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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Inanition Anorexia and Cachexia

Anorexia can be defined as a reduction in food intake caused primarily by diminished appetite, as opposed to the literal definition of not eating. This definition emphasizes the important role of central neural mechanisms in the pathophysiology of anorexia in diseases such as cancer, when other common problems, such as pain and nausea, may also cause a person to consume less food. Anorexia nervosa is an abnormal psychic state in which a person loses all desire for food and even becomes nauseated by food as a result, severe inanition occurs. Cachexia is a metabolic disorder of increased energy expenditure leading to weight loss greater than that caused by reduced food intake alone. Anorexia and cachexia often occur together in many types of cancer or in the wasting syndrome observed in patients with acquired immunodeficiency syndrome (AIDS) and chronic inflammatory disorders. Almost all types of cancer cause both anorexia and cachexia, and more than half of cancer patients develop...

Anorexia Nervosa

Anorexia nervosa is a psychophysiological disorder especially prevalent among young women and characterized by refusal to eat or maintain normal body weight, intense fear of becoming obese, a disturbed body image in which the emaciated patient feels overweight, and absence of any physical illness accounting for extreme weight loss. The term anorexia is actually a misnomer, because genuine loss of appetite is rare and usually occurs only late in the illness. Most anorectics are actually obsessed with food and constantly deny natural hunger.

Bulimia

Bulimia, more accurately known as Bulimia Nervosa, is an eating disorder characterized by three primary symptoms recurrent episodes of binge eating, inappropriate compensatory behaviors, and extreme concern about body weight and shape. Binge eating involves the consumption of a large amount of food in a relatively short period of time along with a perception of loss of control over eating. Binge eating may be triggered by a number of factors, including hunger, negative mood, interpersonal stressors, and thoughts about weight and shape. Inappropriate compensatory behaviors are strategies aimed at controlling body weight and shape, including self-induced vomiting, misuse of laxatives and or diuretics, excessive exercising, and fasting. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV American Psychiatric Association, 1994) divides Bulimia Nervosa into two subtypes. The purging subtype is distinguished by the presence of purging compensatory behaviors such as...

Bulimia Nervosa

The finding that non-depressed bulimic patients respond to pharmacotherapy with antidepressant drugs suggested that these compounds may have a specific use in the treatment of the symptoms of bulimia nervosa.34 The demonstration of the role of serotonergic neurons in the regulation of appetite and satiety provided a scientific base to underpin this.35 The positive finding of Freeman and Hampson36 in their early open-label trial of fluoxetine paved the way for larger more formal evaluations of efficacy. The Fluoxetine Bulimia Nervosa Collaborative Study Group37 performed an 8 week, double-blind trial comparing fluoxetine (20 and 60 mg day) with placebo in 387 bulimic female outpatients. They found significant dose-dependent effects of active treatment in reducing the frequency of weekly binge-eating and vomiting, depression, carbohydrate craving, eating attitudes and behaviors at the end point. This dose response was also found in the reports of adverse events these occurring...

Eating Disorders

Both subjective and behavioral aspects of meals are disturbed in eating disorders. The behavioral neuroscience of eating has begun to contribute to understanding these problems. For example, patients with Bulimia Nervosa eat larger than normal meals under laboratory conditions ingested food is less satiating than normal for these patients, and the decreased satiety is related to decreased CCK secretion.

Association Between Glucocorticoid Regulation and Psychopathology

Several lines of research support the association between glucocorticoid regulation and psychiatric disorders (Hols-boer, 1989 Tsigos & Chrousos, 1994). Both physical and psychological stressors have been shown to be temporally related to psychiatric illness. Because glucocorticoids are intricately linked to the neurobiology of stress, alterations in glucocorticoid levels and or activity are expected in association with psychiatric conditions. Indeed, altered HPA function has been shown in a variety of psychiatric disorders, including depression, Anxiety Disorders, Substance Abuse, Anorexia Nervosa, and Schizophrenia. Pharmacological studies indicate that glucocorticoids directly modulate neurotransmitter function and behavioral systems, as well as the activity of psychotropic agents. Moreover, there is evidence that glucocorticoids exert genomic effects in the brain and regulate transcription of many genes, including those that code for behaviorally active neuropeptides....

Affective Disorder Syndromes

Major depression has a lifetime prevalence of about 15 percent and is about 15 times as common as bipolar disorder (manic-depressive disorder). Major depression is about twice as common in women as in men in all countries and cultures and does not vary in occurrence among different races. It may occur at any age, but the majority of cases occur in adulthood. Studies suggest a genetic predisposition because there is an increased incidence of major depression and alcoholism in relatives of patients with this mood disorder. The diagnosis of depression is often overlooked, especially in patients with chronic neurological disease. The Diagnostic and Statistical Manual, 4th edition (DSM-IV) criteria for this diagnosis requires either that the patient have a depressed mood or that the patient have a sustained loss of interest and pleasure. Some depressed patients have a depressed affect or become withdrawn or irritable but do not admit to or complain of feelings of sadness. Almost all,...

Types of Anxiety Disorders

The fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes 11 different anxiety disorders. Each of these is listed in Table 1, along with their most important defining features. Although other psychological problems may be associated with extreme fear or anxiety (e.g., eating disorders are associated with a fear of gaining weight), only the conditions listed in Table 1 are officially classified as anxiety disorders in the DSM-IV.

Clinical Pharmacokinetics of SSRIs

Citalopram,1 fluoxetine,2,3 fluvoxamine,4 paroxetine5 and sertraline6 are the five antidepressants which are known as selective serotonin reuptake inhibitors (SSRIs) (Fig. 2.1). Their clinical efficacy, good tolerance and safety have been demonstrated in many studies7,8 and some of them may also be prescribed successfully for the treatment of obsessive compulsive disorder, bulimia or panic attacks. Despite their common pharmacological properties, the SSRIs differ in their metabolism by cytochrome P450 and in their interaction profile with other drugs which are also substrates of this enzyme system. Sensitive and selective (including stereoselective) methods, using high performance liquid chromatography or gas chromatography, have been introduced for their quantitative analysis in blood samples.9 These have enabled studies of their pharmacokinetics as well as investigations of the relationship between plasma concentration and clinical efficacy. This review summarizes our present...

Professional practice

Children and young people who experience repeated episodes ofhealth interventions or medical examinations, or who need intimate personal care, sometimes feel that their body is not under their own control. They can develop a learned compliance that leaves them more vulnerable to sexual abuse than other children (Westcott and Jones 1999). Sometimes their relationship with their body becomes so dissociated that they do not feel that it is worth looking after. This can lead to poor health choices, including indiscriminate sexual activity. Negative comments from others about weight or physical appearance can contribute to the development of poor body image or even, in more extreme cases, an eating disorder (CMEC Council of Ministers of Education Canada 2001). In any discussion of future relationships, care needs to be taken to avoid setting up limiting assumptions that reduce the child or young person's perceptions of the range of experiences and relationships that might be possible for...

Clinical Presentations

Subacute effects of radiation therapy (those occurring within the first 6 months of exposure) are more common than acute effects. One of the most common of these, the somnolence syndrome, has been described as occurring in up to 50 of children who receive radiation as CNS prophylaxis for acute lym-phoblastic leukemia. The syndrome presents with fatigue, somnolence, anorexia, and nausea typically occurring 4-8 weeks after the completion of radiation therapy 60 . In some instances, the syndrome may include fever and changes in EEG. While the condition is usually self-limited, treatment with steroids may ameliorate the symptoms. Typically occurring in the setting of cranial radiation for ALL or other CNS-directed whole brain radiation, the somnolence syndrome has also, on rare occasions, been reported

Clinical Manifestations

In our series, four patients (5 ) had both spleen and liver enlargement, whereas isolated liver or spleen enlargement was observed in 19 (23 ) and in 18 (22 ) patients, respectively (14). Lymphadenopathy was noted in three patients (4 ) (14). Other symptoms such as malaise, anorexia, myalgia, cough, perspiration, conjunctivitis, nausea, joint pain, and so on. were less common (Table 1).

Signs and Symptoms Prompting Immediate Evaluation

(1) slow growth rate or failure to show catch up growth (2) failure to thrive (3) obesity (4) persistent fatigue or anorexia (5) polydipsia and polyuria (6) severely dry skin or thin and brittle hair (7) altered timing of onset of puberty (e.g. signs of puberty before age 9 years or, in patients with short height, failure to enter puberty by age 12 years in girls and 13 years in boys) (8) abnormal tempo of puberty (e.g. rapid or interrupted progression of puberty) (9) galactorrhea and (10) abnormal menstruation or sexual function.

