Bulimia Recovery Programs

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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Bulimia Help Method

Endorsed by University Professors, Eating Disorders Specialists, Doctors and former bulimics, the Bulimia Help Method is a proven & trusted approach to lifelong recovery from bulimia. The Bulimia Help Method home treatment program gives you the insight, skills and tools needed to break free from bulimia and to make peace with food and your body. You are guided step-by-step along the way so you always know what to expect and what to do next. A powerful audio program will help to reprogram your old eating habits at a sub-conscious level, speed up your recovery and help you feel more calm and grounded.

Bulimia Help Method Summary


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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...

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...

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...

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...

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...

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...

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...

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...

Bulimia Nervosa

Initial assessment of the patient with bulimia nervosa for psychotherapeutic readiness, to assess comor-bid psychiatric states and attend to them, and to determine what approaches are likely to be most helpful for the given individual is of critical importance to maximize the likelihood of successful treatment. Eor patients with comorbid substance abuse or dependence disorder, successful treatment of bulimia nervosa ordinarily requires that the substance abuse disorder be attended to first, or at least concurrently. The odds of successfully treating bulimia nervosa in the presence of untreated substance abuse or dependence disorder are The fact that binge eating and purging episodes are relatively easily counted has stimulated and facilitated psychotherapy research for this disorder. Accordingly, a large number of studies have examined the efficacy of several different types of individual and group psy-chotherapies for bulimia nervosa. Cognitive-behavior therapy (CBT) has been most...

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.

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...

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...

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 Features

Early anal canal malignancies usually cause nonspecific symptoms such as pruritus, pain, and bleeding admixed with stool. Ihe sensation and presence of a lump in the anal canal may be erroneously diagnosed as a hemorrhoid. As the neoplasm progresses, the patient experiences anorexia, weight loss, constipation, narrowing of the caliber of the stool, and eventually tenesmus with or without bowel movement. Complete obstruction may also occur.

Applications And Exclusions

Finally, it is important to identify individuals with eating disorders. The most common type of eating disorder associated with obesity is binge eating disorder. Binge eating disorder is characterized by recurrent episodes of binge eating in which the individual consumes large amounts of food and perceives a loss of control over eating. Unlike the pattern of behavior observed in bulimia nervosa, binge eating episodes in binge eating disorder do not occur with compensatory behaviors to prevent weight gain (e.g., fasting, purging, exercise). Binge eating disorder occurs in less than 2 of obese people, although binge eating as a behavioral symptom is much more common (10 to 25 ). Other problems that are often observed include bulimia nervosa, nonpurging type and preoccupation with body size and shape, as the source of all of the person's problems. When such problems are identified, the treatment strategy should incorporate a component to reduce the frequency of binge episodes and...

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.

Clinical Significance

Migraine Cycle

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....

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.

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.

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.

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,...

Clinical manifestations

Most ovarian cancers are diagnosed between the ages of 40 and 65. Symptoms of early stage disease are often vague. Acute symptoms due to ovarian rupture or torsion are unusual. As a result, 75 to 85 percent of cases of ovarian cancer are advanced at the time of diagnosis. More advanced disease is typically associated with abdominal distention, nausea, anorexia, or early satiety due to the presence of ascites and omental or bowel metastases.

Empirical Support For Cbt With Children

Evidence-based practice has become a common catchphrase within the educational and mental health professions. However, most of the literature on the use of CBT with children and adolescents has involved clinical populations rather than addressing the use of CBT in schools. The literature has shown CBT to be effective in the treatment of a number of childhood difficulties including depression, anxiety, and disruptive behaviors (see reviews in Kazdin & Weisz, 1998 Weisz & Jensen, 1999). There continues, however, to be a need for further investigation into a number of childhood difficulties including eating disorders, posttrau-matic stress disorder, bipolar disorder, substance abuse, school-related problems, and other health conditions (e.g., pain management, obesity). Additionally, further investigation is necessary regarding the provision of CBT in alternative settings such as a school system.

Constitutional Symptoms

Nonspecific symptoms, including cachexia, anorexia, weight loss, and fatigue, are common presenting features in up to one-third of patients with large RCC. The etiology is not well established, but the cancer cachexia is likely cytokine-mediated. Tumor necrosis factor alpha is the cytokine most commonly involved by altering fat metabolism and appetite regulation (Laski and Vugrin 1987). Other cytokines including interleukin-1, interleukin-6, and interferon gamma, have also been implicated in cancer cachexia (Tsukamoto et al. 1992 Walther et al. 1998). In a series of 1,046 patients treated by radical nephrectomy for renal cell carcinoma, cachexia (defined as hypoalbuminemia, weight loss, and malaise), predicts worse survival after controlling for well-established prognosticators, including TNM and Fuhrman grade (Kim and al. 2003). Fever has been associated with renal cell carcinoma in approximately 20 . In patients evaluated for fever, a renal cell carcinoma was found in up to 2...

Inappropriate Antidiuretic Hormone Secretion

Inappropriate antidiuretic hormone secretion (IADHS) may occur in a variety of diseases, including malignancies, acute and chronic pulmonary diseases, central nervous system and endocrine disorders, acute psychosis, and surgical stress. It can be induced by drugs such as phenothiazines, cyclophosphamide, vincristine, thiazides, morphine, carbamazepine, and cisplatin. IADHS may accompany certain malignancies, particularly small-cell lung carcinoma, head neck carcinomas, brain tumors, and lymphomas. The symptoms of IADHS syndrome include anorexia, nausea, headache, confusion, with the possible end result being coma. Laboratory findings include serum hyponatremia, elevated urinary sodium concentrations with normal renal and adrenal homeostasis. Few cases of prostate cancer associated with IADHS syndrome have been reported, and tumors were either poorly differentiated or small cell carcinoma and were almost uniformly metastatic at the time of diagnosis. Most of the patients died a few...

Late Phase Ii Clinical Trial Of S1 In Head And Neck Cancer

This clinical trial was conducted to examine the antitumor activity and toxicities of S-1, in which 60 patients with head and neck cancer were enrolled. S-1 was administered at a dose of 40 mg m2d, with at least four courses, each of which consisted of twice-a-day (once each after breakfast and dinner), 28-d consecutive oral administration and of 14-d withdrawal two courses were repeated every 6 wk unless the disease progressed. As shown in Table 9, there were four complete response cases and 13 partial response cases (response rate 28.8 ) among 59 evaluable cases. The adverse events that were assessed to be Grade 3 or higher were as follows hemoglobinemia (6.8 ) neutropenia (5.1 ) leukopenia (1.7 ) decreased RBC (3.4 ) and anorexia, nausea vomiting, stomatitis, and fatigue (1.7 each) (34).

