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Query: UMLS:C0020175 (hunger)
 5,670 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Most of the drugs commonly used in the treatment and prophylaxis of depression, mania, and psychotic illness have, as one of their prominent side effects, the ability to increase appetite, stimulate carbohydrate craving, and promote weight gain. These side effects are troublesome to patients, and frequently constitute a major reason for premature discontinuation of therapy. This review examines the relative likelihood of the occurrence of appetite stimulation and weight gain with various psychotropic medications. Potential mechanisms of these effects and strategies to minimize or avoid weight gain during pharmacotherapy of psychiatric illness are examined. Evidence suggests that those compounds, which either antagonize or downregulate serotonin receptors, are more likely to stimulate carbohydrate hunger and weight gain. Amitriptyline, chlorpromazine, mesoridazine, thioridazine, and lithium are most likely to produce weight gain. Compounds that have more pronounced serotonergic action, such as fluoxetine and fenfluramine, are more likely to decrease carbohydrate craving and promote weight loss.
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PMID:Psychotropic drug induced weight gain: mechanisms and management. 305 18

Anorexia is a severe psychological disorder in which a person's dieting turns into compulsive fasting. Some victims develop, after a time, a bulimic phase; their fasting is interrupted at intervals by bouts of indiscriminate gorging. One successful treatment makes use of a naturally occurring trance state, in which the anorexic's obsession with food recedes temporarily, to offer reassurance and rebuild a personality free of the obsession. The proposed model is catastrophe-theoretic. It assumes (a) that the bifurcation of eating attitudes typical of anorexia can be modeled by a cusp whose controls are hunger and eating regimen; and (b) that the normal cycle of falling asleep and waking up can be modeled by a hysteresis loop controlled by alertness. Catastrophe theory predicts two additional controls, and a larger model organized by the E6 singularity. The new controls are identified with loss of self-control and insecurity, and anorexia is correlated with high insecurity. The model makes the following predictions. First, under moderate levels of self-control and eating regimen, an anorexic has access to balanced, nonobsessive attitudes toward food at a reduced level of wakefulness. This is the trance state. Second, a healthy individual has two distinct sleep modes, dominated by cerebral and somatic elements, respectively. Third, with increasing insecurity the distinct modes fuse together, so that an anorexic's sleep patterns are abnormal. The model is geometric because the connection between behavior and controlling factors is made by graphs of certain standard form.
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PMID:A geometric model of anorexia and its treatment. 709 72

Factors associated with undernutrition were investigated in a broad community-based sample of 457 homeless adults (344 men and 113 women) who were interviewed and examined in a variety of settings during the summer of 1985. Latent variables representing drug use, alcohol use, a stereotyped homeless appearance, mental illness, poor physical health status, and measured variables of age, sex, income, and number of free food sources were used as predictors of undernutrition. Undernutrition was indicated with three anthropometric measures (weight, triceps skinfold, and upper arm muscle area in the lowest 15th percentile) and one observational measure. Thirty-three percent of the sample was undernourished as defined by at least one of the anthropometric measures. Undernutrition was significantly associated with more drug use, fewer free food sources, less income, and male sex. The findings identify persons at risk for undernutrition and suggest programs to alleviate their hunger, including increased funding for food stamps and other income supports, more free food sources such as shelters and souplines, and drug treatment programs.
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PMID:Determinants of undernutrition among homeless adults. 763 32

Based on a recently-published article on the triad of drought, hunger, and mental illness, in which the main idea is that destitution may be leading to behavioral disorders in the drought-plagued population of the Brazilian Northeast, we reflect on what this so-called 'madness' may represent for this group of people. We attempt to analyze the issue from various disciplinary perspectives, going beyond merely causal explanations and taking into account that the reported disorders entail meanings following the articulation of cognitive, affective, and experiential elements founded on the social and cultural relations of individuals. From this point of view, the respective discourse assumes other interpretations, showing that illness is a singular process of construction.
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PMID:[Hunger and mental illness]. 976 20

