Anxiety and depression in patients with acute leukaemia treated with hematopoietic stem cell transplantation.

BACKGROUND: Acute leukemia and hospitalization for hematopoietic stem cell transplantation (HCT) are the great psychological stressors. The aim of this study was to assess anxiety and depression associated with such conditions and their psychophysical predictors before and after HCT. SUBJECTS AND METHODS: We conducted a longitudinal study using self-descriptive tools. The questionnaires: LOT-R, AIS, Mini-Mac, CECS, RSCL and HADS were filled by 60 patients with acute leukaemia before and after HCT. RESULTS: Anxiety and depressive symptoms correlated positively with psychological symptom distress. The correlation with depressive symptoms was weak, however, with anxious symptoms was moderate. In both cases, the higher was a level of psychological symptom distress, the higher level of anxiety and depression was observed in patients. The results indicated the weak, positive correlation between onerousness of physical symptoms and a level of anxiety. The greater was the severity of physical symptoms, the higher was the level of anxiety. The negative predictor of anxious symptoms was control of anxiety but it was weakly associated with a lower level of the explained variable. The negative predictor of anxious symptoms was also dispositional optimism whose high level accompanied the lower severity of the explained variable. However, the positive predictor of anxious symptoms was the variable of onerousness of symptoms whose high level accompanied the higher severity of anxious symptoms in the examined group CONCLUSION: Patients with acute leukemia who are hospitalized for HCT require detailed monitoring of their psychological distress to introduce the proper psychological and pharmacological interventions that reduce anxiety as well as boost "dispositional optimism" and mechanisms of control.

Quality of Life and Mental State After Sight Restoration by Corneal Transplantation.

BACKGROUND: Quality of life has frequently been reported to improve after corneal transplantation. However, mental status before and after surgery has until now been less well investigated. OBJECTIVE: The aim of this study was to investigate quality of life and mental status before and after corneal transplantation including postoperative immunosuppression and visual acuity. METHODS: A total of 45 patients were assessed before, and 3 weeks and 4 months after transplantation using the following questionnaires: Visual Function Questionnaire, Beck Depression Inventory, and Hamilton Anxiety Rating Scale. Assessment included a visual acuity test using the logMAR chart, and recognition of the role of postoperative immunosuppression. Finally, patients were asked if they would be willing to have the surgery again. RESULTS: In the candidates for surgery, quality of life was reduced, and symptoms of depression and anxiety were present. Corneal transplantation improved their quality of life and reduced symptoms of depression and anxiety. Changes in quality of life and in mental state were associated with a change in visual acuity in the grafted eye. Higher doses of prednisone were associated with a worse quality of life and with more severe symptoms of depression and anxiety after transplantation. Further, 82.5% of patients would have the surgery again. CONCLUSION: Assessment for psychiatric symptoms should be considered in individuals facing corneal surgery.

Effects of hormones on cognition in schizophrenic male patients--preliminary results.

BACKGROUND: Schizophrenia is a prevalent neurodevelopmental disorder of an unknown etiology and a variable phenotypic expression. In the recent years, the impact of hormones on the course of schizophrenia has been investigated. This study is aimed at assessing the level of correlating serum levels of hormones in schizophrenic male patients with their cognitive functioning measured with neuropsychological tests. SUBJECTS AND METHODS: In the index group there were 15 medicated male schizophrenic patients. In the control group there were 15 age and education matched healthy men. All subjects underwent analysis of serum hormones level (TSH, testosterone, estradiol, FSH, LH, progesterone and prolactin) and a battery of tests (Trail Making Test A and B, Stroop Test, Verbal and Semantic Fluency Test). RESULTS: The mean serum levels of the following hormones were higher in the index group than in the control group: TSH (1.76 mIU/L vs 1.58 mIU/L; p=0.66), progesterone (0.85 ng/ml vs 0.69 ng/ml; p=0.22) and prolactin (558.71 uIU/ml vs 181 uIU/ml; p=0.025). The mean levels of estradiol (24.36 pg/ml vs 25.40 ng/ml; p=0.64), FSH (3.17 mIU/ml vs 5.72 mIU/ml; p=0.019), LH (3.85 mIU/ml vs 5.77 mIU/ml; p=0.056) and testosterone (2.90 ng/ml vs 5.38 ng/ml; p=0.003) were higher in the control group. In the index group there were significant negative correlations between FSH and semantic fluency (ρ=-0.678606), progesterone and: TMT B (ρ=-0.586763), Stroop 1 (ρ=-0.701880) and Stroop 2 (ρ=-0.601074) and prolactin and TMT A (ρ=-0.579607). CONCLUSIONS: The preliminary results of our study show that serum levels of FSH and testosterone are significantly lower, whereas the level of prolactin is markedly higher, in schizophrenic male patients than in healthy men. There is an inverse correlation between serum levels of progesterone, FSH and prolactin and the results of certain cognitive functioning tests in schizophrenic men.