Feline infectious peritonitis

Progressive neurological involvement is common in cats with the non-effusive form of FIP. Severe pyro-granulomatous meningencephalomyelitis and ocular signs may be seen. Multifocal neurological signs are most common, especially cerebellar signs. Other common abnormalities include hindlimb paresis and ataxia, central vestibular signs, seizures and paralysis. This form of the disease is most common in cats younger than 2 years of age and cats older than 9 years of age. Most affected cats show fever and systemic signs such as anorexia and depression. Concurrent uveitis and chorioretinitis are common, which should increase suspicion of this disease. Other systemic signs of FIP may be present.

Acute Mountain Sickness AMS

Usually is described as bifrontal and worsened with bending over and the Valsalva maneuver. Gastrointestinal symptoms include anorexia, nausea, and sometimes vomiting, and the chief constitutional symptoms are lassitude and weakness. The person with AMS is often irritable and wants to be left alone. Sleepiness and a deep inner chill, also are common. If the illness progresses, the headache becomes more severe, and vomiting, oliguria, and increased dyspnea develop. Lassitude may progress to the victim requiring assistance for eating and dressing. The most severe form of AMS, high altitude cerebral edema (HACE), is heralded by onset of ataxia and altered level of consciousness coma may ensue within 12 h if treatment is delayed. The diagnosis can be difficult in preverbal children. 2 PATHOPHYSIOLOGY AMS is due to hypobaric hypoxia, but the exact sequence of events leading to illness is unclear. Figure191-1 offers a schema for the pathophysiology. The symptoms indicate a neurologic...

Precursors As Risk Factors

In preventive medicine, epidemiological studies have generally served to identify risk factors. Unfortunately, in eating disorders research, population-based studies are scarce, and few have determined the absolute risk, the overall probability of developing the disease in the population at large 14 . In the eating disorders, associations with variables preceding the illness have by and large been determined from clinical studies for this reason, the term ''precursor'' is not only descriptively, but also methodologically more accurate than the term ''risk factor''. One of the drawbacks of using clinical populations is that information from clinical samples, with their generally higher comorbidity than cases drawn from the general population, can complicate interpretations. For example, in the eating disorders, comorbidity might influence aspects of the family's or the individual's functioning, but might have less of an impact on precursors like eating or exercising habits. Moreover,...

Shared Precursors For An And Bn

The emphasis on dietary restriction occurs in a population that has become heavier 16 . In 1983, the norms for body weights listed in the Metropolitan Life Insurance Tables were adjusted upward from the earlier 1964 version. The high prevalence of dieting among female adolescents, between 60 and 80 in the Western hemisphere 17,18 , viewed against the low incidence and prevalence of eating disorders, suggest that the relative risk - the magnitude of the association between exposure and disease - is low for AN and somewhat higher for BN. As Bruch 19 aptly commented, ''there is an epidemic of dieting, but not an epidemic of eating disorders''.

Prevalence and clinical features

The prevalence of acute myocarditis is unknown because most cases are not recognised on account of non-specific or no symptoms (but sudden death may occur). Myocarditis may develop as a complication of an upper respiratory or gastrointestinal infection with general constitutional symptoms, particularly fever and skeletal myalgia, malaise, and anorexia. This systemic acute phase response increases energy production but compromises performance. Since myocarditis may not develop for several days or weeks after the symptoms and after a return to normal work and leisure activity, there is a risk of overexertion, which may be dangerous.

Food Labelling Agenda

FLAG (Food Labelling Agenda) is a national consumer pressure organisation launched in June 1997 by a group of concerned food and health writers. The organisation campaigns for 'clear, comprehensive and meaningful labelling on all food and food products' and its first task in March 1998 was to deliver a petition calling for improved food labelling to Downing Street. It won support from a huge number of individuals and organisations, including those with interests in allergy, genetic engineering, infant feeding, heart disease, cancer, vegetarianism, eating disorders and green issues. The accurate labelling of potential allergens is one of FLAG's major concerns. The organisation is steered by Michelle Berriedale-Johnson and Sarah Stacey and their postal address is PO Box 25303, London NW5 1WN. A newsletter is produced for supporters.

Medications for the relief of dyspnoea at the end of life

Median forced expiratory volume in one second (FEV1) was 0.81 (range 0.16-2.35) and forced vital capacity (FVC) was 1.47 (range 0.15-4.29). Median maximum inspiratory pressure was -16cmH20 (normal 50cmH20) suggesting that respiratory muscle weakness (any value < 25cmH20) was a significant contributor to the sensation of dyspnoea as part of the cachexia anorexia syndrome.

General and Salt Restriction

Salt retention and edema can produce a number of significant medical problems which require aggressive intervention. Tense edema can cause skin breakdown and predispose to the development of cellulitis. Superficial infections which otherwise would be easily treated may progress rapidly as a result of impaired local host defense mechanisms. Generalized edema also contributes to fatigue and immobility, which should be avoided in nephrotic patients who are already susceptible to thromboembolic complications as a result of their hypercoagulable state. Tense ascites can produce marked discomfort and anorexia and contribute to malnutrition. Ascitic fluid can also become infected. Salt retention can exacerbate heart failure and cause pulmonary congestion in patients with coexistent cardiac abnormalities. Edema should not be treated for purely cosmetic reasons. However, if disfigurement produced by edema causes severe psychological or psychiatric problems, treatment may be warranted on this...

Family Interaction Environment and Psychopathology

The family characteristics identified by Bruch 19 , Selvini-Palazzoli 36 and Minuchin et al. 37 - rigidity, overprotectiveness, enmeshment, avoidance of conflict - may be somewhat more common in anorectic families than in families with psychosomatically or psychiatrically ill children, yet overall family dynamics show a great deal of variability. Parental styles and parent-child interactions differ between families of different AN subtypes. Families of restricting AN patients present high levels of cohesion, a calm, orderly, ''perfect'' environment not different from healthy controls 38 , by contrast with families of bulimic AN patients, in which in particular fathers tend towards affective dyscontrol with expressions of hostility 39 . Controlled family studies of AN have described strong familial aggregation in AN families, with intergenerational transmission, but there was no clustering of affective disorders, unless AN coexisted with a depressive disorder 40 . These findings were...

Poststroke Eating Problems

Neurological and functional impairments can result in eating problems following stroke, which can lead to an increased risk of protein-energy malnutrition or exacerbate prestroke undernutrition. Specifically, eating disability has been associated with an inadequate consumption of food and fluids and a deterioration in body mass index, triceps skin fold thickness, mid-arm muscle circumference, and serum protein concentrations during the acute phase of recovery. Specific eating problems contributing to this have included anorexia, impaired lip closure leading to oral repulsion of food and fluids, dysphagia, an inability to manipulate utensils linked to loss of motor skills in eating, and difficulties in maintaining an upright posture to aid food ingestion at mealtimes. The presence of visual field and or perceptual deficits can result in an inability to see or perceive the contents of a meal tray, while aphasia, dysphasia, or dysarthria can hinder or prevent the expression of dietary...

