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It required imagination discount reglan 10 mg on-line gastritis diet , creativity generic reglan 10mg online gastritis diet herbs, funding and persistence to even get such a package launched purchase genuine reglan on-line chronic gastritis recipes. It also required networking skills to bring on board not only fellow professionals buy cheap reglan 10 mg line gastritis diet indian, but also professionals from related but separate disciplines. In the case we studied, the GP leaders had also to negotiate with the CCG in order to gain some assurance of ongoing support and eventual ongoing funding for the new model of primary care. The CCG leaders had their own priorities and they were reluctant to devolve funding to 58 NIHR Journals Library www. This provided a stark example of clinical leaders needing to exercise unusual levels of capacity in managing ambiguity and uncertainty. Not all of those who were taking a leadership role in this venture displayed the same level of tenacity in the face of setbacks. Some were inclined to step back and revert to business as usual (that is to retreat to their normal clinical role) when faced with lack of support, but one or two were very different in that they showed persistence and determination to continue in the face of adversity. Locality level The locality level was the sublevel of the CCG where groups of practices came together to share experiences and to act as a communication channel with the CCG. It was a potential arena for the exercise of clinical leadership. So part of the [rationale] is to represent the local practices, with me as a sort of figurehead to feed things in, and represent the locality at CCG level. And indeed for me to represent CCGs in the bigger picture at locality and practice level. Locality director (emphasis added in bold) Locality working is not new. In some ways it could be argued that the influence of the locality level has decreased in this county, rather than increased, with the emergence of CCGs. This point is suggested by another locality director: The locality has no dedicated support staff. In the past it existed as an entity, as part of a primary care trust and at that time it was seen as a meaningful organisation that had staff of its own and a programme of work. Locality director A practice nurse who was interviewed endorsed this view. She observed that activity at locality level had limited impact. An influential manager working across three of the CCGs noted: My concerns about locality working is that localities can become a bit anarchic if you let them go off. You have to keep them corporate as well as giving them some freedom. CCG manager In summary, the localities (as a subsidiary level of the CCGs) are often where ordinary GPs have most direct contact with the CCG, but this is not a level where service redesign or clinical leadership had occurred to any significant degree. The exercise of clinical leadership was concentrated elsewhere. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals 59 provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. FINDINGS FROM THE CASE STUDIES Clinical Commissioning Group level This section includes the initiatives pursued both by individual CCGs and CCGs working in concert with others. There were instances in this arena of the CCG boards of some bold and significant service redesign plans and attempts. These included some unusually large outcome-based contracts which handed significant areas of service provision to new-entrant provider organisations, as well as other bold moves to reconfigure services across the county. The radical nature of these moves could be regarded as proportional to the exceptional nature of the challenges in this health economy. The national centre was taking a very direct and active interest and local leadership in the form of the senior managers were thus empowered to take the lead in an assertive way. This meant that some of the more emergent, bottom-up, clinician-led approaches to service redesign found in other cases were rather crowded out in this case, as the top-down plans were prioritised. There was substantial evidence in the interviews to testify that management in this case area was more influential than clinicians. Furthermore, it was clear that getting the finances back under control was regarded as a priority in this health economy. This may have contributed to the control taken by, and acceded to, professional managers. As a GP board member argued: Managers are in charge, and everything is driven by [them]. GP member of CCG governing body This problem of a depleted clinical leadership pipeline was frequently noted in this case, as indeed in others, but to a lesser extent than in this case. A CCG chairperson argued that a lot of time had been spent on aligning practices and getting them engaged. This chairperson then described priority actions by this CCG: So, we have a primary care strategy which is divided into six work streams. My thinking, as the director of primary care, is in a slightly different place from other managers within the organisation and some of the clinical leads. So, I think part of the challenge is to try and get some corporate thinking around this. Our local federation has worked with another provider and secured a very large fund bid. The challenge for us is sustainability and what this does in terms of our CCG operational plan and so on. This interview extract reveals starkly the tension between multiple logics and multiple agents. Thus, not all clinically led innovations – even those that brought in extra funding – were necessarily welcomed and celebrated. There has been talk by the local acute provider about moving into primary care services. There is a plan to put in a bid around urgent care which will be provider driven. Again we need to assess how all this fits within our own wider plan. CCG chairperson These observations from the chairperson of one of the more influential CCGs in the county raises questions about the difficulties in aligning the plurality of initiatives being encouraged and launched in different arenas. Hence, once again we see the complexities of leadership in practice when the context is given proper consideration. I suspect it will sort of be a natural move in one direction or the other. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals 61 provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising.

