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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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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Anorexia and weight loss

Significant weight loss occurring as an isolated symptom is rarely associated with serious organic disease. However, a careful history may elicit other symptoms and alert the clinician to the underlying cause. While some patients can accurately quantify their weight loss, many cannot. The patient may assess the rate and severity of weight loss from ill-fitting clothes. Whenever possible such subjective assessment should be confirmed objectively. Review of previously documented weights from case records may avoid needless investigation in patients who mistakenly believe they are losing weight. The significance of weight loss relates to its duration and extent together with the presence or absence of anorexia (loss of appetite) or deliberate reduction in food intake. Weight loss of less than 3 kg in the previous 6 months is rarely of significance. Weight loss accompanied by severe anorexia or other alimentary symptoms may not necessarily be due to intraabdominal disease such features...

F502 Bulimia nervosa

A syndrome characterized by repeated bouts of overeating and an excessive preoccupation with the control of body weight, leading to a pattern of overeating followed by vomiting or use of purgatives. This disorder shares many psychological features with anorexia nervosa, including an overconcern with body shape and weight. Repeated vomiting is likely to give rise to disturbances of body electrolytes and physical complications. There is often, but not always, a history of an earlier episode of anorexia nervosa, the interval ranging from a few months to several years. Bulimia NOS Hyperorexia nervosa

Third Party Information

The topics involved arc often highly sensitive, for instance sexual abuse, offending behaviour, drug misuse, eating disorder or domestic violence, and the informant may be genuinely concerned for the patient and apprehensive about the outcome should Ihe patient discover the intervention. In these circumstances, clinically relevant information obtained from a third party should be written on a separate sheet of paper, clearly identified as such and, located separately in the clinical records, preferably behind a casenote divider headed Third Party Information. This ensures that the patient would not have access to this pan of the clinical record (under the Health Records Act 1990). and this assurance should be given to the informant.

Hepatitis A Virus

Clinical disease due to HAV resembles other types of acute hepatitis, and diagnosis is generally dependent on laboratory confirmation of infection by the virus. The incubation period is approximately 28 days but can vary from 15 to 50 days. Initial symptoms include pyrexia, malaise, anorexia, which is often quite prominent, nausea, vomiting, and abdominal discomfort or pain. These initial symptoms are followed a few days later by the development of jaundice with a typical yellow discoloration of the skin, especially the sclera of eye, and darkening of the urine. The acute phase usually lasts between 1 and 3 weeks and is followed by a varying period of convalescence characterized by fatigue, malaise, anorexia, and persisting nausea.

Clinical Presentation Of Aidsrelated Lymphoma

Specific symptoms of AIDS-lymphoma will depend upon the organ(s) involved. Patients with primary CNS lymphoma often complain of headache, seizures, focal neurologic defect, or altered mental status (40). Headache or cranial nerve palsy may occur in patients with leptomeningeal involvement, although approx 20 of patients with lymphoma cells in the spinal fluid will be asymptomatic (41). Gastrointestinal lymphoma may present with abdominal pain or distension, anorexia, nausea, or vomiting. Involvement of the rectum and or perianal region often presents as a rectal mass, or

Adverse Reactions

Gastric upset, heartburn, nausea, vomiting, anorexia, and gastrointestinal bleeding may occur with salicylate use. Although these drugs are relatively safe when taken as recommended on the label or by the primary health care provider, their use can occasionally result in more serious reactions. Some individuals are allergic to aspirin and the other salicylates. Allergy to the salicy-lates may be manifested by hives, rash, angioedema, bronchospasm with asthma-like symptoms, and ana-phylactoid reactions.

Severely Depressed Individuals Lack The Capacity To Utilize Hypnosis

Pettinati, Kogan, Evans et al. (1990) compared hypnotizability on two measures, the Hypnotic Induction Profile (HIP) and the Stanford Hypnotic Suggestibility Scale C (SHSS C) for five clinical and one normal college populations. The group with a diagnosis of major depression scored higher on the SHSS C than the normal population and only marginally lower, although higher than the anorexia nervosa and schizophrenia groups, on the HIP.

Monitoring and Managing Common Adverse Reactions

However, even minor adverse drug reactions can be distressing to the patient, especially when they persist for a long time. Therefore, when possible, the nurse should relieve minor adverse reactions with simple nursing measures. For example, the nurse can assist the patient with dry mouth by giving frequent sips of water or by allowing the patient to suck on a piece of hard candy (provided that the patient does not have diabetes or is not on a special diet that limits sugar intake) to relieve a dry mouth. The nurse can help relieve a patient's constipation by encouraging increased fluid intake, unless extra fluids are contraindicated. The primary care provider also may order a laxative or stool softener. It is important for the nurse to maintain a daily record of bowel elimination. The nurse can help the patient minimize certain gastrointestinal side effects, such as anorexia, diarrhea, and constipation by administering drugs at a specific time in relation to meals, with food, or with...

Gastrointestinal Symptoms

Anorexia, nausea, and vomiting may occur as a result of digitalis excess. Hepatomegaly associated with tricuspid valve disease or severe right-sided heart failure may cause right-upper-quadrant epigastric pain and fullness as well as anorexia. Abdominal pain due to visceral ischemia or infarction may occur in a patient who has had a period of very low cardiac output. The pain of some gastrointestinal diseases may be referred or extend to the chest or back and lead to confusion with myocardial ischemia.

Assessment Of Effectiveness

Any treatment modality stands to be tested based on the outcome, and outcome of treatment must be compared to the natural history of the illness. There are insufficient data regarding the natural history of eating disorders. This refers to patients with any one of the three eating disorders mentioned at the beginning of this chapter in terms of what takes place regarding the outcome of their illness when no treatment is used. This needs to be compared to a variety of treatment modalities, and when treatment interventions produce better outcome compared to the natural history of the eating disorder, such a treatment modality may be 1. Symptom relief Patients who come for treatment suffer from a variety of symptoms that can be measured and recorded with the psychiatric interview, the Mental Status Examination, and a variety of scales such as the Eating Disorders Inventory (EDI) (Garner, Olmsted & Polivy, 1983), the Zung Scale for rating Anxiety (Zung, 1971), and the Zung Scale for...