Psychosocial Problems

Confidence as a major psychological problem. Depression may result from an interaction of several factors including left frontal lobe damage, reactions to physical loss, and impaired performance of activities of daily living. Comparatively little is known of interactions between depression, anorexia, and nutritional status in the early stages of recovery following stroke in individuals with and without physical eating problems. However, patterns of behavioral disturbance characterized by verbal expressions of depressed mood, anorexia, and insomnia have been identified and associated with weight loss. Anxiety-evoking experiences relating to being fed, or choking in the presence of dysphagia, may also result in avoidance or withdrawal from eating. General approaches to the treatment of poststroke depression can involve the use of antidepressant drugs and behavioral and psychotherapeutic techniques. Specifically, the exercise of therapeutic skills in communication, assisting eating, and...

The Cognitive Revolution

The Cognitive Revolution

The principle task in cognitive therapy (CT) is to help clients systematically determine ways of challenging these thoughts, usually by evidence gathering and self-monitoring. Since the time that Beck and his colleagues described this method for treating depression, it has been extended to anxiety disorders, substance abuse, personality disorders, obsessive-compulsive disorder, eating disorders, and delusions. Beck's approach has shown a great deal of promise in alleviating emotional distress, as well as shedding light on the interaction between therapy and medication. Specifically, it has been shown in numerous trials that cognitive therapy alone is at least as effective as antidepressant medication for depression, while also showing greater maintenance of gains following medication discontinuation. This has since become an important experimental design for use in determining the relative contribution of CBT and medication for a number of other psychological conditions such as...

Premorbid Body Weight

In BN, unlike in AN, individual and familial overweight and critical comments about weight shape and eating habits appear to play a significant role as precursors. A greater proportion of patients reported childhood obesity than either healthy controls or general psychiatric control subjects, and BN patients reported more parental obesity than either control group 51 . The McKnight investigators 52 identified thin body preoccupation and social pressure as predictive for the onset of BN, for the partial syndrome BN and for binge eating disorder. Greater previous weight fluctuations and rates of dieting emerged as predisposing variables in the twin study by Kendler et al. 53 .

Experimental Thiamin Deficiency in Man and Measurement of Thiamin Status

In young and healthy nonalcoholic subjects, subjective symptoms appear after 2 or 3 weeks of deficient diet but urinary thiamin will already be falling (Table 3). Characteristic early symptoms include anorexia, weakness, dysthesiae, and depression. At this stage, urinary thiamin will be almost zero, ETKL activity depressed, and the TDP effect approximately 15-30 . After 6-8 weeks the only objective signs at rest may be a slight fall in blood pressure and moderate weight loss, although urinary thiamin will now be negligible and the TDP

Prevention And Intervention Protocols Incorporating Information About Precursors

Whereas the initial prevention trials have focused on providing psycho-educational information about eating disorders, unhealthy eating practices and the consequences of weight fluctuations to all high school students, more recent trials have targeted populations considered at risk. One of the more sophisticated interactive intervention programmes is described by Stice et al. 64 , who recruited adolescent girls who expressed body image concerns. The intervention consisted either of help with developing a healthy lifestyle that incorporated a balanced diet and regular exercise, or of a ''dissonance'' intervention in which participants were asked to help create a body acceptance programme for younger girls. The dissonance intervention programme and the healthy weight control intervention produced reductions in thin ideal internalization, in negative affect and in bulimic pathology, but did not reduce body dissatisfaction or dieting. Of interest is that the effects of the healthy...

Theoretical Bases

Sive-compulsive disorder, David Barlow and Michelle Craske's anxiety and panic manual, and Stewart Agras and Robin Apple's eating disorders manual all contain careful assessment of antecedents, behaviors, and the outcomes of those behaviors. Although early behavioral treatments were focused on external antecedents and consequences, more recent advances such as Barlow and Craske's panic treatment include a wide variety of interoceptive antecedents that are directly targeted in treatment. In these instances, negative mood, cognition, and bodily states can be thought of as both problematic behavior and as antecedents for other problematic behaviors. Using panic disorder as an example, someone may have a panic attack at a shopping mall and begin avoiding shopping malls. Panic as a response pattern is problematic and can be analyzed in terms of its functional relation to external events, such as the shopping mall. However, individuals with panic also begin to avoid activities that will...

Nutritional Issues with Antituberculosis Drug Toxicity

Whose intake is compromised by anorexia and metabolism accelerated by chronic inflammation. Foods such as peas, beans, and cereals contain adequate amounts. Meat and eggs are not good sources, however, and high protein intake increases vitamin B6 requirements. Deficiencies of vitamin B6, like other nutrients, can increase because of significant intestinal malabsorption or loss by gastrointestinal dysfunction. Treatment of TB may induce other problems that affect nutritional status and nutrient intake. Three of the first-line drugs isoniazid, rifampicin, and pyrazinamide all carry a small risk of chemical hepatitis, ranging from the asymptomatic elevation of hepatic transaminases to severe and potentially fatal hepatitis. Although nutritional factors do not contribute to the cause, hepatitis has many important consequences affecting nutritional status and nutrient intake. Other anti-TB drugs that affect nutrition include para-aminosalicylic acid and ethio-namide, which commonly cause...

Psychological Presentations

In addition to the presenting physical symptoms, psychological manifestations may be detected on emergency evaluation. Depression, including suicidal ideation, is the primary psychological complication of eating disorders. Other psychological manifestations include obsessive-compulsive personality traits, with rumination about food, calories, and weight. Ritualistic eating and exercising behavior are also evident. Perfectionistic striving often results in deterioration of friendships and leisure activities. Impulse-control disorder is a psychological complication of eating disorders more commonly seen in bulimics than in anorexics. Other behavioral manifestations include shoplifting and stealing, sexual promiscuity, drug and alcohol abuse, and self-mutilation.

Chapter References

Comerci GD Eating disorders in adolescents. Pediatr Rev 10(2) 37, 1988. 2. Garner DM, Garfinkel PE Anorexia Nervosa A Multidimension Perspective. NeW York, Bruner Mazel, 1982. 4. Garner DM, Garfinkel PE (eds) Handbook of Treatment for Eating Disorders, 2d ed. NeW York, Guilford Press, 1997. 5. Mackenzie JR, LaBan MM, Sackeyfio AH Prevalence of peripheral neuropathy in patients With anorexia nervosa. Arch Phys Med Rehabil 70 827, 1989. 6. LaBan MM, Wilkins JC, Sackeyfio AH, Taylor RS Osteoporotic stress fractures in anorexia nervosa. Arch Phys Med Rehabil 76 884, 1996. 7. Herzog W, Deter HC, Fiehn W, Petzold E Medical findings and predictors of long-term physical outcome in anorexia nervosa A prospective, 12-year folloW-up study. Psychol Med 27 269, 1997. 8. Hoffman L, Halmi K Psychopharmacology in the treatment of anorexia nervosa and bulimia nervosa. Psychiatr Clin North Am 16 767, 1993.