Modern indications for the use of opipramol.

Opipramol is considered as a pharmacological agent that does not fit the classification taking into account the division of antidepressants, antipsychotics and anxiolytics. It has a structure related to tricyclic antidepressants but it has a different mechanism of action, i.e. binding to sigma1 and to sigma2 sites. It has been regarded as an effective drug in general anxiety disorders together with other agents like SSRI`s, SNRI`s, buspirone and pregabalin for many years. It can however also be indicated in other conditions, e.g. it may be used as a premedication in the evening prior to surgery, positive results are also observed in psychopharmacological treatment with opipramol in somatoform disorders, symptoms of depression can be significantly reduced in the climacteric syndrome. The latest data from literature present also certain dangers and side effects, which may result due to opipramol administration. Mania may be induced not only in bipolar patients treated with opipramol, but it can be an adverse drug reaction in generalized anxiety disorder. This analysis shows however that opipramol is an important drug still very useful in different clinical conditions.

Depressiveness, symptoms of anxiety and cognitive dysfunctions in patients with asthma and chronic obstructive pulmonary disease (COPD): possible associations with inflammation markers: a pilot study.

Psychiatric symptoms of anxiety, depression and cognitive dysfunction often occur in patients suffering from somatic conditions such as asthma and chronic obstructive pulmonary disease (COPD) which constitute a major and growing public health problem. In the present study we therefore aimed at analyzing depressive symptoms as well as symptoms of anxiety and cognitive problems in patients with mild to moderate asthma and COPD. 59 participants-17 with asthma, 24 with COPD and 18 healthy controls were enrolled. Depressiveness was assessed with the beck depression inventory (BDI); anxiety symptoms were measured with the State-Trait Anxiety Inventory Part 1 and 2, and cognitive function levels were estimated with the Trail Making Test Part A and B. A score above the threshold indicative for depression was found by 33 % (n = 8) of COPD patients, 29 % (n = 5) of asthma patients compared to 0.05 % (n = 1) of the control group. Clinically relevant anxiety levels were found in 42 % (n = 10) of the COPD group, 41 % (n = 7) of the asthma patients and 17 % (n = 3) of the controls. Patients with COPD performed significantly worse on the TMT than other groups. Psychoemotional state and cognitive functions were found to be correlated with exposure to tobacco smoke (measured in pack-years) and airway obstruction (measured with FEV1). In conclusion, patients with mild to moderate asthma and COPD exhibit significantly higher levels of depressive and anxiety symptoms as well as cognitive dysfunctions than controls. The prevalence of these symptoms is related to the amount of exposure to tobacco smoke and the severity of airflow obstruction.

Delirium Screening in Cardiac Surgery (DESCARD): a useful tool for nonpsychiatrists.

BACKGROUND: The aim of the study was to set up and validate a predictive scoring system for nonpsychiatrists to facilitate screening of postoperative delirium in cardiac surgery patients. METHODS: The project was conducted as a cohort study in 5781 subjects. More than 100 pre- and perioperative somatic variables were collected to build up an algorithm. Delirium was diagnosed using Diagnostic and Statistical Manual of Mental Disorders 4th edition. The patient cohort was divided into a training and validation set to perform cross-validation. Scoring systems (Delirium Screening in Cardiac Surgery [DESCARD] tool) were developed for the set of sole preoperative and all perioperative risk factors. RESULTS: Delirium was found in 236 patients (4.1%). The preoperative model comprised age, weight, total protein concentration, arterial hypertension, mode of surgery (elective/urgent/emergent), preoperative fasting glucose, and form of diabetes treatment (diet/oral agents/insulin). Taking into account all the perioperative variables, the scoring system included postoperative cerebral ischemia and the need for red blood cell transfusion, and arterial hypertension and mode of surgery were excluded. Both pre- and perioperative tools had an excellent overall diagnostic accuracy (area under receiver operator characteristics curve = 0.83 and 0.89, respectively) with higher specificity (92% and 93%, respectively) than sensitivity (60% and 69%, respectively). CONCLUSIONS: The DESCARD tool might be effective in screening of patients at risk of postoperative delirium and can be easily used by all nonpsychiatrists involved in the care of cardiac surgery patients.

