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 32,579 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A young adolescent girl (13.5 years old) with a compulsive eating disorder and gross obesity was treated with a combination of behavior therapy and fenfluramine (Ponderax). The behavior modification program used was adapted from Reiss's program, an approach that had proven effective in individuals with hyperphagia and overweight who had no additional emotional problems or brain damage. In our patient the problem was complicated by the presence of autism, with compulsive eating being particularly ingrained as a form of stereotyped behavior. We therefore decided to administer fenfluramine concurrently because it is known to have both an appetite-depressing effect and a positive effect on behavioral disturbances characteristic of autistic individuals. During inpatient treatment the girl lost weight and showed changes in behavior. The changed eating behavior was still being maintained many months after discharge and after fenfluramine had been discontinued. We assume that drug treatment provided an important kind of support for the behavioral treatment program. Further, we attribute the emotional stabilization in this autistic girl to fenfluramine. We now plan to extend this treatment approach to other subjects with similar problems.
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PMID:[Treatment of compulsive eating disorders in an autistic girl by combining behavior therapy and pharmacotherapy. Case report]. 376 95

Because of the increase in public school programs for severely handicapped children, teachers are more likely than ever to be confronted with serious medical or psychological problems like anorexia nervosa. In this case study, desensitization successfully treated the eating disorder of a preadolescent autistic girl. However, the case also accentuated the problems teachers face in making appropriate decisions due to conflicting literature findings, traditional role responsibilities, and lack of expert resources and supportive services in the public school settings. If programs are to meet the needs of these children in the future, service and resource models for the public school settings must be developed.
J Autism Dev Disord 1980 Mar
PMID:Treatment of atypical anorexia nervosa in the public school: an autistic girl. 692 80

Fifty-one adolescent-onset anorexia nervosa (AN) cases recruited after community screening were compared with 51 age-, sex-, and school-matched cases with regard to personality disorders and autism-spectrum disorders (ASD)/empathy disorders at age 21 years. All 102 cases had originally been examined at a mean age of 16 years, slightly over a year after the reported onset of the eating disorder. Structured Clinical Interview for DSM-III-R (SCID) interviews were performed by a psychiatrist blind to the original eating disorder diagnosis. Most of the former AN cases were recovered with respect to weight, but the outcome in social areas was restricted. Personality disorders coded on axis II in the DSM-III-R and empathy disorders were much more common in the AN group than in the comparison (COMP) group. Obsessive-compulsive (OCD) and avoidant personality disorders were particularly common. Obsessive-compulsive behaviors showed a high degree of stability over time and were unrelated to weight problems. Together with empathy disorder, they tended to predict outcome better than the eating disorder as such. It is concluded that in some cases, AN may be seen to reflect but one axis I diagnosis occurring in the life of an individual with a chronic personality disorder.
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PMID:Anorexia nervosa 6 years after onset: Part I. Personality disorders. 770 90

Naltrexone a pure opioid antagonist, well tolerated in young patients, has been found to be an interesting treatment in some disorders in children and adolescents. Naltrexone has been first tried in mental retardation and autism disorders in children and adolescents. Symptoms like self-injury behaviours, hyperactivity, stereotyped and ritualistic conducts appear to be improved in a subgroup of children with the opiate antagonist. But new controlled studies still need to be done before recommending naltrexone in autism. Preliminary results in the treatment of alcoholic adolescents seem to support the efficacy of naltrexone on abstinence when combined with a supportive psychotherapy. In adults, results found with the use of naltrexone in eating disorders are different, when considering the duration and the dosage of the treatment and the kind of eating disorder (bulimia, binge eating or anorexia nervosa). Studies in children and adolescents are needed before proposing naltrexone in eating disorders. We resumed here the results found with this treatment in these indications.
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PMID:Opiate antagonists in children and adolescents. 1114 Jul 79

In a prospective long-term outcome study of a representative sample of teenage-onset anorexia nervosa (AN), 51 individuals with AN, recruited after community screening, were contrasted with 51 matched comparison cases at a mean age of 24 years (10 years after AN onset). All 102 cases had been examined at age 16 and 21 years. At 24 years all probands were interviewed regarding mental and physical health, and overall outcome was assessed. Ten-year outcome of teenage-onset AN seemed to be relatively favourable in that half of all cases were free from eating disorder (ED) and other axis I disorder. There were no deaths. However, one in four in the AN group had a persisting ED, 3 of whom still had AN. Lifetime diagnoses of affective disorders and obsessive-compulsive disorder (OCD) were overrepresented in the AN group. Affective disorders coincided with the ED, and were not a problem after recovery from the ED. On the other hand, OCD, OCPD (obsessive-compulsive personality disorder), and/or autism spectrum disorder continued to characterise more than one-third of the AN cases. One in six of the AN group had persistent problems with social interaction and obsessive compulsive behaviours from childhood into early adult years. Half the AN group had a poor overall outcome. These were subjects with either persisting ED or lifelong problems with social interaction and obsessive compulsive behaviour.
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PMID:Outcome of teenage-onset anorexia nervosa in a Swedish community-based sample. 1256 19

