Nausea and Vomiting in Cancer Patients
John Kucharczyk, David J. Stewart, Alan D. Miller in Nausea and Vomiting: Recent Research and Clinical Advances, 2017
If nausea and vomiting existed as isolated symptoms in patients with cancer, they would usually not be major problems. The major impact of nausea and vomiting on the long-term health of the patient is due to the fact that they are almost always associated with some degree of anorexia. Moreover, anorexia may be profound with no actual vomiting, although severely anorectic patients frequently do have at least some coexistent nausea.8 Anorexia is the most common cause of malnutrition in cancer patients.9 Changes of taste or appetite will occur in 73% of patients on chemotherapy for cancer.8 They will also occur commonly in the absence of chemotherapy, particularly in patients with carcinomas involving the GI tract, liver, or pancreas or in patients with widely disseminated disease.4,10
Nutrition and the Cancer Patient
David Heber, Zhaoping Li in Primary Care Nutrition, 2017
Liquid supplements are the most common types of nutritional supplements, are readily available for patient consumption, and are effective when patients are unable to meet requirements with normal foods alone, despite dietary counseling (Ravasco et al. 2005). Patients may be anorectic due to illness or be affected by disabling factors, such as difficulty in chewing, inability to prepare foods for themselves, visual difficulties, decreased energy level, or poor access to foods. Nutritional supplements may be homemade and are usually milk based, or they are commercially prepared and packaged. Although somewhat expensive, commercial supplements provide balanced and fortified (vitamin- and mineral-enriched) nutrition that requires little or no preparation. Oral supplementation with liquid concentrated food supplements providing high-calorie, high-protein, low-volume nutrients is the simplest, most natural, and least invasive method of increasing nutrient intake. The benefits of oral supplementation include increased appetite and weight gain, decreased GI toxicity, and improved performance status (Nayel et al. 1992; Ovesen and Allingstrup 1992; Bell et al. 2003). These products are particularly helpful when patients cannot maintain an adequate intake through a regular diet but are able to swallow and have a relatively intact GI tract.
Eating Disorders
David F. O'Connell in Dual Disorders, 2014
Almost all professionals who treat anorectic patients agree that these individuals show severe, long-standing personality dysfunction that predates the onset of the anorectic symptoms. On the surface, the anorectic patient may appear congenial, assertive, and pleasant. Unlike patients suffering from depression, anxiety, and other psychiatric disorders, they may appear in control of all areas of their lives apart from the compulsive attempts to reduce weight. Their amiability and social poise belie inner feelings of loss of control, inferiority, and extreme desperation. Far from being in control, these individuals feel like puppets dangled from the strings of life's demands. Psychologically, they feel incomplete, helpless, and ineffectual in conducting their daily affairs. They secretly feel phony in their relationships with themselves and others. They cannot identify and pursue the gratification of their needs, wants, and desires. They do not trust themselves, their perceptions, or their emotions. The anorectic patient harbors a deep fear of being a “nothing” and feels helpless to correct the situation. This helplessness gives rise to often severe panic, anxiety, and depression. To ward off these feelings, the anorexic finds the unique solution in control over the body. The anorexic acts and feels as if her body is separate from her self and hence is something that she can act upon. The environment and the self may seem uncontrollable, but the body can be controlled through strenuous efforts to reduce weight. Through these efforts, anorectic patients develop a feeling of power, autonomy, and even superiority. Their efforts at weight control become a concrete solution to an inner psychological problem.
Psychoform and somatoform dissociation among individuals with eating disorders
Published in Nordic Journal of Psychiatry, 2020
Doris Nilsson, Annika Lejonclou, Rolf Holmqvist
In order to simplify analyses, three diagnosis groups were formed as follows:Eating disorder, anorectic (including anorexia nervosa and atypical anorexia nervosa), n = 32, aged 15 to 30 years (M age = 19.8, median = 19.0, SD = 3.4)Eating disorder, bulimic (including bulimia nervosa and atypical bulimia nervosa) n = 9 aged 17 to 29 years (M age = 21.4, median = 20.0, SD = 3.6Eating disorder, Unspecified (including overeating associated with other psychological disturbances and other eating disorders) n = 19, aged 14 to 23 years (M age = 19.6, median = 20.0, SD = 2.78)
Adiponectin and resistin in acutely ill and weight-recovered adolescent anorexia nervosa: Association with psychiatric symptoms
Published in The World Journal of Biological Psychiatry, 2019
Marta Tyszkiewicz-Nwafor, Agnieszka Slopien, Monika Dmitrzak-Węglarz, Filip Rybakowski
Several studies suggest the involvement of adiponectin and resistin in the pathogenesis of obesity and its metabolic consequences (Vendrell et al. 2004). A significant inverse correlation between these two adipocytokines has been reported in the literature. It was also speculated that they share a common regulatory mechanism to mediate body metabolism. It was proposed to use the adiponectin–resistin index to assess the metabolic risk in obesity (Lau and Muniandy 2011). Thus, it can be useful to study them together. The potential role of these adipokines in the course of AN is still unclear. Decreased body fat, as well as rapid weight gain during the re-feeding of anorectic patients, can lead to dysregulation of adipokine secretion and action. We suspect that abnormal plasma levels of adipokines involved in homeostatic and non-homeostatic regulation of food intake and energy expenditure may influence certain psychopathological symptoms, such as depressed mood, disturbed body image and obsessive-compulsive symptoms. Only a few studies have examined adiponectin and resistin levels in the acute stage of adult anorexia nervosa; however, the disorder usually starts in adolescence when crucial neuroplastic processes occur (Fuhrmann et al. 2015).
Emerging therapeutic targets for anorexia nervosa
Published in Expert Opinion on Therapeutic Targets, 2023
Andreas Stengel, Katrin Giel
Antipsychotics have been tested in several trials, often with the idea to reduce cognitive and behavioral rigidity as well as obsessive thoughts and behavior [46]. Following the hypothesis of a dopamine receptor hypersensitivity due to a decrease in dopamine levels along with an upregulation of the receptors [47] in AN, second generation antipsychotics such as olanzapine – acting mostly as dopamine D2 and serotonin 5HT2A antagonist [48] – have been tested and were shown to induce a small effect on body weight compared to placebo [49–51]. Interestingly, a recent randomized controlled trial did not observe an effect on obsessionality as assessed using the Yale-Brown Obsessive-Compulsive Scale (YBOCS) [51]. However, other studies did show an effect on anxiety and depressive symptoms [52]. The – albeit modest – effect on BMI difference at the end of treatment as well as on increased BMI after treatment with olanzapine and placebo has been also shown in a recent meta-analysis including seven studies on 304 patients with anorexia nervosa in total, while no effect could be detected for olanzapine as adjuvant treatment in adolescents [53]. Further support for the importance of targeting the dopamine signaling system comes from a recent genome-wide association study including data of 16,992 subjects with anorexia nervosa and 55,525 non-anorectic controls of European descent. This analysis showed that high TXNDC12 levels were associated with a higher risk of anorexia nervosa, whereas a decreased risk was shown for ADH1B [54]. Since both proteins are involved in modulating the brain dopamine reward system, the possible functional implications should be followed up in further studies.
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