Detailed insight into the impact of postoperative neuropsychiatric complications on mortality in a cohort of cardiac surgery subjects: a 23,000-patient-year analysis.

OBJECTIVES: This study sought to evaluate the impact of postoperative delirium with/without cerebral ischemia on short- and long-term mortality in a large cohort of cardiac surgery patients. DESIGN: The study constituted a prospective cohort observation of patients following various cardiac surgery procedures. SETTING: The investigation was conducted in a single high-volume tertiary cardiac surgery center. PARTICIPANTS: Consecutive candidates for cardiac surgery (n = 8,792) from 2003 to 2008 were subjected to the following exclusion criteria: History of any psychiatric disorders, alcohol abuse and intake of psychoactive drugs and incomplete data. INTERVENTIONS: No additional interventions were performed, except for standard perioperative management. MEASUREMENTS AND MAIN RESULTS: 5,781 patients finally were assigned to cohorts depending on the presence of postoperative delirium with/without cerebral ischemia and then prospectively followed up over the median time of 46 months. Overall 30-day mortality in patients with delirium was 15.25%, including 6.43% of patients without and 38.46% of subjects with cerebral ischemia. After adjustment for more than 100 perioperative variables, short-term mortality was associated independently with delirium (OR = 3.735), stroke (OR = 5.698), hypertension (OR = 0.333), urgency of surgery (OR = 13.018), baseline plasma glucose and protein concentrations and blood transfusions (AUROC for the model 0.94). Long-term mortality in patients who developed delirium was 23.31%, including 15.2% of patients without and 44.62% of those with postoperative stroke. Long-term mortality independently corresponded with stroke (HR = 3.968), urgent surgery (HR = 27.643), baseline plasma glucose and protein concentrations, chronic obstructive pulmonary disease and blood transfusions. Impact of postoperative delirium was insignificant (p = 0.2). Compared to subjects with cerebral ischemia, death in patients only with delirium was less frequently of cardiovascular cause (p < 0.01). CONCLUSIONS: Delirium with/without cerebral ischemia significantly worsened the short-term prognosis. Stroke, yet not delirium, considerably increased the long-term mortality, especially of cardiovascular origin.

Complex assessment of the incidence and risk factors of delirium in a large cohort of cardiac surgery patients: a single-center 6-year experience.

BACKGROUND: Previous reports provided inconsistent data on the occurrence of postoperative delirium and emphasized its considerable impact on outcome. This study sought to evaluate the incidence and predictors of delirium, together with its relation to cerebral ischemia in a large cohort of cardiac surgery patients in a tertiary high-volume center. METHODS AND RESULTS: Consecutive patients (n = 8792) were prospectively enrolled from 2003 to 2008. Exclusion criteria were history of psychiatric disorders, use of psychoactive drugs, alcohol abuse, and data incompleteness. Finally, 5781 patients were analyzed in terms of 100 perioperative patient-specific and treatment variables. The incidence of postoperative delirium (DSM IV criteria) was 4.1% and it coexisted with cerebral ischemia in 1.1% of patients. In bivariate analysis, 49 variables were significantly linked to postoperative delirium. Multivariate analysis confirmed that delirium was independently associated with postoperative stroke (logistic odds ratio (logOR) = 2.862, P = 0.004), any blood transfusions (logOR = 4.178, P < 0.0001), age > 65 years (logOR = 2.417, P = 0.002), carotid artery stenosis (logOR = 2.15, P = 0.01), urgent/emergent surgery (logOR = 1.982, P = 0.02), fasting glucose level, intraoperative oxygen partial pressure fluctuations, and hematocrit. Area under ROC curve for the model was 0.8933. CONCLUSIONS: Early identification of nonpsychiatric perioperative determinants of delirium facilitates its diagnosis and might help develop preventive strategies to improve long-term outcome after cardiac surgery procedures.

[Evaluation of anxiety and depression in the perioperative period in patients subjected to myocardial revascularization]. / Ocena leku i depresji w okresie okolooperacyjnym u pacjentów poddawanych rewaskularyzacji miesnia sercowego.

