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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors describe a case of intermittent fasting and self-induced vomiting in a student aviator whose symptoms do not meet the full criteria for either anorexia or bulimia. The range of symptomatology and differential diagnosis of eating disorders is discussed. New DSM-IV diagnostic criteria for eating disorders, including Eating Disorder Not Otherwise Specified (NOS), and associated therapeutic alternatives are reviewed. The case demonstrates the importance of comprehensive physical and psychiatric evaluation of those patients with complex or atypical presentations. Issues pertaining to the aeromedical disposition of such patients are discussed, with emphasis on the role of the flight surgeon in the early recognition of eating disorders.
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PMID:A case of "eating disorder NOS": aeromedical implications of DSM-IV diagnostic criteria. 883 42

The characteristics of anorexia nervosa and bulimia nervosa were studied in ballet dancers in full-time training and compared with other young women at school. Dancers had higher scores on the Eating Attitudes Test. Dancers were more likely to have an eating disorder when strict modified DSM-3-R criteria were applied. Currently 1 dancer (1.6%) and no student had anorexia nervosa, 1 dancer (1.6%) and 3 students (1.3%) had bulimia nervosa and 5 dancers (8.3%) and 9 students (4.2%) had an unclassified eating disorder. Another dancer had been treated for anorexia nervosa in the past. One dancer was treated for bulimia nervosa and 6 for weight loss. Dancers were more likely to have been told to increase their body weight. Dancers were not more likely to be afraid of losing control of their weight and becoming obese if they attempted weight gain, to ignore the advice to gain weight or resist gaining weight. Regular self-induced vomiting was reported by 4% of women. Dancers are at risk for the development of eating disorders. Ballet dancers are under pressure to maintain low body weight. The low body weight and menstrual disturbance found among young dancers during training are two of the characteristics of anorexia nervosa Ballet dancers use behaviours aimed at weight control and weight loss. In dancers and professional groups under intense pressure to diet, low body weight and amenorrhoea are not sufficient criteria to diagnose anorexia nervosa. These behaviours can result in binge eating and multiple behaviours aimed at preventing binge eating. Whether the characteristics of bulimia among dancers are sufficient for a diagnosis of bulimia nervosa to be made is unknown. The aim of this paper is to study the characteristics of the eating disorders anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified among young ballet dancers in full-time ballet training and to provide information about the risk of development of eating disorders among young women required to maintain below average body weight while continuing above average exercise.
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PMID:Characteristics of eating disorders among young ballet dancers. 886 53

Following the conduct of a 28-day inpatient bioequivalence study of clozapine in schizophrenia patients, withdrawal effects after abrupt discontinuation from clozapine were assessed. Thirty patients who met DSM-III-R criteria for schizophrenia, residual type, or schizophrenia in remission were enrolled in the study. Patients were evaluated for symptoms of withdrawal effects for 7 days after clozapine 200 mg/day was abruptly withdrawn. Of 28 patients who completed the study, 11 had no withdrawal symptoms; 12 had mild withdrawal adverse events of agitation, headache, or nausea; four patients experienced moderate withdrawal adverse events of nausea, vomiting, or diarrhea; and one patient experienced a rapid-onset psychotic episode requiring hospitalization. Cholinergic rebound is a likely explanation for the mild to moderate withdrawal symptoms and is easily treated with an anticholinergic agent. Mesolimbic supersensitivity, as well as specific properties of clozapine, are discussed as likely causes for rapidonset psychosis. Our findings are consistent with previous reports of withdrawal reactions associated with clozapine, further reminding clinicians to monitor patients closely following abrupt discontinuation of clozapine.
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PMID:Cholinergic rebound and rapid onset psychosis following abrupt clozapine withdrawal. 893 13

The effectiveness and safety of ECT in pharmacotherapy-refractory depression was examined in 11 hospitalized adolescents (ages 16.3 +/- 1.7 years, 10 females) with a primary DSM-III-R diagnosis of mood disorder, which had failed to respond to three or more adequate trials of antidepressant pharmacotherapy. After a thorough diagnostic evaluation, patients received a course of ECT involving 11.2 +/- 2.0 (range 8-15) administrations. ECT was commenced with bilateral treatment in 2 adolescents and nondominant right electrode placement in 9 patients; 5 of the 9 patients were subsequently changed to bilateral treatment. All 11 patients improved to a clinically significant degree. Significant improvements were noted in scores on the Children Depression Rating Scale-Revised (CDSR-R) and the Global Assessment of Functioning Scale (GAF) (p < 0.05). Euthymia, defined as CDRS-R score < or = 40, was achieved by 64% (7/11) of patients. The Mini-Mental State Examination showed no significant decline in cognitive functioning. Neuropsychological testing completed in 5 subjects both before ECT and 1-5 days after the last treatment, indicated a significant decline in attention, concentration, and long-term memory search. Minor side effects, experienced within the first 12 hours of treatment, were headache (80% of patients) and nausea/vomiting (64%). The potentially serious complication of tardive seizure (after full recovery of consciousness) occurred in 1 adolescent. Prolonged seizures (> 2.5 minutes) were noted in 7 of the 11 patients (9.6% of the 135 ECT administrations). Pending further research on ECT in youth, it is recommended that ECT should only be administered to youth in hospital settings, that all regularly administered psychotropic medications (including antidepressants) be discontinued before ECT and restarted after the final administration of ECT, and that physicians be aware that 12 treatments are usually sufficient, but that 15 treatments may occasionally be necessary for treating depressed adolescents. With the understanding that scientific evaluation of ECT in youth is lacking, it appears that ECT can be an effective and relatively safe treatment for depressed adolescents who have failed to respond to antidepressant pharmacotherapy.
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PMID:Electroconvulsive treatment in adolescents with pharmacotherapy-refractory depression. 923 19

