1/13. Three different presentations of bulimia nervosa.This case report describes the different presentations of three women with bulimia nervosa, all of whom demonstrated purging behaviour. Two of the patients also had hypokalaemia, whereas the third exhibited Russell's sign-that is, calluses on the dorsum of each hand. Drug treatment and psychosocial intervention improved the condition of all three patients. The report emphasises the need for both health care professionals and the public to recognise this potentially dangerous but treatable disorder.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/13. compliance and outcome in treatment-resistant anorexia and bulimia: a retrospective study.OBJECTIVES: To investigate the extent to which compliance with treatment is related to outcome, and factors associated with compliance in a group of treatment-resistant eating-disordered in-patients. DESIGN: A retrospective case study design was employed where clinic staff made expert ratings of eating behaviours, attitudes and outcome of former in-patients. METHOD: Ten health-care staff at a specialist eating disorders clinic rated overall success of treatment outcome at discharge, as well as compliance, severity of disordered eating behaviours and body-image disturbance at both admission and discharge for 46 anorexic and 14 bulimic patients. RESULTS: For all participants, high compliance at admission was associated with lower levels of body image disturbance, less disordered eating behaviours and higher ratings of overall treatment success at discharge. compliance at admission predicted the body mass index (BMI) at discharge for anorexic participants and predicted higher ratings of overall treatment success at discharge for all participants. In all participants, compliance at admission was related to the extent of eating-disordered behaviours at admission. CONCLUSIONS: Results suggest the importance of compliance in facilitating recovery and treatment success among treatment-resistant eating-disordered in-patients. The promotion of strategies to improve compliance in this population should be considered. A role for motivational interviewing is discussed.- - - - - - - - - - ranking = 4keywords = behaviour (Clic here for more details about this article) |
3/13. Severe disturbance occurring during treatment for depression of a bulimic patient with fluoxetine.We report on a 32-year old woman with bulimia nervosa treated with fluoxetine for depression. fluoxetine is the only drug currently recommended for the treatment of bulimia. The patient became severely disturbed with tension, irritability, self-damage by cutting and violent, intense, suicidal and paranoid ideation qualitatively different to previous symptoms in the course of her illness. Clinical impression was of a striking association between fluoxetine and these symptoms. We suggest caution when using fluoxetine in bulimic patients with depression who have additional impulsive behaviours such as self-cutting, alcohol and/or drug abuse and shop-lifting.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
4/13. bulimia nervosa and acne may be related: a case report.Acne is a very common, often cosmetically disfiguring, cutaneous condition of adolescence that is associated with increased sebaceous gland activity. We present the case of a patient with bulimia who reported that the negative effect of acne on her appearance increased her body image concerns and exacerbated her eating disorder. Improvement of the acne was associated with a significant improvement in her eating disorder. Eating disordered patients may go on restrictive diets in order to control their acne since levels of androgens, which are one of the primary stimulants of sebaceous gland activity, are lower in starvation. As a significant number of adolescents with eating disorders also develop acne, it is important for the clinician to be aware of this previously unreported association between acne and eating disorders, and to evaluate the impact of acne upon the patient's body image and eating behaviour.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
5/13. Pre-menarchal bulimia nervosa.Although pre-pubertal anorexia nervosa has been well described, pre-pubertal bulimic behaviour in the context of this disorder appears to be uncommon. There have been no published reports of pre-pubertal bulimia nervosa occurring independently. Of 323 patients with bulimia nervosa attending an eating disorders research clinic between 1980 and 1989, the authors identified six patients who described pre-menarchal binge eating in the absence of a concurrent history of anorexia nervosa or massive obesity. Three (0.93%) of these patients described a pre-menarchal onset of bulimia nervosa, but there was no evidence that they were pre-pubertal. The implications of these findings are discussed.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
6/13. Successful treatment with duloxetine in a case of treatment refractory bulimia nervosa: a case report.The authors report a case of treatment refractory bulimia nervosa successfully treated with duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, with complete remission of the patient's bingeing and purging behaviours. This case is discussed in the context of existing literature on the psychopharmacology of bulimia nervosa.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
7/13. Compulsive buying and binge eating disorder--a case vignettes.Compulsive buying behaviour has recently received long overdue attention as a clinical issue. Aim of this report is to describe treatment of two female patients diagnosed with compulsive buying disorder in comorbidity with binge eating disorder. In both cases, criteria for diagnosing of other axis I or axis II disorder were not present. fluvoxamine was used in pharmacotherapy, and psychodynamic psychotherapy as a psychotherapeutical approach. We conclude that fluvoxamine and psychodynamic psychotherapy may be effective in treatment of compulsive buyers in comorbidity with binge eating disorder.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
8/13. A case of bulimia successfully treated by cue exposure.In the present case-study, a 22-year-old female patient with a 7-year history of bulimia nervosa was treated by cue-exposure. During cue-exposure sessions the relationship between CS (stimuli associated with binge-eating behaviour) and UCS (the sensations related to the intake of binge food) was broken. As predicted, the patients' craving for food declined within as well as between cue exposure sessions and a radical decrease in the frequency of binge-eating persisted for at least nine months. Although during the therapy no explicit attention was paid to the patient's low mood and irrational self-talk, mood was improved and beliefs were less irrational after cue-exposure and at the follow-ups. The data suggest that cue exposure may be an effective part of the treatment of bulimia nervosa.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
9/13. naltrexone in organic bulimia: a preliminary report.Multiple lines of experimental evidence point to the involvement of endogenous opiates in appetite regulation. Post brain injury patients often exhibit driven eating behaviour. Since this problem fails to respond to behaviour modification, appetite suppressants, lithium, or any other usual approach, the use of the oral narcotic antagonist, naltrexone, was given to three such patients. naltrexone binds multiple opiate receptor sites in the hypothalamus, including the kappa receptors which have been implicated in appetite regulation, the use of this narcotic antagonist in hypothalamic hyperphagia appears to be a rational approach to this intractable problem. In this open trial, lasting from 4 1/2 to 9 months, the minimal effective dose appeared to be in the range of 100 mg per day. No side-effects (for example elevations in liver enzymes) were noted. All of the patients had an improved sense of well-being and their behaviours were less difficult to manage when on the naltrexone. The significance of this preliminary trial is that narcotic antagonists may have a role in the treatment of brain-injured patients with bulimia. Also, naltrexone may be useful in treating other maladaptive behavioural consequences of head trauma such as stealing, manipulation, demandingness, and depression. Likewise, the effects on the deranged endocrine system, such as the hypogonadism, are significant and deserve further exploration.- - - - - - - - - - ranking = 4keywords = behaviour (Clic here for more details about this article) |
10/13. Outpatient treatment of bulimia nervosa: an illustrative case study.The salient features of bulimia nervosa is highlighted. Essential principles of an effective outpatient treatment programme is illustrated using an uncomplicated case history. Cognitive, behavioural and psychodynamic principles are illustrated in the course of therapy. The treatment programme is short-term, can be effectively carried out by non-medical personnel under medical supervision and is therefore likely to be cost-beneficial compared to longer term psychotherapies for the treatment of this disorder.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
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