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All studies related to interventions in primary and community care purchase reglan 10 mg with mastercard gastritis diet pregnancy, including one study that randomised patients to community-based care on discharge from hospital cheap 10mg reglan with amex gastritis diet 2000. Records identified through other sources (n=11) • Citation and reference Records identified through searches reglan 10mg discount diet plan for gastritis sufferers, n=3 database searching • Hand-searches order reglan 10mg without a prescription gastritis symptoms vs. heart attack, n=7 (n=10,244) • Expert suggestion, n=1 Records after duplicates removed (n=6621) Records screened Records excluded (n=6621) (n=6406) Full-text articles Full-text articles assessed for eligibility excluded, with reasons (n=215) (n=202) • No routine data emergency admission risk prediction model involved, n=143 Articles included in review • Development or validation (n=13 from 11 studies) of a risk model only, n=21 • Non-primary care setting, n=9 • From database searches, n=8 • No empirical data • From other sources, n=5 (e. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals 9 provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. T ua lity a ssessm en to fq ua n tita tive p a p er s D a ta co llecti ithdr a w a ls ver a ll q ua lity A utho ( yea r fp ublica ti Selecti bia s esign f un der s li di g etho ds a n d dr uts a ti g B ak eretal. W eak oderate W eak W eak S trong oderate W eak D h alla etal. S trong S trong oderate W eak S trong S trong S trong F reund etal. W eak W eak W eak W eak W eak oderate W eak L ev i ne etal. W eak S trong oderate oderate oderate oderate oderate R ei lly etal. W eak S trong oderate W eak oderate oderate W eak U pati si ng etal. W eak S trong oderate W eak oderate oderate W eak T ua lity a ssessm en to fq ua lita tive p a p er s A utho Sco e a n d Sa m li g thica l Releva n ce a n d ver a ll q ua lity ( yea r fp ublica ti ur se esign sta tegy a lysis ter eta ti Reflexivity di en si s ta n sfer a bility a ti g A belletal. A no orfew flaw s, th e study credi bi li ty, transferabi li ty, dependabi li ty and confi rmabi li ty i s h i g h ; some flaw s, unl ely to affectth e credi bi li ty, transferabi li ty, dependabi li ty and/ or confi rmabi li ty ofth e study; some flaw s w h i ch may affectth e credi bi li ty, transferabi li ty, dependabi li ty and/ orconfi rmabi li ty ofth e study. T ha r a c ter istic s o fin c luded studies A utho ( yea r a ta co llecti o fp ublica ti un ty i esign a n d etho ds escr i ti fi ter ven ti s co ver a ge A belletal. S pai n tool users ( 1 Ps and 1 nurses) i denti fy targ etpopulati ons forserv i ces such as secondary prev enti on acti v i ti es by pri mary care practi ce staffforpati ents w i th h yperch olesterolaemi a, h i g h blood pressure, ortype 2 di abetes melli tus, not sufferi ng h eartfai lure ori sch aemi c h eart di sease B ak eretal. Pati ents i denti fi ed th roug h use of pri l2 to ( 2 reduci ng unplanned h ospi tali sati ons omparati v e analysi s ofA Pv s. S outh - w est o compare pati entselecti on for Observ ati onalstudy compari ng S tudy relates to testi ng performance of ( 2 ermany care manag ementi nterv enti ons pati ents selected by predi cti v e model predi cti v e ri sk tool as partofi nterv enti on by ph ysi ci ans and by predi cti v e w i th th ose selected by ph ysi ci ans dev elopmentprocess modelli ng F reund etal. S outh - w est o explore h ow ph ysi ci ans select uali tati v e: i nterv i ew s w i th S tudy relates to v i ew s aboutuse of otreported ( 2 ermany pati ents forcare manag ement ph ysi ci ans from pri mary care predi cti v e ri sk toolto i denti fy pati ents and h ow ri sk predi cti on may practi ces forcase manag ement as partof complementth ei rcase fi ndi ng i nterv enti on dev elopmentprocess H alletal. R outi ne pati ent- speci fi c h ealth educati on; condi ti ons atri sk ofh ospi tali sati on data, costs and teleph one pati ent self- manag ementorcareg i v er sati sfacti onquesti onnai res. V ari ous case fi ndi ng meth ods a rang e ofpri mary care staff( e. October2 used i ncludi ng predi cti v e ri sk communi ty matrons, di stri ctnurses, coh ortanalysi s strati fi cati on and di rectreferral communi ty nurses) across 1 PC s h andsearch i ng R oland etal. Predi cti v e ri sk toolnotnecessari ly part S taffquesti onnai res: ( 2 care pi lots nalysi s ofsecondary care uti li sati on ofi nterv enti on. V i rtualw ards, w i th summer2 and usi ng S data on 3 pati ents and nurse- led case manag ement Plus