Home Remedies for Anorexia

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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Anorexia and cachexia

Anorexia, defined as the loss of appetite and early satiety, often accompanies cachexia and has been suggested to play a role in the loss of body weight. However, loss of skeletal muscle is not prominent in primary anorexic states, as the brain adapts to using ketone bodies derived from metabolism of fat, reducing the requirement for gluconeogensis from amino acids derived from muscle proteins. This suggests that the metabolic changes in anorexia and cachexia are different. Indeed, appetite stimulants such as megestrol acetate failed to restore the loss of lean body mass, and weight gain was shown to be caused by an accumulation of adipose tissue and water (12). Anorexia can arise from (1) decreased taste and smell of food, (2) early satiety, (3) dysfunctional The etiology of anorexia in cachexic states is not well understood. CKD patients with anorexia regain appetite soon after starting dialysis treatment, presumably because of removal of one or more toxic factors that suppress...

Leptin and the Anorexia of the Elderly

Several cross-sectional and longitudinal studies have described a decline in food intake with aging in healthy elderly subjects 80-83 . This physiological decrease in food intake with age was defined as anorexia 80-83 . In the NHANES III an average decline in energy intake of about 1000 kcal day (men) and 500 kcal day (women) between the age of 20 and 75 years was described 84 . Aging was also associated with a decline in total energy expenditure that is accounted not only by a decline in physical activity but also by a decrease in resting metabolic rate 83 . When the decrease in energy intake is greater than the decrease in energy expenditure, involuntary weight loss may occur. Anorexia in the elderly and involuntary weight loss has been related to adverse outcomes, such as increased risk of sarcopenia, frailty, functional impairment, and mortality 80-83 . Anorexia has multiple causes including alterations in taste, flavor and palatability of food, increased gastrointestinal...

Eating disorders

High states of stress or anxiety may exacerbate a variety of eating disorders including binge eating, anorexia nervosa, and bulimia nervosa 51 . Alleviation of stress and anxiety by antagonism of CRF receptors may be useful for the treatment of these maladaptive eating habits. Yohimbine, an a-2 adrenoceptor antagonist commonly used to induce stress- and anxiety-like symptoms in humans and non-humans, causes stress- and anxiety-induced reinstatement of food-seeking in rats 84 . CRF-R1 antagonist 37 was shown to attenuate this food-seeking behavior as well as block the stress and anxiety effects when tested in the social interaction behavioral model. Compound 37 did not block pellet-priming-induced reinstatement of food-seeking, suggesting it selectively blocked the effects of yohimbine. While studies show CRF-R1 plays a role in food-seeking behavior, there is mounting evidence indicating that the CRF-R2 receptor plays a role in controlling food intake. CRF-R2 KO mice showed increased...

Okines in and Uisease

Edited by Adrianne Bendich and Richard J. Deckelbaum, 2005 The Management of Eating Disorders and Obesity, Second Edition, edited by David J. Goldstein, 2005 The Management of Eating Disorders and Obesity, edited by David J. Goldstein, 1999 Vitamin D Physiology, Molecular Biology, and Clinical Applications, edited by Michael F. Holick, 1999

New Developments in the Study of Corticotropin Releasing Factor

Introduction - Corticotropin releasing factor (CRF) or hormone (CRH) is one of several neurohormones synthesized by specific hypothalamic nuclei in the brain and released into the portal system, which bathes the anterior pituitary. Here the peptide activates the transcription of the pro-opiomelanocortin gene resulting in release of ACTH and pendorphin from anterior pituitary cells. The fundamental role of CRF is to prepare the organism for an appropriate response to various stressors such as physical trauma, insults to the immune system and social interactions. CRF also has marked CNS effects by acting at higher centers in the brain, particularly cortical regions where there is a widespread distribution of CRF neurons. It is the hyper- or hyposensitivity of the system that can lead to human pathologies. Since this topic was last reviewed in Annual Reports (1), several other detailed accounts have appeared covering receptor structure and function (2), small molecule receptor...