Antimicrobial Therapy

Wounds with evidence of heavy bioburden can usually be managed with topical agents, such as sustained-release antibacterial dressings (e.g., cadexomer iodine or sustained release silver). Topical antimicrobials alone will not suffice in cases of invasive infection (e.g., cellulitis and osteomyelitis). A patient manifesting signs or symptoms of sepsis, like anorexia, malaise, confusion, lethargy, fevers, and chills, resulting from the wound state, requires surgical debride-ment in addition to systemic antibiotics. The appropriate antibacterial is that to which the microbe is sensitive. Ideally, antibacterials should be administered prior to bacterial contamination so that an effective tissue concentration is obtained, termed surgical prophylaxis. The bloodstream is the preferred route of administration, and is ideally delivered within the first three hours of wounding. After that time, the efficacy of systemically delivered antimicrobials reaching the wound is significantly impaired.

Animal Models of Infection

Domestic mice and outbred white Swiss Webster mice inoculated intraperitoneally, intranasally, intracerebrally, or intravenously with R. akari develop ruffled fur, closed eyelids, rapid breathing, and anorexia, followed by death 5 to 14 days after exposure (7,21,58,59,145). Intraperitoneal inoculation causes massive accumulation of rickettsiae in the liver, spleen, and peritoneal fluid, with necrosis in the liver and spleen, and occasionally in the kidneys, brain, and lung (21,59,145). White mice inoculated intraperitoneally with a concentrated suspension of R. akari (strain Toger) exhibit weight-dependent mortality. All mice weighing 6 to 8 g die within 10 days of infection, 50 of mice weighing 10 to 12 g die within five days, and mice weighing 16 to 18 g show no clinical signs of illness (60). Intranasal inoculation of R. akari in mice causes a rickettsial pneumonia and death of the animal within three to five days (59). Intracerebral inoculation results in a massive accumulation of...

Constructivist Psychotherapy

Constructivist therapy has been used with a wide range of problems, from mild adjustment issues to the most severely disturbed clients. It has been used with specific symptoms (e.g., stuttering, obesity, bulimia, posttraumatic flashbacks) as well as more general life distress. It also has been useful with young children as well as elderly clients. Specific constructivist techniques have been developed for family therapy (e.g., systemic bow-ties to help each client understand how their actions, based upon their deepest fears, confirm the deepest fears of other family members).

Heather Ashton and Allan H Young

Selective serotonin reuptake inhibitors (SSRIs) have considerable advantages over earlier antidepressants, such as most tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), but like all drugs they also have adverse effects. Advantages of SSRIs include greater tolerability and safety and a wider range of clinical applications, one of which is a potential use in the treatment of drug abuse and some eating disorders (see also Chapter 4). However, recent evidence shows that SSRIs are associated with a withdrawal reaction on discontinuation after regular use. A further emerging problem is that SSRIs may themselves be entering the repertoire of polydrug abusers. Three aspects of SSRIs are considered in this chapter withdrawal effects after chronic administration, potential therapeutic value in the treatment of drug abuse and the possibility of SSRI abuse.

Extrahypothalamic CRH Systems

Implications for Biological Psychiatry. The evidence described above clearly points to CRH transmission within discrete regions of the amygdala in the unconditional generation and learned maintenance of fear-related behavior. At the human level, extrahypothalamic CRH has been implicated in a number of human disorders such as major depression (Gold et al., 1996 Nemeroff, 1996), PTSD (Grillon et al., 1996), and bulimia (Krahn and Gosnell, 1989). As a result, the development of novel therapeutic agents that target specific CRH receptor subtypes has become a major thrust in recent years. However, one major problem associated with the use of anti-CRH drugs to treat human clinical populations has been that most of these agents do not pass through the blood-brain barrier efficiently and thus cannot bind to CRH receptors in the necessary neural substrates to effect therapeutic change. As a result, there has been a push in the past decade toward the development of nonpeptide CRH antagonists...

Efficacy Research on Psychotherapy

Anorexia Nervosa Binge-Eating Disorder Bulimia Nervosa Psychotherapies are not efficacious for all conditions (for example, interpersonal psychotherapy (IPT) has been shown to be ineffective in two studies with opiate abusers). However, for several disorders, psychotherapies have been shown to be as effective as psychotropic interventions (e.g., cognitive-behavioral therapy CBT for Panic Disorder, CBT and IPT for Bulimia Nervosa). For other disorders, psychotherapy is an invaluable adjunct to medication (e.g., bipolar disorder, Schizophrenia).

Substance Abuse and Personality Disorders in the General Population

Psychiatric disorders studied included the Axis I disorders of mania, schizophrenia, somatization, anorexia, affective disorders, and anxiety disorders and the Axis II disorder ASPD. Of all the psychiatric diagnoses investigated, the highest comorbidity rate observed was between alcoholism and ASPD. In the general population, male alcoholics were four times more likely to have a diagnosis of ASPD than nonalcoholics, and female alcoholics were 12 times more likely to be diagnosed with ASPD then nonalcoholic females. In 1997, Kessler and colleagues (5) examined the lifetime co-occurrence of alcohol use disorders and other psychiatric disorders among a nationally representative household sample. They found that persons with alcohol dependence had higher rates of comorbidity with ASPD than with Axis I Anxiety or Affective disorders. In both of these studies, ASPD was the only personality disorder investigated along with selected Axis I disorders. Thus, a comprehensive picture...

Katharine A Phillips MD

BDD is defined in DSM-IV as a preoccupation with an imagined defect in appearance if a slight physical anomaly is present, the person's concern is markedly excessive (American Psychiatric Association 1994). The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, and it cannot be better accounted for by another mental disorder, such as anorexia nervosa. Although BDD is classified as a somatoform disorder, its delusional variant is classified as a psychotic disorder (a type of delusional disorder, somatic type).

Neurotransmitter Imaging of the Serotoninergic System

The serotoninergic system is thought to be critically involved in a large number, if not the majority, of psychiatric illnesses. The most important and well studied of these is major depressive disorder (MDD). However, the serotonin system is also considered important in schizophrenia, anxiety and phobias, obsessive-compulsive disorder, eating disorders, sleep, and numerous other psychiatric conditions.

Extra Articular Manifestations

Because RA is a systemic inflammatory disease, it is not surprising that there are multiple extra-articular manifestations that help with the diagnosis systemic symptoms such as fatigue, malaise, anorexia, weight loss, and fever may be prominent. Serious infections and hematological malignancies such as non-Hodgkin's lymphoma are also more common in patients with RA. Renal disease is usually secondary to drug toxicities or amyloidosis. RA can cause pericardial effusions, pericarditis, myocarditis, and coronary arteritis. Pulmonary complications include pleural effusions, pulmonary fibrosis, nodular lung disease, and possibly small airways disease. RA can also cause secondary Sjogren syndrome.

The Genus Anaplasma 1910 Taxonomy and Phylogeny

The genus Anaplasma includes three species that infect circulating erythrocytes, one species that infects platelets, and two species that infect circulating white blood cells. A. marginale is responsible for bovine anaplasmosis, a severe febrile hemolytic anemia of cattle that occurs after bites of several different tick species such as Dermacentor andersoni in Northern America and Boophilus microplus in Africa the infection occurs worldwide. A. centrale causes a similar but usually mild disease in cattle, and A. ovis does so in sheep and goats. A. platys is the causative agent of infectious cyclic thrombocytopenia in dogs and cats, a disease that manifests as progressively diminishing episodes of fever and thrombocytopenia. The bacterium is transmitted to animal by the bite of Rhipicephalus sanguineus or Amblyomma sp. ticks. A. bovis is the causative agent of bovine ehrlichiosis of Africa, the Middle East, India, and Sri Lanka, a disease that is clinically characterized by...

Interpersonal Psychotherapy

Tested for bulimia, social phobia, Post-Traumatic Stress Disorder, and other conditions. For many of these syndromes, researchers developed new manuals to adapt IPT to the particular psychosocial needs of patients with the target diagnoses. Only in two studies of patients with substance abuse has IPT not been shown to be helpful. Research on IPT has focused largely on outcome, that is, symptomatic improvement. Its success in this area has led to the inclusion of IPT in American and international treatment guidelines for depression and bulimia. Other research domains also deserve exploration which of the eclectic ingredients of IPT help which patients when IPT might be preferable to, or less helpful than, other treatments such as cognitive-behavioral therapy and how well IPT works in general practice. Some research has begun to reveal biological and psychological outcome predictors as well as neuro-imaging brain changes due to IPT. Initially a purely research therapy, IPT is now...