Clinical Features And Spectrum

It is followed by a general malabsorption resulting in weight loss and anorexia. Weight loss can be found in about 90 of the patients. Gastrointestinal symptoms, which lead to the diagnosis, consist of episodic and watery diarrhea and steatorrhea accompanied by colicky abdominal pain and, in one-third, by occult blood in stool. 13 Endoscopic investigation reveals a pale yellow mucosa alternating with erythematous, erosive parts in the duodenum or jejunum, and duodenal biopsies are positive in the PAS stain.

Counseling and Testing for Human Immunodeficiency Virus

The true risk of contracting human immunodeficiency virus (HIV) from a single sexual encounter is unknown but believed to be rare. Estimated rates are felt to be highest with receptive, unprotected anal intercourse (0.008 to 0.032 infections per episode with an HIV positive partner). The risk with receptive vaginal intercourse is 0.005-0.0015, and with insertive vaginal intercourse is 0.0003-0.0009 per episode. Local inflammation, bleeding, or trauma can affect the risk of transmission also. 20 Victims should be counseled regarding HIV testing and the need for repeat testing. Besides the uncertainty of risk of exposure after sexual assault, other factors complicating decision making about PEP for HIV include potential inability to identify or test the assailant for HIV expense of PEP (about 700) side effects of medication (nausea, vomiting, anorexia in up to 50 percent of patients) the need for laboratory testing and the need to provide follow-up with physicians informed about PEP for...

Inclusion of Ecotoxicological Aspects in These Strategies

The inhibition of daphid grazers by toxic substances or other abiotic stressors is not addressed explicitly in current restoration practise. However, as we have seen in Chap. 3, toxic anorexia may well be an important factor in specific cases. By explicitly addressing the possibility of toxic anorexia occurring during lake restoration procedures, the risk of projects being unsuccessful due to the influence of abiotic stressors being overlooked is reduced. An approach is proposed in Fig. 5.5. Step 1 - Detection of Toxic Anorexia It is of the utmost importance to address the possibility of toxic anorexia from the start of the restoration project. During diagnosis of the problem and the target setting phase, the possibility that zooplankton grazing may be inhibited by abiotic stressors must be assessed. Basically, there are three possible approaches (see Table 5.3). The first is to deduce, from data on zooplankton and phytoplankton in the lake, the possibility of reduced top-down...

Behavior Modification

Research is now directed towards finding ways of improving the results of such programs in terms of long-term weight loss maintenance. An increased focus on weight-maintaining behavior rather than weight loss, a stronger emphasis on increasing activity and exercise, and better relapse strategies are being evaluated. Targeting the needs of specific subgroups, for example those with binge eating disorders or dysfunctional family circumstances, is another way in which behavioral therapy may be improved. See also Eating Disorders Bulimia Nervosa. Energy Expenditure Indirect Calorimetry. Exercise Diet and Exercise. Obesity Definition, Etiology and Assessment Fat Distribution Childhood Obesity Prevention Treatment. Starvation and Fasting.

Psychological Consequences

Among obese people were the topic of a literature review that reported that weight cycling was not associated with depression or other psychopathology or depressogenic cognitive styles. It was observed, however, that weight cycling was associated with decreased perceptions of health and well-being, decreased eating self-efficacy, and weak increases in binge eating severity. Subsequently, it was concluded that an individual's perception of being a weight cycler may be more related to psychological problems than the actual number of pounds lost and regained over time. In 2000, the National Task Force on the Prevention and Treatment of Obesity concluded that concerns that dieting induces eating disorders or other psychological dysfunction in overweight and obese adults are generally not supported by empirical studies. This is in contrast to the wide belief that dieting is a necessary precursor for subsequent development of eating disorders.

Vitamin A deficiency and infection

Infections may predispose to vitamin A deficiency because of low intake of vitamin A-rich foods, anorexia, malabsorption, increased utilization of vitamin A, inability to mobilize vitamin A from the liver, and accelerated depletion of vitamin A. During the acute phase response, retinol-binding protein can cleave away from the circulating RBP-TTR-retinol complex, allowing high, abnormal urinary losses of vitamin A. An episode of infection, such as chickenpox, has been shown to hasten the depletion of liver vitamin A stores in preschool children. Vitamin A deficiency during infection has widespread implications for innate and adaptive immunity.

Immobilization Hypercalcemia

Most cases of immobilization hypercalcemia are seen in adolescent boys following recent spinal cord injuries. 16 Risk factors include age less than 21 years, complete neurologic injuries, cervical injuries, prolonged immobilization, and dehydration. 16 Presenting symptoms include anorexia, nausea, headache, malaise, and depression in mild cases. In more severe cases, patients may have persistent nausea and vomiting, gastric dilatation, fecal impaction, and abdominal pain. Microscopic calcium deposition in the kidney may impair its ability to concentrate urine, leading to polyuria and polydipsia. Patients may also develop cardiac dysrhythmias and seizures.16

Description Of Treatment

The list of conditions treated in groups is extensive. Virtually all models of individual therapies have been used in group therapy. The highest use of intensive group models is with the more common conditions of depression, anxiety states, eating disorders, and personality disorders. Groups of a more supportive nature are widely used as an adjunctive treatment for more severe and chronic conditions such as bipolar disorder and schizophrenia.

Types Of Cognitive Distortions

Cognitive distortions were originally identified in patients with depression. Since then, clinicians have expanded their identification and treatment of cognitive distortions to many other disorders (DiTomasso, Martin, & Kovnat, 2000 Freeman, Pretzer, Fleming, & Simon, 1990, 2004 Freeman & Fusco, 2000 Wells, 1997). Further, cognitive distortions have been found to play a role in sexual dysfunction (Leiblum & Rosen, 2000), eating disorders (Shafran, Teachman, Kerry, & Rachman, 1999), sex offender behavior (McGrath, Cann, & Konopasky, 1998), and gambling addictions (Delfabbro & Winefield, 2000 Fisher, Beech, & Browne, 1999). In addition to the identification of cognitive distortions in Axis I disorders, distortions appear to play an important role in Axis II disorders.

