Management Of Anorexia Research Articles

Management of anorexia in primary care

Management of anorexia in primary care

La réponse institutionnelle à l’anorexie mentale

AimsThrough this article, we question the relevance of institutional responses and their implicit theories in the care of patients with anorexia nervosa. We demonstrate the interest of thinking about a care framework based on psychoanalytic theory in a context where the safeguarding of subjects’ narcissism is often centered on the body. MethodWe draw on our clinical experience in a psychiatric hospital for adolescents and young adults. We start from the question of the body, which is at the center of this pathology. Faced with a body—a body on display, a body that has lost its capacities for containment, and that is a site where psychic survival is at stake—, we question the different forms that the institutional response can take : a protective shield role, a role of containment, a role of differentiation between “inside” and “outside.” These institutional responses are evoked by relying on analytical theory, while trying to think through the object relationship—experienced by these patients as never satisfactory. ResultsWe see the importance of defining a framework of care that is different from the concept of the “contract.” A framework of care that should be discussed with the patient, giving them time to take ownership. We insist on the institutional work and the notion of institutional transfer so that the teams can manage these patients’ destructiveness, without feeling as if they themselves are destroyed. A clinical example emphasizes the importance for patients to find a form of autoeroticism when they are alone with themselves. DiscussionSeparation from the environment is often criticized in the management of anorexia. We observe that separation allows the institution to play the role of auxiliary self in a context where the object relationship is experienced as insufficient and/or intrusive. ConclusionIt is important for an institution to define its implicit theoretical approach, in particular in the management of adolescent pathologies. The psychoanalytic approach allows us to better understand destructiveness and the issues of psychic survival. It is a precious tool in constructing a relationship with the patient and in helping her/him out of her/his internal chaos.

Dronabinol oral solution in the management of anorexia and weight loss in AIDS and cancer.

The true incidence of anorexia secondary to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and cancer is not well classified owing to the fact that there is a lack of standardized definitions and recent clinical data in these settings. Dronabinol, or Δ-9-tetrahydrocannabinol, is a synthetic molecule that closely mimics the action of Cannabis sativa L., a naturally occurring compound activated in the central nervous system by cannabinoid receptors. Dronabinol exerts its effects by directly acting on the vomiting and appetite control centers in the brain, which in turn increases appetite and prevents vomiting. In the USA, dronabinol is currently available in two dosage formulations – oral capsule and oral solution. While the oral capsule was initially approved by the US Food and Drug Administration in 1985, the recent approval of the oral solution in 2016 presents an “easy-to-swallow” alternative for patients using or intending to use dronabinol. Dronabinol is indicated in adult patients with HIV/AIDS for the treatment of anorexia and weight loss. However, there is no approved indication in the setting of cancer-related anorexia and weight loss. This review aims at presenting available data on the use of oral dronabinol in the management of anorexia and weight loss in HIV/AIDS and cancer, as well as characterizing and highlighting the pharmacotherapeutic considerations of the newest formulation of dronabinol.

Management of the anorexic cat

Anorexia in cats is often encountered in practice. In many cases, the underlying cause is not readily apparent. In this situation, the aetiology of the anorexia must be determined by...

Management of Anorexia, Cachexia, and Weight Loss in Patients With Advanced Cancer

The purpose of this multi-institutional, double-blind, randomized study was to assess the efficacy of dronabinol (Marinol®, Unimed Pharmaceuticals, Deerfield, IL) administered either alone or in combination with megestrol acetate (Megase®, Bristol-Myers Squibb Oncology, Princeton, NJ) in comparison to megestrol acetate for cancer-associated anorexia.

A systematic review of the evidence on symptom management of cancer-related anorexia and cachexia.

To evaluate and synthesize the evidence regarding cancer-related anorexia and cachexia symptom management and make recommendations for future directions. Cochrane Library, MEDLINE, CANCERLIT, CINAHL, Dissertation Abstracts, EBM Reviews--Best Evidence, EMBASE, and the Computer Retrieval of Information on Scientific Projects. Current overviews, clinical trials, systematic research reviews, and meta-analyses. All studies focused on increasing food intake. Nonpharmacologic clinical trials increased caloric and protein intake but resulted in no improvement in nutritional status, weight, tumor response, survival, or quality of life. Weight, appetite, and well-being were improved with megestrol acetate, but nutritional status was not improved. Some exercise studies demonstrated improvements in nutrition-related outcomes, but these were not primary research outcomes. Symptom management of anorexia and cachexia should focus on decreasing energy expenditure or minimizing factors creating a negative energy balance, as well as improving food intake. Increased measurement sensitivity also is needed. Improved nutritional assessment skills are needed with an emphasis on anticipated problems and current status.

Management of anorexia in the cat

One of the most frequent motivations for seeking veterinary attention for a cat is when the owner recognises a loss of normal appetite in his pet. The medical term for a lack of appetite for food is ‘anorexia’, and it may be partial or complete. While anorexia is a common manifestation of disease, the mechanisms underlying decreased food intake are complex and not completely understood. The regulation of appetite involves interaction of external stimuli with signals from the gastrointestinal tract and central nervous system. Aberrations in any of the internal control systems for hunger and satiety, or changes in external factors such as diet or feeding environment, can result in partial or total anorexia. The challenge for the practitioner is not only to diagnose and treat the underlying condition, but to recognise at what point inadequate food intake has or will impinge on the patient's nutritional status to the extent that it might deleteriously affect clinical outcome. It is also important to bear in mind the significance that the patient's appetite and food intake has for the cat owner in his overall perception of his pet's condition and quality of life.

The role of physiotherapy in anorexia nervosa management

There is disparate evidence within the current literature concerning the nature and level of involvement that physiotherapists have with patients suffering from anorexia nervosa. The study outlined in this article investigated such issues. Physiotherapists actively working with anorexic patients were targeted using a postal questionnaire. Results indicated that there is an active involvement of physiotherapists within the multidisciplinary team in the management of anorexia, and that the application of physical treatments were appropriate in a condition that is largely regarded as a psychiatric/psychological problem. In particular, physiotherapy was perceived as a useful application in the management of distorted body image, in programmes to control excessive exercise and in anxiety reduction.

The use of corticosteroids in the treatment of symptoms associated with cancer.

Abstract Despite a paucity of controlled studies, the use of corticosteroids in the management of pain and other symptoms associated with cancer has achieved wide acceptance. A controlled study of methylprednisolone for pain in advanced cancer patients has demonstrated the analgesic potential of this class of drugs, but data are inadequate to judge the best drug, dosing schedule or persistence of the effect. The bulk of data from controlled studies indicates efficacy in acute nausea and vomiting, but long-term efficacy is unknown. Although controlled data are meager, anecdotal evidence suggests the utility of these drugs in the management of anorexia, malaise, and other symptoms associated with advanced cancer. This article reviews the data extant and suggests guidelines for the management of these drugs.

PREVENTION OF ANOREXIA IN CHILDREN

Before outlining the method of preventing poor appetites, to be presented here, I should like to mention the thoughts that suggested its use. In the first place, lack of appetite was so common a condition and its results so disastrous to the physical and mental welfare of many children that I became interested in its treatment and prevention. In treating other abnormalities, it has been customary to begin with a study of normal function, but in the matter of hunger and appetite our textbooks, until recently, have afforded little information. One gathers from this lack of attention to the subject that eating has been assumed to be instinctive. Perhaps some of our difficulties in the management of anorexia have been due to this vague conception of the eating mechanism. Since hunger and appetite are the main stimuli to eating, it is worth while to investigate their nature. According to Webster's