Food refusal occurs for a variety of reasons. It may be used as a political tool, as a method of exercising control over others, at either the individual, family or societal level, or as a method of self-harm, and occasionally it indicates possible mental illness. This article examines the motivation behind hunger strikes in prisoners. It describes the psychiatrist's role in assessment and management of prisoners by referring to case examples. The paper discusses the assessment of an individual's competence to commit suicide by starvation, legal restraints to intervention, practical difficulties and associated ethical dilemmas. Anecdotal evidence suggests that most prisoners who refuse food are motivated by the desire to achieve an end rather than killing themselves, and that hunger-strike secondary to mental illness is uncommon. Although rarely required, the psychiatrist may have an important contribution to make in the management of practical and ethical difficulties.
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PMID:Food refusal in prisoners: a communication or a method of self-killing? The role of the psychiatrist and resulting ethical challenges. 1063 97

In order to evaluate the effectiveness of a cognitive behavioural group therapy programme for the treatment of obesity in clinical practice, 122 patients from 14 general practices (n = 70) were randomised into either a treatment or a control arm with a ratio of 3 to 2. The group treatment programme was also assessed in a clinical centre (n = 52; University Hospital Basel). Before therapy, a clinical interview and a mental disorder examination were carried out on all patients. The instructors of the programme (practitioners; clinic physicians) were trained during two afternoon meetings to supervise the group sessions. The treatment programme consisted of 16 group sessions of 90 min each, and contained psycho-educational elements concerning a balanced diet, instruction for the integration of more activity in everyday life (lifestyle activity), problemsolving strategies, and the cognitive restructuring of dysfunctional cognition regarding the own body. All the patients who were treated in the various settings demonstrated a benefit from therapy. Compared to the control groups which received usual medical care, they were able to reduce their starting weight by around 5% (p <0.001 for the group treated by practitioners) at the end of treatment and stabilise it until follow up after one year. In regard to psychological factors the treatment groups showed an increased sense of control over eating behaviour, and feelings of distractibility and hunger were reduced after treatment and at follow up (p <0.05). All treatment groups showed statistically relevant increases in feelings of attractiveness regarding their body and shape (p <0.05). These results support the effectiveness of the integrated cognitive behavioural treatment programme in clinical practice over a duration of 12 months.
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PMID:Evaluation of a lifestyle change programme for the treatment of obesity in general practice. 1270 42

The aims of the study were to test the hypotheses that some symptoms of starvation/severe dietary restraint are interpreted by patients with eating disorders in terms of control. Sixty-nine women satisfying the Diagnostic and Statistical Manual of Mental Disorders-IV edition (DSM-IV) criteria for a clinical eating disorder and 107 controls participated in the study. All the participants completed an ambiguous scenarios paradigm, the Eating Disorder Examination Questionnaire (EDE-Q) and the Beck Depression Inventory (BDI). Significantly more eating disorder patients than non clinical participants interpreted the starvation/dietary restraint symptoms of hunger, heightened satiety, and dizziness in terms of control. The data give further support to the recent cognitive-behavioural theory of eating disorders suggesting that eating disorder patients interpret some starvation/dietary restraint symptoms in terms of control.
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PMID:The interpretation of symptoms of starvation/severe dietary restraint in eating disorder patients. 1798 34