TABLE 1999 Acute Radiation Syndrome

Four distinct phases are seen in the unfolding of ARS prodromal phase latent phase manifested illness phase and recovery phase or death. The prodromal phase is a transient period of self-limiting symptoms that may occur within minutes, hours, or days after exposure. The acuity of onset and the duration of this phase are directly related to the dose received. The prodromal phase is an autonomic nervous system response that initiates gastrointestinal symptoms such as anorexia, nausea, vomiting, and, with high doses, diarrhea. In addition, neuromuscular symptoms often accompany the autonomic response and may include hypotension, pyrexia, diaphoresis, cephalgia, and fatigue. The latent phase is a symptom-free interval that follows the resolution of the prodromal phase. Shorter latent phases correspond to higher levels of dose received. The latent period may last 1 to 3 weeks with a dose of less than 4 Gy (400 rad), but the latent period may last only a few hours when a dose above 15 Gy...

Recognizing Causative Factors of Undernutrition

Age-related physiological reduction in appetite, 'anorexia of aging,' is well documented. Several factors have been implicated in the genesis of this phenomenon. Evidence suggests that the decrease in lean body mass, energy expenditure, and metabolic rate that occurs with advancing age may partially account for the reduction of food intake in healthy older persons. Age-related reduction in olfactory and gustatory receptor sensitivity may compromise the hedonic qualities of meals, further reducing the desire to eat. Similarly, age-related alterations in hormonal and neurotransmitter-mediated function may also play a role in suppressing food intake. Animal studies suggest that aging results in a reduction in the opioid feeding drive and an increase in the satiating effect of cholecystokinin. This may lead to the ingestion of smaller meals and prolonged periods of satiety between meals. More recently ghrelin, a hunger-inducing peptide hormone, has been shown to decrease with age....

Winnie Eng and Richard G Heimberg

Exposure and response prevention An approach to treatment for obsessive-compulsive disorder (and other disorders such as bulimia nervosa) in which the client is systematically and gradually exposed to his or her feared thoughts or situations while compulsive rituals or other behaviors are actively prevented. Another behavioral technique used in the treatment of some disorders is exposure and response prevention (EX RP). Here, clients are encouraged to resist the urge to engage in dysfunctional behaviors while exposing themselves to the stimuli that typically elicit these behaviors (e.g., refraining from bingeing after eating a bit of a fattening food in the case of bulimia nervosa refraining from washing after touching something perceived by the client as contaminated in the case of obsessive-compulsive disorder). These exercises are again intended to test out the veracity of the client's beliefs (e.g., eating a bit of a forbidden food does not need to invariably result in a binge...

Therapeutic use of IFNa

Effects, including fever, headache, chills, fatigue, anorexia, leukopenia and thrombocytopenia. Despite their current limitations, IFNs are now well established as useful drugs. IFNa is the most widely used and has received approval in many countries, including Food and Drug Administration (FDA) approval in the US, for several clinical indications. Since 1986 it has been used as a therapy against haii v-cell leukemia. Significant regression of the cancer is observed in more than 90 of patients. Since 1988, IFNa has been successfully used as a therapy against diseases associated with human papillomavirus infection such as juvenile laryngeal papillomatosis and condyloma acuminatum. Since that same year it has also been used in the treatment of Kaposi's sarcoma in patients infected with HIV. Around 30 of the patients who reccive IFNa, however, withdraw from treatment because of side-effects associated with the high IFNa doses. In 1991, IFNa was licensed for the treatment of chronic...

Tian P S Oei and Genevieve Dingle

Accumulated empirical evidence shows that CBT is efficacious for the treatment of many psychological and psychiatric disorders, ranging from anxiety, to eating disorders and the psychoses. For many patients, it can be argued that CBT is the treatment of choice for these disorders. At the turn of the new millenium, CBT was generally accepted as an evidence-based psychotherapy that has benefited many people with mental health problems.

Treatment Of Ascites And Edema In Patients With Hepatic Cirrhosis [35

Tense ascites and edema do produce significant adverse clinical consequences which can be mitigated by judicious treatment. Ascites can exacerbate gastroesophageal reflux, contribute to anorexia, and possibly increase portal venous pressures, which will heighten the risk of variceal bleeding. Massive ascites in cirrhotic patients commonly becomes infected and the abdominal wall pressure may produce umbilical eventration skin ulceration and necrosis. Elevation of the diaphragms restricts respiration and contributes to development of basilar atelectasis.

Pharmacological Management of Undernutrition

Megestrol acetate is a synthetic progestogen approved for use by the Food and Drug Administration (FDA) as an orexigenic agent in patients with Acquired Immune Deficiency Syndrome (AIDS) and cancer-related anorexia and cachexia. Recent evidence indicates that megesterol acetate is also an effective orexigenic agent in geriatric patients. Thromboembolic disease and adrenal suppression are rare complications, but patients should be monitored closely for these events.

Acquired neuropathies

Sacrococcygeal Fracture

Feline dysautonomia is a polyneuropathy of unknown cause that affects autonomic ganglia, resulting in failure of the autonomic nervous system. The disease was first reported in the UK in the 1980s but has since been uncommon until increased numbers of cases were diagnosed in the early 2000s. There is usually a rapid onset of clinical signs, developing over 48 h, but slower progressive development can occur. Clinical signs include dilated pupils, prolapsed nictitating membranes, bradycardia, dry mucous membranes, megaoesophagus, regurgitation, constipation, bladder atony, dysuria, urinary incontinence, loss of anal tone and reflex, and anorexia. Cats become dehydrated and without nursing support and fluid replacement will deteriorate rapidly.

General Considerations

INTRAABDOMINAL ABSCESS Intraabdominal abscess is caused most frequently by preoperative contamination, spillage of bowel contents during surgery, contamination of a hematoma, or postoperative anastomotic leaks. Patients may have abdominal pain, nausea, vomiting, ileus, abdominal distention, fever, chills, anorexia, and abdominal tenderness. If the diagnosis is suspected, CT or ultrasound studies of the abdomen are required. The patient should receive broad-spectrum antibiotics. Although some abscesses are amenable to percutaneous drainage, many patients require surgical exploration.

Differential Diagnosis And Comorbidity

Bipolar youths exhibit significantly higher rates of comorbid psychiatric conditions, including disruptive behaviour disorders (especially ADHD, conduct disorder and oppositional defiant disorder), anxiety disorders (especially separation anxiety and panic disorder) and eating disorders. The relationship between ADHD and mania is of interest. A very high comor-bidity between paediatric bipolar disorder and ADHD has been reported. As many as 60-90 of the paediatric bipolar disorder cases have been diagnosed with concurrent ADHD 55,56,48 . Careful assessment is needed to clarify whether children have ADHD, bipolar disorder or both. There is an overlap of symptoms between mania and ADHD. These symptoms include increased motor activity, distractibility, rapid or pressured speech, impaired attention, racing thoughts and irritability.