AIM: The aim of the paper is to define a relationship between the anxiety level and depression intensification, as well as to define the impact of: age, sex, education level and family situation on the anxiety level and depression intensification in the pre- and postoperative period in patients subjected to myocardial revascularisation (CABG). METHOD: Prospective studies were carried out in a group of 100 patients qualified for the surgical myocardial revascularisation in the planned course. The Polish version of the STAI questionnaire was applied to study anxiety as a state and as a trait. Depression intensification was evaluated with the Beck depression scale. RESULTS: 1. The intensity of depression significantly correlates with anxiety as a state and anxiety as a trait before and after CABG surgery. 2. When assessing anxiety as a state, its negative correlation with male patients and with age before CABG were found. A negative correlation of anxiety as a state with a patient's age was identified after CABG. 3. When assessing anxiety as a trait, its negative correlation with male patients before CABG was found. 4. The intensity of depression correlates significantly and negatively with the educational background of the patient before and after CABG surgery. 5. There is no statistically significant correlation between anxiety, depression and family situation in the perioperative period.

Eating disorders in Silesian schools - pilot study.

BACKGROUND: Modern media have a huge impact on eating habits, which result in pathologies among young people, especially females. Fashion models have become a pattern for ordinary women, however the difference in a mean weight between these two groups is increasing. The aim of the study was to assess the correlation between school students' results in EAT-26 self-report questionnaire and their daily diet behavior and to analyze the occurrence of eating disorders among students in schools of the region of Silesia in Poland. SUBJECTS AND METHODS: Our survey was based on the EAT-26 (Eating Attitude Test) and Behavioral Four Questions Test. 150 questionnaires were given to students of Secondary Schools, 116 were filled out correctly. The interviewed group consisted of 85 girls and 31 boys. Average age was 17.24±1.18. All of the data were analyzed statistically. RESULTS: Average BMI was 21,06; half of the recruited subjects had correct BMI whereas over 40% of them presented underweight. Within 116 responses from the EAT-26 nearly 93% belonged to the group with a small risk of the development of future eating disorders. Nevertheless, over 6% of the survey participants were in the group at high risk. In the Behavioral Four Questions Test 10% participants turned out to be in the compulsive overeating group, other ones in the group of a probable development of anorexia (7%) or bulimia nervosa (3%). CONCLUSIONS: There is a strong correlation between particular daily activities and the score achieved in EAT-26, however there is no significant correlation between the calculated BMI and EAT-26 results. Specific socio-cultural factors are faced by public services. They refer both to health promotion programs and the organization of spare time spent by teenagers outside schools.

[Delirium in cardiac surgery patients - a multi-disciplinary approach]. / Majaczenie u chorych kardiochirurgicznych - problem wielodyscyplinarny.

We describe a case of a 86 year-old male who underwent urgent cardiac surgery and developed post-operative delirium. The treatment and prevention of this condition are discussed.

Quality of life in young, professionally active men undergoing on-pump coronary artery bypass grafting--short-term follow-up results.

BACKGROUND: The impact of coronary artery bypass grafting (CABG) on the quality of life (QoL) is one of the important measures of the efficacy of the procedure. This issue in young, professionally active male patients has not been extensively studied. AIM: To assess QoL before and after on-pump CABG, and before and after cardiac rehabilitation in young men with low operative risk. METHODS: The study group comprised 50 men aged 54.4 +/- 5.6 years who were professionally active before the surgery. The QoL was assessed on the basis of the MacNew questionnaire (in points). We analysed QoL changes and effects of basic demographic and peri-operative data on QoL during a short-term follow-up. RESULTS: All components of QoL deteriorated shortly after CABG: emotional - from 4.97 +/- 0.96 to 4.66 +/- 1.0 (p = 0.03); physical - from 4.49 +/- 1.1 to 4.2 +/- 1.2 (p = 0.02); and social - from 4.68 +/- 1.0 to 4.47 +/- 1.1 (p = 0.1). Pre-operative physical and social QoL positively correlated with age (r = 0.45 and r = 0.37, respectively) and left ventricular ejection fraction (LVEF) (r = 0.49 and r = 0.48, respectively). However, there was a negative impact of history of myocardial infarction on physical QoL (p < 0.05). A negative influence of cardiopulmonary bypass time (r = -0.45) and cross-aortic clamp time (r = -0.36) on physical QoL was also noted. The QoL values were also influenced by class of angina symptoms (R = -0.33 / -0.42), total drainage (r = -0.11 / -0.34) and quantity of grafts (R = -0.35 / -0.42). During rehabilitation, QoL significantly improved: emotional - from 5.29 +/- 0.92 to 5.96 +/- 0.9 (p = 0.01); physical - from 4.66 +/- 1.1 to 5.42 +/- 1.2 (p < 0.01); and social - from 4.69 +/- 1.2 to 5.65 +/- 1.1 (p < 0.01). The QoL during rehabilitation was correlated with baseline peri-operative risk (for logistic EuroSCORE algorithm r = -0.21 / -0.31 and for EuroSCORE R = -0.47 / -0.89). Significant determinants of some components of QoL were also LVEF (r= 0.26 / 0.47), morphological blood parameters (r = 0.37 / 0.43), baseline CCS class (R = 0.31 / 0.58), age (r = -0.41 / -0.83), and extent of surgery defined by cardiopulmonary bypass time, cross-aortic clamp duration and total drainage. CONCLUSIONS: Quality of life in young, professionally active men significantly deteriorates a few days after on-pump CABG but systematically improves during the next weeks, particularly after rehabilitation. Pre-operative QoL correlates positively with age and LVEF, and negatively with a history of myocardial infarction. Age, pre-operative risk, angina symptoms and the extent of surgery have negative effects on physical QoL after CABG during short-term observation.

