Nutritional assessment of drug addicts

OBJECTIVE

To discern if factors such as organic pathology, sex, duration and/or intensity of drug addiction, alcohol abuse, hepatitis B infection, anorexia with poor food and drink consumption, or disturbance of social and familial networks, are related to an impaired nutritional status in hospitalized drug addicts.

DESIGN

Cross-sectional prospective study.

SETTING

Detoxication unit and internal medicine unit of a university hospital.

PATIENTS

140 drug addicts without acute organic pathology and 18 with acute organic pathology related to drug addiction. The immunological study was compared with a control group composed of 50 healthy and well-nourished individuals (26 women and 24 men), age-matched with our patients.

RESULTS

Drug addicts without organic pathology were under-nourished: 92.4% weighed under the mean weight for the population and 55.7% had had a weight loss above 5%. The distribution of mid-upper arm circumference (MUAC), triceps skinfold (TSF) measurement and mid-arm muscle area (MAMA) compared with the percentiles for the population showed a shift towards lower values. We found a high percentage of patients with a high lymphocyte count (55%). Despite the high lymphocyte count, delayed hypersensitivity was depressed in our patients. Of our patients, 66.4% exhibited anorexia at admission. The mean calorific intake was 978 +/- 89 kcal/day in females and 1265 +/- 64 kcal/day in males. However, in most cases, malnutrition (usually marasmus-like malnutrition) was not very severe; only 30% of the drug addicts weighed less than 80% of the mean weight for the population, or admitted to a weight loss above 10%, and by subjective nutritional assessment, only 18% were deeply malnourished. Otherwise, the nutritional status was very poor in drug addicts with acute organic pathology. We also found a worse nutritional status in our patients related to female sex, intensity of drug addiction, anorexia with poor food and drink consumption, and disturbance of the social and familial networks.

CONCLUSIONS

Many drug addicts suffer from calorie and protein malnutrition. This mainutrition is related to female sex, intensity of drug addiction, anorexia and poor food and drink consumption, and disturbance of the social and familial links. Acute organic pathology leads to a significant worsening of the nutritional status of drug addicts.

Behavioral conditioning of lipopolysaccharide-induced anorexia

One manifestation of the acute phase response, sickness behavior, is now considered an important response in the organism's overall attempt to reinstate homeostasis. This report aimed to determine whether the sickness behavior of anorexia was conditionable using the conditioned taste aversion paradigm. To investigate this phenomenon, lipopolysaccharide (LPS) (100 micrograms/kg) was used as the unconditioned stimulus, and was paired with a novel 1% saccharin solution (conditioned stimulus). Upon conditioned stimulus representation, the anorectic effects of LPS were observed. These data are consistent with recent literature showing acute phase events to be conditionable.

Anorexia nervosa in an adolescent with early profound deafness

This paper reports a case of anorexia nervosa in a 15-year-old schoolgirl who had been profoundly deaf since birth. She was admitted to a specialized eating disorders unit following a dramatic reduction in her weight. Her deafness and limited communication skills posed significant problems with regard to her overall management on the unit. Her clinical presentation and difficulties in management are presented.

Risk and trigger factors for the development of eating disorders in female elite athletes

This study examined risk factors and triggers for eating disorders in female athletes. Subjects included were all of the elite female athletes in Norway (N = 603), ages 12-35 yr, representing six groups of sports: technical, endurance, aesthetic, weight dependent, ball games, and power sports. The Eating Disorder Inventory was used to classify individuals at risk for eating disorders. Of the 117 athletes defined at risk, 103 were administered a structured clinical interview for eating disorders. A comparison group was also interviewed, consisting of 30 athletes chosen at random from a pool not at risk and matched to the at-risk subjects on age, community of residence, and sport. Ninety-two of the at-risk athletes met criteria for anorexia nervosa, bulimia nervosa, or anorexia athletica. The prevalence of eating disorders was higher in sports emphasizing leanness or a specific weight than in sports where these are less important. Compared with controls, eating disordered athletes began both sports-specific training and dieting earlier, and felt that puberty occurred too early for optimal performance. Trigger factors associated with the onset of eating disorders were prolonged periods of dieting, frequent weight fluctuations, a sudden increase in training volume, and traumatic events such as injury or loss of a coach.

Systemic clonidine increases feeding and wheel running but does not affect rate of weight loss in rats subjected to activity-based anorexia

Activity-based anorexia (ABA) is an animal model of anorexia nervosa with two characteristics of the disorder, decreased food intake and increased activity. We have shown that chronic noradrenergic stimulation of the paraventricular hypothalamus exacerbates ABA rather than ameliorates it. This study determined if peripheral chronic administration of clonidine affects ABA. Rats were implanted SC with osmotic minipumps infusion 0, 30, or 300 micrograms/kg/day of clonidine and exposed to ABA (1.5 h/day ad lib food, 22.5 h/day ad lib wheel access). Results showed that clonidine did not affect the rate of weight loss during ABA, but increased food intake at the lower dose and wheel activity at the higher dose. It is proposed that increased energy expenditure due to wheel running is counteracted by an inhibition of sympathetically mediated diet-induced thermogenesis, and that the elevation in running by the higher dose potentially increases the risk of developing ABA.

