Palliative Medicine in Alzheimer's disease and other dementia disordersruparnakhurana
Integration of palliative medicine in advanced neurological disorders like dementia, motor neuron disease, multiple sclerosis, amyotrophic lateral sclerosis, stroke is the need of the hour as these patients have a progressive incurable illness with heavy symptom burden and psychosocial implications
Feeding and Eating disorders are one of the devastating disorders , Anorexia is a killer disease , very common in childhood and adolescent, mainly in girls more than boys. Bulimia is charecterize by binge eating followed by compulsive purging . Binge eating disorders and night eating syndrome are becoming very prevalent
Feeding disorders as avoidant restrictive food intake disorder , rumination disorders and pica are the types of feeding disorders in infant and childhood period
psychological rehabilitation, nutritional plan and medical therapy are the most effective lines of treatment foe eating Disorders
Palliative Medicine in Alzheimer's disease and other dementia disordersruparnakhurana
Integration of palliative medicine in advanced neurological disorders like dementia, motor neuron disease, multiple sclerosis, amyotrophic lateral sclerosis, stroke is the need of the hour as these patients have a progressive incurable illness with heavy symptom burden and psychosocial implications
Feeding and Eating disorders are one of the devastating disorders , Anorexia is a killer disease , very common in childhood and adolescent, mainly in girls more than boys. Bulimia is charecterize by binge eating followed by compulsive purging . Binge eating disorders and night eating syndrome are becoming very prevalent
Feeding disorders as avoidant restrictive food intake disorder , rumination disorders and pica are the types of feeding disorders in infant and childhood period
psychological rehabilitation, nutritional plan and medical therapy are the most effective lines of treatment foe eating Disorders
Complementary and Alternative Therapies For LupusLupusNY
A presentation by Swamy Venuturupalli, MD from Lupus LA's 4th annual patient education conference at Cedars-Sinai Medical Center in Los Angeles, CA on June 28th, 2008.
Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)Andri Andri
This is a standard presentation for teaching medical students and colleagues about psychosomatic disorder, its diagnosis and therapy. We hope by reading this slides, you will understand the nature of psychosomatic disorder and its current approach in therapy
A presentation about common eating disorders in detail , most common types are anorexia nervosa , bulimia nervosa , night eating disorder , binge eating disorder , purging disorder , rumination disorder , pica , Avoidant/Restrictive Food Intake Disorder , Anorexia nervosa is a syndrome characterized by three essential criteria, one behavioral, one psychopathological, and the last, physiologic.
•The first is self- induced starvation, to a significant degree (behavioral).
•The second is a relentless drive for thinness or a morbid fear of fatness (psychopathological).
•The third criterion is the presence of medical signs and symptoms resulting from starvation (physiologic).
Two subtypes of anorexia nervosa exist: restricting and binge/purge.
•Approximately half of anorexic persons will lose weight by drastically reducing their
total food intake. The other half of these patients will not only diet but will also
regularly engage in binge eating, followed by purging Behaviors.
•Anorexia nervosa is much more prevalent in females than in males and usually has its onset in adolescence.
•The outcome of anorexia nervosa varies from spontaneous recovery to a waxing and waning course to death
People with bulimia nervosa have episodes of binge eating combined with inappropriate ways of stopping weight gain. Physical discomfort—for example, abdominal pain or nausea—terminates the binge eating, which is often followed by feelings of guilt, depression, or self-disgust. Individuals with binge-eating disorder engage in recurrent binge eating during which they eat an abnormally large amount of food over a short time.
In-service presentation to the rehabilitation therapy department about Denver Health's ACUTE service for severe eating disorders and the role of therapy in treatment.
severe and enduring anorexia nervosa : clinical and neuropsychological aspectsHeba Essawy, MD
severe and enduring anorexia nervosa is a persistent dietary restriction , underweight and over evaluation-of weight , history of more than 3 years and exposure to at least two evidence based treatments delivered
Alexithymia and eating disorders : clinical and treatment implicationHeba Essawy, MD
alexithymia and emotion regulation difficulties have an impact on the course and maintenance of eating disorders
lack of insight and the externally- oriented thinking styles typical to alexithymia will interfere with treatment compliance and patients with eating disorders ability to benefit from interventions especially psychotherapy ones
always screen for alexithymia in the everyday clinical practice with psychiatric patients including those suffering from eatings
Complementary and Alternative Therapies For LupusLupusNY
A presentation by Swamy Venuturupalli, MD from Lupus LA's 4th annual patient education conference at Cedars-Sinai Medical Center in Los Angeles, CA on June 28th, 2008.
Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)Andri Andri
This is a standard presentation for teaching medical students and colleagues about psychosomatic disorder, its diagnosis and therapy. We hope by reading this slides, you will understand the nature of psychosomatic disorder and its current approach in therapy
A presentation about common eating disorders in detail , most common types are anorexia nervosa , bulimia nervosa , night eating disorder , binge eating disorder , purging disorder , rumination disorder , pica , Avoidant/Restrictive Food Intake Disorder , Anorexia nervosa is a syndrome characterized by three essential criteria, one behavioral, one psychopathological, and the last, physiologic.
•The first is self- induced starvation, to a significant degree (behavioral).
•The second is a relentless drive for thinness or a morbid fear of fatness (psychopathological).
•The third criterion is the presence of medical signs and symptoms resulting from starvation (physiologic).
Two subtypes of anorexia nervosa exist: restricting and binge/purge.
•Approximately half of anorexic persons will lose weight by drastically reducing their
total food intake. The other half of these patients will not only diet but will also
regularly engage in binge eating, followed by purging Behaviors.
•Anorexia nervosa is much more prevalent in females than in males and usually has its onset in adolescence.
•The outcome of anorexia nervosa varies from spontaneous recovery to a waxing and waning course to death
People with bulimia nervosa have episodes of binge eating combined with inappropriate ways of stopping weight gain. Physical discomfort—for example, abdominal pain or nausea—terminates the binge eating, which is often followed by feelings of guilt, depression, or self-disgust. Individuals with binge-eating disorder engage in recurrent binge eating during which they eat an abnormally large amount of food over a short time.
In-service presentation to the rehabilitation therapy department about Denver Health's ACUTE service for severe eating disorders and the role of therapy in treatment.
severe and enduring anorexia nervosa : clinical and neuropsychological aspectsHeba Essawy, MD
severe and enduring anorexia nervosa is a persistent dietary restriction , underweight and over evaluation-of weight , history of more than 3 years and exposure to at least two evidence based treatments delivered
Alexithymia and eating disorders : clinical and treatment implicationHeba Essawy, MD
alexithymia and emotion regulation difficulties have an impact on the course and maintenance of eating disorders
lack of insight and the externally- oriented thinking styles typical to alexithymia will interfere with treatment compliance and patients with eating disorders ability to benefit from interventions especially psychotherapy ones
always screen for alexithymia in the everyday clinical practice with psychiatric patients including those suffering from eatings
A Comprehensive Exploration of Alexithymia, Autism spectrum Disorders and Eat...Heba Essawy, MD
Alexithymia , autism and eating disorders are sophisticated conditions that have garnered significant attention in recent years
these conditions have dramatic effects on mental and emotional well-being
one of the specific psychological variables that contribute to the etiology of eating disoders and autism is emotion regulation ability
Alexithymia is sub-clinical phenomenon not identifying a personality disorder per se, but a personality trait with a dimensional nature
construct of alexithymia , difficulty in identifying feelings, difficulty differentiation between typical bodily processes ( Hunger cues exhaustions
externally oriented thinking where the clients are paying more attention to external things arond than to internal experiences
difficulty of describing emotions
Autism eating experience and sensory processing constructs , exteroception, interoceptive
Uncovering the correlation between PTSD and Eating DisordersHeba Essawy, MD
traumatic experience and PTSD and eating disorders commonly co-occur , which can complicate recovery due to how the two psychiatric disorders can fuel one another .
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. SEVERE AND ENDURING ANOREXIA
NERVOSA : CLINICAL AND
NEUROPSYCHOLOGICAL ASPECTS
By Heba Essawy MD., CEDS.,
Prof of psychiatry
Head of Eating Disoreders unit
Egyptian International chapter chair . Iaedps –USA
Okasha Institute of psychiatry.
Ain Shams University , Egypt
2. Introduction
■ Anorexia Nervosa (AN) is a severe psychiatric illness associated
with various medical complications that arise as a result of
weight loss and malnutrition,
■ Increased mortality rates
■ Even receiving treatment, many patients do not recover or
remain symptomatic.
