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Am Fam Physician. 2000;62(7):1680

Anorexia Nervosa

(Australia—Australian Family Physician, April 2000, p. 328.) In adolescent patients, anorexia nervosa often begins with moderate dieting, but then they become driven to be in control of their diet because they feel they have little control in other areas of their life. The disease progresses to a preoccupation with food and a distorted body image. Adolescents with anorexia nervosa commonly come from higher socioeconomic backgrounds and tend to be high-achieving perfectionists. It has been suggested that patients with anorexia nervosa may fear adult life, especially sexuality, and may have controlling and enmeshed families. Several significant medical conditions are associated with anorexia nervosa, including the side effects of long-term starvation, and the high prevalence of depression among these patients can lead to a serious risk of suicide. Diagnosis of anorexia nervosa may be difficult because of the secretive and evasive behavior that is associated with the condition. Management of anorexia nervosa often requires a multidisciplinary approach, involving nutritionists and psychologic support. Up to one half of all patients with anorexia nervosa manage to regain and sustain weight. Conversely, the mortality rate may be as high as 20 percent. The remaining 30 to 40 percent of patients will have continuing weight problems, mal-adaptive behaviors and associated medical problems.

Is Treating Elevated Lipid Levels Worthwhile?

(Australia—Australian Family Physician, March 2000, p. 223.) The true cost of long-term lipid-lowering therapy in terms of money, patient anxiety and inconvenience may be underestimated and many patients may require treatment for a few patients to benefit. Nevertheless, studies show that the relative risk of major coronary events can be reduced by about one third and that patients at highest risk benefit the most. High-risk patients include those with established coronary disease, diabetes, significantly elevated levels of low-density lipoprotein cholesterol and the presence of more than one lipid disorder. Lipid-lowering interventions are also effective in the primary prevention of coronary disease and may reduce coronary events by up to 40 percent. In comparison, smoking cessation after three years is associated with a risk reduction of major coronary events by approximately 50 percent.

Obsessive-Compulsive Disorder

(Hong Kong—The Hong Kong Practitioner, May 2000, p. 231.) The estimated lifetime prevalence of obsessive-compulsive disorder is 2.5 percent, but many cases are believed to be unrecognized. Obsessive-compulsive disorder is characterized by recurrent, persistent and distressing thoughts, impulses or images that intrude and disrupt the patient's normal activities despite attempts to ignore or suppress them. In response to these obsessions, the patient feels driven to perform repetitive actions or thought patterns. The most common behaviors associated with obsessive-compulsive disorder are washing or cleaning, compulsive checking or arranging, and, less commonly, hoarding or ritual behaviors. Obsessive-compulsive disorder is frequently associated with depression and other anxiety conditions, such as panic disorder. Treatment based on cognitive therapy, with or without medications (clomipramine, selective serotonin reuptake inhibitors or buspirone), often controls symptoms. Psychotherapy and other treatments, such as electroconvulsive therapy, do not appear to be effective.

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