focus spri ng Pati ent 1 match ed controls. V ari ous on deli v ery system redesi g n and questi onnai res: case fi ndi ng meth ods used i ncludi ng i mprov ed cli ni cali nformati on systems autumn 2 and predi cti v e ri sk tools. R och ester o determi ne th e di fference i n R C li g i bi li ty fortri aldetermi ned by h e telemoni tori ng i nterv enti on i ncluded ov ember2 to ( 2 S A h ospi tali sati ons and emerg ency use ofpredi cti v e modelforri sk of usualmedi calcare and telemoni tori ng J uly 2 room v i si ts i n olderadults usi ng readmi ssi on ( E R A llpati ents case manag ement si ng telemoni tori ng telemoni tori ng v s. H ome h ealth care i ncludes prov i si on of h ome h ealth nursi ng and/ orph ysi caland occupati onalth erapi stv i si ts c T ha r a c ter istic s o fin c luded studies A utho ( yea r a ta co llecti o fp ublica ti un ty i esign a n d etho ds escr i ti fi ter ven ti s co ver a ge U pati si ng etal. R och ester o ev aluate th e effecti v eness of S econdary analysi s ofR C data. H ome h ealth care i ncludes prov i si on of h ome h ealth nursi ng and/ orph ysi caland occupati onalth erapi stv i si ts A P, anti ci patory care planni ng ; f/ t fullti me; S , ospi talE pi sode S tati sti cs; multi di sci pli nary team; O occupati onalth erapi st p/ t partti me; R C randomi sed controlled tri al W w h ole- ti me equi v alent DOI: 10. Risk tools identified The majority of studies reported the use of a single tool predicting emergency admissions to hospital. Three studies reported findings relating to the use of multiple risk tools, as applied in different PCT 48 52 56, , areas, although none provided a disaggregation of results by area or tool used. The Patients at Risk 48 49 52 54 55, , , , of Re-hospitalisation (PARR) tool was used in five studies. PARR uses data on prior hospitalisations to predict risk of rehospitalisation and, hence, calculates risk only for those patients with a previous 48 49 52, , admission. The combined predictive model was reported in three studies, with single references to the Elder Risk Assessment (ERA),50 Case Smart Suite Germany,46 Length of stay, Acuity, Comorbidities, ED visits in previous 6 months (LACE),45 Nairn Case Finder,44 High Impact User Manager52 and Adjusted Clinical Groups (ACGs). The LACE tool predicts risk within 30 days45 and the ERA tool51 predicts risk within 24 months. The time span for the ACG tool used in Sauto Arce et al. Only one paper explicitly addressed risk tool technical performance – Baker et al. A number of 45 48 50, , –55 papers did include a reference to resources where details of the development and validation of the respective risk tools could be found. No technical performance details or references were included in 46 47 56, , three papers. Risk tools users 47 48 55, , Identification of who used the risk tools was included in all studies, except three (Table 6). Interventions Predictive risk stratification was generally used as a tool for identifying patients suitable for a further intervention (e. In some cases, a predictive risk tool was used as one of several methods of case-finding. No studies reported comparative data about processes or outcomes related to predictive risk stratification. In each of the RCTs, predictive risk tools were used to identify patients eligible for the trial – and were therefore used in both trial arms. With regard to the follow-on (secondary) interventions, eight of the studies focused on case (or care) 44–48 52 54 55, , , management of patients at high risk of emergency admission to hospital. Two studies featured 46 50, the use of telemedicine as part of an overall package of care. A range of primary care and community staff delivered, or were proposed to deliver, these secondary interventions. This included the use of 48 52 54 55, , , 54 community matrons – senior nurses with a care co-ordination function, who were introduced following Department of Health funding in support of the care of patients with long-term conditions. The virtual ward model is based on the use of predictive models to identify those at risk of emergency admission, and the provision of a period of intensive, multidisciplinary case management at home using the processes and staff associated with hospital wards. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals 15 provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. T S um m a r y o fr isk m o dels A utho ( yea r Risk p edicti utco e a n d ti e s a n ula ti isk m del o fp ublica ti del fr isk m del V a lida ti a p lied t U ser so fr isk m del a se selecti etho d A belletal.