Laurie Haas and Luis Marsano

Patients with infections of the gastrointestinal (GI) tract may present with a range of complaints from vague symptoms such as malaise and anorexia to more serious manifestations such as severe diarrhea and sepsis. Although many GI infections require antibiotic therapy, others cause self-limited disease and only supportive care is needed. In the last decade, the recognition of the clinical importance of Helicobacter pylori and its cause and effect on peptic ulcer disease has changed what was once thought to be a disorder of excessive acid production to an infectious disease. The rising incidence of hepatitis C virus and progression to chronic active hepatitis and cirrhosis has also placed a tremendous burden on the health care system to find more effective and tolerable therapies for this disease. The emergence of resistance to antibiotics used to treat many of these infections, especially Helicobacter pylori infection and infectious diar-rheal syndromes, poses new challenges for...

Grontologie Alert

The nurse must also closely observe the patient for other adverse drug reactions, such as anorexia, nausea, vomiting, and diarrhea. Some adverse drug reactions are also signs of digitalis toxicity, which can be serious. The nurse should carefully consider any patient complaint or comment, record it on the patient's chart, and bring it to the attention of the primary care provider.

Clinical Presentation

The signs and symptoms of cancer vary widely, depending on the type and site of the tumor, as well as the stage of its development. Tumors of the skin and breast often present as lumps. Hollow tubes in the body, such as trachea, bronchi, ureter, intestine, and bile duct can be partially occluded by tumors, leading to symptoms from compromise of their function. Cancer can ulcerate and bleed into any of these hollow pathways. Pain occurs when hollow organs attempt to overcome the obstruction by contractions or when the tumor cells press on nerve fibers. Cancers can lead to weight loss by competing for energy supplies and diminishing appetite. Because the symptoms of cancer often imitate those of a broad category of other diseases, physicans must first eliminate possible alternative causes of the symptoms. Cancer diagnosis has enormous importance, but a false diagnosis is worse. Cancer sometimes presents with nonspecific constitutional complaints, such as anorexia, weight loss, fatigue,...

Clinical manifestations

The signs and symptoms of HME described in a well documented series of cases diagnosed at the Centers for Disease Control and Prevention included fever (97 ), headache (81 ), myalgia (68 ), anorexia (66 ), nausea (48 ), vomiting (37 ), rash (36 ), cough (26 ), pharyngitis (26 ), diarrhea (25 ), lymphadenopathy (25 ), abdominal pain (22 ), and confusion (20 ) 16 . More than 60 were hospitalized. An active, prospective population-based study in Cape Girardeau, Missouri observed similar signs and symptoms, with more than 40 requiring hospitalization, indicating that HME is a relatively severe, multisystem disease 35 . Severity has been compared with Rocky Mountain spotted fever and toxic

Other Dietary Treatment Programmes

VLCDs should not be used in patients with unstable metabolic conditions (such as renal or hepatic insufficiency), in patients with eating disorders, infections, or other acute catabolic conditions such as renal failure, severe liver disease etc. When VLCDs were introduced, several medical precautions were taken and patients kept under strict medical supervision. Later experience has demonstrated that after an initial metabolic screening, laboratory tests and safety control can be kept to a minimum.

Blood Component Therapy

GVHD has been observed to arise 4-30 days after the administration of nonirradi-ated blood products to immunocompromised patients. It results from viable donor precursor cells or stem cells engrafting in the immunocompromised host's marrow. The clinical manifestations are fever, erythematous maculopapular skin rash, anorexia, nausea, vomiting, diarrhea, elevated liver enzymes, and hyperbilirubine-mia. A very high morbidity and mortality rate is associated with transfusion-acquired GVHD. Measures to prevent GVHD include irradiating all blood products with 2500 cGy and depleting the blood products of leukocytes.

Conclusions And Recommendations

Based on the data outlined, it is clear that the elderly are a population at special risk for malnutrition that may lead to increased risk of infection. Global malnutrition is particularly prevalent in hospitalized elderly and may become worse during the hospitalization. Reversible causes of malnutrition such as depression, dental disorders, poorly controlled diabetes, and medication-induced anorexia are common in elderly outpatients and undertreated. Among micronutrients, deficiencies of vitamins A, B12, and E and the trace elements zinc and selenium appear to be most prevalent and of greatest importance for immune function in elderly subjects. The majority of data favor a daily multivitamin trace-mineral supplement in elderly adults with additional vitamin E if necessary to achieve a daily vitamin E dose of 200 mg d. Specific replacement therapy should be provided for those individuals with documented deficiencies of other micronutrients (particularly vitamin B12), but specific data...

Chlorambucil Leukeran

The most common side effects are allergic eruptions and gastrointestinal disturbances (anorexia, nausea, cramps, diarrhea). The most serious complication is ocular toxicity, which appears to be dose-dependent but more common than with hydroxychloroquine. Reversible corneal deposits of the drug are detectable by slit-lamp examination, but retinopathy affecting macular pigmentation may be irreversible. Less common side effects include hyperpigmented rash, hypopigmentation of hair, neuropathy, ototoxicity, and cardiomyopathy. Hematologic toxicity is rare.

Cyclophosphamide Cytoxan

Bone marrow depression, primarily of white cell series, and predisposition to infection, both of which may be life-threatening but reversible with discontinuation of drug. Alopecia, drug-induced infertility with amenorrhea or defective spermatogenesis, hemorrhagic cystitis (in up to 25 of patients), fibrosing cystitis, carcinoma of the bladder, hematopoietic malignancies, anorexia, nausea, vomiting, and pulmonary fibrosis. Antidiuretic hormone-like activity may occur with large doses and result in hyponatremia.

The dosage is 100 mgd Sulfasalazine Azulfidine

The most common side effects, occurring in up to one-third of patients, include anorexia, headache, nausea, vomiting, gastric distress, and apparently reversible oligospermia. Rash, pruritus, urticaria, fever, and hemolytic anemia are less frequent. Rare reactions such as blood dyscrasia (especially leukopenia), hypersensitivity reaction, and central nervous system reaction have been reported.

And Mitochondrial Leukoencephalopathies

Pyruvate Dehydrogenase Deficiency Mri

Although Leigh syndrome is a multisystem disorder, the clinical picture is dominated by signs of CNS dysfunction. In patients with neonatal and infantile onset, frequent signs are respiratory problems (irregular respiration, apnea, sighing, and hyperventilation), ocular abnormalities (strabismus, bizarre eye movements, external ophthalmoplegia, ptosis, optic atrophy, nystagmus, loss of vision, impaired pupillary reaction, retinal pigmentary degeneration), hypoto-nia, pyramidal signs (spastic paresis, hyperreflexia, extensor plantar reflexes), weakness, easy fatigability, and feeding problems (anorexia, difficulty in swallowing or sucking, vomiting, weight loss, and retarded growth). Episodes of lethargy, seizures, deafness, renal tubular dysfunction, and cardiac problems (car-diomyopathy and disturbances of cardiac rhythm with periods of tachycardia and bradycardia) may also be present. The same problems are frequent in later-onset forms of the disease, in addition to mental and motor...