Jesse H Wright and D Kristen Small

Research studies on computer-assisted CBT have found that computer programs are well accepted by patients and are usually efficacious in treating symptoms (Greist, 1998 Marks et al., 1998 Wright & Wright, 1997 Wright et al., 2002). Investigations reviewed below are limited to those that involved the use of a computer to deliver a significant element of CBT for depression, anxiety disorders, and eating disorders. Programs developed for habit control and sex counseling are not included because they were not designed to augment or provide psychotherapy. Also, interactive voice response (IVR) systems are not discussed. These interventions use an automated, computer-controlled telephone system, in addition to manuals and videotapes, to provide treatment (Griest et al., 2002 Osgood-Hynes et al., 1998). But, they do not utilize a computer interface to communicate with patients. 2000), PTSD (Rothbaum et al., 2001), and body image problems in persons with binge eating disorder (Riva,...

The psychostimulants cocaine and the amphetamines

Psychotropics Chemical Diagram

The subjective effects of all the psychostimulants depend on personality, the environment in which it is administered, the dose of the drug, and the route of administration. For example, moderate doses of D-amphetamine (10-20 mg) in a normal person will produce euphoria, a sense of increased energy and alertness, anorexia, insomnia, and an improvement in the conduct of repetitive tasks. Some people become anxious, irritable and talkative. As the dose of amphetamine is increased, the symptoms become more marked and the influence of the environment less pronounced. Fenfluramine is an amphetamine that selectively stimulates the release of 5-HT and lacks dependence and stimulant properties. This drug is used as an anorexiant, a property which it shares with the stimulant amphetamines. Amphetamine users also develop a tolerance to some of the central effects, such as the euphoria and anorexia, which may lead to the escalation of the dose this may be partly ascribed to enhanced excretion of...

Localization of HEV epitopes

Typically the incubation period for HF is about 6 weeks, with a range of 2-9 weeks. Clinical HF occurs in two phases. First, the prodromal phase is usually characterized by fever and nausea. Second, the icteric phase, which lasts about 2 weeks, is characterized by jaundice and dark urine. General symptoms include abdominal pain, anorexia, hepatomegaly, splenomegaly and vomiting. Fulminant hepatic failure, particularly among pregnant women in the second and third trimester, has been associated with HE, although it is not a regular sequela of this disease. Diagnostic testing has shown that subclinical infection occurs in pediatric and adult populations.

Marsha M Linehan and Eunice Y Chen

Keywords dialectical behavior therapy, DBT, bulimia nervosa, anorexia nervosa, eating disorders not otherwise specified, binge eating disorder, borderline personality disorder Dialectical Behavior Therapy (DBT) is a multimodal cognitive-behavioral treatment originally developed to treat chronically suicidal individuals meeting borderline personality disorder (BPD) criteria. DBT is informed by Eastern mindfulness practices and behavior therapy, and is conducted within the frame of a dialectical epistemology. The underlying dialectic involves acceptance of clients in their current distress, yet aiding clients with skills to alter their dysfunctional behavioral patterns. The behavior change strategies it employs include methodical and iterative behavioral analyses of dysfunctional chains of behavior, the use of commitment strategies to engage clients in treatment, didactic strategies, exposure-based strategies to block avoidance and repetitive behaviors and reduce maladaptive emotions,...

Internal And External Causes Of Eating

Much of the interest in the mechanisms of eating arises from attempts to understand eating disorders. Twenty-five years ago, Stanley Schachter moved on from emotions to propose an explanation of obesity that stimulated a great deal of research. His theory eventually began to seem too simple and is no longer seen as an adequate explanation of obesity or other eating disorders (Lowe, 1992 Rodin, 1981). However, some of the main implications of his theory seem as reasonable today as they did then, so a brief review of the history of this theory and the research it inspired seems worthwhile.

Specific Appetites And Nutrient Depletions

Recently, speculation has arisen that the organism may regulate nutrients (especially macronutrients) not so much for their medicinal value as for their psychoactive effects. Most notably, a carbohydrate-craving hypothesis has been championed (19). It is argued that a deficiency of carbohydrates affects neurotransmitter levels to create a negative affective state accordingly, individuals may learn to (over)eat carbohydrates in an attempt to bolster their mood, especially when they are feeling upset or depressed. This hypothesis has been offered to explain the overeating characteristic of bulimia nervosa and some forms of obesity.

Paraneoplastic syndromes

This syndrome is also termed 'shiny cat syndrome' because of the profound shiny appearance of the skin on the ventrum. The relationship between the pancreatic (and occasional hepatic) carcinoma to the skin lesions is unknown. The clinical signs are observed in moribund to lethargic aged cats, and include bilateral symmetrical alopecia of the ventrum and limbs, dry fissured to crusting footpads and a shiny appearance to the skin in some cases, possibly due to excessive grooming. Systemic signs are profound and include anorexia, weight loss and lethargy. The diagnosis is achieved from a thorough physical examination that may reveal abdominal abnormalities confirmed with imaging, especially with ultrasound, that allows the collection of a fine-needle aspirate (or biopsy at laparotomy) to obtain tissue samples. There are no distinct changes in serum biochemistry or haematology. The histological changes in a skin biopsy are very helpful, and include marked follicle atrophy and...

Ischaemic encephalopathy

Thiamine Deficient Cat

Concentration, but also on the rate of change. Compensatory mechanisms are in place for any chronic cause of hypoglycaemia (e.g. insulinoma). The most common cause of hypoglycaemia is insulin overdosage in a diabetic cat, manifesting with stupor, depression, seizures and coma. Insulin-secreting islet cell tumours are very uncommon in cats and hypoglycaemia associated with other neoplasms, such as hepatoma, is uncommon. Affected cats are frequently normal between episodes. Young kittens with anorexia from systemic disease or other causes can become hypogly-caemic rapidly, and become stuporous and comatose. The demonstration of a low blood glucose concentration (< 2mmol l) with signs of cerebral dysfunction is supportive of hypoglycaemia. In an older cat, if the hypoglycaemia is not associated with diabetes and insulin administration, investigation of insulinoma or other tumours is indicated, by ultrasonography of the liver and pancreas, and calculation of the insulin glucose ratio....

Religious Practices and the Body

The cultural-historical transformation of the body is highlighted by comparison of fasting as a technique of the body in the medieval somatic spirituality with the phenomenon of anorexia nervosa in the late twentieth century. In a study of 261 holy women in Italy since the year 1200, Rudolf Bell distinguishes between contemporary anorexia nervosa and what he calls holy anorexia. While the former is regarded as a syndrome of clinical pathology, in the latter, the suppression of physical urges and basic feelings fatigue, sexual drive, hunger, pain frees the body to achieve heroic feats and the soul to commune with God (p. 13). There are parallels between the two conditions and historical epochs. Bell suggests that the observation that the internal locus of evil as a corrupting force for women in the Middle Ages, in distinction to the external locus of sin as a response to external stimulus for men, corresponds to the Freudian model of anorexia nervosa as a food sex oral...