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Because the whole illness is not being modeled buy reglan 10mg mastercard gastritis diet mango, the sets of symptoms may have different underlying substrates endophenotype approach affords greater possibility for con- and thus may be ameliorated by different treatments generic 10 mg reglan fast delivery gastritis disease definition. There- struct and predictive validity in the model cheap reglan 10mg gastritis diet 91303, and can incorpo- rate species-specific manifestations of the core process being modeled order 10 mg reglan with visa gastritis diet 8 day. This approach may also make screening for ge- VaishaliP. Kalin: DepartmentofPsychiatry,Univer- sity of Wisconsin at Madison, Wisconsin Psychiatric Institute and Clinics, netic abnormalities associated with the disorder more fruit- Madison, Wisconsin. Moreover, heterogeneity among other variables, the nature of the perceived threat within a diagnostic category could potentially dilute the (14,15). Studies of defensive behaviors in rhesus monkeys strength of a sample population (i. Ideally, one might be able to generate occur in dispositionally fearful humans who have an in- several different endophenotypes for a particular disorder, creased risk to develop psychopathology (16). In other words, pathologic anxiety could be concep- definition and use of endophenotypes in animal models of tualized as the inappropriate expression of defensive or fear- psychiatric illness is a developing area. This chapter presents related behaviors, consisting of either an exaggerated or some promising candidates of animal models of fearful and overly fearful response to an appropriate context, or a fearful anxious endophenotypes, and outlines some of the prelimi- response to an inappropriate or neutral context. Although nary genetic factors that have been identified to contribute appropriate levels of defensive behaviors in response to envi- to the manifestation of these endophenotypes. Thus, in- FEARFUL TEMPERAMENT appropriate or exaggerated expression of defensive behaviors may represent an important animal endophenotype of anxi- Defensive Behaviors ety. An understanding of the specific neural substrates un- In an attempt to understand the basic neural mechanisms derlying the expression and regulation of defensive behav- underlying psychiatric conditions involving fear and anxi- iors may therefore ultimately shed insight into the processes ety, several groups have focused on identifying the neural that become dysregulated in stress-related psychopathology. Defensive be- In defining animal endophenotypes relevant to anxiety, spe- haviors are exhibited by a wide array of species including cific symptoms of a particular type of anxiety disorder are rats, nonhuman primates, and humans in response to per- not being modeled, but rather the general phenomenon of ceived threats from the environment, and are essential com- hyperreactivity to mildly stressful stimuli is studied. Because organisms display defen- iors in animals has been described previously for rodent sive behaviors in reaction to threat, it is thought that the models (17,18). In the following sections, both primate and aberrant expression of defensive behaviors may represent a rodent analogues of stress hyperresponsiveness are de- good example of a fearful endophenotype that would have scribed, with a particular emphasis on models of either the relevance to stress and anxiety-related disorders. Although overly intense but context-appropriate expression of defen- the specific behavioral responses that compose defensive be- sive behaviors or the normal but context inappropriate haviors are dependent on the environmental context and expression of defensive behaviors. Because specific examples of fearful endophenotypes that have been defensive behaviors are expressed in response to an immedi- identified using these tests are discussed. One defensive response pattern Paradigm expressed by many species is to inhibit all body movements and assume an immobile or freezing posture. In the cial relevance for understanding psychopathology. A human in- paradigms including the elevated plus maze (composed of truder then enters the test area, representing a potential safer closed, dark arms versus riskier open bright arms), the predatorial threat to the animal (14,15,19). The test session open field (consisting of a darker wall-bordered peripheral consists of three consecutive brief conditions: alone ('A,' portion versus a brighter open center section), a light-dark animal left alone in cage); no eye contact ('NEC,' animal transition box (consisting of an exploratorium divided into presented with the facial profile of a human standing 2. The NEC condition causes a reduction in cooing Conditioned Fear and an increase in behavioral inhibition, which functions to help the monkey remain inconspicuous in the face of a Behavioral tests that measure conditioned fear utilize basic predator and is often manifested as hiding behind the food principles of Skinnerian conditioning. The ST condition elicits aggressive (open- paradigms to assess fear conditioning are conditioned freez- mouth threats, lunges, cage