Is the pharmacological treatment of cancer cachexia possible?

Cancer cachexia is highly prevalent in patients with advanced cancer. Its main clinical manifestation is profound anorexia. Progestational drugs have shown meaningful effects on appetite, food intake, and nutritional status in patients with advanced cancer and AIDS, and could be useful in managing anorexia. Corticosteroids also seem to produce increased appetite, but these effects are short-lived. Cyproheptadine, hydrazine sulfate, and cannabinoids also are being studied in the management of cancer-induced anorexia, but their role has not yet been clearly established. Future research should evaluate how the different drugs affect specific symptoms associated with cachexia.

Psychomotor retardation, anorexia, weight loss, sleep disturbances, and loss of energy: psychopathological correlates of hyperhaptoglobinemia during major depression

Recently, we have established that major depression is characterized by hyperhaptoglobinemia, which may be regarded as an index of an "acute" phase response in that illness. The present study investigates the psychopathological correlates of increased plasma concentrations of haptoglobin (Hp) in major depression. To this end, the authors studied the Hp levels in relation to depressive items of the Structured Clinical Interview for DSM-III (SCID) and the Hamilton Rating Scale for Depression (HRSD) in 90 depressed subjects. There was a significant positive relationship between the SCID symptoms anorexia/weight loss, sleep, and psychomotor disorders and Hp plasma concentrations. Hp plasma levels were significantly and positively correlated with overall severity of illness (HRSD). The HRSD symptom correlates of higher Hp levels were loss of interest, middle insomnia, and psychomotor retardation. Up to 31.4% of the variance in Hp plasma values could be explained by psychomotor disorders, anorexia, weight loss, middle insomnia, and less diurnal variation of mood. It is suggested that hyperhaptoglobinemia, as an index of an "acute" phase response in major depression, is related to the somatic dimension of depressive illness.

Appetite stimulants in terminal care: treatment of anorexia

Anorexia is a common problem in terminally ill patients. The loss of appetite brings with it physical, psychological, and social problems. Effective treatment, therefore, should be multidimensional. The pharmacist is well-positioned to evaluate the appropriate use of medications for their effects on appetite, weight gain, mood, nausea, and anorexia. Studies have demonstrated that megestrol acetate has the most positive results in patients with advanced cancer and human immunodeficiency virus. Other medications studied have a less significant impact. Total parenteral nutrition can also sustain meaningful life for many terminally ill patients, but it is rarely successful in alleviating the anorexia associated with terminal illness.

Bombesin-induced anorexia requires central bombesin receptor activation: independence from interaction with central catecholaminergic systems

Intraperitoneal (IP) administration of bombesin (BBS; 2.5-20 micrograms/kg) induced a dose-dependent inhibition of food intake. The effect was decreased by intraventricular (ICV) administration of bombesin receptor antagonist [Leu14-psi (CH2NH)-Leu13] (3 micrograms/rat) but not by the D1 antagonist SCH 23390, the D2 antagonists sulpiride and pimozide, the dopamine antagonist cis-flupentixol, adrenoceptor blockers phenoxybenzamine or propranolol and serotonergic antagonist methergoline. It is concluded that BBS-induced suppression of feeding may be mediated through central BBS receptors, and is independent of interaction with brain catecholaminergic system.

A quantitative study of body-related attitudes in patients with anorexia and bulimia nervosa

The Ben-Tovim Walker Body Attitudes Questionnaire (BAQ) is a psychometrically sound self-report instrument for assessing women's attitudes towards their own bodies. The BAQ responses of a large sample of patients with eating disorders (ED) diagnosed in accordance with DSM-III-R criteria were compared with those from a normative population and from diverse groups of psychiatrically and physically ill patients. The ED group was distinct, and showed extreme responses in the area of weight and shape concerns. But a better discrimination between the ED and other populations was achieved using subscales that related to 'body disparagement' (an intense loathing of the body) and 'attractiveness', rather than to weight and shape concerns. ED patients may have a more pervasive disturbance in body-related attitudes than is currently widely accepted. Patients with anorexia and bulimia nervosa showed very similar attitudes despite the symptomatic differences between the groups.

Anorexia in the terminally ill cancer patient: the emotional impact on the patient and the family

Anorexia is a troublesome symptom, experienced by the majority of cancer patients. Loss of appetite in the terminally ill patient is seen as a certain sign of impending death and is a source of considerable anxiety. This study was designed to explore the ways in which terminally ill cancer patients and their primary caregivers view and respond to the patient's loss of appetite. Semi-structured interviews were conducted to elicit data. Findings suggest that loss of appetite is indeed a source of anxiety and conflict within the family, and that the amount of food and fluid taken is used as a barometer of the patient's overall condition. Findings also suggest that caregiver anxiety is more pronounced in the female than in the male because the patient's inability to eat impacts upon her customary role identity. The majority of patients viewed anorexia to be of less concern than other problems, and also voiced a preference to have their family members focus less energy on encouraging them to eat.