Susan E Frates MS RD and Heidi Schauster MS RD

Eating disorders are characterized by a disturbed relationship between nutritional intake and body image, often leading to subsequent medical problems. While eating disorders are found predominantly in the adolescent and young adult populations, they are increasingly being recognized in children and preadolescents. Eating disorders are the third most common chronic illness in adolescents following obesity and asthma.1 Anorexia nervosa is estimated to occur in < 3 of adolescent women and bulimia nervosa in 1 to 49r.- Undiagnosed disordered eating appears to afflict many school-aged Americans. In 1995. over one-third of Boston high school students reported that they were trying to lose weight. Six to seven percent of these students reported having vomited or taken laxatives in the last 30 days to avoid absorbing calories.-1 Males are also currently emerging as a population at risk for disordered eating. The age of onset of eating disorders appears to be decreasing. The Diagnostic and...

Hypogonadotropic Hypogonadism

Anorexia nervosa, which results from a distorted body image, an obsessive fear of obesity, and avoidance of food, can be associated with severe, even fatal, weight loss. For unknown reasons, this disorder is much more common in girls than in boys. The boys' functional hypogonadotropic hypogonadism at least partly results from severe weight loss. The underlying pathophysiology of delayed puberty is GnRH deficiency, because the LH secretory pattern in adolescents with anorexia is similar to that of normal prepuberty low or absent LH pulses and a blunted LH response to stimulation by exogenous GnRH (56). Pulsatile administration of GnRH restores a pubertal pattern of LH secretion, confirming the hypothalamic location of the defect. The mechanism for GnRH deficiency may relate to the effects of stress (57). Corticotropin-releasing factor (CRF) levels increase in stress, and CRF, in turn, stimulates P-endorphin levels, which then directly inhibit GnRH release. Recovery to...

Age Regression Abreactions And Catharsis

This specific technique has been found useful with patients in whom the underlying dynamic for the eating disorder has been found to be related to past trauma. This can be done by using hypnosis as a diagnostic tool with the aid of such techniques as the affect bridge (Watkins, 1978 Channon, 1981) and other methods of hypnoanalytic exploration in conjunction with ideomotor signalling (Cheek & Le Cron, 1968 Barnett, 1981 Brown & Fromm, 1986). Once this has been identified, the patient can be guided with the use of age regression to the original trauma to which the eating disorder is being related. Many patients then have a chance to fully abreact emotions attached to the original trauma, and the emotional catharsis in the abreaction itself already produces some relief. At times, a significant improvement (although not a full cure) of the eating disorder symptoms is apparent. This has been described in previous publications on the special subgroup of patients with eating disorders...

The Psychobiological System Of Appetite Control

Appetite Diagram

It is now accepted that the control of appetite is based on a network of interactions forming part of a psychobiological system. The system can be conceptualized on three levels (Figure 8.1). These are the levels of psychological events (hunger perception, cravings, hedonic sensations) and behavioural operations (meals, snacks, energy and macronut-rient intakes) the level of peripheral physiology and metabolic events and the level of neurotransmitter and metabolic interactions in the brain (2). Appetite reflects the synchronous operation of events and processes in the three levels. When appetite is disrupted as in certain eating disorders, these three levels become desynchronised. Neural events trigger and guide behaviour, but each act of behaviour involves a response in the peripheral physiological system in turn, these physiological events are translated into brain neurochemical activity. This brain activity represents the strength of motivation to eat and the willingness to refrain...

Nutritional Assessment In Sick Or Hospitalized Children

Unlike the clinical situation of prolonged fasting (eg. anorexia nervosa) or other states in which malnutrition is due solely to energy deficiency, the protein-energy malnutrition that occurs in the face of catabolic injury is less amenable to simple repletion of energy, protein, or other nutrients. Nutritional requirements of patients who are stressed by critical illness may be significantly different than those of healthy individuals (see Chapter 5. USRDA and DRIS) or other patients who are less ill. Important mechanisms by which infections or critical illness impact on these requirements are anorexia associated with infection, decreased absorption of ingested nutrients, increased requirements of energy and protein (especially with fever), drug-nutrient interactions, and decreased energy requirements due to absence of body growth and reduced physical activity.

The Adipose Tissue Around Lymph Nodes

Energy Store Body

From the adipocytes near the nodes would maximize supplies of polyunsaturated fatty acids to the activated lymphoid cells. Lipolysis from these adipocytes is not strongly stimulated by fasting (Figure 13.2), so these local controls determine fatty acid release regardless of fever, anorexia or other whole body state that the larger 'general storage' depots (e.g. perirenal, inguinal) readily respond to. These observations are also consistent with the reports that lymphocyte function is more strongly modulated by polyunsaturated fatty acids than by monounsaturates or saturates both in vitro (38) and in vivo (39). Certain adipose depots also have significant capacity for the synthesis and release of glutamine (3), that activated lymphoid cells use in large quantities (43). Provision of glutamine to support protein synthesis in lymphoid cells may be another way in which adipose tissue supplies the immune system during periods of anorexia and cachexia, when external sources are greatly...

Radiation Tolerance Of The Central Nervous System

Acute reactions during radiotherapy for pituitary adenoma in the form of acute edema are extremely rare and reversible. Early delayed reactions in the brain are characterized by a transient period of exhaustion, drowsiness, and anorexia, and this is described as the somnolence syndrome (1). The severity relates to the intensity of radiotherapy and the volume irradiated. Apart from tiredness, the full somnolence syndrome after small-volume pituitary irradiation is relatively uncommon.

Special Considerations

Infection, illness, and surgery all make glucose control difficult due to multiple factors, including increased counter-regulatory hormones, anorexia, and altered meals and snacks. In general, sick children should be given their usual insulin dose. Insulin should never be skipped, and extra insulin is often required. Blood glucose levels should be checked every 3 to 4 hours and urine ketones should be checked if the blood glucose level is over 240 mg dL. If the child is able to eat. he or she should be given 4 to 6 oz of sugar-free fluid each hour in addition to regular meals. If the child is not able to eat his usual meals and snacks, sugar-free drinks should be alternated with sugar-containing drinks. The carbohydrate grams or servings allotted in the meal plan should be replaced with sugar-containing sodas, popsicles, juices, and gelatin.

