 days. Acute diarrhea may be resolved in a few days or may persist for 4-7 weeks. Three major presentations of symptoms are observed 1) asymptomatic carriage, 2) acute, usually watery diarrhea, and 3) chronic, persistent diarrhea for several weeks. Other symptoms include abdominal cramps, anorexia, nausea and vomiting, fatigue, low-grade fever, and cough. A different picture is seen in immunocompromised patients. Four clinical patterns of infection are observed in AIDS patients with chronic infection as the most common presentation 1) asymptomatic, 2) transient infection with diarrhea cleared within 2 months, 3) chronic infection, diarrhea for...

TABLE 731 Traditional Drugs for Peptic Ulcers

Traditional emergency department treatment would entail initiating a trial of antacids and or H 2RAs and early referral to a primary care provider to direct evaluation and subsequent treatment. This still is a reasonable option. Immediate referral for definite diagnosis is mandated if certain alarm features are present advanced age, weight loss, long history, anemia, persistent anorexia, early satiety, persistent vomiting, or gastrointestinal bleeding. 11 16 Cost-effectiveness analysis supports treatment of H. pylori-positive dyspeptic patients with antimicrobial and antisecretory therapy followed by endoscopic study only in those with persistent symptoms.3,1 18 It would also be reasonable for the emergency department physician to begin symptomatic therapy, order serologic testing for H. Pylori, and refer for early follow-up with a primary care provider for initiation of antibacterial therapy if the test results are positive.

General features of CAH

The general features include symptoms of hepatitis, including nausea, anorexia, jaundice, hepato-splenomegaly, and biochemical evidence of liver parenchymal damage, in particular high levels of transminase enzymes in serum. The biopsy of the liver may show either of two histological lesions, named as chronic persistent hepatitis which is indolent and nondestructive, or chronic active hepatitis in which the main morphological feature is the disruption of the peripheral limiting plate of the liver lobule, with a periportal 'spillover' of the inflammatory exudate into the liver parenchyma 'piecemeal necrosis' (Figure 1). This lesion generates scarring and eventually macronodular cirrhosis (Figure 2). Hepatocellular carcinoma is a frequent late sequel in CAH due to chronic virus infection but is seldom seen in autoimmune hepatitis. There are features unique to each of the individual categories, as indicated below.

Basic Tenets And Philosophy

Relative to other treatment approaches, CBT for children has received strong empirical support. Today CBTs are applied to a wide range of childhood problems and disorders including anxiety and phobic disorders, depressive disorders, aggressive and disruptive behavior problems, substance abuse and eating disorders, as well as pediatric or medical concerns (e.g., coping with painful medical procedures, enuresis, and irritable bowel syndrome). Although reviews clearly highlight the need to develop more and better empirically supported treatments for youth, CBTs for children and adolescents stand out in that they have led the way in doing so. For example, a recent review of the empirically supported treatment literature finds support for CBTs in the treatment of anxiety disorders and phobic disorders, conduct disorder oppositional defiant disorder, chronic pain, depression, distress due to medical procedures, and recurrent abdominal pain (Chambless & Ollendick, 2001). In addition,...

Etiology of Tooth Wear

The enamel surfaces of the crowns of the teeth may be damaged by wear arising from abrasion, attrition, or erosion. Abrasion can arise from the action of rubbing a hard substance across the surfaces of the teeth, for example when brushing too vigorously with a hard toothbrush. Attrition involves one tooth surface wearing down because of contact with another. A third form of wear involves the direct erosive action of acids present in foods (such as yoghurt or pickles) or drinks (especially citrus fruit juices). No bacterial metabolism is required for these processes to occur. It is unclear, however, whether the apparent increase in the prevalence of clinically apparent erosion of the teeth is the result of dietary habits or of some other factor. Only recently have dental-health surveys assessed this problem specifically, so it is possible that it has been noticed more, rather than actually occurring more, in these later surveys. It is also not always possible to distinguish acid...

Food Intake during Diarrhea

Food intake during diarrhea is often reduced due to poor appetite (anorexia), vomiting, deliberate withholding of food, and inappropriate dietary supplementation with diluted food items. Diarrhea can also be associated with fever. Both fever and anorexia have clear effects on the nutritional status of the host. An increase in body temperature of 1 C causes an increase in the basal metabolic rate of 12-23 . Although the reason for anorexia is not clear, its effect can be important. In a controlled study in Bangladesh, 41 hospitalized children with acute diarrhea consumed only about half of the total calories consumed by healthy children despite an educational intervention.

Contemporary Contributors And Empirical Research On Cognitive Vulnerability

Two current researchers, Lauren Alloy and Lyn Abramson, have played a major role in spearheading the use of behavioral high-risk designs of cognitive vulnerability. Their Temple-Wisconsin Cognitive Vulnerability to Depression (CVD) Project is more advanced in testing prospective designs than any comparable program of vulnerability research in other disorders, and is an exemplary program of cognitive vulnerability research. In the case of other disorders (e.g., anxiety, eating disorders), research has moved more slowly but is speeding up.