Gender Similarities and Differences

Two studies that examined gender-related aspects of BDD found that the clinical features of the disorder appear to be similar in men and women. One of these studies (N 188) found, however, that women were more likely than men to focus on their hips and weight, camouflage with makeup and pick their skin, and have comorbid bulimia nervosa (Phillips and Diaz 1997). In addition, the study found that men were more likely to be unmarried be preoccupied with body build, genitals, and hair thinning use a hat for camouflage and have alcohol abuse or dependence. In the other study (N 58), women were more likely to focus on their breasts and legs, check mirrors and camouflage, and have bulimia, panic disorder, and generalized anxiety disorder men were more likely to focus on their genitals, height, and excessive body hair, and have bipolar disorder (Perugi et al. 1997a).

A phagocytophilum Human Granulocytic Ehrlichiosis

A. phagocytophilum is an agent which causes human granulocytic ehrlichiosis. The disease is characterized by fever, headache, myalgia, leucopenia, anemia, and thrombocytopenia. The agent also causes granulocytic ehrlichiosis in horses. The clinical findings include fever, depression, anorexia, limb edema, icterus, ataxia, and reluctance to move (1) however, the disease is not fatal. In ruminants, it causes disease known as tick-borne fever or Pasture fever. The agent primarily infects neutrophils and other granulocytes of sheep, goat, cattle, and deer. Fever, moderately disturbed general condition, and reduced milk production and growth rate are reported as the main clinical findings (2). Respiratory signs such as nasal discharge and cough may also be present. Mortality is generally low, but secondary infection may cause death to the patients.

Detection and Screening

Assessment of cancer-related GI tract sequelae should begin with a thorough history with close attention to symptoms attributable to GI tract pathology, including dysphagia, odynophagia, vomiting, chronic abdominal pain, chronic constipation or diarrhea and hematochezia (Table 12.1).Anorexia,

Neorickettsia risticii

This ehrlichia causes equine monocytic ehrlichiosis or Potomac horse fever in horses. The consistent clinical features of Potomac horse fever are fever, depression, anorexia, and diarrhea (122,123). The fever is usually biphasic, whereby an initial increase in rectal temperature of limited duration (12-18 hours) may occur several days prior to the onset of depression and anorexia. The clinical course of the disease then progresses to include the following signs subcutaneous edema of the lower limbs and ventral abdomen, colic, mild to profuse diarrhea, laminitis, and abortion (123).

Complex Relationships Between Behavior and Motivation

One cannot infer the existence of a motivation merely by the presence of certain behaviors. For example, aggressive behavior does not presuppose a motivation or drive for aggression. Behavior is due to many factors. This complexity is illustrated by eating disorders such as obesity or bulimia, as well as in everyday life when people who are not food deprived nevertheless crave food when bored or anxious. Likewise, individuals can find food aversive and abstain from eating even when there is a strong tissue need for nourishment (Capaldi, 1996). People may eat when feeling unloved, and individuals may refrain from eating when motivated to seek social approval, obtain a job, or participate in a political hunger strike. Similarly, sexual behavior may occur when individuals seek power, prestige, or social approval rather than sexual gratification related to sexual arousal (McClelland, 1973). Although physiological needs may be powerful sources of motivation, they are neither necessary nor...

Cognitive Behavioral Therapy

Gray zone between BDD and eating disorders. In a pilot study of 19 patients, there was significantly greater improvement among patients who participated in group CBT than among patients in a no-treatment waiting-list control group, with the symptoms of 7 (77 ) of 9 patients no longer meeting criteria for BDD (Veale et al. 1996b). It is unclear whether exposure and response prevention alone are effective for treating BDD. Some studies suggest that it is effective (McKay et al. 1997), whereas others indicate that it is not and suggest that cognitive restructuring is a necessary component of treatment (Campisi 1995), perhaps because of the poor insight and depression characteristic of BDD.

Regional Chemotherapy with Chemoembolization

In contrast to the poor response rates for systemic chemotherapy, a large number of reports have shown promising response rates of 40-68 for a variety of agents which may be administered through the hepatic artery as a bolus injection, often with some agent such as lipiodol, microspheres, or starch which allows for arteriolar embolization. These agents include doxorubicin, cisplatin, mitomycin C, and neocarzinostatin.4 Side effects include fever (95 ), abdominal pain (60 ), anorexia (20 ), and ascites (20 ).

Clinical Presentation

Patients with stress fractures of the malleoli typically have a history of increased physical activity preceding the development of symptoms. For an established athlete, there may be a recent increase in training intensity or the addition of adjunctive training activities. Other patients may relate the recent commencement of a physical fitness program. Conversely, some patients report no recent changes to account for their symptoms. It is important to inquire regarding training habits, footwear, orthotics, and previous injuries. Patients who cross-train are less likely to experience a stress injury. Shoe and orthotic quality and design should be investigated. A history of previous injuries, including previous stress-related problems, may be revealing. It is important to inquire about eating disorders, weight loss, and menstrual irregularities in females. There is usually no history of trauma. As with most stress injuries, symptoms are aggravated with activity and relieved with rest....

Complexity of Adaptation

Trauma early in the life cycle, particularly when it is recurrent and when it occurs in the context of an inadequate caregiving system, has pervasive effects on cognition, socialization, and the capacity for affect regulation (Cicchetti and Beeghly, 1996 Putnam and Trickett, 1993 van der Kolk and Fisler, 1995). Children exposed to abuse and neglect are at increased risk to develop depression and anxiety disorders. They have a high incidence of aggression against self and others, are vulnerable to develop disturbances in food intake, as in anorexia and bulimia, and suffer from a high incidence of drug and alcohol addiction (van der Kolk et al., 1996b Felitti et al., 1998). It is thought that early and persistent sensitization of CNS circuits involved in the regulation of stress and emotion produces an increased vulnerability to subsequent stress by means of persistent hyper(re)activity of neurotransmitter systems, including corticotropin-releasing factor (CRF) (Heim and Nemeroff,...

Lori L Davis Kimberly A Yonkers Madhukar Trivedi Gerald L Kramer and Frederick Petty

The SSRI's remarkably broad spectrum of utility, crossing (and blurring) diagnostic boundaries of depressive disorders, panic disorder, obsessive-compulsive disorder, bulimia, post-traumatic stress disorder, premenstrual dysphoric disorder and, no doubt, other conditions, raises important and potentially controversial questions regarding the utility, if not outright validity, of contemporary diagnostic terminology, presently codified in DSM-IV. In some respects, this promotes a degree of diagnostic nihilism, similar to the scenario in American psychiatry in the pre-psychopharmacologic era, when psychoanalysis was widely regarded as an effective treatment of choice for most, if not all, neurotic patients, regardless of precise diagnosis. In other words, if the treatment works, independent of diagnosis, why bother to diagnose at all A new diagnostic scheme may evolve from clinical experience and further neurobiological research, in which we might diagnose 'serotonin (5-HT) deficit...

Bovine Anaplasmosisgallsickness

Clinical disease is common when susceptible animals are introduced into endemic areas or the vector distribution expands mortality rates can be over 50 . The incubation period is around three to four weeks and clinical signs depend largely on age (4). Cattle of all ages can be infected, but in enzootic areas animals are exposed at a young age. Calves under six months of age have a nonspecific resistance to infection, irrespective of their dams' immune status they usually develop only mild anemia and show few, if any, clinical signs. In cattle up to three years of age, signs are usually only seen with parasitemias of over 15 . They include steady or fluctuating fever for up to two weeks, partial anorexia, weight loss, and jaundice that develops later in the course of the disease. There is no hemoglobinuria or hemoglobinemia and convalescence is slow, over one to two months. Pregnant cows frequently abort and there is decreased milk production in lactating animals. Young bulls might...

SSRI Spectrum of Therapeutic Action

The efficacy of SSRIs in the treatment of major depression, panic disorder, and obsessive-compulsive disorder has clearly been demonstrated. In addition, data is accumulating on the therapeutic effects of SSRIs in conditions of obesity, eating disorders, post-traumatic stress disorder, social phobia, premenstrual dysphoric disorder and trichotillomania. How can one class of medications work for such a seemingly diverse group of illnesses Are these agents in fact nonspecific and work as a steroid might for a multitude of inflammatory conditions Or alternatively, is there an underlying psychopathology, relating to 5-HT, that represents a common neurochemical theme among these conditions Our methods of classification in psychiatry are clinical and descriptive and may relate poorly to actual brain function.