■ Approximately 20–30% of people with AN do not recover fully
despite treatment but develop an enduring form of the disorder
3. Road Map
■ Proposed Criteria /Diagnosis for severe and Enduring AN
■ Severe and Enduring Anorexia Nervosa :Developmental stages
■ Why do people not get better ?
■ Severe and Enduring Anorexia Nervosa :Neurophysiological aetiology
■ Severe and Enduring Anorexia Nervosa :Neurobiological model
■ Severe and Enduring Anorexia Nervosa : Treatment Challenges
■ Severe and Enduring Anorexia Nervosa : psychotherapeutic treatments
4. Case Z
■ Late fourties sinle lady with restriction of food intake , lives with her family , not
been able to work for last 15 years due to her illness
■ Multiple admission , not able to maintain her weight in community over longer
period of time , BMI 13
■ Multiple psychotherapy attempts , different modalities
■ Current care plan : short term , planned admissions for limited weight restoration
5. Severe and Enduring Anorexia Nervosa
: Known Data
■ Chronic eating Disordrers , consisting on AN , restricting or binging/ purging type,
EDNOS.
■ Being consistentently ill for than 7 years (10 years)
■ Undergoing at least one unsuccessful evidence –based tratment
■ Common criteria used to define this final stage of the staging model include
previously failed treatment attempts,
■ Having severe impairment across a number of life domains
■ Having a strong motivation to hold onto AN, and thus a relectance to continue
active treatment
6. Proposed Criteria /Diagnosis for severe
and Enduring AN
■ A persistent state of dietary restriction, underweight ,and
overvaluation of weight /shape with functional impairment .
■ A history of more than 3 years of AN
■ Exposure to at least two evidence –based treatments appropriately
delivered , with a diagnostic assessment and formulation that
incorporates an assessment of the person s eating disorder health
literacy and stage of change
Drs. Phillipaand stephen touyz-proposed for ICD-11 2022
7. Severe and Enduring Anorexia Nervosa
:Developmental stages
■ Initial phase -1-2 years of duration
- Extreme medical instability ( body adapting to starvation )
-Low body weight
- Increase risk of death
Middle phase -10-30 years of duration “stable sick”
- Bioadapted
- Stable weight at low level
- Death less likely ( if occurs often accident Na, K, suiccide)
8. Severe and Enduring Anorexia Nervosa
:Developmental stages
■ Terminal phase-duration 2-5 years
- Return of medical instability
- Unexpected /nondelibrate weight loss
- Becomes impossible to return to “stable sick”
- Final effort or death
9. Why do people not get better ?
Psychological /Social
1. Trauma and attachementdisorders ( Trust)
2. Primary/ secondary gain ( conflict theory)
3. Family ( role of illness in family conflicts)
4. Fear of becoming adult ( intamicy /responsibility )
5. Inability for change
10. Why do people not get better ?
■ Biological/Genetic
1. Predisposition to a particular cognitive style or personality
Characterstics ( Narcissism )
2. Comorbidities make it more likely that the Eds become chronic (
Depression Anwxiety/OCD/ personalty Disorders
3. Reward / addictive behavior ( repeated cycles of starvation/binging
may impact on reward system)
11. Severe and Enduring Anorexia Nervosa
:Neurophysiological aetiology
■ Abnormal Reward processing in AN
■ Set Shifting
■ Information Processing Speed
12. Severe and Enduring Anorexia Nervosa :
Abnormal Reward processing in AN
■ AN is an illness characterised by behaviours that become reinforced in a manner
that become pathological .
■ Development of reward linked behaviors ( involving conditioning and reinforcement
) ex patients find skiny body and self starvation reinforcing and rewarding
■ Patients engage in starvation to relive anhedonia and thus develop dependence on
this mechanism ( reward dysfunction become addicted to starvation)
■ Eating rituals reduce anxiety/fear (negative reinforcement or reduced bad feelings,
as OCD)
■ Abnormalities in reward systems and in fronto-striatal systems and have paved the
way for “top-down,” approach that probes the neural activity related to
disturbances in eating behavior.
■ “top-down rely on : some aspect of dieting behavior is initially rewarding, but that
this behavior persists in individuals with AN as maladaptive behavior because it is
ultimately mediated by neural circuits linked to habit formation.