Criticisms Of Cognitive Vulnerability Research

Another criticism of cognitive vulnerability research is that most of the work has concentrated on depression. As noted, cognitive vulnerability research on factors involved in risk of future anxiety, eating disorders, or schizophrenia is in need of further development, particularly in terms of high-risk, behavioral designs.

Adipose Tissue Hormones

The adipose tissue secretes different hormones called adipocytokines. Their secretion seems to vary in relation to the amount of adipose tissue accumulated, although the exact mechanism is not known. During profound weight loss, as in anorexia nervosa, there is a marked decrease in the adipose tissue mass with the typical changes in adipocytokines secretion that occur in these circumstances. One of the most studied adipocytokine changes is decreased leptin secretion. Increased fat mass stores are accompanied by an increased leptin secretion decreased fat mass stores decrease leptin secretion. Low serum levels of leptin reaching the hypothalamus increase the activity of the 'hunger center,' in part by increasing the local activity of neuropeptide Y. Individuals with anorexia nervosa have very low levels of leptin in blood and cerebrospinal fluid, in relation to their decreased adipose tissue. This should cause an increase in hypothalamic neuropep-tide Y content and hunger, but this...

Psychiatric Treatment

Despite the common use of antidepressants, several double-blind trials have been inconclusive or only slightly favorable. Patients with clear manifestations of depression and the more severe cases seem to benefit more from these medications. Tricyclic antidepressants tend to increase appetite and are more suited for patients with pure anorexia nervosa. Selective serotonin reuptake inhibitors may help decrease binging in patients with associated bulimia. Olanzapine, an atypical antipsychotic medication associated with weight gain, has been shown to be useful in some patients with anorexia nervosa in uncontrolled studies.

Nutritional Treatment

Initially, oral intake should be monitored carefully with a nurse sitting through the eating period and for 30 min thereafter to prevent postprandial vomiting. The tray should be checked for any food not consumed. In this way, a careful energy count is obtained daily. If the energy intake is inadequate or if the patient is not gaining weight, the diet should be supplemented with low-residue, high-energy canned formulae dispensed by the nurse during medication rounds. These diet supplements should be consumed in front of the nurse. Many patients with anorexia nervosa have subclinical vitamin deficiencies and they should receive a multivitamin tablet every day.

Dietary Management

Dietitians and nutritionists are increasingly involved in the treatment of bulimia nervosa. While this is best utilized within a multidisciplinary team, ideally with some form of psychological intervention available, it is not uncommon for dietitians or nutritio-nisists to be the only professional involved. Any professional working with eating disorders should be clear about what they can address and be aware of when it is appropriate to enlist other forms of help. Thus, nutritional intervention should aim to separate food from underlying issues, leaving these to be addressed by professionals more experienced in psychological techniques. Research suggests that nutritional intervention, alongside other psychological therapies, most notably cognitive behavior therapy (CBT), is an important part of treatment. In addition, training in CBT techniques is advized for dietitians and nutritionists involved in bulimia nervosa management. The aim of dietary management of bulimia nervosa is to...

Assessment of Binge Eating

Table 1 DSM-IV-TR criteria for binge eating disorder 5. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, and excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa.

Prevalence and Risk Factors

More diverse, affecting relatively more men and minority groups than BN or anorexia nervosa. Furthermore, binge eating is more prevalent among obese individuals in both clinical and community samples. It is estimated that up to one-third of individuals who present for treatment in university-based weight control clinics report significant binge eating.

Selection of Treatment for Specific Patients

Eating disorder and obesity history A history of early onset of binge eating, binge eating in the absence of obesity, or obesity in combination with numerous bouts of weight loss and regain over time ('yo-yo' dieting) suggests a course of psychosocial treatment. Such patients can be reassured that significant improvements in the aberrant eating and eating disorders psychopathology associated with BED can be obtained without weight loss. On the other hand, clinical experience suggests that patients who report adult onset of binge eating and obesity, and do not have a history of marked weight fluctuations, may be more likely to benefit from a behavioral weight control approach. Behavioral weight control may also be indicated for patients who remain overweight after a trial of eating disorders treatment. Although behavioral weight control appears to be beneficial on average, it is important for each individual to evaluate the likelihood that he or she will be able to sustain lifelong...

Existential Analysis Theory

Philosophical existentialism is an approach holding that one's existence cannot be studied objectively, but is revealed via reflection on existence in space and time it tends, also, to reject objective values and to discredit scientific knowledge and methodology. Psychoanalytical existentialism (daseinsanalysis) seeks to reconstruct the inner experience of patients, not necessarily to cure symptoms the goal of this therapeutic approach is to get patients to confront their existence and to exercise their personal freedom and autonomy. Binswanger's case study of Ellen West - the pseudonym of a young woman patient with anorexia nervosa who experienced extreme mental distress, ending in her tragic death - is one of the most disturbing, and celebrated, case studies in the literature of existential analysis and psychiatry. See also FREUD'S THEORY OF PERSONALITY MEANING, THEORY AND ASSESSMENT OF. REFERENCES

