Boys with eating disorders.

Although commonly associated with girls and women, eating disorders do not discriminate. School nurses need to be aware that male students also can suffer from the serious health effects of anorexia nervosa, bulimia, anorexia athletica, and eating disorders not otherwise specified. Sports that focus on leanness and weight limits can add to a growing boy's risk of developing an eating disorder. Issues of body image and sexual development can complicate and can distort previously normal eating habits. Students may use powerful and dangerous drugs readily available via the Internet, including growth hormone, creatine, testosterone, and aminophylline, to build muscle and to eliminate fat, potentially causing serious health consequences. School nurses can partner with health and physical education teachers, coaches, school staff, parents, and students to identify and to support boys with eating disorders     

Treatment of a compulsive paraphiliac with buspirone

This report provides an illustration of the potential value of drugs which enhance the effects of serotonin in the treatment of a compulsive paraphilia. A 37-year old man who had a long history of little control over urges to expose and to engage in obscene telephone calling, was placed on an open trial of buspirone. Buspirone proved very effective and this outcome, along with other reports of the beneficial effects of serotonin enhancers, encourages further research. Most interesting and notable was the observation that benefits continue to be maintained at 30 months after withdrawal of treatment.     

ED management of patients with eating disorders

Background

Eating disorders are one of the “great masqueraders” of the twenty-first century. Seemingly healthy young men and women with underlying eating disorders present to emergency departments with a myriad of complaints that are not unique to patients with eating disorders. The challenge for the Emergency Medicine physician is in recognizing that these complaints result from an eating disorder and then understanding the unique pathophysiologic changes inherent to these disorders that should shape management in the emergency department.

Objective

In this article, we will review, from the perspective of the Emergency Medicine physician, how to recognize patients with anorexia and bulimia nervosa, the medical complications and psychiatric comorbidities, and their appropriate management.

Conclusions

Anorexia and bulimia nervosa are complex psychiatric disorders with significant medical complications. Recognizing patients with eating disorders in the ED is difficult, but failure to recognize these disorders, or failure to manage their symptoms with an understanding of their unique underlying pathophysiology and psychopathology, can be detrimental to the patient. Screening tools, such as the SCOFF questionnaire, are available for use by the EM physician. Once identified, the medical complications described in this article can help the EM physician tailor management of the patient to their underlying pathophysiology and effectuate a successful therapeutic intervention.     

Examining supervised meals in patients with restrictive eating disorders

ObjectivesAnorexia nervosa is a chronic, life-threatening illness affecting adolescents with increasing incidence. Previous research has demonstrated that, although weight gain is a key to medical stabilization, there is wide and significant variability in treatment practices. Meal supervision in hospitalized patients involves the use of clinical staff as active and supportive observers during meal time. No studies to date have examined the effects of meal supervision in medically hospitalized patients with anorexia nervosa. The primary aim of this study was to examine the effect of meal supervision on outcomes during inpatient medical hospitalization.MethodsA retrospective record review of 52 patients with restrictive eating disorders admitted to a tertiary pediatric hospital from July 2008 to July 2009 was conducted.ResultsThe data revealed higher average weights and improved overnight heart rate trends for patients who received at least 1 supervised meal during hospitalization compared with those who received no supervised meals.ConclusionsThe findings warrant further investigation of meal supervision as a possible treatment modality.     

Safety and efficacy of prolonged outpatient ketamine infusions for neuropathic pain

Ketamine has demonstrated usefulness as an analgesic to treat nonresponsive neuropathic pain; however, it is not widely administered to outpatients due to fear of such side effects as hallucinations and other cognitive disturbances. This retrospective chart review is the first research to study the safety and efficacy of prolonged low-dose, continuous intravenous (IV) or subcutaneous ketamine infusions in noncancer outpatients. Thirteen outpatients with neuropathic pain were administered low-dose IV or subcutaneous ketamine infusions for up to 8 weeks under close supervision by home health care personnel. Using the 10-point verbal analog score (VAS), 11 of 13 patients (85%) reported a decrease in pain from the start of infusion treatment to the end. Side effects were minimal and not severe enough to deter treatment. Prolonged analgesic doses of ketamine infusions were safe for the small sample studied. The results demonstrate that ketamine may provide a reasonable alternative treatment for nonresponsive neuropathic pain in ambulatory outpatients.     