Tumor Necrosis Factora

TNF-a was originally identified as a macrophage product implicated in the metabolic disturbances of chronic inflammation and malignancy. Later on, its biological actions were shown to further extend to anorexia, weight loss, and insulin resistance (7). Elevated adipose tissue expression of TNF-a mRNA has been reported in different rodent models of obesity as well as in clinical studies involving obese patients (23). TNF-a mRNA expression is positively correlated with body adiposity as well as with hyperinsulinemia, showing positive associations with fasting insulin and triglyceride concentrations. TNF-a inhibits the expression of the transcription factor CCAAT enhancer binding protein-a (CEBPa) and the nuclear receptor peroxisome proliferator-activated receptor (PPAR)y2 (8,12,14). Furthermore, TNF-a stimulates the nuclear factor- kB transcription factor (NFkB), which orchestrates a series of inflammatory events, including expression of adhesion molecules on the surface of both...

Pharmacological Studies

Eating Disorders - Stress decreases food intake and weight gain and these effects are reproduced with centrally administered CRF (11). These effects are inhibited by antisauvigine-30 and CRF(9-41), which also alleviates the stress-like effects are also seen with the brain anorectic agent, CART (68, 73 - 74). In contrast, the small molecule CRFi antagonist 20 had no effect CRF induced decreases in body weight suggesting a role for CRF2 (73). Urocortin is a 30-fold selective CRF2 agonist whose effects on food intake can also be blocked by antisauvigine-30. Antisauvagine-30 had no effect on the associated changes in tissue weights and serum chemistry seen with central CRF administration implying that CRF2 mediates only the anorexic, not the metabolic effects, of CRF (71). Central administration of urocortin-ll has supported earlier observations in CRF1 knock out mice that intimated CRF2 activation may be only responsible for later stage (beyond 6 hours) suppression of food intake and not...

Clinical Opportunities For

Conclusions - Identification of urocortin-ll, antisauvagine-30 and stresscopin should help elucidate the relative contributions of CRF2 to the CRF system. There continues to be advances in the understanding of the receptor structure and the SAR of small molecule CRF1 antagonists but completely novel structures away from the current, well-mapped area are still awaited. Unlike the CRF1 receptor, CRF2 appears to be reticent to small molecule intervention. Recent research has added to the understanding of the role of CRF in disease areas like drug addiction, eating disorders and IBS with some encouraging results in the clinical utility of CRF1 antagonists in the treatment of anxiety and depression.

Who gets osteoporosis

Children, adolescents, and young adults can get osteoporosis too, particularly those with genetic or nutritional disorders, and eating disorders such as anorexia nervosa and bulimia, because they do not make hormones or absorb calcium, Vitamin D, and other nutrients and protein required for normal bone development. Those who are treated with medications that interfere with bone development may also get osteoporosis. People who are treated with long-term methotrexate ( 1 month), usually for cancer or arthritis, are more at risk. Long-term use of the gonadotropin-releasing hormone analogs, such as Lupron, for the treatment of endometriosis in young women can contribute to the development of osteoporosis as well. And the most common class of medication to cause osteoporosis or osteopenia at any age is corticosteroids, used for such problems as lupus, arthritis, or asthma. Osteoporosis occurring after taking a glucocorticoid is so common that it has its own name glucocorticoid-induced...

The Characteristics of Individuals Suffering from BDD

People with eating disorders and obesity have similar features to those of BDD patients, such as frequently weighing themselves, checking in the mirror and excessive weightlifting or exercising. Other symptoms might include avoidance of mirrors or reflective surfaces, constant scrutinizing the appearance of others, excessive grooming (Fig. 18.1), seeking reassurance from parents or dependence on others for constant reassurance, touching, picking or fiddling with the defect, repeated measuring or photographing of the defect, avoidance of social contact, withdrawn, housebound truancy, avoiding athletics, boating or drama classes and failure to hold employment.

