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Binge eating may be triggered by a number of factors cholesterol levels by age and gender discount pravachol 20mg visa, including hunger cholesterol test kit singapore discount 20 mg pravachol with visa, negative mood cholesterol guidelines 2015 discount 20mg pravachol otc, interpersonal stressors cholesterol medication nausea generic pravachol 10mg otc, and thoughts about weight and shape. Inappropriate compensatory behaviors are strategies aimed at controlling body weight and shape, including self-induced vomiting, misuse of laxatives and/or diuretics, excessive exercising, and fasting. The purging subtype is distinguished by the presence of purging compensatory behaviors such as selfinduced vomiting or laxative misuse. The nonpurging subtype is diagnosed in the presence of only nonpurging compensatory behaviors. Individuals with Bulimia Nervosa also exhibit overconcern about their body weight and shape and usually engage in extreme dietary restriction outside of binge-eating episodes in order to control weight and shape. The dysfunctional concerns about weight and shape are typically conceptualized as the central feature or core psychopathology of Bulimia Nervosa. Bulimia Nervosa typically begins with rigid and unhealthy dieting that is motivated by the desire to be thin and lose weight. Individuals with Bulimia Nervosa attempt to limit the amount and type of food that they consume, particularly during the early stages of the disorder. Over time, they become increasingly preoccupied with thoughts of food, and episodes of binge eating alternate with periods of restriction. Vomiting, laxative misuse, and other inappropriate compensatory behaviors usually follow the onset of binge eating. Bulimia Nervosa most commonly occurs in women and usually begins in adolescence or early adulthood. In contrast to Anorexia Nervosa, individuals with Bulimia Nervosa maintain normal weight. As a result, Bulimia Nervosa is more difficult to detect than Anorexia Nervosa as physical signs are not readily apparent to the casual observer. Bulimia is often a secretive disorder, and individuals with Bulimia Nervosa typically experience guilt and shame about their behavior. Individuals with Bulimia Nervosa display rigid patterns of thinking and tend to view the world and their experiences from an "all or nothing" perspective. For example, bulimics often describe eating as being either "in control" or "out of control" and weight or appearance as either "thin" or "fat. Electrolyte disturbances represent the most serious medical complication and may lead to cardiac irregularities and, in some cases, heart failure. Inflammation and rupture of the esophagus is another serious potential complication resulting from repeated vomiting. Additional medical complications include laxative dependence, fatigue, enlarge- ment of salivary glands leading to puffy cheeks, headaches, dry skin, abrasions to fingers from inducing vomiting, and dental erosion. Numerous causal factors have been proposed as being related to the development of Bulimia Nervosa. Disturbances in such neurotransmitter systems as those of serotonin and norepinephrine have been observed, but it remains unclear whether these biological irregularities cause Bulimia Nervosa or result from the disturbed eating behaviors that characterize the disorder. Findings from several studies suggest that Bulimia Nervosa may result, in part, from dieting-based changes in serotonin functioning in vulnerable individuals. A genetic basis for bulimia is supported by family studies, which examine the clustering of disorders within families. Family studies find increased rates of eating disorders in the families of individuals with Bulimia Nervosa as compared to the families of individuals without Bulimia Nervosa. The exact role genetic factors play in the development of Bulimia Nervosa, however, remains unclear, and environmental factors clearly influence the development of the disorder. Although it is widely believed that childhood sexual abuse causes Bulimia Nervosa, there is little evidence for a specific relationship between a history of sexual abuse and the development of the disorder. The ideal female weight in Western society, often referred to as the thin ideal, has continued to decrease even as the average female weight increases. As a result, more and more women experience normative body dissatisfaction secondary to a discrepancy between their ideal and actual weight.
