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 6,116 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The following principles are associated with successful treatment of anorexia nervosa and bulimia: (1) correct identification of these syndromes by history and mental examination, rather than by the elimination of all possible medical explanations; (2) a balanced approach between changing the abnormal weight or eating pattern and understanding and correcting the predisposing and underlying psychodynamics; (3) an empirical practical approach to treatment that avoids speculative concepts of origin; (4) an understanding of the natural history and underlying psychopathology of these disorders; (5) a non-blaming supportive approach, with variation in the specific kind of psychotherapy chosen according to the needs and abilities of the patient; (6) global treatment goals including psychologic, biologic, and social improvement; (7) avoidance of procedures with high morbidity such as tube feeding, hyperalimentation, and high-dose medication; and (8) an attitude of realistic optimism. Virtually all aspects of these disorders have the potential for complete improvement.
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PMID:Anorexia nervosa and bulimia: diagnosis and comprehensive treatment. 635 16

The evidence suggests that poor diabetic control in adolescence is often associated with omissions of insulin, overeating and other failures in adherence to the treatment regime in the context of some kind of emotional disturbance. Six young patients with diabetes mellitus and an eating disorder (anorexia nervosa or bulimia), who failed to control their diabetes in order to lose weight and to compensate for bulimic episodes, are discussed. Other noteworthy features were their feelings of hopelessness and their unco-operativeness with treatment. Our knowledge of the pathogenesis of anorexia nervosa and of the special problems faced by diabetic adolescents would lead to a prediction that a combination of the two disorders should arise more often than could be accounted for by chance.
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PMID:Anorexia nervosa and bulimia in diabetics. 639 33

In this paper the indications for inpatient treatment of anorexia nervosa are reviewed. Although all programs aim at weight gain and normalization of eating habits, the means for achieving these goals vary widely from nursing encouragement, operant conditioning or, rarely, hyperalimentation. Most programs now utilize an integrated treatment program that includes a weight restoration program, individual psychotherapy and family involvement. Nutritional considerations during inpatient treatment are also reviewed. The signs and symptoms that commonly occur during weight restoration are outlined. The major psychodynamic conflicts that occur are described and psychotherapeutic methods for treating each are presented.
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PMID:Inpatient treatment of anorexia nervosa. 644 81

Anorexia nervosa (AN) can be considered a result of complex instrumental conditioning. It is postulated that in healthy nonsatiated individuals, the sight and smell of the preferred food, acting as a conditioned stimulus (food CS), activates a memory pattern of associations "eating--desirable sensory input" (approach pattern). This leads to the instrumental reaction of eating which is reinforced by sensory satisfaction. In victims of AN, in addition to the approach pattern the food CS activates another pattern of associations consisting of such components as "eating--obesity--failure" and " noneating --thinness--success" (avoidance pattern). The establishment of the avoidance pattern depends on such factors as social preferences and pressures to be slim, inborn dispositions, and personal psychological problems. If the activation of the avoidance pattern prevails over the activation of the approach pattern, the individual refrains from eating. The refusal to eat is here an instrumental avoidance reaction; its performance is reinforced by satisfaction derived from successful self-control and losing weight. A prolonged activation of the avoidance pattern leads to malnutrition and ultimately to death. In cases in which the approach pattern and the avoidance pattern are frequently activated simultaneously to the same degree, a neural conflict may develop. In a variation called "bulimia nervosa," an activation of the approach pattern alternates with the activation of the avoidance pattern. First, overeating takes place; it is reinforced by oral-gastric satisfaction. Then, the avoidance reaction of self-induced vomiting or purging follows; it is reinforced by satisfaction derived from preventing weight gain.
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PMID:Anorexia nervosa as a case of complex instrumental conditioning. 672 79

Hyperalimentation is a feeding technique in which all essential nutrients are infused intravenously to sustain patients who cannot eat. Although no panacea for anorexia nervosa, hyperalimentation can provide calories for intractable, malnourished patients. The authors describe the psychiatric and hyperalimentation treatment for four severely anorectic patients who had lost up to 44% of their body weight before entering the study. With treatment their percentage of ideal weight rose from a mean of 59% to a mean of 81% during hospitalization, and to a mean of 94% on outpatient follow-up of 5--16 months. The authors discuss the indications, limitations, and need for interdisciplinary collaboration in this treatment.
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PMID:Treatment of severe weight loss in anorexia nervosa with hyperalimentation and psychotherapy. 676 76

