Holiday time can be really stressful for patients with eating disorders - here is what to do

From Mayo Clinic YouTube channel:

For people with eating disorders such as binge eating disorder, bulimia nervosa and anorexia nervosa, the holiday season can be a nightmare.

People with eating disorders usually begin to worry about food consumption at holiday gatherings weeks sometimes even months - before the event, says Leslie Sim, Ph.D., clinical director of the Mayo Clinic Eating Disorders Program. "It's really a stressful time because there are large amounts of food around."

Dr. Sim suggests a few tips to navigate through holiday gatherings:

- Have a plan. People with eating disorders should eat like they would on a normal day and not skip any meals. Make sure to eat breakfast, lunch, and a light snack in addition to the meal. People who starve themselves are more likely to skip out on the meal entirely or engage in binge eating.

- If family or friends know someone is struggling with an eating disorder, it's not a good idea to comment on their weight during a holiday gathering. Even a compliment can be taken the wrong way.

- If you're hosting a holiday gathering with plenty of food, don't take offense if someone doesn't eat.

- People with eating disorders should have a coping strategy if they begin to feel stressed during a gathering. Such tactics include deep breathing, meditation and talking to a close friend of family member.

Gambling disorders affect 0.2-5% of adults

Gambling opportunities have expanded around the world and consequently gambling disorders (pathological gambling and problem gambling) have received increased attention.

Gambling disorders affect 0.2-5.3% of adults. They are highly comorbid with other mental health and substance use disorders.

Several treatment approaches have been favorably evaluated:

- cognitive behavioral models
- brief treatment models
- pharmacological interventions

Although promising, family therapy and support from Gamblers Anonymous are less well empirically supported.

References:

Gambling disorders. The Lancet, Volume 378, Issue 9806, Pages 1874 - 1884, 26 November 2011.

Image source: United States one-dollar bill. Wikipedia, public domain.

Spectrum of gluten-related disorders: consensus on new nomenclature and classification

A decade ago celiac disease was considered extremely rare outside Europe and, therefore, was almost completely ignored by health care professionals.

Celiac disease is the most common genetically based food intolerance (1% prevalence among general population) (JAMA 2014, http://buff.ly/1cJWgFy).

In only 10 years, key milestones have moved celiac disease from obscurity into the popular spotlight worldwide.

Now we are observing another interesting phenomenon that is generating great confusion among health care professionals. The number of individuals embracing a gluten-free diet (GFD) appears much higher than the projected number of celiac disease patients, fueling a global market of gluten-free products approaching $2.5 billion (US) in global sales in 2010.

This trend is supported by the notion that, along with celiac disease, other conditions related to the ingestion of gluten have emerged as health care concerns.

This review summarized the current knowledge about the 3 main forms of gluten reactions:

- allergic (wheat allergy)
- autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia)
- possibly immune-mediated (gluten sensitivity) ("non-celiac gluten sensitivity" or NCGS)

New nomenclature and classifications are proposed (see the figures below).



Key figures:

New nomenclature and classification of gluten-related disorders - http://www.biomedcentral.com/1741-7015/10/13/figure/F1

Algorithm for the differential diagnosis of gluten-related disorders, including celiac disease, gluten sensitivity and wheat allergy - http://www.biomedcentral.com/1741-7015/10/13/figure/F4

3 million Americans are living with celiac disease

Celiac disease, an immune system reaction to gluten in the diet, is four times as common today as it was 50 years ago. Lack of awareness of celiac could be contributing to a delay of up to 11 years in diagnosis of adults in North America (http://goo.gl/sy778).

This is an informative and beautifully designed video by the University of Chicago Celiac Disease Center. It looks like an infographic made into video - have a look:



New classification is being proposed for gluten-related disorders: celiac disease; dermatitis herpetiformis; gluten ataxia; wheat allergy; gluten sensitivity. WSJ, 2012.

Recent studies support the existence of the new condition nonceliac gluten sensitivity which is defined as symptoms with negative celiac antibodies and biopsy (http://goo.gl/57IlB).

References:

Spectrum of gluten-related disorders: consensus on new nomenclature and classification. Anna Sapone et al. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13.
Image source: Colon (anatomy), Wikipedia, public domain.
Disclaimer: I am an Assistant Professor of Medicine and Pediatrics at University of Chicago.
Non-coeliac gluten sensitivity | BMJ http://bit.ly/SlOTNO

Comments from Twitter:

Karen Price @brookmanknight: reflects well what we see in clinical practice, though haven't seen or dx'd too much derm herpetiformis.