Pharmacologic management of eating disorders

Treatment of eating disorders is difficult regardless of the methods employed. Pharmacologic management in anorexia nervosa and in bulimia nervosa is especially helpful when it is part of a multimodal treatment approach that includes individual, family and behavioral therapy. Care must be taken to guard against side effects, abuse and noncompliance in a group of patients that tends to be prone to all three.     

Medical consequences of eating disorders

While much has appeared in the recent literature about various psychotherapeutic techniques used to treat eating disorders, little attention has been paid to the medical complications. Prominent among these are heart damage, failure of the endocrine system, infarction and perforation of the stomach after acute dilatation, multiple suicide attempts, aspiration, injury or rupture of the esophagus, severe bleeding per rectum causing anemia due to laxative abuse, hypokalemic nephropathy, depressive disorders due to starvation, and severe erosion of the enamel of the teeth resulting in extensive loss of teeth. I decry the sudden trend of nonmedically trained personnel rushing into the treatment of eating disorders, particularly anorexia nervosa and bulimia, because they know little about the possibly fatal consequences of their failure to attend to some of these medical phenomena. I also note with grave concern the identification of the medical profession with the "thin is better" mentality of our culture, which blinds them to the serious medical consequences of eating disorders.     

The stigma of eating disorders

Those who suffer from eating disorders often carry the added burden of stigmatizing attitudes from the lay public and the medical profession. These attitudes not only restrict the opportunities for effective treatment but also confer additional handicaps. To some extent, stigmatizing beliefs are based on partial truths about these disorders, namely their dangerousness, their sometimes poor response to treatment, the sufferers' part in their maintenance, and difficulties in communication. This review explores the truth of these beliefs and suggests ways in which a more positive approach to the management of eating disorders might help to reduce the stigma. This includes empathy with the patient's predicament and an approach to treatment in which the patient's wishes are paramount.     

Treating eating disorders in primary care

Binge-eating disorder, bulimia nervosa, and anorexia nervosa are potentially life-threatening disorders that involve complex psychosocial issues. A strong therapeutic relationship between the physician and patient is necessary for assessing the psychosocial and medical factors used to determine the appropriate level of care. Most patients can be effectively treated in the outpatient setting by a health care team that includes a physician, a registered dietitian, and a therapist. Psychiatric consultation may be beneficial. Patients may require inpatient care if they are suicidal or have life-threatening medical complications, such as marked bradycardia, hypotension, hypothermia, severe electrolyte disturbances, end-organ compromise, or weight below 85 percent of their healthy body weight. For the treatment of binge-eating disorder and bulimia nervosa, good evidence supports the use of interpersonal and cognitive behavior therapies, as well as antidepressants. Limited evidence supports the use of guided self-help programs as a first step in a stepped-care approach to these disorders. For patients with anorexia nervosa, the effectiveness of behavioral or pharmacologic treatments remains unclear.     

Renal involvement in psychological eating disorders

Psychological eating disorders--anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder--are an increasing public health problem with severe clinical manifestations: hypothermia, hypotension, electrolyte imbalance, endocrine disorders and kidney failure; they are of interest to nephrologists, but pathophysiological mechanisms in determining the renal involvement are still unclear. We describe pathophysiology, histological features and clinical manifestations of the most frequent psychological eating disorders: AN and BN. Regarding AN, we analyze the recent literature, and identify 3 principal pathways towards renal involvement: chronic dehydration-hypokalemia, nephrocalcinosis and chronic rhabdomyolysis. Regarding BN, we describe the correlation between obesity and many proinflammatory cytokines, chemokines, growth factors and adipokines, having potential metabolic and hemodynamic effects on the kidney and an important role in the pathogenesis of obesity-related renal injury, independently of hypertension and diabetes.     

Reproductive functions in eating disorders.

This article reviews current knowledge about the effects of anorexia nervosa, bulimia nervosa and partial syndromes on ovulation, menstruation, sexuality, fertility, pregnancy and fetal-infant health. Eating disorders may result in failure to ovulate, oligomenorrhea, amenorrhea, reduced sex drive, infertility, hyperemesis gravidarum, low maternal weight gain in pregnancy, small babies for gestational date, low birth weight infants, increased neonatal morbidity and problems in infant feeding. The available information suggests that clinicians should inquire about nutritional intake, a history of eating disorders and weight reducing behaviours as part of the routine assessment of patients with the disorders of reproductive function listed above. If an eating disorder is discovered before conception, the woman should be encouraged to delay pregnancy until the eating disorder is treated and effectively under control. If the woman is pregnant, early diagnosis and treatment are essential to reduce maternal and fetal complications. The infants of eating-disordered women should be carefully followed to ensure adequate nutritional intake. Problems in reproductive function related to eating disorders offer rich opportunities for multispecialty collaboration in primary and secondary prevention programmes directed toward both mother and infant.     