Serum factors which stimulate DNA synthesis were investigated in patients with anorexia nervosa. The factors were assayed by examining [3H]-thymidine incorporation into the nuclei of human fibroblasts in culture using autoradiography. The mean percentage of labeled nuclei (labeling index) induced by serum was significantly lower (p < 0.005) in 5 patients with anorexia nervosa (21.0 +/- 5.9 percent, mean +/- S.D.) than in 5 normal adult subjects (33.9 +/- 3.3 percent). Two of the patients with anorexia nervosa were treated with intravenous hyperalimentation (IVH). In one of the IVH treated patients, the labeling index increased from 17.4 to 32.8 percent at the 6th week of treatment, and in the other increased from 19.4 to 29.8 percent at the 4th week. In both patients, body weight increased by 1.5 to 2 kg. IVH in these patients increased DNA-synthesis-stimulating activity.
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PMID:DNA-synthesis-stimulating activity in the sera of anorexia nervosa. 678 Mar 32

Ten patients with anorexia nervosa were treated with intravenous hyperalimentation (IVH) and/or psychotherapy. The five patients were treated with both IVH and psychotherapy. The five patients were treated with both IVH and psychotherapy. Their body weight rose from 66 +/- 3% (mean +/- SE) to 78 +/- 6% of their ideal weight during hospitalization, and then to 91 +/- 5% during ambulatory observation for a period of 6 to 36 months. Another group of 5 patients were treated only with psychotherapy. Their body weight increased 69 +/- 3% to 73 +/- 1% of their ideal weight during hospitalization, and then to 78 +/- 1% during during the observation period at the out-patient department during a period of 6 to 48 months. The former group gained more weight than the latter group during hospitalization (P less than 0.025) and during ambulatory observation (P less than 0.025), respectively. These results suggest that IVH is one effective remedy for anorexia nervosa and that good results can be expected from IVH and psychotherapy used in combination.
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PMID:Hyperalimentation in treatment of anorexia nervosa. 680 55

This paper describes the inpatient phase of an anorexia nervosa treatment program in an adolescent unit of a children's hospital. This program focuses on four goals: improving eating behavior, improving socialization, achieving initial weight gain, and engaging the patient and her family with an outpatient psychotherapist. The patients were divided into three groups according to severity. All five Group I patients (less than 25% body weight loss) had a composite 100% achievement of the four goals. Twenty out of 21 Group II patients (greater than 25% body weight loss) had 100% achievement of the four goals. Three out of six Group III patients (greater than 25% body weight loss and requiring hyperalimentation) had 100% achievement of the four goals. The success of this inpatient program is felt to be due to the pediatric-psychiatric collaboration, the involvement of the family during the inpatient phase, the therapeutic use of an interdisciplinary team and of the social system of the inpatient unit including other patients and recreation therapist.
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PMID:Interdisciplinary model for the inpatient treatment of adolescents with anorexia nervosa. 684 Dec 35

Thirty-two patients who complained of episodes of ravenous overeating which they felt unable to control (bulimia) were asked to describe their behaviour and symptoms. There was considerable variation both between and within individuals, but a number of factors were defined which appeared to be common to all with the complaint. It is difficult to set up strict criteria for the recognition of bulimia, and those that have recently been proposed are criticized in the light of our present findings. Bulimia is usually associated with an excessive concern about body weight. It occurs in patients with anorexia nervosa, in whom it is often a relatively early feature of the illness, but it is also found in subjects of normal weight or obese subjects who have never been emaciated. Episodes of bulimia are usually preceded by dysphoric mood states. The gorging may alleviate the dysphoria temporarily, but many patients later experience negative feelings such as depression and self-depreciation. The ability to induce vomiting after a bulimic episode is a major influence determining the clinical presentation.
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PMID:How patients describe bulimia or binge eating. 695 5

Four patients with primary anorexia nervosa were interviewed in order to demonstrate some of the characteristic features of this disorder. Although this disorder occurs only rarely in males, one of these four patients was a young man. Primary anorexia nervosa is discussed from a variety of perspectives, including descriptive, psychodynamic, and hormonal. A brief review of the theoretical rationale underlying a variety of psychotherapeutic approaches is offered, and reports of their effectiveness are considered. Primary anorexia nervosa is probably best conceptualized as a complicated disorder with an admixture of serious psychological and somatic components, including the characteristic approach-avoidance conflict over eating. The authors speculate on the possibility of an underlying disorder of central catecholamine metabolism, particularly in relationship to dopamine transmission.
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PMID:Anorexia nervosa: a group case conference. 742 56


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