Theoretical Integration

If these approaches are to be comprehensive in scope, then each must answer the question of how psy-chopathology develops. Efforts have been made to articulate etiology so that treatment may be informed with greater clarity. We have identified two different perspectives on this matter. First, a radical cognitive perspective supports the idea that negative (and positive) thoughts arise through discrete learning opportunities. Therefore, one has opportunities to understand emotional reactions through a lens of either rational or irrational beliefs, and these beliefs are shaped by feedback from significant others or information provided by various sources. The second (and more popular) view involves the presence of dispositional traits that set up opportunities for developing these same maladaptive patterns of thinking. There are numerous examples of how preexisting traits may predict later psychopathology such as anxiety sensitivity and panic disorder and other anxiety conditions,...

Personality Differences by Gender

Female addicts are much less visible. Most bulimics and people with eating disorders are female, although males are slowly catching up. Obesity affects both genders equally, with increasing numbers of children affected. As in other Western societies most obese people are generally from lower social classes.

TABLE 791 Vomiting and Diarrhea The Gastroenteritis Mnemonic

PHYSICAL EXAMINATION Clinical clues may also assist in making the diagnosis. In addition to evaluating the ABCs, much of the physician's initial attention should be directed toward the assessment of hydration status. Severely volume-depleted patients require immediate intervention, lest circulatory collapse be imminent. The abdominal, genitourinary, and pelvic examinations are often revealing. Physicians should search carefully for tenderness, peritoneal signs, hernias, masses, and evidence of obstruction or torsion. The findings of a careful physical examination may point toward unsuspected causes of vomiting, such as bulimia (scars on the dorsum of hands), pneumonia (consolidative findings on lung examination), or Addison's disease (hyperpigmentation). The rectal examination is important. An anal fistula may be the only clue to Crohn's disease in an otherwise healthy teenager with vomiting, or may demonstrate fecal impaction.

Prolonged QT Syndrome

This is searched for more than any other etiology as a cause of syncope in young healthy children. In nearly all cases, the syndrome is inherited and is associated with deafness in about 75 percent of cases. Secondary, noncongenital cases result from anorexia, bulimia, or chronic ingestion of antidysrhythmic medications. Undiagnosed, untreated, or undertreated congenital prolonged QT syndrome results in a mortality rate in excess of 90 percent.

Clinical Significance

Frequently, Balantidium infections can be asymptomatic however, severe dysentery similar to those with amoebiasis may be present. Symptoms include diarrhea or dysentery, tenesmus, nausea, vomiting, anorexia, and headache. Insomnia, muscular weakness, and weight loss have also been reported. Diarrhea may persist for weeks or months prior to development of dysentery. Fluid loss is similar to that observed in cholera or cryptosporidiosis. Symptomatic infections can occur, resulting in bouts of dysentery similar to amebiasis. Colitis caused by Balantidium is often indistinguishable from E. histolytica (Castro et al, 1983). Diarrhea, nausea, vomiting, headache, and anorexia are characteristic of balantidiasis.

Three classic US cases 1979 and Vijay Soman 1981 and John Darsee 1985 and Robert Slutsky

Soman was an assistant professor of medicine at the Yale School of Medicine, who plagiarised parts of a manuscript sent in 1978 by the New England Journal of Medicine for peer review to his boss, Philip Felig, who passed the job on to him. Subsequently Soman and Felig published an article on the same topic, insulin binding in anorexia nervosa, in the American Journal of Medicine. Accused of plagiarism and conflict of interest, Felig seemed to settle the difficulties by stating that the work had been completed before they had received the paper for review. But its author, Dr Helena Wachslicht-Rodbard, a young researcher at the National Institutes of Health (NIH), who during this episode was to switch to hospital practice, persisted with her complaints. An inquiry by Dr Jeffrey Flier, a Boston diabetologist, in February 1980 showed that these were justified. Not only had Soman copied her manuscript, but most of the data in his own joint study had been faked. A subsequent investigation...

Other Clinical Characteristics

Anorexia nervosa is more frequent among daughters of white, affluent, achievement-oriented families in developed societies it is extremely uncommon in areas of the world with poor nutrition. It tends to occur during the last years of high school or at the time of departure to a university or college. The onset of anorexia nervosa is usually subacute, over a period of weeks, not uncommonly after an episode of weight gain or after somebody has made a comment about the patient being overweight. Initially, it appears as an innocent attempt to lose weight, but soon thereafter it starts showing its rebellious and progressive nature. Anorexia nervosa appears in small epidemics in cities and countries, probably owing to social pressures and to imitation behaviors. In primary or classical anorexia nervosa, patients lose weight by dieting (restrictive) and exercising. These patients tend to be younger, more naive, introverted, and obsessive, and they do not resort to subterfuges to lose weight....