Serotonergic System and Relevance to Disease and Therapy

Nal, are frequently effective in treating depression, anxiety, and OCD. Moreover, recent studies suggest that combined 5-HT2A- and 5-HT2C-receptor antagonists such as clozapine alleviate some of the symptoms (especially negative symptoms) of schizophrenia and that aberrant function of the serotonergic system may indeed be a major component of the disease. Moreover, alterations in serotonin uptake have been demonstrated in postmortem tissue studies in the lim-bic systems of schizophrenic patients. In addition, there is some evidence to suggest that there may be serotonergic dysfunction in at least some patients with anorexia nervosa. Animal studies using the motoneuron disease model (Wobbler mouse) suggested that sprouted serotonergic fibers in the cervical spinal cord could have excitotoxic effects on motoneurons and thus be causal to the loss of moto-neurons (Bose & Vacca-Galloway, 1999).

Canine Granulocytic Ehrlichiosisanaplasmosis

Dogs naturally and experimentally infected with equine or human strains of A. phagocytophilum show no clinical signs or have acute disease with mild pyrexia, lethargy, anorexia and musculoskeletal pain discomfort with lameness, and reluctance to move (17). There might be transient thrombocytopenia and mild anemia. Diagnosis is usually made by detecting morulae that can be seen in neutrophils (3-35 ) for up to nine days. Analysis by PCR is needed to differentiate A. phagocytophilum from the other granulocytic organism, E. ewingii. The recommended treatment is doxycycline (10mg kg PO q24 hours for 10 days).

Canine Infectious Cyclic Thrombocytopeniacanine Thrombocytotrophic Anaplasmosis

The etiological agent is A. platys which occurs in the United States, Western Europe, Africa, the Middle and Far East, and Australia (23). The pathogenicity of strains varies, with those in the United States generally causing minimal clinical signs. The organism is thought to be transmitted by ticks, and high percentages of platelets are infected in the initial parasitemic episode. Clinical signs include fever, anorexia, lymphadenomegaly, pallor, and petechial hemorrhages

Canine Monocytic Ehrlichioses

The acute phase may be subclinical or there may be depression, lethargy, anorexia, mild weight loss, fever, lymph node enlargement, and splenomegaly. Thrombocytopenia is common but there might also be anemia and leucopenia the bone marrow is usually hyper-cellular. Most dogs recover in one to four weeks and enter the subclinical phase. In naturally infected dogs, in which the stage of infection is unknown, depression (67 ), weight loss (59 ), anorexia (56 ), hemorrhagic tendencies, in particular, epistaxis (46 ), pyrexia (40 ), and lymphadenomegaly (30 ) are the most commonly reported clinical signs in the United States (28). Rarely, there might be polymyositis, paresis, meningoencephalitis, cranial nerve deficits, seizures, abortions and infertility, corneal opacity, anterior uveitis, hyphema, focal chorioretinal lesions, retinal detachment, coughing, and exercise intolerance.

Salmon Poisoning Disease

The incubation period is about a week and signs include fever, anorexia, lymph node enlargement, and severe hemorrhagic enteritis that may be fatal in 7 to 10 days if untreated. Diagnosis is based on the presence of intracellular pleomorphic rods that fill the cytoplasm of the mononuclear phagocytic cells in lymph node aspirates. Finding ova of N. salmincola in the animal's feces supports the diagnosis.

Potomac Horse Feverequine Monocytic Neorickettsiosis

N. risticii circulates in monocytes and has a predilection for the mucosa of the cecum and large colon. Most infections are subclinical and when signs appear they are very inconsistent, including combinations of fever, depression, anorexia, colic, and ileus. Diarrhea occurs in under 60 of horses and laminitis in up to 40 of cases (54). The mortality rate can reach 30 signs in horses that survive without treatment usually resolve over 5 to 10 days. Organisms are seldom seen in blood smears, serology is unreliable, and diagnosis is best based on PCR detection of organisms (54).

Canine Rocky Mountain Spotted Fever

Dogs with clinical signs often have fever, depression, anorexia, lymph node enlargement, subcutaneous edema, muscle and joint pain, and petechiation of the skin and mucous membranes (58). There might also be epistaxis, melena, hematuria, focal neurological signs, necrosis of the extremities, and death from hemorrhagic diathesis, failure of vital organs, or vascular collapse and shock. Dogs seropositive due to previous exposure are common but rising titers in serial samples are diagnostic for RMSF. Direct fluorescent antibody tests on skin samples may be diagnostic, and PCR is available for blood and skin samples. Isolation is possible in specialized laboratories but may take many weeks.

Blastomyces dermatitidis

As discussed previously, infection with Blastomyces dermatitidis is primarily associated with outdoor activities including occupational exposure such as construction work, mining, and recreational activities. The AIDS epidemic has not affected the epidemiology of blastomycosis. 115 Initial infection with this fungus is essentially a pulmonary disease. The chest radiograph demonstrates nonspecific infiltrates predominantly at the bases. y Dissemination to the CNS presents as single or multiple intracranial abscesses or granulomas, cranial and spinal extradural abscesses and acute or chronic meningitis. Meningitis due to B. dermatitidis presents as a subacute infection with headache, anorexia, and weight loss. B. dermatitidis brain abscess or abscesses present with focal neurological deficits, seizures, and signs of increased ICP. Neuroimaging demonstrates evidence of a single or multiple homogeneously enhancing lesions. Chronic blastomycotic meningitis predominantly involves the...

Methods of Diagnosis

Patients with gallbladder cancer present with signs and symptoms that are indistinguishable from those of cholelithiasis (Table 11.10). Small tumors are often found when patients have concomitant symptoms from their gallstones. More-advanced cancers often present with obstructive jaundice and are often associated with other, nonspecific signs such as weight loss, anorexia and malaise. Occasionally, patients can present with fever and severe pain. Tumors that obstruct the cystic duct can cause a clinical picture indistinguishable from acute cholecystitis. Tumors invading the common bile duct will often present as jaundice and sometimes, patients have associated ascending cholangitis.

Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) was not recognized as a unique diagnosis until 1987. Since that time, there has been a marked increase in systematic research into the characterization, comorbidities, and treatment of BDD. The essential feature of BDD is preoccupation with an imagined defect in appearance in a normal-appearing person or a markedly excessive concern about a slight imperfection (Allen and Hollander, 2000). The preoccupation must cause significant distress or impairment in functioning and must not be confined to another disorder, for example, preoccupation with obesity in anorexia nervosa. BDD is relatively common and has been reported to affect 1.9 percent of nonclinical samples (Rich et al., 1992) and 12 percent of psychiatric outpatients (Zimmerman et al., 1998). Similar to OCD, serotonin reuptake inhibitors

Clostridium Haemolyticum

Bacillary hemoglobinuria typically occurs among well-nourished animals at least 1 year old. Migration of immature flukes through the liver causes hepatic necrosis, and the resulting hypoxia induces spore germination in Kupffer cells.239 Production of P-toxin by vegetative cells leads to multiplication of the bacteria and further toxin production.240 Local toxin action results in liver necrosis, while dissemination via the bloodstream causes intravascular hemolysis and hemorrhage.241 Clinical signs include fever, pale mucus membranes, anorexia, abdominal pain, and hemoglobinuria (from which the disease derives its common name, 'redwater'). When hemoglobinuria appears, 40-50 of the red cells have been lysed. Serosal effusions and widespread hemorrhage are common, and the pathognomonic lesion is a large circumscribed liver infarct.240 Large numbers of Gram-positive rods can be found in the sinusoids.4 The case fatality rate is 90-95 in untreated animals, and death ultimately results from...

Mycobacterium tuberculosis

The combination of an unrelenting headache (+ - low grade fever) with malaise and anorexia and a CSF lymphocytic pleocytosis with a mild decrease in the glucose concentration is suggestive of tuberculous meningitis. The initiation of therapy should not await bacteriological proof of tubercle bacilli by smear or culture. The development of hydrocephalus and the clinical scenario just described is additional strong evidence for tuberculous meningitis. The absence of radiographical evidence of pulmonary tuberculosis and or a negative tuberculin skin test does not exclude the possibility of tuberculous meningitis. The classic Ghon complex refers to Anton Ghon's observation from autopsy specimens that the primary lesion of tuberculosis is in the lung with secondary infection in the tracheobronchial lymph nodes.y In addition to the primary complex, chest radiographic abnormalities suggestive of pulmonary tuberculosis are hilar adenopathy, a miliary pattern, upper lobe...