shaking, barking vocalizations) ing and fear-potentiated startle. Conditioned freezing is eval- and submissive (lip smacking, fear-grimacing) behaviors uated using a two-step procedure. First, during the training that represent adaptive responses to the perceived threat of or conditioning phase, a stressful unconditioned stimulus the staring experimenter. The different test conditions (A, (UCS, such as a foot shock) that elicits freezing is paired NEC, ST) reliably elicit responses in young or adult labora- with a neutral stimulus that subsequently becomes a condi- tory-reared monkeys or in feral animals (14,19). On the test day, the amount of freez- these context-specific defensive responses are not dependent ing in response to the CS is assessed; animals that have on the gender of the intruder, and can also be elicited by not undergone the CS-UCS pairing do not normally freeze showing the animal a videotape of the intruder (Kalin et when the CS is presented, but animals that have learned to al. The Endophenotype in Rodents level of conditioned freezing is thought to correspond to To identify fearful endophenotypes in rodents, a variety the level of fear or anxiety that the animal is experiencing of behavioral paradigms have been employed. The behavioral tests measure one of four general cate- previously with shock. The startle response is markedly in- gories of stress-related behavior: approach-avoidance con- creased when the startling stimulus occurs in the presence flicts, conditioned fear, aggression, and punished of the CS; this relative increase in startle magnitude is quan- responding conflicts. Detailed descriptions and protocols tified, and serves as an index of the level of fear (thought for these tests can be found in a recent review by File and to be elicited by a discrete cue as the CS) or anxiety (thought colleagues (22). The study of defensive aggressive behaviors ment that seems novel but risky (usually bright, wide open, has been summarized and reviewed by a number of investi- large spaces). The entries into and amount of time spent gators (26–28). A number of flight, freezing) of a male intruder are measured. Other 886 Neuropsychopharmacology: The Fifth Generation of Progress stress-related paradigms involve the study of affiliative be- specific defensive responses. These defensive responses have haviors and include the social interaction test in which ap- been characterized using the HIP (see previous section). For proach toward and contact between two rats is measured example, some monkeys tend to coo frequently during the (e. A condition (in which the animal is isolated), whereas other same-aged animals engage in little or no cooing. Large indi- vidual differences have also been observed in the duration Punished Responding Conflict of NEC-induced freezing (in the presence of a human pro- The basic principle of punished responding tests is to pre- file) and ST-induced hostility (in response to direct eye sent the animal with a situation in which a particular behav- contact with the human intruder). Some animals freeze the ioral response results in both a rewarding outcome and an entire length of the test period, whereas at the other extreme aversive outcome. The extent to which the animal exhibits some never freeze and act relatively undisturbed by the the behavioral response during the conflict schedule is used human intruder. These individual differences in fear-related as an index of its level of stress. For example, in the classic responses seen in the laboratory are similar to those that Geller-Seifter conflict test (29), rats are trained to press a have been observed in rhesus monkeys who inhabit Cayo lever for a food reward. Gradually, the bar press is also paired Santiago, a 45-acre island with approximately 1,000 free- with a mild foot shock, and a stable rate of responding is ranging monkeys (Kalin et al. For example, benzo- suggesting that the intensity of defensive behavior that is diazepines have been found to increase bar-pressing during displayed reflects a trait rather than a state characteristic. It the conflict schedule, putatively by decreasing the stress or was initially demonstrated that the duration of NEC- anxiety induced by the aversive stimulus. Similarly, in the induced freezing behavior remained stable in 12 animals tested twice with an interval of 4 months (r. Using Vogel punished drinking paradigm (30), thirsty rats with ac- a larger sample size, the stability of NEC-induced freezing cess to a water bottle are periodically given mild electric was confirmed; ST-induced hostility was also found to be shocks through the spout of the bottle; the extent to which relatively stable (Kalin et al. Interest- licking is decreased is used as an index of stress. Thus, monkeys that exhibited extreme INDIVIDUAL DIFFERENCES IN DEFENSIVE levels of NEC-induced freezing did not necessarily display BEHAVIORS: NATURALLY OCCURRING extreme levels of ST-induced hostility. For example, manipulations of the opiate system affect characteristic (which in part may be derived from the nature A (alone condition)–induced cooing without affecting of early postnatal maternal interactions, see below).