Hypothalamic Control Of Feeding

Results from classic lesion studies carried out in the 1940s and 1950s led to a dual-center model for the hypothalamic control of hunger and satiety that drove scientific research in this area for more than 30 years. The model was based on profound and consistent changes in ingestive behavior observed in rats after bilateral mechanical or electrolytic lesions centered in the ventromedial nucleus of the hypothalamus (VMH) or lateral hypothalamic area (LHA). Rats with VMH lesions displayed an apparently insatiable hunger and would become quite obese when food was made freely available. Conversely, rats with LHA lesions displayed adipsia and anorexia, and they required careful nursing during the postlesion period to prevent fatal dehydration and starvation. The dual-center model of hunger and satiety enjoyed strong appeal as an organizing framework for understanding how the hypothalamus contributes to the central control of ingestive behavior. However, the model ultimately was undermined...

Cannabis and the cannabinoids

The abrupt withdrawal of very high doses of THC from volunteers has been associated with some withdrawal effects (irritability, insomnia, weight loss, tremor, changed sleep profile, anorexia), suggesting that both physical and psychological dependence may occasionally arise.

Very Low Calorie Diets and Meal Planning

Began to substantially increase physical activity. He began running and lifting weights. During this 6-month period, he lost 40 more pounds. Over the second year, Brain consolidated most of the behavioral changes that he had made and continued to increase his physical activity. He eventually lost 100 pounds and weighed between 220 and 225 pounds. He graduated with a bachelor's degree in finance and eventually enlisted in the military. He is now a career officer in the military and has successfully maintained his weight loss for the past 10 years. He is married and has two children. He reports that he occasionally has urges to binge, but can control the urges with effort to direct his attention away from eating and by focusing upon engaging in exercise. He never developed symptoms indicative of an eating disorder although he clearly emphasizes the importance of exercise as a means of managing his body weight.

Contemporary Views Of Cognitive Vulnerabilities

Today, most investigators recognize that most individuals who are exposed to precipitating stressful events do not develop clinically significant psychological disorders. Moreover, the specific disorder that emerges for different individuals is not determined just by the stressful event alone (i.e., precipitating stresses do not just occur in conjunction with any one clinical disorder), and is hypothesized to depend on their particular cognitive vulnerabilities (Riskind & Alloy, in press). In CBT, cognitive vulnerabilities are hypothesized to help account for not only who is vulnerable to developing disorders (e. g., individuals with a particular cognitive style) and when (e.g., after a stress), but to which disorders they are vulnerable (e.g., depression, anxiety disorder, eating disorder).

Painless Visual Reduction Loss

GIANT-CELL ARTERITIS (TEMPORAL ARTERITIS) Giant-cell arteritis (GCA) is a systemic vasculitis involving medium-sized arteries in the carotid circulation and can include the aorta and its primary branches. GCA can cause a painless ischemic optic neuropathy with devastating visual consequences and rapid contralateral involvement if not diagnosed and treated promptly. Patients are generally over 50 years of age and frequently have a history of polymyalgia rheumatica. Women are more commonly affected than men. Symptoms may include headache, jaw claudication, myalgias, fatigue, fever, anorexia, and temporal artery tenderness. Up to 33 percent may have associated neurologic symptoms such as transient ischemic attacks or stroke. The patient can develop rapid and profound visual loss, with the contralateral eye becoming involved within days to weeks. The physical examination will frequently reveal an APD if the optic nerve circulation is involved. An elevated Westergren sedimentation rate is...

Examples of Specialist Roles in Dietetics Renal Dietetics

The dietetic care of patients with HIV and AIDS has become increasingly important in the past decade. Dietitians may work with people who are HIV positive to help them optimize their nutritional status and resist the opportunistic infections that eventually cause death in patients with frank AIDS. Once the person develops AIDS, the dietitian's role becomes both therapeutic and palliative, devising and implementing with the patient regimens that enable him or her to satisfy nutritional requirements when, for example, disease of the gastrointestinal tract results in multiple malabsorption or cancer results in weight loss and anorexia. The advent of new, multidrug regimens that require careful planning of meals to match their absorption characteristics and that have side effects affecting nutritional status has made the dietitian's role even more important.

Body Weight and Energy Balance

Multicenter studies, alcoholic hepatitis patients demonstrate universal evidence for protein calorie malnutrition, according to the physical findings of muscle wasting and edema, low levels of serum albumin and other visceral proteins, and decreased cell-mediated immunity, whereas their 6-month mortality is related in part to the severity of malnutrition. Anorexia is a major cause of weight loss in alcoholic liver disease, and may be caused by increased circulating levels of leptin. Furthermore, active alcoholic hepatitis contributes to increased resting energy expenditure as another cause of weight loss. On the other hand, resting energy expenditure is normal in stable alcoholic cirrhotics who are also typically underweight or malnourished in part due to preferential metabolism of endogenous fat stores. At the same time, the digestion of dietary fat is decreased in cirrhotic patients due to diminished secretion of bile salts and pancreatic enzymes.

Vitamins Water Soluble Thiamin Riboflavin and B6

Early symptoms of a thiamin deficiency include anorexia and an associated reduction in weight gain. 4 These nonspecific symptoms are similar to the symptoms of several other vitamin deficiencies. Other deficiency symptoms include a depression in body temperature, occasional vomiting, a flabby heart, bradycardia, hypertrophy of the heart, myocardial degeneration, and sudden death associated with heart failure. Transketolase activity has also been noted to be decreased in response to a thiamin deficiency. The most widely used and best functional test of thiamin status is the assay for eryth-rocyte transketolase.

Nutritional Management Acute Liver Failure

The nutritional status of someone with acute liver failure versus chronic liver failure can differ greatly. The primary goal of the nutritional management in acute liver failure is supportive. An increase in nausea, vomiting, and anorexia may be associated with acute liver disease, which may result in decreased oral intake. If normal nutritional status prior to the insult is assumed, the patient will have a much higher nutritional reserve than that of a patient in chronic liver failure. Energy needs can be met by providing the Dietary Reference Intakes for infants and children and approximately 30kcal kg for adults. The provision of adequate protein is crucial in fulminant hepatic failure and encephalopathy. Adequate protein must be provided to minimize catabolism, which may exacerbate any hyperammonemia present. Excessive protein intake should be avoided because it may increase ammonia levels.