Psychiatric Disorders

Because of the recent interest in hypocretin dysfunction in neurological diseases and because of the functions of the hcrts, recent studies have evaluated whether altered hypocretin neurotransmission might be also involved in some psychiatric disorders. We will focus in the present review on depression and schizophrenia. The involvement of the hypocretins in stress and drug addiction is also today documented and we recommend to the readers to refer to the specific chapters in the book devoted to these two aspects of behavior. The hcrt system is also currently evaluated in other psychiatric disorders such as eating disorders.

Nutrition Therapy Goals for Type 2 Diabetes

Growth and weight gain, activity pattern, psychosocial economic issues, smoking, medical history (celiac disease, nephropathy, hyperllpidemia, eating disorder, high blood pressure, asthma, attention deficit disorder, hypothyroidism, and other autoimmune diseases), insulin regimen, oral glucose-lowering medications, blood glucose monitoring schedule

Respiratory Syncytial Virus Infection Control Guidelines

RSV appears to be an increasing cause of respiratory disease in this population, especially those in nursing care facilities. During outbreaks, the attack rate ranges from 10 to 40 and accounts for 5-27 of all respiratory tract infections in long-term care facilities. Individuals over the age of 60, typically, present with mild nasal congestion, but fever, anorexia, pneumonia, or bronchitis may develop (55-57).

Appendicitis In The Elderly

The diagnosis of appendicitis may not be as simple as in the young adult and this may delay treatment. The classic findings of nausea, vomiting, anorexia, fever, right lower-quadrant pain, and leukocytosis may not all be found in the elderly patient. Furthermore, the symptoms and signs of acute appendicitis are similar to other disease processes common in the older patient, resulting in the delayed diagnosis of appendicitis (see Table 2). Physical examination will indicate tenderness to palpation, involuntary guarding, and or rebound tenderness in the right lower quadrant, which are similar in the younger patient. Typical physical findings in younger patients, which may not be present in the elderly patient, are fever, leukocytosis, abdominal distention, psoas sign, decreased bowel sounds, and or rectal tenderness.

Kathleen M Gura PharmD BCNSP

N V D hemorrhage, anorexia N V D, anorexia, stomatitis, glossitis antibiotic associated pseudomembranous colitis esophagitis, oral candidiasis N V D abdominal pain anorexia N V D, anorexia, stomatitis, weight loss N V D, anorexia Anorexia, abdominal cramps, V D, atrophic glossitis Anorexia, gastritis, glossitis, V D N V, abdominal pain, anorexia N V D. abdominal pain, excessive salivation, metallic taste, anorexia, weight loss, stomatitis Heartburn, N V D, anorexia, abdominal cramps N V D, constipation, anorexia, abdominal pain N V D, feeding problems, abdominal discomfort, pancreatitis, anorexia N V D. abdominal pain, anorexia, dyspepsia epigastric pain, mouth ulceration. Gl bleeding, pancreatitis N V D. abdominal pain, anorexia, pancreatitis N V D, oral esophageal ulcers, dysphagia, anorexia, abdominal pain, constipation, pancreatitis, weight loss, anemia N V D. anorexia N V D. abdominal cramping, anorexia. N V. anorexia, pancreatitis Constipation, nausea, anorexia, weight changes,...

Hypnotizabilityand Clinical Populations

There are further disorders which are characterized by high levels of hypnotiz-ability. These include hysteria, multiple personality, post-traumatic stress disorder and some categories of eating disorders such as bulimia (Coman, 1992). Such high hypnotizable groups stand in contrast to schizophrenics (Spiegel et al., 1982), obsessive compulsives and anorexics (Coman, 1992) who have been found to possess lower levels of hypnotizability.

Gastrointestinal Diseases

Gastroesophageal reflux (GER) is the effortless movement of gastrie contents into the esophagus. While GER is considered a normal physiologic process rather than a disease. it can produce clinical symptoms ranging from mild heartburn to esophagitis. respiratory disease, and even apnea. Gastroesophageal retlux disease (GERDl refers to these symptoms. Pediatric patients with GERD may present with chest pain, dyspepsia, vomiting, burping, dysphagia. postprandial fullness, chronic hoarseness and cough, wheezing, and respiratory symptoms of unknown etiology. Gastroesophageal rellux disease is also a major cause of anorexia, resulting in malnutrition among pediatric patients with a variety of chronic illnesses. Multiple physiologic factors are generally thought to be responsible for GERD. including decreased lower esophageal sphincter (LES) tone, esophageal mucosal irritation from hydrochloric acid and pepsin, delayed esophageal peristalsis. and delayed gastric emptying. Anorexia

Gerontologic Alert

MANAGING ANOREXIA Administration of an adrenergic drug may cause anorexia in the patient. Management of this adverse reaction requires diligence on the part of the nurse. The nurse discusses food preferences and aversions with the patient and makes modifications in the diet when possible. An easily digested diet high in carbohydrate and protein and low in fat is usually well tolerated. Several small meals may be better tolerated than three large meals. The nurse weighs the patient daily or weekly and keeps an accurate dietary record. Foods that cause increased gastric motility, such as gas-forming foods, spicy foods, and caffeinated beverages, are avoided. Good oral care is provided. The dietitian may be consulted if necessary. The nurse provides a pleasant, odor-free, relaxing environment for eating.

Differential Diagnosis Of Delayed Puberty

A thorough medical history should note the symptoms and signs of anorexia nervosa, the intensity of athletic training, and the timing of puberty of both parents (see Fig. 5). In boys with constitutional delay of puberty, one parent often developed late as well. A history of chronic illness, such as celiac disease or inflammatory bowel disease, suggests a temporary or secondary delay of puberty. Stature and height velocity should be evaluated using appropriate growth charts. Height velocity is usually reduced in patients with constitutional delay but is normal in patients with isolated hypogo-

Introduction And Literature Review

A review of the recent literature on eating disorders, including anorexia nervosa and bulimia, reveals a remarkable silence on the utilization of hypnosis as a therapeutic tool. It is evident, for example from the book chapters by Walsh (1997) and Yager (1994), as well as journal articles devoted to eating disorders such as that of Doyle (1996), and a whole issue of the Psychiatric Clinics of North America (edited by Yager, 1996) that includes 13 scientific articles on eating disorders. In this special issue, to my surprise, the subject of hypnosis or guided imagery is not even mentioned as a viable option in the treatment of eating disorders. The publications that have appeared in the past decade on the efficacy of hypnotic techniques in the treatment of eating disorders are not even mentioned or cited the subject of hypnosis does not exist in this special issue. This phenomenon reflects a level of ignorance on this subject reminiscent of the old adage 'The eye sees only what the...