Mehrabians PAD Pleasure ArousabilityDominance Temperamen t Model

Mehrabian and his associates gave much attention to the search for links between eating-related characteristics, including such disorders as obesity and anorexia, and temperament. There was no specific and theoretically grounded rationale behind these studies except for the fact that up till then most research in this domain had been conducted using a clinical approach and or referred to inadequate personality traits assumed to mediate eating characteristics. In Mehrabian and his coworkers' studies (Mehrabian, 1987 Mehrabian & Riccioni, 1986 Mehrabian etal., 1985-1986) eating-related characteristics were measured in normal populations (always undergraduate students) by means of specially constructed questionnaires, and related to the three basic temperament factors. In general, the findings suggested several conclusions, which include the following. Three factors of eating-related characteristics predisposition to obesity, uncontrollable urges to eat, and predisposition to...

Pathophysiology of DHEA deficiency

Low DHEA levels have also been described in a variety of non-endocrine medical conditions. The age-related decline in circulating DHEA levels may correlate with many age-related phenomena such as diabetes and states of insulin resistance, hypertension, atherosclerosis, coronary artery disease, decreased bone mineral density, cancer, and dementia 287-291 . Low levels of DHEA have also been described in correlation with various conditions unrelated to aging, including obesity, depression, and other mood disorders, eating disorders, autoimmune disorders, immune deficiency states, and chronic stress states 287-289,292,293 . In the Massachusetts Male Aging Study (MMAS) DHEA-S was the only hormone which showed a strong (negative) correlation with the prevalence of ED among 17 investigated hormones, including T and estradiol 294 .

The International Conference on the Harmonization of Technical Requirements for Registration of Pharmaceuticals for

For pharmaceuticals, dose may be limited by an extension of the primary pharmacodynamic properties of the drug. Hypotension, anorexia or inhibition of blood clotting are examples of dose-limiting pharmacodynamic effects that would be associated with antihypertensive drugs, appetite suppressants or anticoagulant drugs.

N helmintoeca and Other Species

N. helminthoeca causes a disease named salmon poisoning in dogs and wild Canidae. This name was given because the disease is acquired by eating salmon parasitized with Neorickettsia-infected flukes. Clinical findings of salmon poisoning are fever, anorexia, depression, dehydration, vomiting, and watery to bloody diarrhea. The fatality rate in untreated infected dogs approaches 90 (134,135). Nanopyetus salmonicola is a vector trematode of N. helmintoeca that is known to be a pathogen of salmon poisoning of fish-eating Canidae (136). Intestinal hemorrhage and inflammation are the main damage in patients. Thus, salmon is thought to be an important reservoir of this agent. The Elokomin fluke fever agent is often classified as N. elokominica, but likely is another strain of N. helmintoeca (137). N. sennetsu infection is a human disease characterized by fever, malaise, anorexia, constipation, backache, and lymphadenopathy (138). Although mice are highly susceptible to N. sennetsu (139),...

Indications For Esophagoscopy

Esophagoscopy should be performed when upper abdominal discomfort is associated with signs of organic disease, including anorexia or weight loss, or when it persists despite a trial of appropriate therapy. Dysphagia or odynophagia should always be evaluated endoscopically. Symptoms of gastroesophageal reflux disease that persist or progress in spite of proper therapy warrant endoscopic evaluation. Esophagoscopy is also indicated to confirm radiographic findings suggesting a neoplastic lesion, a gastric or esophageal ulcer, or an obstructing stricture or mass in the esophagus. Periodic esophagoscopy should be performed in all patients with Barrett's esophagus for surveillance for malignant degeneration and for follow-up of large ulcers on Barrett's esophagus to demonstrate healing. Esophagoscopy is used as the initial method of evaluation in most cases of acute gastrointestinal bleeding as an alternative to x-ray studies. Esophagoscopy is also indicated when surgical treatment of such...

Sleep Disorders Classification

Parasomnias usually associated with REM sleep share a common pathophysiological mechanism related to REM sleep. Unlike sleep terrors, sleepwalking, and confusional arousals, which are all associated with SWS, nightmares are REM sleep phenomena. Sleep paralysis is its own entity but can occur in narcoleptics. REM sleep-related sinus arrest is quite rare. REM sleep behavior disorder (RBD) is more common and can manifest in association with other disorders. Acute cases of RBD have toxic, metabolic etiologies, particularly withdrawal from ethanol (64). Chronic cases can be due to neurological disorders e.g., Parkinson's disease and other neurodegenerative disorders (65), subarachnoid hemorrhage (66), pontine neoplasm (67), or narcolepsy (68) or may be idiopathic (66). Other types of para-somnias include sleep-related dissociative disorders, sleep enuresis, sleep-related groaning, exploding head syndrome, sleep-related hallucinations, and sleep-related eating disorder.

Pasture Fever And Tickborne Fever

Pasture fever occurs in dairy cattle that have over-wintered in barns and are turned out onto tick-infested pastures in spring. There is a severe drop in milk yield, high fever, mild depression, anorexia, and occasional coughing. Tick-borne fever occurs in sheep, cattle, and very occasionally in goats that are moved from tick-free to tick-infested areas. Infections are usually subclinical but there may be fever, anorexia, coughing, and mild weight loss. Infected lambs may have reduced weight gain (22). Although clinical signs in lambs are usually mild, there are marked hematological changes including high parasitemias (80 ) of neutrophils and lymphopenia, neutropenia, and throm-bocytopenia. Up to 50 of pregnant animals abort or give birth to weak premature offspring, whereas the leucopenia predisposes to a variety of severe concurrent bacterial (lamb pyemia due to Staphylococcus aureus, pasteurellosis, and listeriosis) and viral infections (louping ill). Affected animals, especially...

Antisterility Vitamin In Human Beings

Among the gastrointestinal symptoms of thiamine deficiency are indigestion, severe constipation, anorexia, gastric atony, and hypochlorhydria. All these effects presumably result from failure of the smooth muscle and glands of the gastrointestinal tract to derive sufficient energy from carbohydrate metabolism.

Monoamine Reuptake Inhibitors

Is produced rapidly in humans, with peak plasma levels of up to 3 times those of bupropion and a half-life of 24 hr. Therefore, orally administered bupropion is likely to lead to significant NE reuptake inhibition and relatively less DA reuptake inhibition. Bupropion increases locomotor activity and causes stereotyped behaviors in laboratory animals. In humans, it can cause restlessness, insomnia, anorexia, and psychosis. Bupropion is structurally related to phenylethylamines and unrelated to the TCAs, SSRIs, or MAOIs. It has no significant potency at binding to any known neurotransmitter receptors. Clinical studies have demonstrated that bupropion is effective in the treatment of major depressive episodes (Depression Guideline Panel, 1993). While early studies suggested that bupropion might be less likely to cause hypomania or mania in bipolar patients, subsequent studies suggested that it can cause mania and psychosis in bipolar patients, especially those with high pretreatment...

The Female Athlete Triad

The problem usually begins with disordered eating, which includes a spectrum of abnormal and harmful eating patterns such as binging and purging, restrictive eating, fasting, and the use of diet pills or laxatives. The preoccupation with food, a distorted body image, and intense fear of becoming fat are often present as well. Some athletes will meet the Diagnostic and Statistical Manual of Mental Disorders, revised edition IV 95 , criteria for anorexia nervosa or bulimia, whereas other athletes may display similar behaviors without meeting full diagnostic criteria. A new classification of eating disorder not otherwise specified (ie, ED-NOS) allows for the identification of women who do not meet other classification criteria. This classification has been helpful in this population because the athlete's weight may seem adequate as a result of increased lean tissue mass however they are not consuming enough calories to meet their energy needs.

Cirrhosis In Liver Disease

The liver has immense reserve and regenerative powers. It is estimated that at least 75 of normal hepatic function must be absent for any changes in standard hepatic function tests to occur. Thus, taking an accurate history is important. Careful attention should be given to factors such as alcohol ingestion, state of nutrition, previous history of hepatitis, jaundice, or anorexia, and protean manifestations such fatigue and loss of stamina. A carefully directed physical examination includes a search for petechiae, rhinophyma, Dupuytren's contracture, telangiectasia in the upper trunk, ascites, asterixis, palmar erythema, and testicular atrophy. In our opinion, the classic live function tests, especially of synthetic function, give as good a measurement of hepatic reserve as other more sophisticated tests, such as galactose elimination, urea

Clinical Features

Sialadenosis is a diffuse enlargement of salivary glands described in several conditions. Sialadenosis usually involves the parotid glands, and less commonly the submandibular glands 121, 157, 462 . Minor salivary gland involvement has also been reported 408 . It is frequently bilateral and has an equal sex distribution. It is typically painless and the enlargement may impart a striking facial appearance. Causes can be categorized as nutritional (alcoholism, cirrhosis, eating disorders, kwashiorkor, and

Benefits of Control Therapy

Control therapy has been shown to be effective in both assessment (sensitivity and specificity) and treatment (clinical outcome) with a wide range of mental disorder diagnoses and health-related concerns. Clinical areas investigated include Generalized Anxiety Disorder, panic attack, depression, borderline personality, eating disorders, and adult children of alcoholics. Control issues have also been investigated in type-A individuals with myocardial infarction, women with breast cancer, and individuals at high cardiovascular risk.