Diagnostic Tests for BDD

Cosmetic surgery aims to improve a patient's body image and self-esteem (Fig. 18.3). Disturbances of body image are present in a wide variety of psychiatric illnesses, including hypochondria, eating disorders, social phobia and schizophrenia 1 . Psychological evaluation of patients is not standard in clinical plastic surgery practice. Questioning of motivation and interview techniques to ascertain how realistic a patient is, however, standard. Considering that 50 of patients presenting for cosmetic surgery are on psychotropic medications and 27 of those are taking antidepressants suggests that perhaps some standard psychological tests should be introduced into the initial cosmetic surgery consultation 9 . Only a few authors have suggested this as a routine 15 .

Symptoms And Signs

The mean incubation time is 2 days (1-4). Prodromal symptoms are uncommon. A sudden onset is most typical, with chills and rising fever followed by myalgia (usually back pain in adults). These initial systemic manifestations may later be followed by signs of pharyngitis laryngitis tracheobronchitis. In conjunction with dry cough the patient may complain of substernal pain. Other symptoms may be coryza, flushed face, epistaxis, photophobia, anorexia or vertigo. Croup among small children is a relatively common feature (see also Chapter 11).

Growth of Adipose Tissue Associated With Lymph Nodes

The actions of dietary lipids and hormones can be simulated in vitro, but demonstrating a role for the immune system requires in vivo experiments. Unfortunately, adipo-cytes form and die very slowly, and preadipocytes cannot be recognized unambiguously, so measuring adipocyte turnover in vivo is difficult (78,79). The total adipocyte complement seems to differ substantially between individuals of similar body composition, even among inbred mammals (80), making the detection of experimentally induced increases in numbers of adipocytes difficult unless they are very large. Major systemic immune responses induce anorexia, and eventually cachexia, which deplete the adipose tissue anyway, especially in small laboratory animals. However, by comparing the numbers of adipocytes in the popliteal depots, and locally stimulating the lymph nodes in one of them with small doses of lipopolysaccharide, the formation of more adipocytes in response to chronic inflammation could be demonstrated,...

Energy Balance and Immune Function

For example, the competition for resources model fails to explain why fever generated by endogenous thermogenesis universally accompanies major immune responses to bacteria in mammals, and many cytokines associated with reaction to infection promote anorexia (176) nutrient intake stops just as energy expenditure increases abruptly, hardly an efficient arrangement if the immune system and pyrogenic tissues were normally in direct competition for fuels and other resources. Fever and systemic immune responses combined with anorexia cause small mammals (including human infants) to lose weight and are thus regarded as deleterious. However, when adult mice were experimentally infected with Listeria and fed forcibly or ad libitum over the following days, weight loss (because of the combination of anorexia and high energy expenditure) correlated positively with survival (177). Overriding anorexia by force-feeding seems to accelerate the progress of pathogens, and hasten death, the opposite of...

Epidermodysplasia verruciformis EV

Equid herpesvirus 4 (EHV-4) A species in the genus Varicellovirus. A major cause of acute respiratory disease in horses worldwide, most horses being infected during the first 2 years of life. Shown in 1981 to be distinct from EHV-1 by restriction endonuclease studies on the virus genome. Horses may become latently infected, and reactivation with virus shedding may then occur to infect young foals and so maintain the virus indefinitely in a population of horses. Acute disease is associated with fever, anorexia and profuse nasal discharge. In extreme cases the disease may become a fatal bronchopneumonia. A combined EHV-4 EHV-1 inactivated vaccine is available, and alternative recombinant-derived vaccine candidates are under investigation. Synonyms equine herpesvirus 4 equine rhinopneumonitis virus respiratory infection virus.

Response to Starvation

Fat cell volume and the number of fat cells in the marrow remain essentially unchanged in the rabbit subjected to acute starvation, despite drastic weight loss and depletion of peripheral white fat stores (29). BM adipose cells exhibit no ultrastructural change during short-term starvation when fat is mobilized from extramedullary adipose tissue (30). In prolonged induced starvation or in patients with severe anorexia nervosa, BM fat atrophies and an accumulation of gelatinous extracellular mucopolysaccharide-type matrix is observed (31,32).