13. Severe and Enduring Anorexia Nervosa :
Neuropsychological abnormalities : Set
Shifting
■ In severe and enduring cases are significantly impaired on Set-
shifting .
■ Set-shifting has been consistently found to be negatively impacted by
the AN illness
■ In investigated set-shifting using the WCST :
Severe and enduring participants demonstrated significantly
more perseverative errors compared to healthy control participants in
the data set
Roberts et al., 2007; Tchanturia et al., 2011; Talbot et
14. Severe and Enduring Anorexia Nervosa :
Neuropsychological abnormalities
:Information Processing Speed
■ The speed at which information is processed in the brain has been proposed as
having a key function in facilitating higher order cognitive abilities such as
executive functioning
■ Utilising the Processing Speed Index of the Wechsler Adult Intelligence Scale
IV
■ Some cases reported low average range on attention and within the average
range in respect to information processing speed.
■ Further research suggested that these two processes may represent low
information processing speed
Hemmingsen et al. (2020)
15. Severe and Enduring Anorexia Nervosa
:Neurobiological model
■ Neurobiology of food decision :
- Dorsal fronto- striatal circuits play a greater role in guiding decisions
regarding what to eat than among healthy individuals.
- Habit formation is the process by which a behavior associated with a reward,
if repeated frequently (“practiced”), becomes almost automatic and far less
dependent on the receipt of the reward
■ Neurobiology of reward :
- Mesolimbic neural systems of reward processing encompass the
midbrain/ventral tegmental area, ventral striatum (including nucleus accumbens ),
and orbitofrontal cortex (OFC).
16. Severe and Enduring Anorexia Nervosa
:Structural and Functional studies
■ Functional studies:
- PET studies have shown hypermetabolic abnormalities in the caudate
among patients with AN,
- PET dopamine binding study also reported that dopamine binding
potential in the dorsal caudate correlated with harm avoidance, a trait commonly
found in individuals with AN
■ Structural studies:
- Decreased volume in the caudate among individuals with AN
- fMRI study using food pictures for symptom provocation found greater
caudate activation among individuals who had recovered from AN as compared
with HC
17. Severe and Enduring Anorexia Nervosa
: Treatment Challenges
■ In severe and enduring illness, after several years of eating
disorder, treatments that have not yet led to recovery factors such
as
* Treatment burnout
*Deep ambivalence about recovery
*sense of powerlessness
*Sense of loss of hope may be present .
These factors must be considered and addressed when making
decisions about when to strive for full weight restoration and
recovery.
18. Severe and Enduring Anorexia Nervosa
: Aim of Treatment
■ In the treatment of SE-AN
*Place the focus on improving quality of life
* Medical safety
*Overall functioning in the presence of an enduring illness.
rather than always focusing on full weight restoration and recovery
Touyz et al 2020
19. Severe and Enduring Anorexia Nervosa
: What Might work
It is important that:
■ The team that is planning, coordinating, and implementing the treatment have
adequate training and experience
■ Impact of the disorder on QOL- primary target of interventions
■ Gaining an understanding of their values
■ Weight gain encouraged but not mandated or primary focus .
■ In a study by Jenny Jordan identified that 3 things helped in recovery: finding
God , having a baby and falling in love
■ Never gave up , accept the small victories and believe that things will change
20. Severe and Enduring Anorexia Nervosa :
psychotherapeutic treatments
■ In the only randomized controlled trial (RCT) of psychotherapeutic treatments for
SE-AN, Touyz et al. found that SE-AN patients benefited from both
*Outpatient cognitive behavioral therapy (CBT)
*Specialist supportive clinical management (SSCM)
both treatments were modified to prioritize. Harm minimization and quality of life.
Both CBT and SSCM resulted in positive changes regarding
Quality of life
Mood disorder symptoms
Social adjustment
Body mass index (BMI),
Eating disorder symptoms
Motivation for change.
21. Take Home Messages
■ Explore the clinical utility of illness duration at presentation for treatment in AN,
■ Consider clinical impairment as a marker of severity.
■ Patients with longer duration of illness and higher impairment secondary to ED
may require more individualized and specific treatment.
■ Close monitoring and fast access to treatment to ED cases at early stage in
order to prevent the development of an enduring course with associated functional
impairment.
■ Addressing patient goals , and quality of life and impairment secondary to the
ED can be used as an important clinical strategy to motivate patients to change.