This study describes anorexia nervosa (AN) patients who use excessive exercise for weight management and how this behaviour relates to the classical Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) sub-grouping of AN. The study compared 428 clinical AN patients with 119 age and gender-matched controls. The AN cases were initially dichotomised according to DSM-IV subtype criteria into restricting (RAN; N=198) and binge-purge (BPAN; N=230) anorexia. The psychometric instruments were chosen to reflect key features concerning the diagnosis of eating disorders and characteristics of eating and food behaviour and included the 26-item Eating Attitude Test (EAT-26), Three Factor Eating Questionnaire (TFEQ), Dutch Eating Behaviour Questionnaire (DEBQ), Eysenck Personality Inventory (EPI) and Rosenberg Self-Esteem scale (RSE). Structured clinical interviews (1) were carried out in order to identify the subgroup of patients who use excessive exercise in order to facilitate weight control (EAN). The three groups (RAN, BPAN, EAN) did not differ in measures of current age, current body mass index, age of onset of AN and measures of restrained eating. However, significant differences were observed on EAT-26, DEBQ emotional and external factors, TFEQ disinhibition and hunger factors, EPI extraversion and neuroticism, and self-esteem. The EAN were similar to the RAN on the majority of variables but showed significant differences on extraversion, neuroticism, self-esteem and disease pathology (EAT-26). Compared with BPAN, EAN had lower disease pathology (EAT-26 scores), scored higher on the EPI extraversion scale, lower on the neuroticism scale and had greater self-esteem. The EAN also displayed significantly lower emotional and external eating (DEBQ) than BPAN and significantly lower disinhibition and hunger scores (TFEQ). These data suggest that EAN group display a mixed profile of characteristics resembling both BPAN and RAN. When EAN are defined as a separate group they appear to be phenotypically more similar to RAN than BPAN on this particular profile of variables. However when DSM-IV criteria are applied they are almost exclusively classified as BPAN. This outcome suggests that EAN do constitute an identifiable group that can be distinguished from RAN and BPAN. Consequently it is likely that the behaviour of excessive exercising should be considered as clinically relevant on the outcome of treatment.
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PMID:Similarities and differences between excessive exercising anorexia nervosa patients compared with DSM-IV defined anorexia nervosa subtypes. 2017 6

Schizophrenia is a debilitating mental disorder that afflicts about 1% of the population worldwide. Despite intensive, multifaceted research, its exact etiology remains elusive. Epidemiological data shows that when pregnant mothers experienced malnutrition or famine (e.g. the Dutch Hunger Winter of 1994-1945 and the Chinese famine of 1959-1961), the risk of schizophrenia in their children increased by two fold. This fact could be considered in the context of Developmental Origins of Health and Disease (DOHaD) or fetal programming. The concept of DOHaD is well referenced in the understanding of adult metabolic diseases, but less so in the field of mental disorders. We will attempt to show how the mechanisms of DOHaD could contribute at least in part to schizophrenia pathogenesis. Resonating with this concept, we introduce mainly our data showing increased expression of genes for fatty acid binding proteins (FABPs) in the postmortem brains from patients with schizophrenia and the beneficial effect conferred by the administration of polyunsaturated fatty acids (PUFAs) during the early developmental period of rats.
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PMID:Role of polyunsaturated fatty acids and fatty acid binding protein in the pathogenesis of schizophrenia. 2135 37

Atypical antipsychotic (AAP) medications that have revolutionized the treatment of mental illness have become stigmatized by metabolic side effects, including obesity and diabetes. It remains controversial whether the defects are treatment induced or disease related. Although the mechanisms underlying these metabolic defects are not understood, it is assumed that the initiating pathophysiology is weight gain, secondary to centrally mediated increases in appetite. To determine if the AAPs have detrimental metabolic effects independent of weight gain or psychiatric disease, we administered olanzapine, aripiprazole, or placebo for 9 days to healthy subjects (n = 10, each group) under controlled in-patient conditions while maintaining activity levels. Prior to and after the interventions, we conducted a meal challenge and a euglycemic-hyperinsulinemic clamp to evaluate insulin sensitivity and glucose disposal. We found that olanzapine, an AAP highly associated with weight gain, causes significant elevations in postprandial insulin, glucagon-like peptide 1 (GLP-1), and glucagon coincident with insulin resistance compared with placebo. Aripiprazole, an AAP considered metabolically sparing, induces insulin resistance but has no effect on postprandial hormones. Importantly, the metabolic changes occur in the absence of weight gain, increases in food intake and hunger, or psychiatric disease, suggesting that AAPs exert direct effects on tissues independent of mechanisms regulating eating behavior.
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PMID:Antipsychotic-induced insulin resistance and postprandial hormonal dysregulation independent of weight gain or psychiatric disease. 2397 May 23


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