Linking Body Fat and Reproduction

It is well documented that women who are underweight, or too lean, because of injudicious dieting, excessive athletic activity, or both, experience disruption of their reproductive ability. It is also well documented that moderate weight loss, approximately 10-15 of normal weight for height, unas-sociated with anorexia nervosa (where weight loss is approximately 30 below ideal weight), results in amenorrhea due to hypothalamic dysfunction. Weight loss in this moderate range is equivalent to a loss of one-third of body fat. If the excessive leanness occurs before menarche, menarche may be delayed until as late as the age of 19 or 20 years.

Differential Diagnosis

The differential diagnosis should include the anor-exoid syndromes. In pure anorexia nervosa the weight loss is due only to restrictive eating habits and exercise. Some anorexic patients may start bin-ging and inducing vomiting, in which case their condition is called bulimarexia. In some cases, anorexia nervosa is secondary to a serious, underlying psychiatric illness, with the weight loss being only an added problem. A particular diagnostic and therapeutic dilemma may occur for young women with personality disorder or chronic schizophrenia and anorexia nervosa.

Clinical Manifestations

Trophozoites of these parasites are located in the duodenum, jejunum, and upper ileum. When symptoms occur, they vary from mild to severe abdominal discomfort, diarrhea, cramping, and bloating. 1,2 Infants may have anorexia, weight loss, or a malabsorption syndrome that resembles sprue. 3,4 When a child is evaluated because of failure to thrive or is immunocompromised, the presence of Giardia should be considered. 5 Lactose intolerance may develop in these children and persist after elimination of the parasite.

Biological effects in vivo

The biosynthesis of recombinant GM-CSF protein has permitted a wide number of studies to be undertaken on the efficacy of GM-CSF as a therapeutic agent. As predicted from in vitro studies, GM-CSF has proved to be a potent stimulator of hematopoiesis when administered in vivo. Administration is generally well tolerated but may be associated with bone pain and influenza-like symptoms, including fever, flushing, malaise, myalgia, arthralgia, anorexia and headache. These effects are usually mild, are alleviated by antipyretics and resolve with continued administration. At higher doses, GM-CSF has been associated with a capillary leak syndrome.

Gastrointestinal Emergencies in Children 2 Years and Older

APPENDICITIS Clinical Features Although appendicitis can occur in children younger than age 2, the presentation is usually one of peritonitis or sepsis because of the delay in diagnosis.10 Over age 2, appendicitis becomes a more important part of the differential diagnoses of abdominal pain. The classic progression of symptoms associated with appendicitis applies equally to children and adults. The events involve early anorexia followed by the development of mild to moderate periumbilical pain and then vomiting and the movement of the pain to the right lower quadrant of the abdomen. The youngster should be observed walking into the examining room in most instances, the child appears to be in discomfort as he or she moves along. This discomfort associated with motion can be exacerbated by asking the youngster to jump up and down before he or she lies down on the examining table. On inspection of the patient, the physician may find limited motion of the lower abdomen due to inflammation...

Psychological influences

Particularly influential in relation to the study and attempted manipulation of food choice are discussed. Note that only psychological influences on normative food choice are discussed here and not the etiology of complex psychological disorders, such as anorexia nervosa.

Hierarchy of Constraints

See also Appetite Physiological and Neurobiological Aspects Psychobiological and Behavioral Aspects. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Energy Balance Adaptation. Hunger. Obesity Definition, Etiology and Assessment. Religious Customs, Influence on Diet. Socio-economic Status.

Rotating Theme Groups

The rotating theme group was developed specifically for use in hospital settings (Bowers, 1989). In this type of GCT, an external structure for the therapy agenda is used in an attempt to circumvent some of the problems that are encountered with rapid participant turnover. By focusing a set number of sessions on a particular theme (e.g., the stigma of depression, dealing with children, coping with parents, problems with school or work, or other common areas of difficulty), the therapist can structure a comprehensive GCT experience. Initially, the topics for the sessions can be developed by the group therapists based on their experiences with the range of participants typically encountered in the treatment setting. The topic list should be matched to the population mix. For example, themes for GCT on a program that specializes in depression might include building self-esteem, choosing pleasurable activities, or coping with loss. On the other hand, themes for group therapy for an eating...

TABLE 1414 Natural History of Clinical Rabies in Humans

During the prodromal period, the symptoms and signs of rabies are often nonspecific. They include fever, sore throat, chills, malaise, anorexia, headache, nausea, vomiting, dyspnea, cough, and weakness. Early in the course some patients may report symptoms suggestive of rabies such as limb pain, limb weakness, and paresthesias at or near the presumed exposure site. Nonspecific neurologic symptoms may be reported including apprehension, anxiety, agitation, irritability, depression, and psychiatric disturbances.

Clinical presentation

Clinical presentation is determined by the site of tumour within the bowel (Table 13.2). Transient changes in bowel function are common as a result of GI infection and functional bowel disease such as irritable bowel syndrome. However, persistence of bowel symptoms for more than 6 weeks is of concern, particularly in those over 40 years of age malignant disease should be excluded in this group. As a generalisation, cancers of the left colon and rectum present with change in bowel habit and or bleeding whereas right colon cancers cause anaemia and small bowel obstruction. General malaise, anorexia and weight loss, and uncommon features of bowel cancer generally reflect the presence of metastatic disease.