The Water Soluble Vitamins Are C B1 B2 B6 B12 Niacin Biotin and Folic Acid

Vitamin Bj (thiamine) plays an important role in carbohydrate metabolism. Thiamine is absorbed by the jejunum passively as well as by an active, carrier-mediated process. Thiamine deficiency results in beriberi, characterized by anorexia and disorders of the nervous system and heart. Vitamin B2. Vitamin B2 (riboflavin) is a component of the two groups of flavoproteins flavin adenine dinu-cleotide (FAD) and flavin mononucleotide (FMN). Riboflavin plays an important role in metabolism. Riboflavin is absorbed by a specific, saturable, active transport system located in the proximal small intestine. Riboflavin deficiency is associated with anorexia, impaired growth, impaired use of food, and nervous disorders. Niacin deficiency is characterized by many clinical symptoms, including anorexia, indigestion, muscle weakness, and skin eruptions. Severe deficiency leads to pellagra, a disease characterized by dermatitis, dementia, and diarrhea.

Typhoid And Paratyphoid Infection

Typhoid and paratyphoid fevers have been described in detail by Benenson (12). Typhoid fever is a systemic disease characterized by onset of sustained fever, headache, malaise, anorexia, etc. It is caused by the bacterium Salmonella typhi, which can be isolated from the blood, feces, and urine of patients. The usual fatality rate of 10 can be reduced to < 1 with prompt antibiotic treatment. Paratyphoid fever presents a similar clinical picture but tends to be milder and the case fatality rate is much lower. The infectious agents are Salmonella paratyphi A, B, and C. Paratyphi B is the most common whereas C is extremely rate. Both are transmitted by food and water contaminated by the feces and urine of patients and carriers.

Cognitive Reframing And Restructuring

Cognitive restructuring is described in detail by the Spiegels in their book, Trance and Treatment (1978), and also by cognitive-behavioral therapists such as Meichen-baum (1977) and Kroger and Fezler (1976). In essence, the patient is taught a new way of looking at an old problem and finding new, creative solutions in situations where the patient was cognitively 'chasing his own tail,' and feeling stuck with no way out. The patient with an eating disorder is first guided into a state of self-hypnotic trance, in which the patient is highly receptive to new ideas and suggestions. Under hypnosis, the patient is asked to signify if willing to fully cooperate in this process of therapy, with the aid of ideomotor signalling. Providing the signal is in the affirmative, the therapist may proceed as follows As you are sitting in this chair, in this special state of extra-receptivity and self-hypnotic trance, you realize that your subconscious mind has now become your ally, and together you...

Viral Hepatitis 21 Hepatitis A

Acute HBV in older adults is usually mild and many cases are subclinical or present with a cholestatic picture (66). In addition to the typical symptoms of jaundice, anorexia, and fatigue, diarrhea is a common complaint in elderly persons (66). Complaints reflecting immune complex disease such as myalgias and arthalgias are rare in older adults. Although acute HBV is generally not a severe disease in older adults, the mortality from fulminant HBV increases with age (60). In a multivariant analysis of prognostic factors in 115 patients with HBV, age was an independent predictor of survival. Chronic carriage rates also increase when individuals are infected at older ages. Compared with a 10 carriage rate in young adults, approx 60 of older persons become chronic carriers (60). However, most elderly HBV chronic carriers were infected early in life and have carried the virus for a prolonged period and, although HBSAg is detected, there is little evidence of active viral replication as...

Antimigraine And Antihistaminergic Drugs

(70) probably due to their combined antihista-minergic and serotonergic effect. The weight changes are, however, rather modest and the clinical importance of the problem is limited. Because to its ability to increase appetite attempts have been made to use cyproheptadine as a pharmacological support in the treatment of both anorexia nervosa

Malnutrition and Reproduction

Normal reproductive function requires an optimal nutritional intake, and both caloric deprivation and consequent weight loss, as well as excessive food intake and obesity, are associated with impaired reproductive function (26). Sexual maturation may be substantially delayed during food deprivation (27,28) small animals with a short life span may not even achieve puberty before death during periods of food scarcity (29). Undernutri-tion caused by famine, eating disorders, or exercise results in weight loss and changes in body composition and the endocrine milieu that can impair reproductive function (30). As a general rule, weight loss and body composition changes resulting from undernutri-tion are associated with reduced GnRH secretion, and the decrease in follicle-stimulating hormone (FSH) and LH levels correlates with the amount of weight loss (30). However, both hypogonadotropic and hypergonadotropic hypogonadism have been described in cachexia associated with certain chronic...

Clinical Features of Hepatitis B

Conventionally divided into three phases (1) preicteric, (2) icteric, and (3) convalescent. Following a long incubation period of 6-26 weeks in the case of hepatitis B, the preicteric (prodromal) phase commences with malaise, lethargy, anorexia, and commonly nausea, vomiting, and pain in the right upper abdominal quandrant. A minority of patients develop at this time a type of serum sickness characterized by mild fever, urticarial rash, and polyarthritis, resembling a benign, fleeting form of acute rheumatoid arthritis. Any time from 2 days to 2 weeks after the prodromal phase begins, the icteric phase commences, heralded by dark urine (bilirubinuria) closely followed by pale stools and jaundice. The convalescent phase may be long and drawn out, with malaise and fatigue lasting for weeks.

Classification of Malnutrition

Development of marasmus occurs after severe deprivation primarily of calories, and it is characterized by growth retardation and wasting of muscle and subcutaneous fat. In kwashiorkor, the protein deficiency exceeds the calorie deficiency edema accompanies muscle wasting that results from acute protein deprivation or loss of protein caused by stress or inadequate calorics. Indifference, apathy. and fatigue arc present in victims of both conditions, and psychologic alterations may be profound. Severe anorexia, apathy, and irritability make children with these conditions difficult to feed and manage. Many of the clin-

Nutritional Care in Children with Crohns Disease

Between 15 to 40 of children with Crohn's disease suffer from malnutrition and growth failure, puberty retardation and development of secondary sexual characteristics retardation 4 . The slowing down of height velocity has been also observed 4, 5 . What is clinically relevant is that malnutrition may affect as many as 25 of children even before the apparent onset of the disease 5 . Some factors are involved such as the catabolic state during the acute and or persistent active phase, anorexia leading to insufficient calorie intake to cater to the subject's needs during the critical growth phase, malabsorption and protein dispersion, and deficiencies of zinc, calcium, magnesium and phosphorus. Moreover, steroid treatment plays its most detrimental role in children. A number of hormone deficiencies have been considered such as GH, thyroid hormones and cortisol. A significant correlation between height and body-weight deficits and low circulatory levels of IGF-I has been found 6 , which...