Feline infectious peritonitis virus FIPV

A natural infection of felids (domestic cats, lions and tigers), but in zoos usually the smaller species (raccoons, mink and foxes) are susceptible. Chiefly seen as a severe febrile illness, with vomiting and sometimes blood-stained diarrhea in young cats, although older cats may be attacked when virus is first introduced to a previously virus-free group. Subclinical and mild cases probably occur and give immunity. Infected animals may excrete virus for a year, and virus contaminating the environment may remain infectious for months. Kittens infected before 9 days of age may suffer damage to the developing cerebellum and at 3-4 weeks show ataxia and tremors. Cats, mink and newborn ferrets can be infected experimentally. After an initial leukocytosis there is a progressive fall in circulating lymphocytes and polymorphs, with lethargy and anorexia. Virus replicates in kitten kidney cell cultures. CPE may be transient. Virus

Clinical Implications of Leptin Physiology in the Elderly

In recent years, investigators have hypothesized that leptin may be involved in the pathogenesis of chronic disease states including diabetes, metabolic syndrome, dyslipidemia, anorexia, and malnutrition as well as hypertension, atherosclerosis, osteoporosis, and osteoarthritis 2-5 . Although these diseases are highly prevalent in old age, existing data on the role of leptin in a specific disease state has not been unequivocal. Furthermore, the available literature data were not always obtained in an elderly population. Because of this limitation, the second part of the review addresses those diseases in which the role of leptin has been supported by relevant and unequivocal findings from data collected in elderly populations.

Hepatitisassociated antigen See Australia antigen

Hepatitis delta virus (HDV) A satellite virus, the only species in the genus Deltavirus. First recognized when a novel antigen (delta antigen) was observed in the nuclei of hepatocytes of some patients with chronic Hepatitis B virus (HBV) infection. Virions are spherical, about 34nm in diameter, with no surface projections. Transmission of HDV is dependent upon HBV, since it uses HBsAg as its own virion coat. The HDV genome is a small single-stranded circular RNA comprised of 1675 nucleotides with about 70 base-pairing so that the RNA forms a largely double-stranded, rod-shaped structure. A single conserved open reading frame in the negative sense encodes the Hepatitis delta antigen, which consists of two protein species one contains 195 amino acids (24kDa) and the other is identical except for an additional 19 amino acids at the C-terminus (27kDa). Most sera contain equal amounts of the two species of antigen, which appears to function during replication through its nuclear...

Other Issues Creating Emotional Ambivalence

There are numerous conditions that can create emotional ambivalence for women who are considering an abortion. We discuss some of them in Chapter 6. However, it is important to be concerned with the woman's personal conflicts around her body image and other medical issues. Some women, particularly those with a history of eating disorders including anorexia, fear getting fat and cannot tolerate the idea of a pregnancy. Some women, such as those with careers in modeling or acting and other areas where appearance is paramount, may feel they have to terminate their pregnancies in order to keep their careers but still feel guilty that their reasons are insufficient and thus they experience some ambivalence.

Cytokines and muscle protein degradation in cachexia

Chronic overproduction of cytokines may lead to cachexia in various animal chronic illness models. Cytokines such as interleukin (IL)-1 P, IL-6, and tumor necrosis factor (TNF)-a are upregulated in various animal cachexia models. The pathogenetic role of the cytokine network in upregulating muscle protein degradation has been documented as the result of a complex interplay among TNF-a, IL-6, IL-1 , interferon (IFN)-y, and a variety of humoral mediators. Neutralization of these factors by genetic or pharmacological methods leads to attenuation of cachexia. Chronic infusion of IL-1 or TNF-a causes anorexia, rapid weight loss, and catabolism of body protein stores, analogous to the state observed with chronic illness (31-34). Anticytokine approaches have been proven at least partially effective in attenuating muscle weight loss in cancer. Mice bearing the Lewis lung carcinoma are protected from cachexia when treated with antibodies against IFN-y (35). Implantation of the Lewis lung...

