Cases reported "Bulimia"

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1/15. methylphenidate treatment for bulimia nervosa associated with a cluster B personality disorder.

    OBJECTIVES: psychotherapy and antidepressant medication are helpful to many patients with bulimia nervosa (BN). However, a substantial number of bulimics respond poorly to such treatments. Recent studies suggest that many of the poor responders have cluster B personality disorders. In some ways, the symptomatology of bulimics who have a comorbid cluster B disorder resembles that of patients with attention deficit hyperactivity disorder (ADHD). In particular, individuals in both groups frequently have a high level of impulsivity. Such a resemblance raised the question of whether administration of methylphenidate (MPH), a drug used to treat ADHD, would have therapeutic effects in this subgroup of BN patients. methods: In a pilot study, we administered MPH to 2 patients with BN and cluster B traits and found beneficial effects. These patients had not responded to adequate trials of psychotherapy and selective serotonin reuptake inhibitors (SSRIs). RESULTS: MPH treatment was effective. Both patients had decreased binging and purging. DISCUSSION: MPH may be useful for bulimics with cluster B personality disorder who respond poorly to conventional treatment. Further studies of MPH administration may be worthwhile. Due to the potential risks, however, clinical treatment with this agent is not recommended at this time.
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ranking = 1
keywords = psychotherapy
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2/15. An integration of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa: a case study using the case formulation method.

    OBJECTIVE: The current study provides an illustration of an integration of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for the treatment of bulimia nervosa (BN), based on the case formulation strategy. METHOD: A 25-year-old Hispanic female referred herself for the treatment of eating difficulties and depressed mood. Diagnostic criteria were met for BN, major depressive episode, and alcohol abuse. Components of both CBT and IPT were utilized throughout the course of treatment. RESULTS: CBT techniques appeared to be most effective in eliminating binge eating and binge drinking behavior, whereas IPT techniques seemed to be most effective in reducing purging behavior. Results revealed that the client was no longer experiencing clinically significant symptoms of BN, depression, or alcohol abuse at end of treatment and follow-up (18 months after treatment onset). DISCUSSION: Findings support the integration of CBT and IPT for the treatment of BN and, potentially, other eating disorders.
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ranking = 5
keywords = psychotherapy
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3/15. 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.
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ranking = 2
keywords = psychotherapy
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4/15. Medical complications of anorexia nervosa and bulimia nervosa.

    The internist plays a critical role in the care of eating disorder patients, especially in the management of the life-threatening medical complications of these conditions. In anorexia nervosa, the immediate danger is related to the effects of voluntary starvation, including hypophosphatemia, bone marrow failure, cardiac decompensation, and shock. patients with bulimia nervosa more often experience severe fluid and electrolyte abnormalities resulting in hypovolemia, secondary hyperaldosteronism, depletion of total body potassium, and cardiac arrhythmias. Immediate management of medical complication and correction of nutritional deficits are necessary before patients can benefit from psychotherapy. The need for continued involvement of the internist in the ongoing care of the eating disorder patient is stressed. The high mortality and the likelihood of chronicity without early intervention underscore the need for early recognition and skilled management of eating disorders.
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ranking = 1
keywords = psychotherapy
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5/15. Inpatient care of the substance-abusing patient with a concomitant eating disorder.

    Substance abuse rehabilitation programs have been increasingly faced with the difficult task of treating patients with both an eating disorder and a chemical dependency disorder. The authors discuss screening patients with substance abuse for eating disorder and describe a strategy for care that integrates an eating disorder treatment protocol with a standard chemical abuse rehabilitation program. elements of the treatment protocol include a thorough medical evaluation, nutritional stabilization, strategies to stop the patient's aberrant eating behavior, psychotherapy, medication, and discharge planning that actively addresses both the substance abuse and the eating disorder.
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ranking = 1
keywords = psychotherapy
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6/15. An integrated psychotherapy for eating-disorder patients.

    This paper presents a rationale for integrating brief dynamic and cognitive-behavioral techniques in the treatment of eating-disorder patients. It emphasizes psychodynamic work useful in neutralizing defenses and resistances to therapy, which aids access to key conflicts and characterological issues. The more interpersonal, transference-based aspects of such work are illustrated, and suggestions are made as to when to shift among various therapeutic strategies.
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ranking = 4
keywords = psychotherapy
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7/15. Imaginal desensitization: a cost-effective treatment in two shop-lifters and a binge-eater resistant to previous therapy.

    case reports are given of three patients, two suffering from compulsive shop-lifting and one from binge-eating, who responded to a week's treatment with imaginal desensitization after having failed to respond to prolonged interpretative psychotherapy. Expectancy of improvement did not appear to play a major role in their response, but it appears impossible to disprove that expectancy determines the response to this or any form of psychotherapy. Whether or not imaginal desensitization acted specifically in the present study, in view of its cost-efficacy it is suggested it is worthy of trial in impulse disorders which have persisted despite treatment.
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ranking = 2
keywords = psychotherapy
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8/15. Long-term course in 14 bulimic patients treated with psychotherapy.

    Fourteen patients with bulimia were treated with group psychotherapy and with strategic use of antidepressants and individual psychotherapy as needed. The 12 who achieved sustained remission required an average of 21 months of treatment. patients with both an axis I and an axis II diagnosis did less well and required longer treatment than those who met criteria for bulimia only. Bulimic symptoms varied substantially with time, so that a definition of remission requiring that a patient be symptom-free for 6 months was more accurate than acute outcome data. patients with comorbid affective disorders, personality disorders, and bulimia had the poorest prognosis.
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ranking = 6
keywords = psychotherapy
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9/15. Successful self-management of severe bulimia: a case study.

    A young woman with a nine-year history of bingeing and purging was given instruction in behavioral principles. She then designed and carried out a program that included paced eating of pre-planned meals, following by differential reinforcement of non-purging behaviors, which featured high frequency of reinforcement early in training. Inter-meal "binge-feelings" were treated by reinforcing abstentions. A graded system of contingent exercise also was employed for purging behaviors. Episodes decreased to a low level after one month and were completely absent nine months later. The amelioration of this problem resulted in progress being made for the first time with her emotional problems that were being treated elsewhere by psychodynamic psychotherapy.
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ranking = 1
keywords = psychotherapy
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10/15. Bulimia: an uncommon problem in aircrewmen--a case report.

    This is a case report of a male naval aviator suffering from bulimia. Bulimia is an eating disorder normally associated with young affluent females. A review of bulimia as to etiology, characteristics, prevalence, diagnosis, treatment, and prognosis is presented to familiarize the reader with the disease. About 1% of the U.S. male population is afflicted with this disorder, while it has been estimated that up to 22% of females are afflicted. The only documented case of bulimia in a male aircrewman is presented. He was misdiagnosed on several occasions. When diagnosed, his symptomatology was severe. He was offered psychotherapy and close medical supervision and allowed to return to flight duty. His disease was chronic and recurrent. He was eventually grounded again. It is felt that bulimics are a very poor risk for return to flight duty due to the recurrent nature of the disease, the manipulative characteristics of those afflicted and the extreme difficulty of following patients suffering from this illness.
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ranking = 1
keywords = psychotherapy
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