Pica is a eating disorder, of the eating behavior in childhood. It is defined as the persistent intake of non-nutritional substances for at least one month, in an inappropriate way from an evolutionary perspective, and provided that its practice is not culturally banned. Many animal species, including primates, have this behavior. Documented from antiquity, in most cases it has been considered a symptom of another related disorder rather than as independent condition. Its prevalence is unknown. It is mainly described in mentally disabled people, pregnant women, autism, mentally ill patients, children, and others. The ingestion of earth, ice, starch, ropes, wood, and other products has been observed, although some authors also include the obsessive and reiterative consumption of eatable substances. Geophagia is considered a cultural phenomenon, although sometimes may lead to disease, and an form of paleomedicine or paleonutrition. The etiology of pica is unknown and it has no markers. Sensitive, digestive, nutritional, psychological, and psychiatric factors have been implicated in its origin and maintenance. Although the morbimortality is unknown and difficult to study, we may highlight intoxications, parasitic diseases, and surgical abdomen with serious complications. Finally, as in other eating behavior disorders, the global management of this entity requires a coordinated intervention of different health care professionals.
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PMID:[Pica: the portrait of a little known clinical entity]. 1704 1

Current evaluations used by occupational therapists to assess and treat feeding problems derive mainly from the domain of dysphagia. The purpose of this article is to familiarize the reader with tools used, in research, for children with pervasive developmental disorders (PDD) and to determine if any of these meet the needs of occupational therapists. The following data bases were searched: Medline, CINAHL, HAPI and PsyINFO, using the terms pervasive developmental disorder, autism, Asperger syndrome, pervasive developmental disorder not otherwise specified, eating behavior, eating disorder, food preference, food selectivity, feeding disorders, picky eater and child. All articles published between 1980 and 2006 (n=27) were reviewed. A total of 20 studies met our selection criteria. Assessment methods are compared using the Disability Creation Model (DCP). The DCP is the Quebec alternative to the International Classification of Functioning, Disability and Health (ICF). None of the evaluation tools reviewed met all factors that may influence eating in children with PDD. Implications for research and practice in occupational therapy are discussed.
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PMID:[Review of assessment methods used to evaluate feeding for children with pervasive developmental disorder]. 1856 84

Wernicke's encephalopathy (WE) or thiamine deficiency is fatal if left untreated. We report a case of a 3-year-old boy with infantile autism and a severe eating disorder who developed WE after 3 weeks of starvation without thiamine supplementation. The eating disorder started when he entered preschool. He presented with unconsciousness and a cluster of seizures. Cranial magnetic resonance imaging (MRI) showed high-intensity signal changes in the basal ganglia on T2-weighted images and fluid-attenuated inversion recovery (FLAIR). Treatment with high-dose intravenous thiamine was effective. Pediatric patients with WE tends to show no typical symptoms or brain lesions on MRI as seen in adult WE patients typically along alcoholics. Brain lesions similar to those in hypoxia or mitochondrial diseases such as Leigh's encephalopathy, are observed in patients with pediatric WE, and this makes diagnosis difficult. WE should be considered when patients with severe eating disorders present with unconsciousness and/or frequent seizures, and show basal ganglia lesions on MRI, differential diagnosis should include WE.
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PMID:[Case of infantile autism with pediatric Wernicke's encephalopathy due to severe eating disorder]. 1917 16

OBJECTIVE. Female adults with a diagnosis of anorexia nervosa (AN) have been found to score higher than healthy controls on a questionnaire that measures characteristics associated with Autism Spectrum Disorders (ASD). This research investigated the relationship between eating disorder (ED) and ASD symptomatology in a non-clinical sample, with an additional focus on prenatal testosterone (pT) levels. DESIGN. A cross-sectional research design was used. The selected age group of both males and females allowed for a focus on early onset of ED symptomatology in both sexes. METHODS. Self-reported questionnaire data from the Eating Attitudes Test (EAT-26) and the Autism Spectrum Quotient (AQ) were collected from 132 schoolchildren (61 boys, 71 girls) aged 11 to 14, with no recorded psychiatric diagnoses. Digit ratio (2D:4D) measures to index levels of pT exposure were also obtained. RESULTS. A significant relationship between levels of ED symptomatology and ASD symptomatology was identified. Particularly strong relationships were identified between the EAT-26 and the attention to detail and communication subscales of the AQ. Few relationships were found for digit ratios. CONCLUSION. The results extend previous research from a sample with a diagnosis of AN to a non-clinical population. Those registering higher levels of ED symptomatology also reported higher levels of attention to detail and communication difficulties associated with ASD.
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PMID:An investigation into the relationship between eating disorder psychopathology and autistic symptomatology in a non-clinical sample. 2181 Jan 10

A strong placebo response in psychiatric disorders has been noted for the past 50 years and various attempts have been made to identify predictors of it, by use of meta-analyses of randomised controlled trials and laboratory studies. We reviewed 31 meta-analyses and systematic reviews of more than 500 randomised placebo-controlled trials across psychiatry (depression, schizophrenia, mania, attention-deficit hyperactivity disorder, autism, psychosis, binge-eating disorder, and addiction) for factors identified to be associated with increased placebo response. Of 20 factors discussed, only three were often linked to high placebo responses: low baseline severity of symptoms, more recent trials, and unbalanced randomisation (more patients randomly assigned to drug than placebo). Randomised controlled trials in non-drug therapy have not added further predictors, and laboratory studies with psychological, brain, and genetic approaches have not been successful in identifying predictors of placebo responses. This comprehensive Review suggests that predictors of the placebo response are still to be discovered, the response probably has more than one mediator, and that different and distinct moderators are probably what cause the placebo response within psychiatry and beyond.
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PMID:Placebo eff ects in psychiatry: mediators and moderators. 2581 49


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