Pharmacological Treatment of Obesity in Schizophrenia

Treatment of bipolar disorder, causes a decrease in appetite and sustained weight loss in obese individuals. It has not been systematically studied as primarily a weight loss agent but has demonstrated weight loss in patients with epilepsy and bipolar disorders (McElroy et al. 2000 Norton et al. 1997 Rosenfeld et al. 1997) and is being tested in binge-eating disorder (Yanovski and Yanovski 2002). The use of H2 antagonists for weight loss has been suggested in the literature, with speculation that H2 antagonism may affect weight either by decreasing appetite via increases in cholecystokinin, a hormone that may signal satiety to the brain, or through the suppression of gastric acid secretion, which may decrease appetite (Sacchetti et al. 2000). Nizatidine, a histamine H2 blocking agent, was recently compared with placebo as an adjunct to olanzapine treatment, and modest reductions in weight gain were seen in patients receiving 300 mg of nizatidine versus placebo however, weight gain...

TABLE 152 Vaginal Antifungal Drugs

Including fever, shaking, chills, headache, malaise, anorexia, joint and muscle pain, abnormal renal function, nausea, vomiting, and anemia. This drug is given parenterally, usually for a period of several months. Its use is reserved for serious and potentially life-threatening fungal infections. Some of these adverse reactions may be lessened by use of aspirin, antihista-mines, or antiemetics.

Monitoring and Managing Adverse Reactions

Severe and sometimes fatal hepatitis may occur with isoniazid therapy. The nurse must carefully monitor all patients at least monthly for any evidence of liver dysfunction. It is important to instruct patients to report any of the following symptoms anorexia, nausea, vomiting, fatigue, weakness, yellowing of the skin or eyes, darkening of the urine, or numbness in the hands and feet.

Clinical Focus Box 241

Hyponatremia and hypoosmolality can cause a variety of symptoms, including muscle cramps, lethargy, fatigue, disorientation, headache, anorexia, nausea, agitation, hypothermia, seizures, and coma. These symptoms, mainly neurological, are a consequence of the swelling of brain cells as plasma osmolality falls. Excessive brain swelling may be fatal or may cause permanent damage. Treatment requires identifying and treating the underlying cause. If Na+ loss is responsible for the hyponatremia, isotonic or hypertonic saline or NaCl by mouth is usually given. If the blood volume is normal or the patient is edematous, water restriction is recommended. Hyponatremia should be corrected slowly and with constant monitoring because too rapid correction can be harmful.

Defective Absorption

Imerslund-Grasbeck syndrome is an autosomal recessive disorder that usually presents with pallor, weakness, anorexia, failure to thrive, delayed development, recurrent infections, and gastrointestinal symptoms within the first 2 years of life. In many patients, proteinuria of the tubular type is found that is not corrected by systemic cobalamin. Most of the known patients are found in Norway, Finland, and Saudi Arabia and among Sephardic Jews in Israel. In these patients, intrinsic factor level is normal, they do not have antibodies to intrinsic factor, and the intestinal morphology is normal. They have a low serum B12 due to a selective defect in cobalamin absorption that is not corrected by treatment with intrinsic factor. They have a mild increase in methylmalonic acid and homocysteine. In some cases the ileal receptor for IF-Cbl complex is absent, whereas in other patients it is present.

Osteoporosis

Corticosteroids may be responsible for loss of bone mass, but their use may also be indicative of a more severe disease - which may be the real culprit 38 . Therapy with corticosteroids is only one of the many causes of bone loss in IBD. The inflammatory condition is characterised by an increase in circulating cytokines, which increases osteoclast activity. Tumour necrosis factor (TNF) alpha inhibits osteoblast differentiation and induces osteoclast differentiation, increasing osteoclast survival and decreasing osteoclast apoptosis. A recent study demonstrated that the TNF-receptor-based interaction between osteoblasts and osteoclasts is the common pathway of bone metabolism alteration 39 . Although inflammation itself is an important cause of bone metabolism alteration, malnutrition is common in IBD patients due to anorexia, malabsorption, greater loss of nutrients and increased metabolic demand. In some patients, calcium and vitamin D are low due to a poor dietary intake and...

Subnutrition

Malnutrition and starvation remain major problems in many parts of the world. In developed countries, malnutrition due to poverty is rare. Malnutrition occurs in ihe psychological disorder anorexia nervosa. It may be associated with chronic abuse of alcohol and other addictive drugs and is a feature of HIV infection.

Home Care Checklist

Although rare, the patient may develop hepatitis during itraconazole administration. The nurse closely monitors the patient for signs of hepatitis, including anorexia, abdominal pain, unusual tiredness, jaundice, and dark urine. The primary health care provider may order periodic liver function tests.

Bacteremia

Salmonella enterica serotypes may produce a syndrome characterized by prolonged fever and a positive blood culture (14). Although symptoms of gastroenteritis can precede bacteremia, they are usually lacking. In many instances the only manifestations are prolonged fever, which is usually spiking and accompanied by rigors, sweats, aching, anorexia, and weight loss. The characteristic symptoms of typhoid fever, which include rose spots, leukopenia, and sustained fever, are absent. Stool cultures are normally negative. In contrast to the constant bacteremia seen with typhoid fever, discharge of the organisms into the bloodstream is intermittent, and repeated blood cultures may be necessary to identify the causative organism. At some time during the course of the disease, localizing signs of the infection appear in about one quarter of the cases. Bacteremia caused by salmonellae can be a very puzzling disorder and should be considered in cases of fever of unknown origin.

Interferons

Interferons are not effective by mouth, therefore are injected. IFN-a is much more active in vivo than IFN-p or IFN--y, probably because the latter do not achieve or maintain the required blood levels after intramuscular administration. Toxic side effects are regularly observed and may be marked with doses in excess of 107 units per day, even when highly purified cloned IFN subtypes are employed. Fever regularly occurs at high dosage but lasts only a day or so. Severe fatigue is the most debilitating symptom and may be accompanied by malaise, anorexia, myalgia, headache, nausea, vomiting, weight loss, erythema and tenderness at the injection site, partial alopecia (reversible), dry mouth, reversible peripheral sensory neuropathy, or signs referable to the centra nervous system. Various indicators of myelosuppression (granulocytopenia, thrombocytopenia, and leukopenia) and abnormal liver function tests, both reversible on cessation of therapy, are regularly observed if high-dose...