This study examined the relative efficacy of a brief-psychoeducational treatment approaches for bulimia nervosa. Our sample comprised 26 women who sought consecutively treatment at the Eating Disorders Outpatient Unit. All subjects met DSM-IV criteria for Bulimia nervosa. For the assessment were used commonly applied questionnaires in the fiel of eating disorders such as: Eating Attitudes Test (EAT-40), Eating Disorders Inventory (EDI) and the Beck Depression Inventory (BDI). Outcome measures included also change in vomiting and binge-eating episodes per week. Each patient was assessed before and after a 6 weeks brief psychoeducational group therapy. At posttreatment, 30% of the patients were abstinent from binge eating-purging and 62% reduced their weekly frequency in binge eating and 56% reduced their weekly frequency in vomiting. Good-outcome (EAT scores < 30) was observed in more than 35% of our patients. The authors sought to identify factors that differentiate bulimic patients who improve while receiving treatment from those who do not.
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PMID:[Psychoeducative ambulatory group in bulimia nervosa. Evaluation of a short-term approach]. 954 33

Serum visceral protein and hematological indices and their behavioral and clinical correlates were determined in women with bulimia nervosa and depressed controls. One hundred and fifty-two women who met DSM-IV criteria for bulimia nervosa and 68 women with DSM-IV major depression completed a structured clinical interview and had blood samples drawn prior to admission to outpatient treatment programs. Albumin and prealbumin concentrations were lower in the depressed women, possibly due to recent weight loss. Elevated transferrin values suggested mild iron deficiency in nearly one-fifth of women with bulimia nervosa. Of women with bulimia nervosa, the 10.7% who had hemoglobin and 5.1% who had vitamin B12 levels below the normal range were not distinguishable on measures of body mass index, binge eating, vomiting, or restriction frequency. The 4.3% with low prealbumin levels experienced significantly more episodes of binge eating and vomiting in the prior fortnight than those with normal values. Frequency of vomiting was also inversely associated with albumin concentration. Hamilton Depression Rating Scale scores were inversely and linearly related to serum vitamin B12. Lower B12 levels in those with alcohol abuse/dependence did not explain the association between B12 and HDRS scores. No hematological indices were related to body mass index, binge eating or restriction frequency, or restriction intensity. In summary, women with bulimia nervosa do not appear to be at greater risk of visceral protein or hematological abnormalities than psychiatric controls. It is suggested that a high frequency of vomiting and alcohol abuse/dependence, increases the risk of subclinical malnutrition in women with bulimia nervosa, and that poor vitamin B12 nutriture may interfere with the functioning of the serotonergic or catecholaminergic systems and contribute to depressive symptoms in bulimia nervosa.
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PMID:Visceral protein and hematological status of women with bulimia nervosa and depressed controls. 1022 89

The present study examined the psychometric properties and principal components structure of the Bulimia Test Revised (BULIT-R; [Thelen, M.H., Farmer, J., Wonderlich, S. & Smith, M. (1991). A revision of the Bulimia Test: the BULIT-R. Psychological Assessment, 3, 119-124.]) using a sample of early adolescent males and females. Three hundred and six girls (mean age = 13.66; S.D. = 1.12) and 297 boys (mean age = 13.89: S.D. = 1.13) from grades 7-10 completed the BULIT-R as part of a larger study investigating disordered eating in early adolescence. In comparison to the 5 factors identified in adult female samples, the factor analysis identified four similar factors for adolescent boys and girls: bingeing, control, normative weight loss (dieting and exercise) and extreme weight loss behaviors (vomiting, diuretics and laxatives). The findings highlight similarities between boys and girls and differences in the factorial nature of the BULIT-R for adult and adolescent samples. The BULIT-R also demonstrated good reliability with adolescent samples and adequate concurrent validity with the DFT, DEBQ and binge eating as defined by the DSM-IV criteria. The emergence of bingeing and control as two distinct factors is an important distinction that needs to be considered when attempting to provide accurate incidence rates of binge eating and bulimic symptomatology in adolescents.
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PMID:Factorial validity of the Bulimia Test-Revised in adolescent boys and girls. 1050 Mar 25