Humor Elicitation Theory Of

Friedman, M., & Stricker, E. (1976). The physiological psychology of hunger A physiological perspective. Psychological Review, 83, 409-431. Keesey, R. (1980). A set-point anslysis of the regulation of body weight. In A. Stunkard (Ed.), Obesity. Philadelphia Saunders. Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual Review of Psychology, 53, 187-213.

Outcome Research On Cbgt

A number of studies support the effectiveness of CBGT in the treatment of eating disorders. For example, Telch, Agras, Rossiter, Wilfley, and Kenardy in 1990 assessed the effectiveness of CBGT in treating binge eating disorders Forty-four female patients who binged were randomly assigned to either CBGT (n 23) for ten sessions or a waiting list control condition (n 21). At posttreatment assessment, between-group comparisons revealed that subjects in the intervention group reported significantly reduced binge eating episodes compared with subjects in the waiting list control group. CBGT participants continued to binge significantly less frequently than at baseline. However, bingeing was usually not eliminated entirely.

Benzodiazepine Abuse And Dependence

Reported withdrawal manifestations include anxiety, irritability, insomnia, nausea, vomiting, tremor, sweating, and anorexia. Serious manifestations, including confusion, disorientation, psychosis, and seizures, also have been reported. For patients with an acute organic brain syndrome, a history of possible benzodiazepine withdrawal should always be pursued. Withdrawal reactions may be avoided by dose tapering. Treatment of withdrawal reactions may be accomplished by drug substitution or by reintroduction of a benzodiazepine and subsequent tapering.

The Effect of Infection on Nutritional Status

The acute phase reaction is mainly driven by cyto-kines produced by infected leucocytes. Interleukin-1 (IL-1) is the primary mediator of the acute phase response and stimulates endocrine changes that lead to amino acid mobilization as well as the initiation of anorexia (loss of appetite). This can be compounded by physical discomfort associated with eating or swallowing that can occur in certain infections. For example, dehydration due to diarrhea can lead to mouth dryness, and opportunistic oral infections may occur following acute infections. Nutritional intake can be further reduced as a result of the cultural practice of withdrawal of food from individuals with signs of infection (such as fever or diarrhea).

Markers of Nutritional Assessment

Conventional nutritional assessment in injured, infected, or cancer patients is of clinical value. Body weight and history of weight loss is one of the best indicators of survival in patients with infection or cancer. In addition, serum albumin concentration upon admission is probably one of the best predictors of hospital survival (Table 2). Serum albumin is commonly used as an indicator of nutritional status. Its level provides the clinician with an index of visceral and somatic protein stores for most medical illnesses. A level less than 3.0 is considered malnutrition and may also be called hypoalbuminemic malnutrition or protein malnutrition. Exceptions to this include the isolated starved state such as anorexia nervosa, severe edema, and the rare case of congenital analbuminemia. Serum albumin has a 21-day half-life, and this can reflect processes that have been ongoing for a few weeks. The benefit of serum albumin is that it is also an inverse acute phase reactant. The further...

Hostparasite relationships

In general, hexamitid infections in the intestine are usually chronic, with low numbers of parasites, but in heavy infections clinical disease may occur. Clinical signs of the disease in natural infections include anorexia, emaciation, weight loss, 1979). Mortalities of infected juvenile rainbow trout were moderate to severe in outbreaks of the disease (e.g. Ferguson, 1979 Uldal and Buchmann, 1996). Infected rainbow trout were smaller and often had empty gastrointestinal tracts because of the anorexia (Uldal and Buchmann, 1996). Infected brook charr normally do not have clinical disease (M'Gonigle, 1940), while cyprinids with intestinal hexamitosis have enteritis, liver necrosis and serous exudates in the abdominal cavity (Molnar, 1974).

Complications of Migraine

The photophobia, phonophobia, and headache exacerbated by any movement forces the patient to remain in a dark and quiet room, unable to function at even a basic level. Some patients will even wear dark sunglasses indoors because of excessive sensitivity to light. Dehydration and anorexia may cause electrolyte disturbances, further complicating their condition. Emotional despair and depression with suicidal ideation are generally present. Status migrainosus is considered headache urgency'' requiring immediate care, preferably in an inpatient setting for rehydration, pain control, and reversal of continuous headache.

Withholding Food and Water The Patient Experience

The physiological basis for these effects is incompletely understood, but at least a few suggestions have been offered, based largely on both human and animal studies in which food and water are withheld. For example, accumulation of ketones, which accompanies fasting, may cause anorexia. Increased levels of salutary endogenous opioids have been found in the plasma and hypothalamus of laboratory rodents deprived of food and water. Metabolic changes that occur with dehydration can cause decreased awareness, obtundation, and coma death follows naturally and without suffering.