Stimulus generalization of an instrumental response as a function of the number of reinforced trials cholesterol foods to avoid list effective 10mg pravachol. Stimulus generalization as a function of drive level cholesterol levels while losing weight order pravachol 10 mg on line, and the relation between two levels of response strength cholesterol medication wiki pravachol 10 mg lowest price. Comparison of stimulus generalization following variable-ratio and variable-interval training cholesterol ldl hdl cheap pravachol 20 mg fast delivery. Effects of variable-interval value and amount of training on stimulus generalization. Both the severe and less intrusive stressors may influence physiological and behavioral processes, and both have been implicated in the provocation or exacerbation of a large number of illnesses, including the classical psychosomatic disorders and depressive illness, cardiovascular disease, as well as those that involve immune dysfunction. The stress response has been considered as the homeostatic or adaptive biological and/or behavioral response (allostasis) to a stimulus that is appraised as being aversive. In general, stressors elicit behavioral responses to attenuate the challenge, and concurrently peripheral and central nervous system neurochemical alterations occur that may be of adaptive significance. Among other things, they may be essential in order that animals be prepared to respond appropriately to impending as well as ongoing stressors. This system is readily stimulated not only by psychological or physical stressors but also by systemic stressors. Cortisol is thought to play an integral role in facilitating adequate responses to stressful events and may serve to prevent overshoot of immune reactions. It would be most adaptive for certain neurochemical responses to be mounted rapidly, regardless of the psychological attributes of the stressors. Those systems that are necessary for immediate responses to contend with stressors. In contrast, those central systems that are uniquely involved in the appraisal of stressors would be influenced by the psychological attributes of the stressor. It is well known, for instance, that uncontrollable stressors provoke behavioral disturbances (reminiscent of depressive states) that are not as readily induced by controllable stressors. Some investigators have interpreted these differences as reflecting learned helplessness provoked as animals learn that they have no control over their environment. Others, however, have attributed the behavioral disturbances to the neurochemical alterations that may be unique to uncontrollable aversive events. Generally, stressors promote increased utilization and synthesis of neurotransmitters within particular regions of the brain. Under conditions where behavioral control over the stressor is unavailable, greater strain is placed on neuronal systems, and consequently they may become overly taxed. The excessive utilization of neurotransmitters (or the decline of the transmitter secondary to excessive utilization) in certain brain regions may result in a net decline of the transmitter, thus leading to greater vulnerability to pathological states. In addition to the immediate effects, stressful events may proactively influence the response to later stressor experiences. It seems that stressors may result in the sensitization of processes that promote central neurochemical functioning so that reexposure to the same stressor (and even to alternate stressors) at a later time may result in the neurochemical changes occurring more readily. Thus, such sensitization processes may contribute to the induction of stressor-related illnesses even at lengthy intervals following a trauma and may be responsible for the high rates of relapse associated with illnesses such as depression. It is important to note that in addition to simple sensitization effects, cross-sensitization has been observed so that stressors increase the response to drugs such as amphetamine and cocaine. Likewise, it has been shown that the administration of cytokines, signaling molecules of the immune system, may result in a sensitization effect so that the response is vastly increased on their reexposure. Thus, in considering the impact of stressors, one should consider not only the immediate repercussions but also the increased vulnerability that develops to later stressor experiences. It is also important to note that the sensitization grows with the passage of time and hence may be a contributing factor to illnesses that likewise appear to be linked to temporal processes. The proactive effects of stressors are particularly notable among animals that had encountered distress early in life. For instance, studies in animals have shown that when pups are separated from the mother for several hours a day during early postnatal development, the adult response to stressors is particularly pronounced.
Several theories have attempted to explain the development of obsessional problems and related compulsions cholesterol estimation test buy generic pravachol 20mg on line. For example cholesterol medication weight gain buy discount pravachol 10 mg online, Mowrer (1960) described a two-stage theory how much cholesterol in one large shrimp order pravachol 20 mg, stating that a fear of specific stimuli is first learned through classical conditioning (stage 1 cholesterol guidelines chart pravachol 10mg fast delivery. Because reinforced behaviors will occur more often in the future, the frequency of rituals increases. Rituals or avoidance behavior maintain the fear response because the sufferer does not stay in contact with the stimulus long enough for the anxiety to extinguish. More recent theories for the development of obsessional problems have suggested information processing biases and deficits with respect to decision making, failures of inhibition, and memory (for a detailed review see Steketee, Frost, Rheaume, & Wilhelm, 1998). Rachman and DeSilva (1978) found that those intrusive thoughts were reported by almost 90% of a nonclinical sample. Intrusive thoughts develop into obsessions not because of their content but because of the meaning individuals attribute to them. The appraisal of the intrusion may depend on underlying beliefs or assumptions acquired in a religious, cultural, or family context. People who appraise the intrusions in a maladaptive way experience negative emotions. Thus, in seeking ways to reduce discomfort they often engage in neutralizing strategies such as overt compulsions, mental rituals, avoidance behaviors, and attempts to suppress thoughts. However, a series of thought suppression experiments suggested that efforts to suppress specific thoughts resulted in an increase rather than a decrease of those thoughts (Wegner, 1989). Faulty interpretations of intrusive thoughts have been categorized in several domains (Obsessive Compulsive Cognitions Working Group, 1997) and include overimportance of thoughts, the need to control thoughts, overestimation of threat, intolerance of uncertainty, perfectionism, and excessive responsibility. They may believe that simply because a thought occurs, it is meaningful or indicates that they will act on it. Extreme be- liefs about the importance and meaning of thoughts can lead to beliefs about having to exert control over them. For example, if an individual interprets an intrusive thought as indicating "I am evil," it is likely that this interpretation is followed by emotional discomfort and by attempts to remove the intrusion. The domain of excessive responsibility has received the most attention in recent studies and refers to the assumption that one has the pivotal power to generate or avert unwanted outcomes. Recent studies have tested cognitive treatments that address those cognitive domains (see Steketee et al. In summary, several theories have been introduced for the development of obsessional problems. Behavioral, biological, and other theories examining the cognitive aspects of the development of obsessional problems have been proposed. Current cognitive research suggests that obsessional problems are the result of maladaptive interpretations of intrusive thoughts. A better understanding of obsessional problems may result from an integration of these different areas of research. Obsessions are thoughts, ideas, images, or doubts that are experienced as senseless, unwanted, and distressing. Although the person recognizes the thoughts as irrational, they often evoke anxiety about dreaded consequences. Common themes of obsessions include contamination; terrible mistakes; violent, sexual, or blasphemous thoughts; or thoughts about things not being "just right. Examples include handwashing, checking, asking for reassurance, ordering/ arranging, repeating routine activities, counting, and mentally praying or thinking a "good" thought. For example, a person with obsessional thoughts concerning contamination from "floor germs" may spend hours washing their hands or other objects thought to be contaminated. Someone with unwanted blasphemous thoughts might repeat prayers until the thought has disappeared. Similarly, a person with fears of causing a house fire may check that appliances are unplugged. Compulsive rituals sometimes take the form of mental acts such as repeating phrases to neutralize "bad" thoughts, attempting to suppress a thought, or mentally reviewing to gain reassurance that a mistake was not made. In the first stage (fear acquisition), a natural event becomes associated with fear by being immediately paired with an aversive stimulus that evokes anxiety.