Alimentary Symptoms

Disorders of the alimentary tract may present with a wide range of symptoms including painful mouth, difficulty in swallowing (dysphagia), nausea and vomiting, abdominal pain, heartburn, indigestion (dyspepsia), toss of appetite (anorexia), weight loss, abdominal distension, alLered bowel habit, rectal bleeding and jaundice (Table 5.1). Sometimes, alimentary disease is suggested only by the occurrence of a secondary feature such as anaemia. Occasionally palienls may conceal important symptoms such as rectal bleeding

Ego State Therapy

Ego State Therapy has become a frequent focus in the hypnosis literature (Watkins, 1984 Watkins & Watkins, 1981, 1982 Edelstein, 1982 Beahrs, 1982 Newey, 1986). Ego State Therapy is defined by Watkins and Watkins (1982) as the 'utilization of family and group treatment techniques for the resolution of conflicts between the different ego states which constitute a ''family of self within a single individual.' This method is aimed at conflict resolution and may employ any of the directive, behavioral, psychoanalytic, supportive, existential, and even relaxation and biofeedback techniques of therapy. This method of therapy concerns a notion of how much the individual's behavior is the result of dissociated ego states in a state of conflict. According to Helen and John Watkins, the experience with ego state therapy shows that activating, studying and communicating with various ego states decreases the patient's tendency to dissociate. The patient who used to dissociate and experienced...

Research On Hypnosis

The literature on obesity has been swamped in recent years with very pessimistic and negative treatment results, especially regarding the long-term outcome of treatment (Garner & Wooley, 1991). Unlike the situation with anorexia nervosa and bulimia, hypnotherapists have been intensively engaged in the treatment of obesity (see Vanderlinden & Vandereycken, 1988). Many success stories have been reported in the hypnotherapeutic literature, but these are often reports on a very small number of patients. In addition, they deal with short-term treatment results, and long-term follow-up data are almost completely lacking (Mott & Roberts, 1979 Wadden & Anderton, 1982). Apart from this, most researchers use only one criterion for evaluation, namely weight reduction, while alterations in psychological characteristics such as body image, self-esteem and other criteria are totally

Sideeffect profile

Although adverse events may occur at any time, they tend to develop in the early months of treatment with methotrexate. Events are common but most are minor and usually can be managed without stopping therapy. Gastrointestinal adverse effects are the most common. These include anorexia, nausea, vomiting and diarrhoea. They often resolve or improve with dose reduction or a switch to parenteral administration. Stomatitis, including erythema, painful ulcers and erosions are also frequent.

Symptomatic Therapy

A variety of medical therapies are utilized in the care of patients with leptomeningeal metastasis irrespective of whether the patient is offered aggressive neoplastic meningitis-directed therapy. A minority of patients will manifest seizures as a consequence of neoplastic meningitis and the use of non-sedating anticonvulsant drugs is appropriate for this group of patients. Patients with difficult to control pain may be managed with narcotics or, in the instance of neuropathic pain, either anticonvulsant drug or tricyclic antidepressant drug therapy. Depression is a very common symptom in patients with cancer and is often neglected or not recognized. Early recognition and initiation of antidepressants in symptomatic patients is recognized to improve quality of life and benefit both patients and families. In addition, antidepressants, especially tricyclic agents, are also useful for chronic insomnia. Corticosteroids are most useful to control vasogenic edema secondary to parenchymal...

Nitrofurantoin

Nitrofurantoin administration may result in nausea, vomiting, anorexia, rash, peripheral neuropathy, headache, brown discoloration of the urine, and hyper-sensitivity reactions, which may range from mild to severe. Acute and chronic pulmonary reactions also have been seen.

Alcohol

The role of alcohol in weight control is still controversial. Although alcohol, containing 7 kcal g, has the highest energy density after fat, it is still unclear whether alcohol intake is of importance in body weight regulation. Alcohol may either be added to the diet or substitute for other energy containing food components. Whereas alcoholics who are lean have often experienced the wasting long-term consequences of high alcohol intake with anorexia, vomiting etc., other alcohol consumers experience an appetite enhancing effect of alcohol.

Disordered eating

It is important that the clinician differentiates disordered eating from the eating disorders of anorexia nervosa and bulimia nervosa, which are psychiatric diagnoses with specific diagnostic criteria. Disordered eating is a much more common phenomenon, and restricting awareness to the extremes of anorexia and bulimia will result in failure to recognize girls at risk for the triad.

Review Questions

A patient complains of generalized weakness and fatigue, anorexia, and weight loss associated with gastrointestinal symptoms (nausea, vomiting). Physical examination notes hyperpigmentation and hypotension. Laboratory findings include hyponatremia (low plasma sodium) and hyperkalemia (high plasma potassium). The most likely diagnosis is

Sulfonylureas

Adverse reactions seen with the sulfonylureas include hypoglycemia, anorexia, nausea, vomiting, epigastric discomfort, weight gain, heartburn, and various vague neurologic symptoms, such as weakness and numbness of the extremities. Often, these can be eliminated by reducing the dosage or giving the drug in divided doses. If these reactions become severe, the health care provider may try another oral antidiabetic drug or discontinue the use of these drugs. If the drug therapy is discontinued, it may be necessary to control the diabetes with insulin.

Fluoride Sodium

Most adverse effects appear to be dose-related. These include fatigue, somnolence, reactions at the infusion site, anorexia, nausea, gastrointestinal hemorrhage, and electrolyte abnormalities (hypocalcemia, hypokalemia, hypomagnesemia, hypophosphatemia). Cardiopulmonary effects such as hypertension, atrial fibrillation, tachycardia, syncope, and rales may occur with the highest doses. Fever occurs in about one-fifth of patients. Cytopenias may occur rarely.

Endemic Mycoses

Symptoms Blastomycosis

Another form of histoplasmosis that occurs mostly in middle-aged to elderly men is progressive disseminated disease. In this form of histoplasmosis, the host is unable to eradicate the organism from parasitized macrophages, and the disease is fatal if untreated. The clinical manifestations of progressive disseminated histoplasmosis include fever, fatigue, anorexia, and weight loss. Dyspnea and cough are often present, hepatosplenomegaly is usual, and lesions on the buccal mucosa, tongue, palate, or oropharynx are common. The patient may also present with symptoms of Addison's disease because of adrenal destruction. Pancytopenia and increased alkaline phosphatase are frequent, and diffuse pulmonary infiltrates are often present on chest radiograph.