Leptin and ghrelin in cachexia

Leptin is secreted by adipocytes and regulates adiposity and metabolic rate by reducing food intake and increasing energy expenditure. Leptin is also a member of the IL-6 superfamily of cytokines. Experimental elevation of leptin within the physiological range produces weight loss and relative anorexia. Leptin secretion is increased by both central and systemic immunological challenge and has been proposed as a potential mediator of inflammation-induced anorexia. The mechanism of how leptin expression and secretion is enhanced during inflammation is complex, but there is evidence for mediation by both IL-1 and TNF-a. Conversely, leptin induces production and release of IL-1 in the brains of normal rats and the release of both IL-1P and TNF-a from mouse macrophages. Collectively, these observations suggest a complex interplay between leptin and other cytokines in the regulation of metabolism and appetite during acute and chronic illness (49). The percentage of body fat was strongly...

Neuropeptides in cachexia

We recently tested the hypothesis that leptin was an important cause of uremic cachexia via signaling through its receptor. Our results showed that uremic cachexia was attenuated in db db mice, a model of leptin receptor deficiency. Nephrectomy in db db mice did not result in any change in weight gain, body composition, resting metabolic rate, and efficiency of food consumption (55). Recent studies suggested that db db mice resisted LPS-induced anorexia by reducing TNF-a secretion. Thus, leptin may have an important role in the regulation of appetite, body composition, and metabolic rate in uremia. Indeed, elevated serum leptin was associated with lower dietary intake and higher catabolic rate in uremic children (51). In another set of experiments, we demonstrated that uremic cachexia in experimental animals is attenuated by central MC4-R blockade via a genetic approach. Both homozygous and heterozygous MC4-RKO mice had no decrease in appetite after nephrectomy compared with WT...

Neuropsychiatry Disorders

Feeding Disorders - Anorexia nervosa is an eating disorder characterized by tremendous weight loss in the pursuit of thinness. There is similar pathophysiology in anorexia nervosa and in depression including the manifestation of hypercortisolism, hypothalamic hypogonadism and anorexia (48,49). Furthermore, the incidence of depression in anorexia nervosa patients is high (50). Like depressed patients, anorexics show a markedly attenuated ACTH response to intravenously administered CRF (48,49) and significantly higher basal CSF levels of CRF than controls (49). When the underweight anorexic subjects are studied after their body weight had been restored to normal, their basal hypercortisolism, increased levels of CRF in the CSF, and diminished ACTH responses to exogenous CRF all return to normal at varying periods during the recovery phase (48,49). CRF can potently inhibit food consumption in rats which further suggests that the hypersecretion of CRF may be responsible for the weight...

Drug Development Strategies

In view of the evidence described above suggesting that hypersecretion of CRF may underlie some of the symptomatology seen in affective disorders, anxiety-related disorders and in anorexia nervosa, it stands to reason that CRF antagonists may be useful in the treatment of these disorders. Thus, a CRF antagonist may be a useful antidepressant, anxiolytic or anti-stress drug. Since the drug would have to act in brain in addition to the pituitary (to counteract the hypercortisolemia), it is essential that the compound cross the blood-brain barrier. While major advances have been made

Summary And Conclusions

This chapter provides an overview of preclinical and clinical evidence in support of a role for CRF in neuropsychiatrie disorders and neurodegenerative diseases. Overall, the data suggest that CRF may be hypersecreted in brain in depression, anxiety-related disorders and anorexia nervosa. In contrast, deficits in brain CRF are apparent in neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease, Huntington's disease, progressive supranuclear palsy and amyotrophic lateral sclerosis as they relate to dysfunction of CRF neurons in brain areas affected in the particular disorder. The data suggest that CRF antagonists may represent novel antidepressant anxiolytic drugs and may be useful in the treatment of neuropsychiatrie disorders manifesting hypersecretion of CRF. Finally, some strategies directed at developing CRF-related antagonists for the treatment of the various neuropsychiatrie disorders have been briefly described.