肥胖和糖尿病患者摄食的认知行为分析

目的 探讨肥胖和糖尿病患者在摄食方面的认知行为差异,为认知行为治疗的介入提供依据. 方法 采用日本摄食行为量表对 23例超重和肥胖者(肥胖组)、 42例 2型糖尿病(糖尿病组)和 33例正常体质量者(对照组)进行问卷调查,进行信度分析、方差和相关分析等统计学处理. 结果 在体质认识和饮食方法上,肥胖组积分( 0.80± 0.14)明显高于糖尿病组( 0.62± 0.24)和对照组( 0.58± 0.20)( F=9.829,P< 0.05),饮食内容与肥胖度呈正相关( r=0.498, P< 0.016);在摄食规律上,糖尿病组积分( 0.54± 0.19)明显高于肥胖组( 0.46± 0.11)和对照组( 0.46± 0.10) (F=3.709,P< 0.05),体质认识与肥胖度成正相关( r=0.0473,P< 0.002). 结论 纠正肥胖者在体质认识和摄食行为上的错误认知,调整饮食内容有助于减轻体重;矫正适应不良性行为,学习摄食规律化,是预防糖尿病的发生及巩固疗效的重要措施之一.     

Diagnosis of eating disorders in primary care

Eating disorders, particularly anorexia nervosa and bulimia nervosa, are significant causes of morbidity and mortality among adolescent females and young women. Eating disorders are associated with devastating medical and psychologic consequences, including death, osteoporosis, growth delay, and developmental delay. Prompt diagnosis is linked to better outcomes. A good medical history is the most powerful tool. Simple screening questions, such as "Do you think you should be dieting?" can be integrated into routine visits. Physical findings such as low body mass index, amenorrhea, bradycardia, gastrointestinal disturbances, skin changes, and changes in dentition can help detect eating disorders. Laboratory studies can help diagnose these conditions and exclude underlying medical conditions. The family physician can play an important role in diagnosing these illnesses and can coordinate the multidisciplinary team of psychiatrists, nutritionists, and other professionals to successfully treat patients with eating disorders.     

Recognizing alcohol and drug abuse in patients with eating disorders

Eating disorders and alcohol/drug abuse are frequently comorbid. Eating-disordered patients are already at an increased risk for morbidity and mortality, so alcohol and drug use pose additional dangers for these patients. Restricting anorexics, binge eaters, and bulimics appear to be distinct subgroups within the eating-disordered population, with binge eaters and bulimics more prone to alcohol and drug use. Personality traits such as impulsivity have been linked to both bulimia nervosa and substance abuse. Many researchers have proposed that an addictive personality is an underlying trait that predisposes individuals to both eating disorders and alcohol abuse. Interviewing is generally the most useful tool in diagnosing alcohol and substance abuse disorders in individuals with eating disorders. It is essential for the physician to be non-judgmental when assessing for substance abuse disorders in this population. We discuss interviewing techniques, screening instruments, physical examination, and biological tests that can be used in evaluating patients with comorbid eating disorders and substance abuse. More studies are needed to understand psychobiological mechanisms of this comorbidity, and to develop treatments for individuals with comorbid eating disorders and substance misuse.     

脑卒中患者饮食行为护理干预的效果观察

目的探讨脑卒中后进食障碍患者的护理干预效果。方法将120例脑卒中后有进食障碍的患者分为2组,每组60例。对所有患者进行饮食指导,在此基础上对试验组患者实施穴位按摩、口腔刺激、舌功能训练、咀嚼训练、吞咽训练,采用自设饮食行为干预调查表评估2组患者饮食行为。结果重复测量方差分析显示组间效应(F=141.52,P<0.05),交互效应(F=19.35,P<0.05),干预后1、2、3、6个月试验组患者饮食行为均优于对照组(P<0.01)。结论对脑卒中后进食障碍患者进行综合康复护理效果较好。