Specific Nutritional Issues

Fat-soluble vitamins Deficiencies of fat-soluble vitamins are common in liver disease associated with steatorrhea due to the concomitant malabsorption of fat. Vitamin A deficiency can result in anorexia, growth failure, decreased resistance to infections, and night blindness. Vitamin D deficiency results in osteopenia or osteoporosis as well as rickets. The prevalence of fractures is increased in women being treated for alcohol abuse and also following sobriety deficiencies of vitamin D as well as calcium, phosphorus, and fluoride may play a role. The deficiency of vitamin E results in neur-axonal dystrophy, clinically manifesting as peripheral neuropathy and cerebellar disturbances. Vitamin K deficiency results in hemorrhage because of reduced synthesis of clotting factors. Trace elements Zinc deficiency in cirrhotics may contribute to hypoalbuminemia and dermatitis as well as anorexia from hypogeusia. Deficiency of selenium can lead to decreased synthesis of important antioxidant...

Clinical Features And Diagnosis

A history of underlying lung disease provides important clues to the underlying cause of hemoptysis. An abrupt onset of cough with bloody purulent sputum, with or without fever, may indicate acute pneumonia or bronchitis. A chronic productive cough may reflect chronic bronchitis or bronchiectasis. Although typically seen with tuberculosis, fevers, night sweats, and weight loss may represent other infections. Anorexia, weight loss, and change in cough may reflect bronchogenic carcinoma. While some tumors present with new-onset cough and hemoptysis, 80 percent of neoplastically caused hemoptysis had duration of greater than 1 week. Smoking, male gender, and age over 40 are the predominant risk factors for neoplasm. Alveolar hemorrhage syndromes from vasculitis present with dyspnea and mild hemoptysis associated with renal disease and hematuria. As noted earlier, hemoptysis is an insensitive marker for pulmonary embolism and the symptom of hemoptysis is usually overshadowed by anxiety,...

Eosinophilic collagenolyticlinear granuloma

Clinically, nodular granulomas may be seen within the oral cavity on the tongue, hard palate and palatine arches, concurrently with or without cutaneous eosinophilic granulomas and plaques. Oral cavity disease may be associated with halitosis, anorexia and hypersalivation. Lesions of eosinophilic granuloma may be single or grouped, nodular, linear, papular

Assessment Of Perfectionism

There are a number of other scales that are useful for measuring perfectionism. The Almost Perfect Scale-Revised (APS-R for a review, see Slaney, Rice, & Ashhy, 2002) was developed to examine adaptive and maladaptive aspects of perfectionism. The Perfectionism Cognitions Inventory (PCI Flett, Hewitt, Blankstein, & Gray, 1998) is a 25-item scale for measuring beliefs associated with perfectionism. Finally, several scales designed to measure eating disorder symptoms include items or subscales that measure perfectionism (e.g., Garner, Olmsted, & Polivy, 1983 Slade & Dewey, 1986).

Cognitivebehavioral Treatment Of Perfectionism

Although there are hundreds of studies examining the efficacy of cognitive-behavioral therapy (CBT) for psychological problems that are known to be associated with perfectionism (e.g., social phobia, depression, obsessive-compulsive disorder, eating disorders Nathan & Gorman, 2002), there are no controlled studies examining the use of CBT for treating perfectionism directly (Shafran & Mansell, 2001). Instead, there are a few case studies examining the effects of CBT on perfectionism, a few studies examining the impact of perfectionism on CBT outcome, and a few studies on the effects of CBT for anxiety on perfectionism. The results of these studies are summarized below.

Reasons for Malnutrition

With COPD are not hypermetabolic, malnutrition is related more to impaired gas exchange (as evidenced by a low diffusing capacity of carbon monoxide) than to airflow obstruction. The impaired gas exchange results from loss of the pulmonary capillary bed and may result in an inability to augment cardiac output in response to the stress of even minimal effort, leading to lack of oxygen delivery to the tissues and nutritional depletion. An alternative hypothesis is that malnutrition is precipitated by acute illnesses, leading to a combination of anorexia and hypercatabolism causing significant weight loss. Hypoxia-related appetite suppression or anorexia

Coexistence of Primary and Secondary Malnutrition

To the extent that a disease process produces anorexia or dysphagia, or even psychic depression, the net effect is to reduce total intake of dietary energy and nutrients. Whatever, malabsorptive or nutrient-wasting components of the underlying disorders will further compromise the nutritional state.

Therapeutic options for immunemediated skin diseases

Cats that are responding poorly with steroid therapy are potential candidates for chlorambucil therapy daily or every other day, in combination with steroids, using 0.1-0.2 mg kg. Tablet size is 2 mg, so most cats receive half a tablet per day. The mode of action is on DNA synthesis and inhibition of rapidly proliferating cells at all stages of the cell cycle. Therapy has to be given for 4-8 weeks and side-effects may include vomiting, diarrhoea, anorexia and, more importantly, bone-marrow suppression. The initial therapy can be combined with prednisolone at 2 mg kg per day. After initial therapy an alternate-day dose regimen is given for the chlorambucil and prednisolone thereafter, one should be able to stop chlorambucil and use glucocorticoids alone. Cats should be monitored with haematology samples for white cell and platelet counts, every 2 weeks (Helton-Rhodes, 1995).