There are also genome mutations cholesterol levels natural remedies buy cheap pravachol 20 mg on-line, which involve a change in the number of chromosomes cholesterol test and fasting discount pravachol 20mg online, such as trisomy 21 (the cause of Down syndrome) cholesterol levels and alcohol buy pravachol 10mg with visa, as well as chromosome mutations cholesterol medication dangers 20 mg pravachol sale, in which the chromosomal structure is altered. Mutations can occur either in the germ cells (germ-line mutation) or in the differentiated cells of the body (somatic mutation). Indirect genotypic analysis, with investigation of the affected and nonaffected members of a single pedigree, is used in the diagnosis of disorders for which a gene locus is known but the responsible mutation(s) has not yet been determined. A malformation is a structural abnormality of an organ or part of the body in an individual whose body tissues are otherwise normal. Malformations arise during prenatal development because of primary absence or abnormality of the primordial tissue destined to develop into a particular part of the body ("anlage"). Dysplasia is malformation due to anomalous organization or function of tissues and tissue components; disorders involving dysplasia include tuberous sclerosis, neurofibromatosis, migration disorders, and various neoplastic diseases. Disruption of the growth of an organ or body part after normal (primary) primordial development can cause a secondary developmental anomaly. Mechanical influences during development can cause an anomalous position and shape (deformity) of an organ or body part. Prenatal causes include chromosomal defects, infection, hypoxia, or blood group intolerance; perinatal causes include hypoxia, cerebral hemorrhage, birth injury, adverse drug effects, and kernicterus; postnatal causes include meningoencephalitis, stroke, brain tumor, metabolic disturbances, and trauma. Paucity of spontaneous movement, abnormal patterns of movement, and delayed development of standing and walking are noted just after birth and as the child develops. Cerebral palsy frequently involves central paresis (hemiparesis, paraparesis, or quadriparesis), spasticity, ataxia, and choreoathetosis (p. There may also be mental retardation, epileptic seizures, behavioral disturbances (restlessness, impulsiveness, lack of concentration, impaired affect control), and impairment of vision, hearing, and speech. The motor disturbances produce deformities of the bones and joints (talipes equinus, contracture, scoliosis, hip dislocation). Physical, occupational, and speech therapy and perception training should be started as soon as possible. Botulinum toxin can be useful in the treatment of spasticity at certain sites (dynamic talipes equinus, leg adductors, arm flexors). If the cranial sutures have not yet fused, congenital obstructive hydrocephalus produces an enlarged head (macrocephaly) with a protruding forehead, the result of chronic intracranial hypertension. The head circumference should be measured regularly, as it is a more useful indicator of congenital hydrocephalus than the clinical signs of intracranial hypertension (p. Signs of intracranial hypertension are the most useful indicators of hydrocephalus once the cranial sutures have fused. Porencephaly Porencephaly (from Greek poros, "opening"), the formation of a cyst or cavity in the brain, is usually due to infarction, hemorrhage, trauma, or infection. Porencephaly in the strict sense of the term involves a communication with the ventricular system. Large ones reflect extensive loss of brain tissue; the extreme case is termed hydranencephaly. Porencephaly may be asymptomatic or may be associated with focal signs (paresis, epileptic seizures). Arachnoid Cysts An arachnoid cyst is a developmental anomaly of the leptomeninges (p. Symptomatic arachnoid cysts are treated neurosurgically by shunting, fenestration, or excision. Central Nervous System 291 Postural abnormalities, spasticity Malformations and Developmental Anomalies Anomalies of the Craniocervical Junction Syndrome Platybasia Occipitalization of C1 Basilar impression Symptoms and Signs Usually asymptomatic Usually asymptomatic; possible signs of medullary dysfunction Occipitocervical pain; reduced neck flexibility. Central Nervous System 293 Malformations and Developmental Anomalies changes (retinal hamartoma), and tumors (cardiac rhabdomyoma, renal angiomyolipoma, cysts). There may be marked mental retardation and behavioral abnormalities (vocal and motor stereotypy, psychomotor restlessness). Cystic cerebellar hemangioblastoma causes headache, vertigo, and ataxia, and possibly hydrocephalus by compression of the 4th ventricle. Regular screening of each potentially involved organ system is carried out so that tumors can be resected and vascular complications prevented as early as possible.