Anthropometric and biochemical assessment of the nutritional state in depression: evidence for lower visceral protein plasma levels in depression

Severe depression is characterized by anorexia and weight loss, symptoms that could endanger the patient's nutritional state. In order to investigate the nutritional state of depressed patients we determined the following in 113 healthy controls and depressed inpatients: (1) anthropometric variables such as body weight, ideal body weight (IBW), percentage of IBW, mean arm circumference, triceps skinfold thickness and arm muscle circumference, and (2) biochemical parameters such as albumin (Alb), prealbumin (Prealb), and transferrin (Tf). We were unable to detect any differences in the anthropometric parameters between healthy controls, minor and major depressed patients. Depressed patients exhibited significantly lower Alb and Tf levels than healthy controls. The drop in both plasma proteins was highly sensitive (72%) and specific (92%) for melancholia. These results may point towards the existence of a disorder in protein homeostasis or protein malnutrition without a marasmic component.

Methionine sulfoximine intensifies cancer anorexia

Consistent anorexia was first observed 33 days after inoculating Fischer 344 rats with methylcholanthrene-induced sarcoma. Daily treatment of a similar group of rats with the glutamine synthetase inhibitor, methionine sulfoximine, elicited significant reductions of feeding by day 29 at a dose that had no effect on nontumor-bearing rats. Blood concentrations of ammonia were elevated in both groups of tumor-bearing rats and brain ammonia level was increased in the methionine sulfoximine-treated tumor-bearing rats. Forebrain concentrations of tyrosine, tryptophan, DOPAC and 5-HIAA were elevated in both groups of tumor-bearing rats. Since ammonia is detoxified through the glutamine synthetase reaction, these results suggest that blood and brain ammonia concentrations are more important than the neurochemical consequences of ammonia detoxification for the etiology of cancer anorexia.

Who knows best? Family interaction and eating disorders

Links have been established between eating disorders and abnormal patterns of interaction between members of the sufferer's family. Faced with often contradictory information, the clinician needs to know which member of the family will give the most valid description of that family's interaction. This study demonstrated the value of the Family Assessment Device (FAD) as a measure of 'pathology' in the families of anorectic and bulimic women. Using the ability to predict the eating disorder as an index of concurrent validity, the sufferers themselves had the most realistic perceptions of their families' interactional styles.

The use of conditioned cues associated with air hunger as reinforcers: a case report

During the operant conditioning of eating behavior with a 3-year-old boy who breathed with the aid of a respirator, it was discovered serendipitiously that the patient had apparently associated certain secondary cues with the experience of air hunger. An attempt was made to use these cues as secondary reinforcers to condition eating behavior. The results were dramatic. Implications for the use of conditioned cues associated with air hunger as secondary reinforcers in the conditioning of respiratory, and possibly other, patients are discussed.

Anorexia, psychoanalysis, and feminism: fantasy and reality

Two distinct trends inform current psychoanalytic and feminist approaches to anorexia: one focuses on its roots in the fantasy, the other in the reality of childhood and adolescent deprivation and abuse. In outlining these two approaches, this article shows how both increasingly attend to the place of the mother to the neglect of the father in the genesis of anorexia--a shift of perspective somewhat redressed by systemic family therapy.

Eco-systemic analysis of anorexia nervosa

Aspects of the eco-systemic approach were used to provide a framework for the understanding of anorexia nervosa and were empirically tested by comparing 30 anorexics and their parents to 34 matched control subjects and their parents. The theoretical model employed was an adaptation of Conger's Ecological-Systems approach which was based on the principles of Bronfenbrenner's theory of human development. The subjects were compared on selected variables arising from the individual, parent, family, and community systems using (a) the California Psychological Inventory (CPI), (b) the Structural Analysis of Social Behavior (SASB), (c) the Family Environment Scale (FES), and (d) the Pattison Psychological Inventory (PPI). Discriminant analysis revealed that the Affiliation score (SASB) for the anorexic and the control subjects and the Psychopathic Deviancy score (CPI-Clinical) of the mothers of the anorexics and the controls were the variables which contributed most to the discrimination between the groups. With the Affiliation and the Psychopathic Deviancy scores alone, it was possible to correctly classify 87.5 per cent of the research subjects. Analyses also showed statistically significant results at the individual, parent, and family levels. Interactions within the family, as perceived by the anorexics, were characterized by overprotection and control by the mothers, while the anorexics themselves responded with significantly less affiliation to both their mothers and their fathers. The mothers of the anorexics also viewed their daughters as being less friendly in the relationship. The families of the anorexics were less supportive, helpful, and committed to each other than were the families of the control subjects as measured by the FES.