Disease Management

Levodopa, which is converted into dopamine by decarboxylases that are present peripherally, can cause symptoms such as anorexia, nausea, and vomiting due to excess peripheral dopamine levels. When levodopa is combined with carbidopa, a peripheral decarboxylase inhibitor, smaller doses of levodopa are required for effectiveness, and side effects are reduced. Over time, the effectiveness of levodopa will diminish, requiring the additional use of dopamine receptor agonist therapy. PD patients who are fully mobile, in the on state, can suddenly convert to the off state and become akinetic, especially in the morning shortly after rising and prior to taking the initial daily dose. This on-off phenomenon is treated by the use of controlled-release preparations of the combined carbidopa-levodopa therapy.

Total Cerebral Volume

Autism, attention deficit hyperactivity disorder (ADHD), childhood-onset schizophrenia, dyslexia, eating disorders, fetal alcohol syndrome, obsessive-compulsive disorder, Sydenham's chorea, and Tourette's syndrome. It is evident that a normative sample must be carefully screened to rule out these conditions. Likewise, affective disorders and substance abuse have been associated with structural anomalies in adults and should be considered as potential confounds in pediatric samples as well.

Description Of Treatment Processes

Comprehensive treatment for eating disorders generally requires attention to four distinct features of these disorders (1) biological aspects, particularly nutritional status and the deleterious consequences of semistarva-tion and undernutrition on the one hand, or serious obesity on the other (2) eating disorders related behaviors including restrictive and idiosyncratic eating patterns, eating binges, purging, ordinarily by means of vomiting or use of laxatives, and excessive, compulsive exercise (3) eating disorder related thoughts, attitudes, and emotions, which may include distorted self-perceptions, overvalued ideas, and self-disparagement, all related to shape and weight, diminished cognitive complexity and increased obsessionality and perfectionistic thinking accompanying malnutrition, and increased nutrition-related emotional fragility with mood and anxiety symptoms and (4) associated psychopathological and interpersonal problems, the frequent comorbid conditions of mood,...

Christine Maguth Nezu and Michelle A Peacock

Treatment strategies based on the principles of operant conditioning include token economies, time out from reinforcements, differential reinforcement schedules, extinction, and overcorrection. These strategies have been effectively utilized to treat a wide range of disorders in patients with mental retardation such as eating disorders, anxiety disorders, depression, phobias, self-injurious behaviors, and aggression (Nezu & Nezu, 1994). For example, reinforcement (e.g., small prize) for attending weight loss meetings as well as losing weight was successfully used as one component of a self-monitoring behavioral weight loss program (Fox, Haniotes, & Rotatori, 1984).

Hypercalcemia Of Malignancy

Approximately 40 percent of patients with multiple myeloma will have hypercalcemia, often accompanying the clinical triad of back pain, anemia, and lethargy. Hypercalcemia from any cause may produce nausea, vomiting, anorexia, and constipation. Altered mental status, confusion, and coma are consistent with rapid and or high levels of hypercalcemia. Elevated ionized calcium is responsible for neuromuscular dysfunction, and therefore, serum calcium levels should be interpreted in conjunction with serum phosphorus, albumin, and blood pH determinations. The QT interval of the electrocardiogram may shorten as the serum calcium rises.

Constitutional Symptoms and Febrile Illnesses

Disseminated M. avium complex is the most common opportunistic bacterial infection in AIDS patients, causing disseminated disease in up to 50 percent of patients at some time during their illness. Infection occurs predominantly in patients with CD4 counts of 100 cells pL or less. Persistent fever and night sweats are typical. Associated symptoms include weight loss, diarrhea, malaise, and anorexia. Dissemination to the bone marrow, liver, and spleen result in the common associated laboratory findings of anemia and elevated alkaline phosphatase levels. Diagnosis may be made by acid-fast stain of stool or other body fluids, or by blood culture. Mycobacterium avium complex cannot be eradicated, but clarithromycin combined with ethambutol and rifabutin have been shown to significantly reduce bacteremia and improve symptoms.

Syndrome Of Inappropriate

Symptoms of hyponatremia range from anorexia, nausea, vomiting, and weakness to confusion, decreased mental status, seizures, and coma. Patients with a serum sodium level above 125 mEq L generally are asymptomatic or mildly symptomatic and usually can be controlled with water restriction of 500 mL day along with close follow-up. Demeclocyline, a tetracycline derivative, can be given at a dose of 250 mg qid, and this raises the serum sodium by producing a nephrogenic diabetes insipidus. Patients with serum sodium concentrations below 115 mEq L may present with severe, life-threatening manifestations requiring acute care monitoring, meticulous attention to intake and output measurements, and frequent electrolyte determinations. Furosemide 0.5 to 1.0 mg kg is given with normal saline supplementation to maintain euvolemia and effect a net free water clearance. In addition, 3 hypertonic saline may be used, but the amount must be calculated carefully to avoid volume overload and congestive...

The Cycle of Malnutrition and Infection

Conversely, infection can affect energy requirements and appetite, and can lead to weight loss in adults and growth faltering in children. This occurs through a simultaneous increase in energy requirements during the acute phase response of an infection, anorexia (primarily mediated by inter-leukin (IL)-1 released by infected macrophages), physical loss of nutrients from the intestine, and malabsorption. The resulting deterioration in nutritional status is associated with additional mucosal damage, which can in turn further prolong and increase the severity of the infection as well as leaving the individual susceptible to further pathogenic invasion, thus bridging the vicious cyclical relationship between malnutrition, impaired immunity, and infection.

Economic Pressures on the Political System

Politicians at the present time are trying to balance the complaints about HMOs and managed care with the inevitability that the industry must be part of the solution if there is to be one. Along with the professional societies exerting pressure, by 2000 the National Alliance for the Mentally Ill (NAMI) emerged as a potent force advocating the strengthening of the 1996 mental health parity law. The bill under serious consideration in the year 2000, called the Mental Health Equitable Treatment Act, would require full insurance parity for schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, posttraumatic stress syndrome, autism, anorexia nervosa, and ADD. It takes its lead from the states that have passed some kind of parity law, and cuts directly to parity only for a list of disabling disorders, eliminating the diffuse nature of much mental health diagnosis and treatment. Thirty-four states had passed some kind of parity law by 2000, suggesting...

Barbiturate Abstinence Syndrome

Abrupt discontinuation of barbiturates in a chronically dependent user will produce minor withdrawal symptoms within 24 h and major life-threatening symptoms within 2 to 8 days. The severity of the withdrawal reflects the degree of physical dependence and drug half-life. Cessation of short-acting barbiturates results in more severe abstinence symptoms than stopping long-acting barbiturates. This is consistent with the clinical observation that the brain has more time to adapt to declining drug concentrations that are gradual. Clinical manifestations of abstinence mimic those described for alcohol withdrawal. Minor symptoms include anxiety, restlessness, depression, insomnia, anorexia, nausea, vomiting, muscle twitching, abdominal cramping, and sweating. Major symptoms include psychosis, hallucinations, delirium, generalized seizures, hyperthermia, and cardiovascular collapse. 3415

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