Plating efficiency See efficiency of plating

Pleuronectid herpesvirus (PiHV-1) An unas-signed virus in the family Herpesviridae. First recognized in 1978 among young turbot, Scophthalmus maximus, in a fish farm in Scotland, but since then also recognized in Wales. The fish develop anorexia and lethargy and heavy mortality occurs. The only signs of infection are pathological changes in epithelial cells of the skin and gills where giant cells are seen containing herpesvirus-like particles. Virus isolation has not been reported. Synonyms herpesvirus scophthalmus turbot herpesvirus.

Social influences on health

In general, broad cultural factors also have a strong influence on health. An obvious example in Western society comes from the huge emphasis on slimness equating with beauty and fashionability throughout the previous two or three decades. No doubt this has not been the only influence on the development of eating disorders in women, with all the attendant health risks, but it has surely been an important factor. Similarly, although, in another sense, by contrast, the large-scale advertising of fast foods has surely added to the potential to be overweight and thus at a greater health risk. There are numerous examples of such influences, such as the influence on tooth decay in children or the advertising of sugar-based products.

Pathological Changes In The Pharmacokinetics

Metformin can cause adverse gastrointestinal effects with anorexia, nausea and vomiting. Patients may experience a metallic taste and there may be weight loss, which in some diabetics could be an advantage. Hypoglycaemia is less of a problem with metformin than with sulphonylureas.

Clinical Presentation

Diseases due to C. difficile represent a wide spectrum. These ranges from asymptomatic cases, watery diarrhea, dysentery, PMC, complicated colitis and bacterial metastatic infections (7,8). Some degree of watery diarrhea, infrequent with blood or mucus, develops in most patients. The extent of other abdominal complaints or systemic symptoms varies from mild to severe. The disease may be fatal. Abdominal pain, cramps, lower quadrant tenderness, fever, and leukocytosis are common. Other findings include nausea, malaise, anorexia, hypoalbumi-nemia, anasarca, electrolyte disturbances, occult colonic bleeding, and dehydration. Extraintestinal manifestations are rare and include bacteremia, generally polymicrobial, splenic abscess, osteomyelitis, and reactive arthritis or tenosynovitis.

Evidence in favor of safety

A review of clinical trials 70 showed that together, 9 of patients showed adverse drug reactions. These reactions included neutropenia, reduced reticulocyte count, anemia, eosinophilia, acute haemolysis, elevated aspartate aminotransferase, ECG abnormalities (w o clinical effect), transient bradycardia, prolongation of the QTc interval, prolonged PR interval (first-degree atrioventricular block), atrial extrasystoles, and non-specific T-wave changes. In all cases, the effects were independent of the artemisinin derivative and route of administration. An additional study 71 showed that when treating uncomplicated falciparum malaria with artemisinin derivatives alone, substantially fewer side effects were observed than with mefloquine-containing combination therapies. Notably, there was significantly less nausea, vomiting, anorexia, and dizziness. Furthermore, studies have shown no adverse effects on mother or fetus if artesunate or artemether are used to treat acute falciparum at...

Adverse Event Profile Of Tnp470

Treatment-emergent medical events, which include adverse events (AE events considered by the investigator to be possibly, probably, or definitely related to TNP-470 administration, or of unknown relationship) and complaints considered by the investigator to not be related to TNP-470, were reported for 100 of patients. The AEs most frequently (incidence in excess of 15 ) reported by patients include asthenia (42.1 ), nausea (32.2 ), anorexia (18.2 ), and dizziness (15.7 ). It is important to note that the incidence of complaints of anorexia (18.2 ) was not reflected in the incidence of weight loss greater than 10 (grade 2), which occurred in only six of 121 (5.0 ) patients, and complaints of anorexia were recorded in only three of these cases. Overall, 99 of 121 (81.8 ) patients experienced at least one AE, and a total of 408 AEs were recorded. Greater than 70 of AEs were categorized as mild or grade 1 (Common Toxicity Criteria). An additional 20 were moderate or grade 2 in severity,...