IoTb management of hepatitis

Most anti-TB drugs can damage the liver. Isoniazid and pyrazinamide are most commonly responsible. Ethambutol is rarely responsible. When a patient develops hepatitis during anti-TB treatment, the cause may be the anti-TB treatment or something else. It is often difficult to find out. Try to rule out other possible causes before deciding that the hepatitis is drug-induced. Hepatitis presents with anorexia, jaundice and often liver enlargement.

Equine Ehrlichiosisequine Granulocytic Anaplasmosis

The etiological agent was first named E. equi, but is now recognized as a strain of A. phagocy-tophilum (1). The disease is common in northern California but has been reported across the United States and in Europe and South America. The vectors are Ixodes spp., in particular I. pacificus (black-legged tick) in California (15) and I. ricinus in Europe. Most infections are subclinical but in horses that develop a more severe vasculitis, clinical signs evolve over a number of days and include fluctuating fever, depression, partial anorexia, ataxia, reluctance to move, limb edema, and icterus (16). Deaths are uncommon and animals gradually improve after one to two weeks. Laboratory abnormalities include anemia, leucopenia, thrombocytope-nia, and increased bilirubin. After a few days of clinical signs, morulae are readily seen in neu-trophils or eosinophils, but infections can also be diagnosed using an IFA or by identification of the organism in blood using PCR. Although oxytetracycline...

Clinical Manifestations Of Epidemic Typhus

After an incubation period of 10 to 14 days, epidemic typhus begins abruptly. The majority of patients with epidemic typhus develop a malaise and nonspecific constitutional symptoms (anorexia, chills, headache, myalgias, arthralgias, and fever) (17). In a recent study in Burundi, a crouching attitude due to myalgia, named sutama, was reported (18). A cough is frequent, as well as confusion and stupor. There is no eschar of inoculation at the site of the lice biting. Most patients develop a skin rash that classically begins on the trunk and spreads to the periphery. A macular, maculopapular, or petechial rash may appear in 20 to 60 of cases, which may be difficult to detect on dark-skinned persons. The face, the hands palm, and the foot plants are saved. Rarely, patients with severe cases may develop gangrene of the distal extremities, necessitating amputation. The majority of patients with epidemic typhus manifest one or more abnormalities of function of the CNS, such as signs of...

Criteria for Selection of Preferred Treatment

Depression with melancholic features is classified as a loss of pleasure in all or almost all activities, or lack of reactivity to usually pleasurable stimuli, and three of the following distinct quality of depressed mood, depression worse in the morning, early morning awakening, marked psychomotor retardation or agitation, significant anorexia or weight loss, and excessive or inappropriate guilt.

The Use of SSRIs to Treat Conditions Other Than Depression

One of the major spin-offs to occur as a result of the overwhelming commercial success of the SSRIs has been the spread of their use not only for severe depression to mild dysthymia, but also to other psychiatric, e.g., bulimia, panic disorder, obsessive-compulsive disorder, anxiety, and non-psychiatric conditions, e.g., obesity, premature ejaculation, Raynaud's syndrome, headache. In view of the postulated role of central serotonergic systems in eating disorders and also in the control of food intake, considerable attention has been focused on the potential benefit of the SSRIs in the treatment of bulimia, anorexia and obesity. In view of the compulsive behavioral component in bulimia, it is not surprising that the SSRIs show the greatest benefit in this psychiatric disorder. Double-blind, placebo-controlled clinical trials have demonstrated that high doses of fluoxetine reduce the frequency of binge eating sessions and the number of vomiting episodes.101-104 Currently, it is the...

Epidemiology

There was a consistent increase in the incidence of AN over the period from 1931 to 1986 in industrialized countries (Hoek, 1993). A study conducted in northeastern Scotland (Eagles et al., 1995) showed that between 1965 and 1991 there was almost a sixfold increase in the incidence of anorexia (from 3 in 100,000 to 17 in 100,000 cases). The male-female ratio for eating disorders lies consistently between 1 10 and 1 20 (Hoek, 1993). AN is rare in non-Western, poorly industrialized countries (Lee, Leung, & Lee, 1996). Individuals and groups who are exposed to the ideal of a slender body type seem to be a risk for developing an eating disorder (Crago, Schisslak, & Estes, 1996). Areview of eight studies in the 1980s (Gard & Freeman, 1996) failed to support a higher social economic class prevalence in AN.

Genetic Factors

In a series of 67 twin probands, the concordance for restricting AN was markedly higher for monozygotic twins, 66 , than for dizygotic, 0 . A familial aggregation of AN and Bulimia Nervosa is present in AN probands (Treasure & Holland, 1989). Agenomewide linkage analysis of 192 families with one AN member and another with any related eating disorder identified in the Diagnostic and Statistic Manual of Mental Disorders (fourth edition) showed a modest linkage on chromosome 4. When a subset of 37 families containing 2 with restricting AN was analyzed, a more robust linkage was found on chromosome 1p (Devlin et al., 2002 Grice et al., 2002). A vulnerability for destabilization of the endocrine and metabolic mechanisms affecting eating behavior may cause the full-blown eating disorder under stresses such as severe dieting. Neurotransmitter serotonin pathways modulate feeding and inhibitory behaviors. There is evidence of aberrations in this neurotransmitter system in anorectic patients.

Stressful Events

Stressful life events may be a risk factor for developing AN. Studies investigating the relationship between sexual abuse and eating disorders have produced highly discrepant results (Connors & Morse, 1993). Alow rate of sexual abuse has been reported among anorectic restrictors relative to either bulimic anorectics or to normal-weight bulimics (Waller, Halek, & Crisp, 1993). Normative developmental events, such as the onset of puberty, departure from home, or a change of school, can precipitate an eating disorder. Adverse life events, such as the death of a close relative, the breakup of a relationship, or illness, may also precipitate an eating disorder (Tobin et al., 1995).

Course of Illness

Long-term follow-up research indicates that about one fourth of those with AN recover from the disorder, one fourth stay chronically ill with no improvement, and about half have partial improvement. Most of the latter have bulimic behaviors. Mortality rates at 10 years are 6.6 and at 30 years are 18 to 20 after presentation for treatment (Eckert et al., 1995).

Family Therapy

E., & Morse, W. (1993). Sexual abuse in eating disorders A review. International Journal of Eating Disorders, 13, 1-11. Crago, M., Schisslak, C. M., & Estes, L. S. (1996). Eating disturbances among American minority groups A review. International Journal of Eating Disorders, 19, 239-248. Crisp, A. H. (1970). Premorbid factors in adult disorders of weight, with particular reference to primary AN (weight phobia). Journal of Psychosomatic Research, 14, 1-22. Devlin, B., Bacanu, S. A., Klump, K., Bulik, C., Fichter, M., Halmi, K. A., et al. (2002). Linkage analysis of anorexia nervosa incorporating behavioral covariates. Human Molecular Genetics, 11, 689-696. (1994). Washington, DC American Psychiatric Association. Eagles R., Johnston M., Hunter D., et al. (1995). Increasing incidences of AN in the female population of northeast Scotland. American Journal Psychiatry, 152, 1266-1271. Eckert, E. D., Halmi, K. A., Marchi, E. P., & Cohen, J. (1995). Ten-year follow-up of...

Contraception

Some studies have shown that oral contraceptive pills (OCP) seem to have a protective effect in preventing stress fractures in female athletes 17,75 . It appears that exogenous estrogen may help curb further bone loss in the hypo-estrogenic amenorrheic athlete however, it may not be sufficient to stimulate bone growth 71,76-79 . Several small studies of amenorrheic women or those with anorexia have found BMD at the lumbar spine or hip to be higher for women taking OCP compared with those who were not 76,77,80 , whereas other studies show no significant change 71,78 . It has also been theorized that OCP may act through another mechanism, such as improving bone microarchitecture and quality without significantly affecting BMD 4 . However, to add to the controversy, a recent study by Hartard and colleagues 81 has shown that OCP use is associated with decreased BMD of the spine (7.9 ) and the femoral neck (8.8 ) in female endurance athletes compared with non-OCP users. The authors 81 also...