Talks at Google: Voice coach to stars Gary Catona aims to help patients with voice disorders, singers, public speakers

Voice coach to the stars Gary Catona has worked with Andrea Bocelli, Sting, Whitney Houston, and Sara Bareilles, to name just a few. The system aims to help singers, public speakers, or anyone who wants to enhance the quality of their voice - including patients. I am not aware of any randomized controlled trials backing up his claims, but the presentation is inspiring.





Related:

Voice Builder on the App Store on iTunes
https://itunes.apple.com/us/app/voice-builder/id537753638?mt=8

http://www.youtube.com/user/garyacatona/videos

How to Develop A Manly Voice | Art of Manliness - YouTube http://buff.ly/1lFtPO6

Neurological and autoimmune disorders after influenza vaccination: no change in risk for Guillain-Barré syndrome, MS, type 1 diabetes, or RA

This Swedish retrospective cohort study, published in BMJ, examined the risk of neurological and autoimmune disorders in people vaccinated against pandemic influenza A (H1N1) with Pandemrix (GlaxoSmithKline) compared with unvaccinated people over 8-10 months.


Image of the H1N1 Influenza Virus, CDC.

One million people were vaccinated against H1N1 and 900,000 remained unvaccinated.

Excess risks among vaccinated people were of low magnitude, but present, for:

- Bell’s palsy (hazard ratio 1.25)
- paresthesia (1.11)
- inflammatory bowel disease (IBD)

Risks for Guillain-Barré syndrome, multiple sclerosis, type 1 diabetes, and rheumatoid arthritis remained unchanged.

The risks of paresthesia and inflammatory bowel disease (IBD) among those vaccinated in the early phase (within 45 days) of the vaccination campaign were significantly increased; the risk being increased within the first 6 weeks after vaccination.

The risks were small but significant among more than one million vaccinated, but only in high risk groups targeted for early vaccination and who were likely to have earlier comorbidity.

The absolute risk of Bell’s palsy was low, 6.4 cases per 100 000 vaccinated population.

References:

Neurological and autoimmune disorders after vaccination against pandemic influenza A (H1N1) with a monovalent adjuvanted vaccine: population based cohort study in Stockholm, Sweden. BMJ 2011; 343:d5956 doi: 10.1136/bmj.d5956 (Published 12 October 2011).

New additions to Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

From TIME:

Doctors use the the Diagnostic and Statistical Manual of Mental Disorders (DSM)'s definitions to diagnose more 300 other conditions. Insurance companies use it to justify reimbursements; without a DSM code, mental-health patients and doctors usually don't get paid. DSM-5 is already so famous that it has its own website: http://dsm5.org

On Dec. 1, the American Psychiatric Association approved the fifth edition of the DSM which took 13 years and 1,500 mental-health experts to complete. They tried to approach mental disorders less as discrete illnesses, like leukemia, and more as problems on a continuum, like hypertension.

Here are a few of the new additions in DSM-5:

- Hoarding is included as a diagnosis, meaning those who can't get rid of ephemera can now seek reimbursement for therapy

- Binge eating was in the appendix for more than a decade, but now it's an official diagnosis

- Bereavement. The previous DSM said those in mourning don't necessarily qualify for depression therapy or medication. DSM-5 eliminates that exclusion.

- Excoriation, or skin picking, should be considered a mental illness according to DSM-5

References:

Redefining Mental Illness. TIME, 2012.

Effect of deployment on mental health of soldiers: common disorders and alcohol misuse more frequent than PTSD

This Lancet study examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009.

9990 (56%) participants completed the study questionnaire (roughly 8000 regulars, 1700 reservists).

The prevalence was:

- 19·7% for symptoms of common mental disorders

- 13% for alcohol misuse

- 4% for post-traumatic stress disorder (PTSD)

Deployment to Iraq or Afghanistan was significantly associated with alcohol misuse for regulars (odds ratio 1·22) and with post-traumatic stress disorder (PTSD) for reservists (2·83)

Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of post-traumatic stress disorder (PTSD) was low.

References:

What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. The Lancet, Volume 375, Issue 9728, Pages 1783 - 1797, 22 May 2010.

What Happened to the Marlboro Marine?

Image source: The Los Angeles Times.