Alcohol and substance abuse

Alcohol withdrawal presents as anorexia, insomnia, weakness, combativeness, tremors, disorientation, auditory and visual hallucinations, and convulsions. Onset is usually 10 to 30 hours after abstinence, and the symptoms may last for 40 to 50 hours. Prolonged abstinence may lead to delirium tremens or autonomic hyperactivity (tachycardia, diaphoresis, fever, anxiety, and confusion). Alcohol withdrawal syndrome may occur while under anesthesia and manifest as uncontrolled tachycardia, diaphoresis, and hyperthermia. The treatment is administration of benzodiazepines or intravenous infusion of ethanol.

When You Need to Gain Weight

Some men are underweight because of an eating disorder or because of treatment for a chronic disease such as cancer. They need to maintain their weight and add more pounds. For these men, taking in more calories than they burn is the answer. As simple as this may sound, underweight men often have to struggle with this concept. Some of these men experience appetite loss from chemotherapy or radiation therapy taken for cancer. Others struggle with an overwhelming fear of being fat that compels them to restrict their intake of food while burning calories by obsessively exercising. If you are underweight, there are a number of steps you can take to gain additional pounds.

The Relationships Between Lipid Profile Levels Depression and Suicide Attempts

Depressive symptoms are common in patients with physical illness, including cardiovascular disease, diabetes mellitus, end-stage renal disease, and women in pregnancy, delivery, or menopause. The depressive symptoms in patients with physical illness include apathy, anorexia, sleep disorder, fatigue, and cognitive deficits 42 .

Key Points Concerns In Patients Taking Cocaine

Signs and symptoms of intoxication include anorexia, diaphoresis, hypertension, tachycardia, hyperthermia, agitation, and psychosis. Patients can also have myocardial infarctions, seizures, strokes, rhabdomyolysis, and renal failure. The withdrawing patient will experience fatigue, irritability, insomnia, anxiety, and psychotic reactions. An unusual sign seen in chronic methamphetamine users is dental decay, known as meth mouth.

Leptin in multiple sclerosis

Leptin is involved in both the induction and progression of EAE in mice (11-13). Analysis of the disease susceptibility in naturally leptin-deficient ob ob mice before leptin replacement revealed resistance to both active and adoptive EAE that was reversed by leptin administration. Leptin replacement converted Th2- to Th1-type response and shifted IgG antibodies from IgG1 to IgG2a. In addition, leptin administration to susceptible wild-type C57BL 6J mice worsened the disease by increasing proinflammatory cytokine release and IgG2a production (11). In addition, it has also been recently observed that a serum leptin surge precedes the onset of EAE in susceptible strains of mice (12). This peak in serum leptin is correlated with inflammatory anorexia, weight loss, and development of a pathogenic T-cell response against myelin (12). In animals with EAE, inflammatory brain infiltrates have also been shown to be a source of leptin, attesting to an in situ leptin production in active lesions...

What are the presenting symptoms of heart failure

Exertional dyspnea and fatigue are most often the primary complaints. Paroxysmal nocturnal dyspnea, nocturia, coughing, wheezing, right upper quadrant pain, anorexia, and nausea and vomiting also may be complaints. Although HF is generally regarded as a hemodynamic disorder, many studies have indicated that there is a poor relation between measures of cardiac performance and the symptoms produced by the disease. Patients with a very low EF may be asymptomatic (stage B), whereas patients with preserved LVEF may have severe disability (stage C). The apparent discordance between EF and the degree of functional impairment is not well understood but may be explained in part by alterations in ventricular distensibility, valvular regurgitation, pericardial restraint, cardiac rhythm, conduction abnormalities, and right ventricular function. In addition, in ambulatory patients many noncardiac factors may contribute substantially to exercise intolerance. These factors include but are not...