Subtypes of functional dyspepsia (FD), including refluxlike dyspepsia, ulcerlike dyspepsia, dysmotility-like dyspepsia, and nonspecific dyspepsia, have been described and are widely used clinically. However, these symptom patterns often overlap, and the terms are insufficient for indicating all FD symptoms. In this study, we divided 71 FD patients into two groups: patients with or without pain. Group I, the pain dyspepsia group, included patients in whom the main symptoms were epigastralgia and/or chest pain. Group II, the painless dyspepsia group, included patients without pain, in whom the symptoms were nausea, vomiting, and heartburn. We examined the relationship between esophageal function and psychiatric factors in the test groups and compared them with a control group. Of the FD patients, 19.7% [8 (25%) of 32 group I patients, 6 (15.4%) of 39 group II patients] had esophageal motility disorders, such as nutcracker esophagus and diffuse esophageal spasm. The LES pressure of group I was higher than that of group II by esophageal manometry (P < 0.05). In 17 (53.1%) of 32 group I patients and 31 (79.5%) of 39 group II patients, psychiatric disorders (38.0% had depressive disorder and 21.1% had an anxiety disorder) were diagnosed following DSM III-R criteria. Group II tended to be more depressive than group I (P = 0.0508). Psychological assessment scores, STAI-I and STAI-II, were higher in groups I and II than in the control group (P < 0.001). Long-term distress, anxiety, and depression seem to influence the symptoms of FD patients. Esophageal dysmotility may be an important functional abnormality of FD.
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PMID:Esophageal motility and psychiatric factors in functional dyspepsia patients with or without pain. 1054 63

Recent reports have postulated the existence of two different types of self-injurious behavior: impulsive and compulsive. The aim of the present study is to analyze the dimensionality of self-injurious behavior and to study the link between self-injurious behavior and clinical features in anorexia nervosa. The study involved 236 consecutive patients with anorexia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-reported questionnaires, such as the Eating Disorders Inventory and Hopkins Symptom Checklist. A principal component analysis was used to study the dimensionality of different types of self-injurious behavior, including purging. Our findings confirm the distinction between impulsive and compulsive self-injurious behavior. The dimensions appear to be represented as a continuum in both the anorexia nervosa diagnostic subgroups. A third distinct dimension emerged that included self-induced vomiting and laxative/diuretics abuse. Childhood sexual abuse and anxiety significantly predict the presence of impulsive self-injury, whereas obsessionality and age predict compulsive self-injury. The coexistence of a positive score on both dimensions of self-injurious behavior was the strongest predictor of treatment dropout. The present study highlights the importance of self-injurious behavior; it should be given due consideration in future outcome studies on anorexia nervosa
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PMID:Self-injurious behavior in anorexia nervosa. 1097 74

Among somatoform disorders, pain disorder (DSM IV) appears to be relatively common in general practice and to cause social, psychological, and functional impairment. A previous study conducted by Lemoine (1997) has shown that sulpiride is more effective than placebo in reducing intensity and frequency of pain in this disorder. The aim of our study was to assess safety and efficacy of sulpiride in a large sample of patients under natural conditions of use, in general practice. In a multicenter, open clinical trial, 669 patients (mean age: 47 years +/- 12; male: 245, female: 424) fulfilling the DSM IV criteria for pain disorder (of gastrointestinal localization), were included by 321 general practitioners (GP) and treated for 6 weeks with sulpiride 150 mg/d. Investigators' evaluations were planned at D14 and D42. Furthermore a diary was given to each patient for self evaluation and intercurrent events reporting. The pain was of psychological type in 93% of cases and caused social or working disabilities in 78% of patients. At inclusion the mean score of the Hamilton Anxiety Rating Scale was 18 +/- 8, and the mean score of the depression scale HARD (Humeur, Angoisse, Ralentissement, Danger) was 14.8 +/- 6.4. During the study 7.9% of the patients had at least one adverse event, and 3% of patients were withdrawn for adverse event. Safety assessed with a specific variable (grouping together adverse events' reporting and results of CGI item 3) was good for 88% of patients. The principal criterion of efficacy was the clinician's evaluation of the intensity and frequency of abdominal pain on a four-point scale from 0 (asymptomatic) to 3 (important/continuous) from D0 to D End a decrease in pain intensity (91% of patients) and in pain frequency (89%) was observed as well as in frequency and intensity of related gastroenterological symptoms such as disturbances of bowel movements (79% and 78%), bloated symptoms (88% and 83%), nausea/vomiting (90% and 90%). A similar improvement (p < 0.001) was observed from D0 to End point on the self evaluation parameters (Visual Analogic Scales), assessing pain (mean score D0-D End: 17.1 +/- 15.9), quality of sleep (mean score D0-D End: 27.1 +/- 17.8), activity (mean score D0-D End: 24.4 +/- 18.8), and appetite (mean score D0-D End: 22.6 +/- 16.6). In conclusion these results confirm the usefulness of sulpiride in the treatment of pain disorders a symptomatology known to cause difficulties to GP's in their practice.
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PMID:[Sulpiride: study of 669 patient presenting with pain of psychological origin]. 1106 41


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