Disordered Eating

Inadequate caloric intake relative to the energy expenditure required for exercise appears to be the primary mechanism by which female athletes are predisposed to menstrual dysfunction and detrimental effects on bone. Anorexia nervosa has been associated with a significantly decreased BMD 7,89 . Nearly 75 of adolescent girls with anorexia have a BMD more than two standard deviations below the normal value 90 . Not surprisingly, women with anorexia nervosa are at an increased risk for stress fracture development 91,92 . Interestingly, disordered eating is associated with low BMD in the absence of menstrual irregularities 59 .

ACTH Deficiency

The symptoms of central adrenal insufficiency can be subtle. They include poor weight gain, anorexia, easy fatigability, and poor stamina. In patients who have ACTH deficiency, as opposed to primary adrenal insufficiency, symptoms of salt craving, electrolyte imbalance, vitiligo, and hyperpigmentation usually are not observed. More overt manifestations of complete ACTH deficiency include weight loss and shak-iness that is relieved by eating (hypoglycemia). Signs of adrenal crisis at times of medical stress include weakness, abdominal pain, hypotension, and shock.

Beriberi

Beriberi, the most common thiamin deficiency syndrome in humans, is characterized by peripheral neuropathy, exhaustion and anorexia that progress to edema, cardiovascular diseases and neurologic and muscular degeneration.51-53 Beriberi strikes in three major types dry beriberi, wet beriberi and infantile beriberi. Beriberi is considered an epidemic disease in some parts of Southeast Asia54 and Cuba55 where refined rice is a staple diet, and these regions have inadequate thiamin-enrichment programs.

History

A careful dietary and nutrition history should be obtained. Patients who are dehydrated chronically from bulimia or anorexia or during chemotherapy are at risk for parotitis. Swelling and pain during meals followed by a reduction in symptoms after meals may indicate partial ductal stenosis.

Tolerability

The peripheral role of 5-HT affecting the gastrointestinal tract is well recognized in all patient groups of whatever age. In elderly patients with depression, and treated with fluoxetine, nortriptyline, desipramine or no medication, Brymer and Winograd115 noted that those on fluoxetine experienced significantly greater weight loss and were more likely to report nausea and anorexia than the other groups. The weight loss was greatest in those over the age of 75.

Rapid Weight Loss

It's been observed that Graves' disease commonly presents in people (women in particular) after they have begun a rapid weight-loss program. The rapid weight loss from the diet can mask the symptoms of Graves', and even lead some physicians to suspect amphetamine abuse or an eating disorder. A theory (not confirmed) is that sudden changes in the metabolic rate, which can be brought on by starvation or rapid weight loss, may trigger autoimmune thyroid disease in people who have antithyroid antibodies.

Culture And Health

Some health-related practices are dramatically culture-bound, such as infanticide and malnutrition in girl children because of boy preference in several Asian countries. Mothers in West Papua do not take ferum tablets due to the fear of having large babies, since they have to deliver their babies by themselves in the hut in the back yard outside their homes. Certain mental illnesses, such as amok (sudden frenzy), koro (fear of penis constriction), and taijin-kyofusho (fear of being looked at) are thought to be culture-specific rather than universal. Anorexia Nervosa (self-starvation and distorted body image) is mainly confined to Western countries, but more recently it has been showing up in Asian locations.

Nutritional Habits

Circumstances, the athlete must be evaluated for the female athletic triad 30 , consisting of disordered eating, amenorrhea, and osteoporosis. Severe eating disorders are considered medical emergencies and often require a multidisci-plinary approach including nutritional and psychologic counseling.

Cannabinoids

The duration of REM sleep is reduced by THC, which is a sedative, and it disproportionately reduces the number of rapid eye movements. It slightly increases the duration of stages 3 and 4 NREM sleep, but these effects become less marked with long-term THC use. Withdrawal leads to REM sleep rebound and a reduction in REM latency, as well as anxiety and anorexia.

Clinical Disease

RMSF is a systemic illness that can involve endothelial cells of capillaries and small-to-medium-sized vessels of all tissues and organs however, the signs and symptoms of early disease resemble many other infectious syndromes, and even in areas where the awareness of the disease is reasonably high, as many as 60 to 75 of patients with RMSF receive an incorrect diagnosis on their first visit for medical care (60-62). Approximately one week (range 3-12 days) following the bite of an infected tick, the disease begins with abrupt onset of fever and is often accompanied by headache, nausea, vomiting, anorexia, and generalized myalgia, especially in the muscles of the lumbar region, thigh, and calf. The fever is typically high (39-41 C) and is accompanied by a severe frontal headache (60,63,64). Other findings recorded consistently but with varying frequency include irritability, altered mental status, abdominal pain, splenomegaly, conjunctival injection, and periorbital edema (65,66).

Impulsivity

Environmental social constructs are important in the study of impulsivity because many of the sociocultural cues for impulsive responding, which are acquired at various developmental stages, are learned unconsciously. This implicit learning process can provide the cues for unconscious impulsive acts. These are the cues which, for example, marketing experts capitalize on or which substance abuse patients respond to. Learned cues can become part of a pathological process, as observed, for example, in bulimia. A refrigerator door may become a cue to eat.

Valproic Acid

Valproic acid appears to have the most favorable side effect profile of all available antimanic drugs. Dose-related and common initial side effects include nausea, tremor, and lethargy. Gastric irritation and nausea can be reduced by dividing the dose or using enteric coated preparations. Valproic acid has been associated with potentially fatal hepatic failure, usually occurring within the first 6 months of treatment and most frequently occurring in children under age 2 and individuals with preexisting liver disease. Transient, dose-related elevations in liver enzymes can occur in up to 44 percent of patients. Any change in hepatic function should be followed closely and patients should be warned to report symptoms of hepatic failure such as malaise, weakness, lethargy, edema, anorexia, or vomiting. Valproic acid may produce teratogenic effects including spina bifida (1 percent) and other neural tube defects. Other potential side effects include weight gain, inhibition of platelet...

Marital Discord

Inquiry into the causes, consequences, and correlates of marital discord is driven, in part, by the perceived importance of better understanding the effect of marital discord on numerous processes related to personal and family adjustment. Supporting this perception, much recent research suggests that marital discord and the related constructs of marital dissatisfaction and marital conflict play an important role in individual and family well-being. For example, marital dissatisfaction commonly co-occurs with depression, eating disorders, and some types of alcoholism, as well as physical and psychological abuse of partners. In addition, marital discord and marital dissolution co-vary with problems of delinquency and may presage children's later problems with intimate communication. Similarly, marital discord is associated with poorer health and with specific physical illnesses such as cancer, cardiac disease, and chronic pain. Marital interaction studies suggest possible mechanisms...

Toxicity

The risk of vitamin D toxicity is related to the underlying potential cause. Excessive sunlight does not lead to vitamin D toxicity (however, skin cancer is a real risk from exposure to the sun). Overindulging in oral sources (dietary supplements) of vitamin D in infants can lead to anorexia, nausea, renal insufficiency and failure to thrive. In adults, excessive vitamin D intake can lead to hyper-calcemia and possible calcification of soft tissue.13

Narcolepsy

Narcolepsy requires lifelong treatment. Daytime sleepiness is countered with stimulants like methylphenidate or dextroamphetamine. The side effects include anorexia, nervousness, tics, and insomnia. Modafinil (Provigil), a drug with an unspecified mode of action, is also effective in enhancing alertness and improving psychomotor performance. Gamma hydroxybutyrate also holds promise as an agent for both enhancing alertness and reducing cataplexy. Because cholin-ergic pathways in the brain stem mediate cataplexy, drugs such as clomimipramine and protryptiline with anticholin-ergic properties have been used to treat cataplexy. Replacement therapy with hypocretin analogues holds some long-term promise. One to three planned naps per day, each lasting 25 to 30 minutes, are also helpful in enhancing alertness. Supportive psychotherapy and fluoxetine may be needed if the patient develops emotional or behavioral problems.

Causes

Athletes are at risk for developing either fatigue or insufficiency fractures. Extrinsic risk factors include training schedule, diet, playing surfaces, and equipment such as footwear. Intrinsic risk factors include age, gender, lower-extremity alignment (leg length inequality, coxa vara, or cavus foot), low bone mass, menstrual cycles, and metabolic disorders 3,27,34,35 . Generally, training errors are the most frequently encountered causes of stress fractures 1,10 . Athletes suddenly either increase the intensity of a routine workout or start a new exercise at a level that is beyond the normal physiologic response of bone. Insufficiency fractures in athletes are most commonly related to a metabolic problem related to diet or hormonal imbalance. A daily diet needs to provide sufficient calories to support certain levels of physical activity in athletes. Daily recommended doses of calcium and vitamin D also should be taken to maintain adequate bone density. Female athletes deserve...