Dialectical Behavior Therapy

Adapted to the treatment of eating disorders and dissociative disorders, and to families and adolescents. In addition, several large-scale mental health systems in the United States, Canada, and Europe have implemented DBT as a treatment for borderline patients across inpatient, day treatment, residential, case management, and crisis services.

Diagnosis Clinical presentation

The classic clinical features of active pulmonary TB include chronic cough, hemoptysis, expectoration of thick sputum, and constitutional symptoms such as fatigue or night sweats, anorexia, and weight loss. Although many case-series exist, there are few population-based studies that describe symptoms of TB. In a population-based study set in Los Angeles County, in which 12 of patients had HIV, the incidence of cough was 48 , fever 29 , weight loss 45 , and hemoptysis 21 .26 Cough for 2 weeks or more was only present in 52 of patients with pulmonary TB, while fever of over 2 weeks' duration was present in only 29 . The other population-based study was from the Ivory Coast, where 44 of patients had HIV.27 In this

TABLE 2041 Common Symptoms and Signs in Alcoholic Ketoacidosis

There are no specific physical findings associated solely with AKA. The most common findings are tachycardia, tachypnea, and diffuse, mild to moderate abdominal tenderness. Volume depletion resulting from anorexia, diaphoresis, and vomiting causes the frequently seen tachycardia and hypotension. Most patients are awake at presentation. Mental status changes in patients with ketoacidosis should alert clinicians to other potential causes, such as toxic ingestion, hypoglycemia, alcohol-withdrawal seizures, postictal state, or unrecognized head injury.

Empirical Evidence

Finally, several quasi-experimental studies from program evaluations and pilot studies have produced encouraging results, expanding the research base on the efficacy of DBT when adapted for other settings and when extended to treat different treatment populations. These include treatment on inpatient units and in forensic settings, and with suicidal adolescents, and women with binge-eating disorder. These studies do not have the scientific rigor of an experimental design, but taken together, they suggest that extensions of DBT across setting and disorder warrant further investigation.

Lipolysis in adipose tissue5 Clinical Features

Ihe typical patient with HHNS is usually elderly, who is often referred by a caretaker for abnormalities in vital signs and or mental status with complaints which include weakness, anorexia, or fatigue. Many will have either undiagnosed or poorly controlled type 2 diabetes. Ihese patients often have some level of baseline cognitive impairment, and self-referral for medical treatment is rare. In general, any patient with hyperglycemia, an impaired means of communication, and limited access to unassisted free water intake is at risk for HHNS. Ihe presence of renal insufficiency or cardiovascular disease is common to this patient population. Ihe medications such as diuretics that are commonly used to treat these underlying chronic problems, predisposes to the development of HHNS.

Confounding Effects of Infection on Laboratory Assessment

For iron status tests, infection induces an increase in serum ferritin and blood protoporphyrin levels and a decrease in serum iron binding capacity, serum iron, and hemoglobin. Zinc status tests are influenced by acute and chronic infections. A decrease in plasma zinc has been reported, due initially to redistribution of zinc within the body tissues and then to a negative body balance. This is due to anorexia, which reduces dietary intake, and also to increased losses via the faeces (diarrhea), sweat, and urine.

Dietary Counselling and Fortification

Fortified food snacks as part of the diet may improve both the intake and the status of micronutrients. However, the success of these dietary strategies is limited in patients with severe anorexia, those living in poverty and due to other social factors, and in those with inadequate motivation. Thus, patients may find it difficult to purchase, manipulate, or prepare their meals. Financial or other forms of social support, such as help with shopping, cooking (or provision of 'meals on wheels'), and help with eating, may do much to improve intake in some individuals. Although dietary counselling, with or without dietary fortification, is widely used in clinical practice, there is little research supporting its clinical efficacy in patients at risk of malnutrition in developed countries.

Target Nutrient Intake Achievement Failed or Impossible

These patients are prime candidates for NG or NI feeding if the gastrointestinal tract is normal, as in the case of critical care, anorexia (usually secondary to disease and malnutrition), neurological impairment preventing oral feeding, substantially increased requirements with relative anorexia (e.g., in burn cases), or chronic obstructive lung disease with severe dyspnea. However, for diseases of the pharynx, esophagus, or stomach or in cases of surgery of the esophagus, stomach, or pancreas, patients usually require intubation of the stomach or intestine by percutaneous gastrostomy or operative jeju-nostomy to allow feeding beyond the site of obstruction. If there is an abnormality of the intestinal tract, such as short bowel with more than 60 cm of available small intestine, IBD, or chronic partial bowel obstruction, diets must be delivered carefully with the aid of a pump to avoid surges of delivered fluid diets and consequent distension of the bowel. Despite careful selection,...

Pancreatitis and Enteral Nutrition

Colon Disorders Nutritional Management of Disorders. Diabetes Mellitus Dietary Management. Eating Disorders Anorexia Nervosa Bulimia Nervosa. Microbiota of the Intestine Probiotics. Nutritional Support Adults, Parenteral Infants and Children, Parenteral. Supplementation Dietary Supplements.