Nausea and vomiting

The combination of nausea and vomiting usually suggests an upper gastrointestinal disorder but may also be a prominent feature of non-alimentary disorders (see Disorders box). In most instances, vomiting is preceded by nausea, but in some cases, e.g. intracranial tumour, the vomiting can occur without warning. Vomiting may also result from severe pain, as in renal or biliary colic or myocardial infarction, from systemic disease, metabolic disorders and drug therapy. Vomiting may be self-induced in paiients with peptic ulceration (for pain relief) or with bulimia nervosa. * Anorexia nervosa, bulimia

Jaundice

Enterohepatic System And Urobilinogen

Characteristic symptoms include anorexia with impairment of taste, nausea, vomiting and upper abdominal pain (often associated with hepatic tender ness). Common causes include viral hepatitis and chemical hepatitis, e.g. alcohol abuse and drug therapy. Vomiting and anorexia are common manifestations of non-alimentary disorders.

Toxic Colitis

Toxic colitis, with or without megacolon, is an emergent life-threatening complication of inflammatory bowel disease. Its overall incidence in patients with ulcerative colitis is about 10 27 . Although in the past, toxic colitis was thought to be a rare complication of Crohn's disease compared with ulcerative colitis, recent studies have shown that Crohn's colitis is the etiology in approximately 50 of the cases 28 . The overall incidence of complicated Crohn's disease is about 6 , with an increasing number occurring in Crohn's colitis 29 . The presentation of toxic fulminant colitis includes fever, an abrupt onset of bloody diarrhoea, abdominal tenderness, colicky pain, and anorexia 30 . Toxic megacolon is present if, in addition to toxic colitis, either total or segmental dilatation of the colon occurs 31, 32 . Once the diagnosis of toxic colitis is suspected, aggressive medical therapy is initiated. A team approach is required involving both gastroenterologists and surgeons. Prompt...

Egostrengthening

Ego-strengthening suggestions are an important part of most hypnotherapy interventions. The technique was named by John Hartland (1965, 1971), and further elaborated by Stanton (1975, 1979, 1989). In this intervention the patient follows a set of general hypnotic suggestions to promote healing, strength, a sense of well-being, competence and mastery. The following verbatim example may be used in patients with eating disorders

Herbal Alert Ephedra

Many members of the Ephedra family have been used medicinally (ie, E. sinica and E. intermedia). Ephedra preparations have traditionally been used to relieve cold symptoms, improve respiratory function, as an adjunct in weight loss, and to treat a variety of conditions from headaches to sexually transmitted disease. Large doses may cause a variety of adverse reactions, such as hypertension, irregular heart rate, tremors, epigastric pain, nausea, vomiting, sweating, weakness, and possible dependence. Ephedra is contraindicated in patients with hypertension, glaucoma, hypertrophy of the prostate, urinary tract problems, clotting disorders, anxiety, anorexia, colitis, thyroid disease, or diabetes. Ephedra should not be used with the cardiac glycosides, halothane, guanethi-dine, MAOIs, oxytocin, and in patients taking St. John's wort. Weight loss preparations containing ephedra should be avoided.

Anabolic Steroids

Jaundice, anorexia, and muscle cramps may also be seen. Blood-filled cysts of the liver and sometimes the spleen, malignant and benign liver tumors, an increased risk of atherosclerosis, and mental changes are the most serious adverse reactions that may occur during prolonged use.

Dabneym Ewin

Seriously burned patients run the gamut of negative emotions. (Ewin, l978). Both the burn and its treatments are excruciatingly painful, and fear of the next treatment sets in early. The accident is usually caused by carelessness (of the patient or someone else), so either guilt or anger intervenes. A sense of helplessness and hopelessness resulting in depression is common. Metabolic rate increases as much as 100 , and nausea and anorexia hinder the increased food intake necessary to meet metabolic demands. It is easy for these patients to become sullen, obstinate, and uncooperative. Curtis Artz, first President of the American Burn Association and one of the early advocates of separate burn centers, is quoted (Dahinterova, l967) as follows

Patient Assessment

The comprehensive and in-depth assessment of patients with an eating disorder is of great value for understanding the underlying dynamics of the condition, the patient's character, and the crafting of an effective treatment plan. The clinical literature identifies a variety of psychodynamics attributed to the psychopathology of eating disorders such as In listening to the patient I specifically explore the possibility of ambivalence and internal conflicts regarding the eating disorder symptoms and behaviors, looking for any clues that the behaviors are ego-dystonic. In previous publications (Torem, 1989a), I have delineated the following examples of clues to an underlying dissociative mechanism in the patient's description of her symptoms An additional method for identifying a possible underlying dissociation in patients with eating disorders is the administration of a dissociation scale. The Dissociation Experiences Scale (DES Bernstein & Putnam, 1986), is easy to administer and...

Training In Hypnosis

Both Dr Torem and Dr Vanderlinden comment that with anorexia nervosa and bulimia there has been remarkably little utilization of hypnosis as a therapeutic tool, whereas hypnotherapists have been intensively engaged in the treatment of obesity. Nevertheless, the effectiveness of hypnotic interventions in patients with eating disorders has been recorded in the literature over and over again since the time of Pierre Janet. The clinical literature identifies a variety of psychodynamics attributed to the psychopathology of eating disorders. Many patients with these disorders feel helpless, hopeless, and ashamed of having to seek psychological help. Ego-strengthening suggestions are therefore an important part of most hypnotherapy interventions. Assignments which they are asked to complete are designed so that the patient will metaphorically and concretely experience a feeling of success, as well as a sense of gaining mastery, control, and exercising new choices and options. Ego State...

Enteral Nutrition

Tube feeding is indicated when a child or infant is unable to meet nutritional needs orally (Table 16-2). Tube feeding can provide either total or supplemental nutrition. It can be used for short-term rehabilitation or long-term nutritional management. In the child with anorexia, a differential diagnosis can help identify the cause of anorexia and the anticipated duration of tube feeding (Table 16-3). This chapter offers guidelines for choosing the delivery Congenital heart disease Bronchopulmonary dysplasia Anorexia (see Table 16-3) Psychosocial disorders Anorexia nervosa Nonorganic growth failure Table 16-3. Differential Diagnosis of Anorexia feeding Anorexia