Other 5ht Receptors

Of these agents to prevent chemotherapy induced emesis is well documented (70-72). Further possible therapeutic indications include the treatment of anxiety, psychoses, anorexia, as well as cognitive disorders and drug abuse. Several recent accounts of compounds with selectivities over a limited set of receptors have been reported. The new structural class represented by 20 has afforded analogs with excellent potency (5-HT3 Ki 10-20 nM) and demonstrated selectivity ( 100-fold) over 5-HT4 and dopamine D2 receptors (73). A second series of related compounds is exemplified by 21 and possesses a comparable profile (74). The related benzimidazole derivative 22 shows a structural similarity to a selective 5-HT4 antagonist described below, but with marked 5-HT3 selectivity (75). In this series, multiple derivatives showed nanomolar potencies with 100-fold selectivity over 5-HT4 and 5-HT1A.


There is a paucity of plastic surgery literature regarding the psychosocial changes in patients who undergo cosmetic surgery 15 . We are aware that surgery will not affect a positive psychosocial change in patients with BDD. BDD is now recognized as a specific entity similar to how the public and medical profession viewed anorexia nervosa in the 1960s and 1970s and we recognize the treatment of the disorder as psychiatric and not surgical. Efforts to screen for BDDs are coming into our plastic surgery literature 2 but this is usually in a university-based setting rather than in an individual private practice 10, 16 . Awareness of the pitfalls of operating on patients with BDD alerts us to the possible adverse psychosocial pitfalls and operating on other patients with related somatoform disorders and, in particular, obese patients. Obese patients might maintain their victim status and be dissatisfied with the ever-increasing services offered to them, including large-volume liposuction...


Eating disorders In the extreme, when eating goes wrong, the disorders of anorexia nervosa and bulimia can develop. There are many reasons for this, some of them stemming from patterns that are laid down in early childhood, from family background, from personality, and so on. These disorders can be extreme and life-threatening and those who suffer from them need a great deal of help to control or overcome them. It is not, as some people think, a matter of simply starting to eat or starting to eat sensibly, in other words, of 'pulling their socks up'. It is far more complex than this.


A role for increased leptin level with age as well as for leptin resistance has been hypothesized in the pathogenesis of the anorexia of the elderly. However, little data is available to support a definitive conclusion. 81 Morley JE. Anorexia, sarcopenia, and aging. Nutrition 2001 17 660-663. 82 Chapman IM. Endocrinology of anorexia of ageing. Best Pract Res Clin Endocrinol Metab 2004 18 437-452. 83 Morley JE, Thomas DR. Anorexia and aging Pathophysiology. Nutrition 1999 15 499-503.

What is abnormal

Axis I disorders disorders of infancy, childhood or adolescence cognitive disorders such as dementia and amnesia substance-related disorders psychotic disorders such as schizophrenia mood disorders anxiety disorders somatoform disorders (that is, disorders about the body) factitious disorders (in which symptoms are feigned or consciously produced) dissociative disorders (temporary alterations to consciousness) sexual disorders eating disorders sleep disorders impulse control disorders (such as compulsive stealing or lying) adjustment disorders.

A healthy life

Imagine a psychotherapist working in the public health system who is conducting an initial interview with a patient. The patient has been referred to the therapist because of an eating disorder. She is clearly anorexic and has become so dangerously underweight that she is somewhat at risk both of extreme physical collapse and possibly of harming herself in other ways.


Adverse reactions to metronidazole therapy are rare and include CNS toxicity symptoms of peripheral neuropathy, ataxia, vertigo, headaches, and convulsions. Gastrointestinal side effects include nausea, vomiting, metallic taste, anorexia, and diarrhea. Other adverse reactions include neutropenia, which is reversible with discontinuation of the drug, phlebitis at intravenous infusion sites, and drug fever. The tolerance of metronidazole in patients is generally very good.


Potassium iodide is the therapy of choice for cutaneous lymphatic sporotrichosis. Localized heat therapy may also be used adjunctively. Some individuals are allergic to potassium iodide. Adverse reactions include a bitter taste, allergic rash, and anorexia.

Chronic Sinusitis

Symptoms of chronic sinusitis vary considerably. Fever may be absent or be of low grade. Frequently symptoms are protracted and include malaise, easy fatigability, difficulty in mental concentration, anorexia, irregular nasal or postnasal discharge, frequent headaches, and pain or tenderness to palpation over the affected sinus.