Management of Hypercalcemia Based on Severity

Hypercalcemia in the moderate range may be associated with symptoms such as polyuria, polydipsia, anorexia, constipation, and various degrees of obtundation. In this setting, it is prudent to embark upon a more aggressive approach to the hypercalcemia as described below. The therapy, however, has to be adapted to the actual level of the serum Ca and is not ordinarily as vigorous as it is when the serum Ca is much higher.

Pathophysiology of Severe Hypercalcemia

Most causes of severe hypercalcemia are associated with increased osteoclastic bone resorption. The osteoclast is activated by substances like PTH, PTH-related protein, and other osteoclast activators. The activated osteoclast leads to excessive bone resorption and the release of Ca from bone into the extracellular fluid. Excessive absorption of Ca from the gastrointestinal tract is not usually an important mechanism although it can play a role in states of vitamin D excess. Hypercalcemia develops when the entry of Ca from the skeletal compartment into the extracellular space overwhelms the normal homeostatic mechanisms that help maintain normal serum Ca levels. The kidney is crucial in this regard and if renal mechanisms can lead to the excretion of the enhanced filtered load of Ca, the tendency to marked hypercalcemia would be ameliorated. Unfortunately, in this setting, renal tubular reabsorption of Ca is often stimulated, worsening the disposition to hypercalcemia. This is due, in...

Hyperviscosity Syndrome

Fatigue, headache, anorexia, and somnolence are early nonspecific symptoms. As blood flow slows, microthromboses may occur, with the advent of local symptoms such as deafness, visual disturbances, and jacksonian or generalized seizures. The diagnosis of hyperviscosity must be considered in the emergency department when patients with unexplained stupor or coma are found to have anemia, with rouleau formation on the peripheral blood smear. The most readily appreciated physical findings are in the ocular fundi and include sausage-linked retinal vessels, hemorrhages, and exudates. Laboratory evaluation should include coagulation, renal, and electrolyte profiles. Hypercalcemia can coincide, and when M-component protein concentrations are high, factitious hyponatremia may also be present. A clue to the presence of hyperviscosity may be the laboratory's inability to perform chemical tests because of the serum stasis in the analyzers, undoubtedly due to too thick blood. Serum viscosity and...

Renal And Urologic Syndromes

Renal insufficiency in the cancer patient often has multiple etiologies. Prerenal azotemia is common due to vomiting, anorexia, or diuretic use. Hepatic and peritoneal disease also may cause sequestration of fluid in the peritoneal cavity, leading to intravascular volume depletion. Multiple myeloma and lymphoma can cause rapidly progressive renal failure by intraglomerular amyloid deposition. In addition, several chemotherapeutic agents (i.e., carmustine, cisplatin, and mitomycin) are directly nephrotoxic.

Psychological Complications

Dieting efforts correlate positively with the prevalence of eating disorders, particularly binge eating. A correlation of eating disorders with abuse of drugs and alcohol has been shown. In strictly dieting female college freshmen who were not alcohol abusers at baseline, the frequency of alcohol abuse was reported to increase after 1 year compared to nondieters.

Protein Metabolism and Neoplastic Growth

Figure 17.1 Postulated pathogenic mechanism involved in the development of cancer anorexia. In the tumor-bearing animal, plasma tryptophan (TRP) concentrations increase, facilitating the competition with other large neutral amino acids (LNAA) in crossing the blood-brain barrier via the specific L-transport system. BCAA, branched-chain amino acids Phe, phenylalanine Tyr, tyrosine Met, methionine CSF, cere-brospinal fluid. As a consequence of the successful competition of TRP across the blood-brain barrier, TRP concentrations in the central nervous system (CNS) increase, leading to enhanced serotonin (5-HT) synthesis in the hypothalamus, ultimately leading to anorexia. (Adapted from Laviano et al., 1996, with permission of the authors and publisher.) Figure 17.1 Postulated pathogenic mechanism involved in the development of cancer anorexia. In the tumor-bearing animal, plasma tryptophan (TRP) concentrations increase, facilitating the competition with other large neutral amino acids...

Fat Free Mass and Energy Needs

In meal size and a reduction in between-meal snacks. Morley called this physiologic decline in food intake ''anorexia of aging.'' This type of anorexia may be considered partially as a response to reduced energy needs but also partially as a dysregulation of food intake. Roberts et al. studied energy regulation in young and older adults by deliberately overfeeding and underfeeding their subjects. After a period of underfeeding, young people compensated by overeating when fed ad libitum. However, the older adults did not compensate. The same holds following a period of overfeeding the older adults did not compensate with a reduction in food intake when fed ad libitum. Anorexia of aging places an increasing number of elderly people at risk for malnutrition because the opportunities for providing an adequate dietary nutrient intake are very limited when total food consumption becomes low (e.g., < 6.3 MJ (1500 kcal) (Figure 1). Current recommendations for daily energy intake are...