Management

And magnesium disrupt the normal metabolism of bone, which has significant effects on the internal structure and strength of bone 41 . Part of this treatment option is determining the appropriate use of hormone replacement therapy in amenorrheic females. A critique of the athlete's diet is also important to ensure adequate caloric intake and appropriate vitamins and minerals to maintain adequate bone density. Psychologic assessment may be needed in athletes with eating disorders. A supervised, graduated physical therapy program is required to define and control the duration, frequency, and intensity of activity as the athlete moves closer to full competition. The correction of training errors that led initially to the stress fracture is essential to the rehabilitation process. Athletes are allowed to continue conditioning exercises such as swimming or cycling during the period of rest for their injured femur. In some patients, the use of unloader braces may be appropriate to decrease...

Hypoxia

Compensatory physiological mechanisms (e.g., increased erythropoiesis and O2 dissociation curve shifts) permit adaptation to hypoxia, thereby making the effects of hypoxia time dependent and necessitating separate discussions for acute and chronic hypoxic states. Healthy human volunteers subjected to rapid decompression hypoxia (analogous to acute hypoxia, clinically) demonstrate an association between the PaO 2 level and the neurological features observed. y New skill learning and the processing of complex information are the most vulnerable to hypoxia. y At a PaO2 of 80 mm Hg, impaired dark adaptation is noted at 55 to 45 mm Hg, impaired learning and short-term memory occurs, whereas measures of selective attention are normal at 40 to 30 mm Hg, loss of judgment, euphoria, delirium, and muscular incoordination occurs additionally, twice as much light is required for visual perception below 25 to 20 mm Hg, consciousness is rapidly lost. y , y High altitude sickness begins shortly...

Subjective Objective

Fatigue, somnolenee, eold intoleranee, syneope, exertional Bradyeardia, hair changes (sparse, eoarse, dry, brittle), puffy face, loss of lateral aspeets of the dyspnea, weight gain, arthralgias, nausea, anorexia, eyebrows, penorbital edema, maeroglossia, voiee deepening and hoarsening, skin ehanges (sealy,

Heartwater

In the acute form, up to 90 of animals die, usually within six days. It is the most common form of the disease, occurring in local and exotic breeds. There is acute fever, anorexia, depression, tachypnea, and classic neurological signs including high-stepping gait, circling, chewing movements, exaggerated blink reflexes, tongue protrusion, and occasionally aggression and apparent blindness. Later, animals become recumbent, make paddling movements with their legs, and have opisthotonus, nystagmus, hyperesthesia, frothing at the mouth and nostrils, and convulsions. There can also be profuse diarrhea.

Cancer

It has been postulated that cancer cachexia, characterized by anorexia, weight loss, and progressive tissue wasting, may be mediated by various cytokines however, the precise mechanism of cachexia induction is not fully explained. Transfection of NFkB decoy ODNs into the tumors of mice bearing adenocarcinoma (colon26) resulted in attenuation of the reductions in body weight, epididymal fat, gastrocnemius muscle mass, and food intake, which were induced by the tumor presence.26 Unexpectedly, tumor growth of colon26 was not affected by transfection of NFkB decoy ODNs as compared with scrambled decoy ODNs. Cytokines regulated by NFkB may play a pivotal role in the induction of cachexia by colon26, providing a new therapeutic strategy for cancer cachexia. In addition, we employed NFkB decoy ODNs to hepatic metastasis of M5076 reticulosarcoma in mice to evaluate the role of transcription factor NFkB in the pathogenesis of cancer metastasis. Murine M5076 reticulosarcoma cells, which arose...

Babesiosis

Babesiosis is a malaria-like illness caused by a protozoan parasite and transmitted by a tick bite. Most human cases of babesiosis have occurred during the summer months in the northeastern United States, Maryland, Virginia, Georgia, Wisconsin, Minnesota, California, and Washington. Symptoms of babesiosis typically begin approximately 1 week after a tick bite and include malaise, anorexia, and fatigue followed several days later by fever, drenching sweats, myalgia, and headache. The clinical spectrum ranges from a mild self-limited illness to a serious disease with hemolytic anemia, renal failure, and hypotension primarily in patients of advanced age or in those with underlying chronic disease. Babesiosis can be diagnosed by examining Wright-stained or Giemsa-stained peripheral blood smears. The parasites invade erythrocytes and appear as small intraerythrocytic ring forms resembling the causative organism of malaria, Plasmodium falciparum. An indirect immunofluorescence test titer of...

Sleep Disorders

Patients with parasomnias are infrequently seen at sleep disorders centers but are of theoretical interest as they may represent dissociation of aspects of sleep stages. Intrusions of waking behaviors in non-REM sleep include sleepwalking, night terrors, episodic nocturnal wandering, and nocturnal eating disorders. Although extremely common and usually benign in adolescents, parasomnias in adults may be accompanied by violence and therefore require treatment. REM behavior disorder is a failure of the normal muscle paralysis that prevents movement during REM sleep, thus representing an intrusion of wakefulness during REM sleep. Patients with this disorder act out their dreams, occasionally causing significant injuries.

The Ocd Spectrum

In the past 10 years, research has begun to focus on a group of illnesses that have been labeled obsessive-compulsive spectrum (OC spectrum) disorders. People affected by these disorders have in common the symptoms of obsessive thoughts and compulsive behaviors and share a similar family history of mental illness and response to treatment. The current literature generally includes OCD, body dysmorphic disorder, hypochon-driasis, and Tourette syndrome in the OC spectrum (Yaryura-Tobias and Neziroglu, 1997a, 1997b). Trichotillomania, eating disorders, and self-mutilation also have overlapping symptoms and some argue that they should be included in this group. Some authors also have included pathologic gambling and sexual impulse control problems within the spectrum (Hollander et al., 1996). All these conditions share a similar core in that a person performs an action or has repetitive thoughts that reduce their anxiety. This performance of a ritualistic behavior to alleviate anxiety is...

Clostridium Novyi

Clostridium novyi type B causes infectious necrotic hepatitis of sheep and cattle, and occasionally infects horses and swine. Spores are often found dormant in Kupffer cells in normal liver. Liver injury, such as that accompanying migration of immature flukes (Fasciola hepatica), produces conditions that encourage germination. Production and dissemination of a-toxin lead rapidly to systemic effects,226 which manifest as depression and anorexia, with acute or peracute death. Venous congestion resulting from pericardial edema produces the characteristic darkening of the underside of the skin, giving rise to the name 'black disease'. a-Toxin can be demonstrated in lesions,227 which typically are characterized by edema, serosal effusion, and focal areas of hepatic necrosis.

Supplementation

Compared with elements such as silicon and manganese, vanadium is a relatively toxic element for humans. As indicated in the following, the threshold level for toxicity through ingestion apparently is between 10-20 mg day. Schroeder et al.232 fed 15 subjects 4.5 and 9 mg V day as diammonium oxytartratovanadate for 6-16 months without apparent detrimental effect. Curran et al.233 fed five subjects 13.5 mg day in three divided doses as diammonium oxytartratovanadate for 6 weeks no sign of intolerance or toxicity was found. In contrast, Sommerville and Davis234 supplemented 12 subjects 13.5 mg day for 2 weeks and then 22.5 mg V day for 5 months as diammonium vanadotartrate five patients exhibited persistent upper abdominal pain, anorexia, nausea and weight loss. Dimond et al.235 supplemented ammonium vanadyl tartrate orally to six subjects for 6-10 weeks in amounts ranging from 4.5-18 mg V day green tongue, cramps and diarrhea were observed at the larger doses. Based on renal effects in...

Clinical Indications

Despite being labeled antidepressants, the tricyclics also produce significant benefit in the treatment of certain anxiety disorders, notably panic attacks and generalized anxiety (Roy-Byrne & Lydiard, 1989). Tricyclics have been shown to decrease significantly the rate of binges in patients with bulimia, although they have been ineffective in the treatment of anorexia nervosa (Walsh et al., 1997). Tri-cyclics are also used for the treatment of other conditions Walsh, B. T., Wilson, G. T., Loeb, K. L., Devlin, M. J., Pike, K. M., Roose, S. P., Fleiss, J. L., & Waternaux, C. (1997). Medication and psychotherapy in the treatment of bulimia nervosa. American Journal of Psychiatry, 154, 523-531.