The case for biology in aetiology of anorexia nervosa buy genuine reglan on-line chronic gastritis recipes. The validity of frequency or weight in obese binge eaters proven 10 mg reglan gastritis problems symptoms. Stunkard and co-workers (86) found that the restricter distinction in anorexia nervosa: parental personality characteristics and family psychiatric morbidity order 10 mg reglan visa gastritis diet . J Nerve Ment appetite suppressant d-fenfluramine generic reglan 10mg gastritis symptoms loose stools, which has since been Dis 1982;170(6):345–351. Personality features of women with good outcome cebo among 28 obese women with BED in reducing binge from restricting anorexia nervosa. Psychosom Med 1990;52(2): frequency; however, surprisingly, not in promoting weight 156–170. Nevertheless, fluvoxamine compared with placebo was orexia nervosa after long-term weight restoration: response to associated with significant reductions in both binge fre- d-fenfluramine challenge. Personality and symptomatological features in young, in particular. Approximately one-third of obese individuals nonchronic anorexia nervosa patients. J Psychosom Res 1980; presenting to weight loss clinics meet diagnostic criteria for 24(6):353–359. BED; therefore, effective treatments for this disorder may 12. Personality variables and disorders in an- orexia nervosa and bulimia nervosa. J Abnorm Psychol 1994; be of widespread clinical utility. Am J Psychia- ber of important issues are unresolved. BED have disturbances in eating behavior by definition, 14. Ten-year follow-up of 50 patients with bu- and are typically overweight and exhibit symptoms of anxi- limia nervosa. Bulimia nervosa: a 5- ety and depression in clinical samples. Alterations in serotonin it is surprising that the response of these presumably related activity and psychiatric symptomatology after recovery from bu- symptoms to medication is at least somewhat inconsistent, limia nervosa. Outcome, recovery, relapse and mor- tality across six years in patients with clinical eating disorders. A major problem in the develop- Psychiatr Scand 1993;87(6):437–444. L-Dopa as treatment for anorexia ner- response of binge eating to nonspecific interventions, in- vosa. In part for this reason, the effects of medi- Press, 1977:363–372. Treatment of compulsive eating disturbances once medication has been discontinued. Am J Psychol 1974;131: the role of pharmacotherapy for BED currently unresolved, 428–432. The use of diphenylhydantoin in compulsive studies to examine the potential benefits of combining med- eating disorders: further studies in anorexia nervosa. New York: Raven Press, 1977: ication with psychological treatment, especially CBT. Naloxone in the treatment of REFERENCES anorexia nervosa: effect on weight gain and lipolysis. In: Kaplan HI, Freedman AM, noses in anorexia nervosa. Comprehensive textbook of psychiatry, vol 2, 3rd 712–718. A comparative psychometric family therapy in anorexia nervosa and bulimia nervosa. Arch study of anorexia nervosa and obsessive neurosis. Long term follow-up of therapy in the short-term treatment of anorexia nervosa. Neuroleptics in the short-term treatment of vosa in women with obsessive compulsive disorder. Int J Eating anorexia nervosa: a double-blind, placebo controlled study with Dis 1986;5:1069–1075. J Clin Psy- activity in anorexia nervosa after long-term weight restoration. Obsessive-compulsive disorder: psychobiologi- treatment of anorexia nervosa. Int J Eating Dis 2000;27(3): cal approaches to diagnosis, treatment, and pathophysiology. Antiserotonin-antihista- 9-tetrahydrocannabinol in primary anorexia nervosa. J Pharmacol Exp Ther 1961; chopharmacol 1983;3:165–171. Cyproheptatadine in an- crossover study of oral clonidine in acute anorexia nervosa. Biol Psychiatry 2001;49(7): cisapride accelerates delayed gastric emptying and increases antral 644–652. Does fluoxetine augment the Garner DM, Garfinkel PE, eds. Diagnostic issues in anorexia ner- inpatient treatment of anorexia nervosa? Effects of carbohydrate depressive illness: a review of 11 studies. Comp Psychiatry 1988; and protein meals on plasma large neutral amino acids, glucose 29:427–432. Am J Psychol weight subjects normalize after weight gain. Amitriptyline in the increases serotonin transporter (SERT) binding sites and SERT treatment of anorexia nervosa: a double-blind placebo-controlled mRNA expression in discrete regions of female rat brain. In: Schatz- trial of lithium carbonate in primary anorexia nervosa. Washington, monoamine metabolism in anorexia nervosa. Arch Gen Psychiatry DC: American Psychiatric Press, 1993:49–70.

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