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1/6. binge-eating disorder and obesity. A combined treatment approach.

    patients presenting with both obesity and BED face multiple challenges: normalizing their eating, improving their physical health, and working to enhance their own acceptance of their body image. In an effort to feel better about themselves, they often have become trapped in a cycle of desperately attempting to diet, then losing control, binge eating, and gaining even more weight. Several psychological and pharmacologic treatment approaches have been used in this population. Most suppress binge eating in the short term, and some seem promising in the long term as well. However, sustained weight loss remains a largely unrealized goal. More recently, BED treatment programs have attempted to address these goals sequentially or in combination. In either approach, it is clear that adopting a long-term focus and promoting enhanced self-acceptance, which have so often been missing from these patients' previous attempts at recovery, are important tasks of treatment that are likely to lead to beneficial lifestyle changes and long-term improvements in physical and psychological health.
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2/6. Binge eating disorder onset by unusual parasitic intestinal disease: a case-report.

    We report a case of binge eating disorder (BED) in a 19-year-old Spanish woman, whose onset followed a nowadays uncommon parasitic intestinal disease (taenia solium by cysticercosis). The patient exhibited bizarre and frequent hyperphagia episodes and extreme loss of weight, common symptoms of this condition. The patient continued to have frequent binge episodes and inappropriate eating patterns, gaining weight consequently over a normal range, despite successful treatment of the condition. No purging behavior was detected. A classical conditioning behavioral model, was useful for the understanding and formulation of this case. To the authors' knowledge, this is the first reported case where a parasitic infestation triggered the onset of BED.
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3/6. bariatric surgery in a patient with possible psychiatric contraindications.

    Grade III obesity (BMI > 39.9 kg/m2) is considered a chronic disease where clinical and diet therapy show poor results, with high rates of relapse. The most consistent results are those obtained through surgical procedures. Several authors discuss the contraindications for the performance of anti-obesity operations. Psychiatric disorders are often considered contraindications to these operations, especially affective disorders, psychotic disorders and personality disorders. The authors report the case of a 37-year-old patient, with obesity history since the age of 12, and anorexiant abuse (amphetamine-derived substances) during 20 years, binge-eating episodes, purgative compensatory behaviors and recurrent depressive symptoms. She was submitted to anti-obesity surgery in August 2000 (BMI 40.2). The outcome is reported and a discussion of the possible psychiatric contraindications for the anti-obesity surgeries is proposed.
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4/6. Massive gastric dilatation after a single binge in an anorectic woman.

    OBJECTIVE: Massive gastric dilatation is a very serious condition that is extremely rare in patients with no history of gastrointestinal disease. Several cases have been reported in patients with eating disorders, particularly after a binge. We report here the case of a young woman who developed severe gastric dilatation after a single binge. methods: A computed tomographic (CT) scan of the abdomen was done and a psychiatric evaluation was performed. RESULTS: The diagnosis of acute gastric dilatation was confirmed and superior mesenteric artery syndrome was excluded. The patient responded to nasogastric drainage and bowel rest. She was also found to have situational anxiety and depressive symptoms as well as a nonspecified eating disorder. CONCLUSION: This case illustrates the serious sequel of even a single binge in any patient with abnormal dietary habits, and demonstrates the useful role of the CT scan in the diagnosis.
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5/6. Early trauma, dissociation, and late onset in the eating disorders.

    Although the majority of patients with anorexia nervosa and bulimia nervosa develop these disorders in their teens and 20s, some patients develop an eating disorder in their 30s, 40s, or 50s. We present a subgroup of patients with the following pattern of symptoms and historical detail: (1) severe sexual and physical abuse by family members; (2) relatively good premorbid professional and marital adjustment (considering later difficulties) though characterized by (3) hypomania, binge eating, and morbid obesity. A pronounced shift in eating behaviors follows (4) medical trauma (e.g., injury, cancer, surgery) that occurs after age 30, interrupts previous hypomanic adaptation, and leads to severe restriction, purging, and dramatic weight loss (e.g., 100 lb). Although only one patient met full criteria for anorexia nervosa, weight loss and starvation were serious enough to provoke further medical crises in all patients. Finally, (5) during both weight loss and weight restoration patients demonstrated significant dissociative disturbance, including dissociated mood and personality states (i.e., multiple personality disorder), self-destructive behavioral episodes repeating early trauma, and avoidance of food as a way to manage PTSD symptoms.
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6/6. superior mesenteric artery syndrome in an intravenous drug abuser after rapid weight loss.

    Superior mesenteric artery (SMA) syndrome is a form of small-bowel obstruction due to vascular compression of the duodenum. We describe a case of SMA syndrome in an intravenous drug abuser who had rapid weight loss during a 2-week drug binge. Radiographic studies are necessary to confirm the diagnosis, and our case illustrates the value of computed tomography in diagnosing this relatively rare but serious disorder. The management of this syndrome requires reversing or removing the precipitating factors as well as correcting any secondary complications. Increased awareness of this condition may result in improved recognition and timely management of this rare cause of high intestinal obstruction, thus reducing its potential morbidity and complications.
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