Total ghrelin plasma level in patients with the restrictive type of anorexia nervosa.

Ghrelin is produced mainly in the stomach and is an essential link of the brain-gut axis. Ghrelin stimulates hunger centers in hypothalamus controlling food intake and body mass gain. The aim of the study is to analyze the total ghrelin plasma level in patients suffering from restrictive type of anorexia nervosa (AN-R). According to DSM-IV classification a group of 30 AN-R patients was investigated before and after 3 and 6 months of therapy. Therapy included normocaloric diet and cognitive-behavioral psychotherapy (CBT). The control group consisted of 20 girls without any eating disorders. Before the therapy the total ghrelin plasma level in AN-R patients was significantly higher than in the control group. After 3 and 6 months of treatment the total ghrelin plasma level in AN-R patients was significantly lower than in the control group. In AN-R patients, the total ghrelin plasma level is connected with the pathological feeding behavior.

[Total plasma ghrelin level in anorexia nervosa female]. / Calkowite stezenie greliny w osoczu pacjentek z jadlowstretem psychicznym.

UNLABELLED: Ghrelin is a peptide exhibiting strong orexigenic, adipogenic and somatotropic properties. About 80% of the peptide is produced in the stomach and it is an essential link of the brain-gut axis. Ghrelin through vagal fibres and circular system stimulates the hunger center in hypothalamus, controlling food uptake and body weight gain. This mechanism fails in eating disorders. The aim of the study was the analysis of total ghrelin levels in anorexia nervosa (AN) girls during cognitive-behaviorally treatment. MATERIAL AND METHODS: A group of 50 AN girls with the restrictive form ofAN (according to the DSM-IV, ICD-10 criteria) behaviorally treated and participating in psychotherapy. The mean BMI in anorectic group was 15.1 kg/m2 and mean ghrelin level 6562 pg/ml. The group of 20 healthy girls with mean BMI of 21.4 kg/m2 and mean ghrelin level 4856 pg/ml served as a control group. The mean age in study group was 17.5 and 18.5 in control girls. Statistical analysis of significance was carried out by the Student's t-test, Mann-Whitney U test, Spearman's correlation and linear Person's correlation. To assess the dynamic change of parameters Anova-Friedman and Anova-Kruskal-Wallis tests were used. The p < 0.05 was accepted as statistically significant. RESULTS: Initial mean plasma ghrelin levels in AN girls was significantly higher than in control group. After 24 weeks of treatment the mean BMI increased to 17.5 kg/m2, ghrelin level decreased to the value of 3919 pg/ml. CONCLUSION: In AN female the decreasing of total plasma ghrelin level is a result of changing pathological feeding behaviour.

[Ghrelin--The guardian of energy balance]. / Grelina--straznik równowagi energetycznej.

Ghrelin was discovered in 1999 and is a subject of various studies. This endogenous ligand for the growth hormone secretagogue receptor (GHS-R) is mostly released by the fundus mucosa in the stomach. Many studies show us, that besides its stimulation of Gh secretion, ghrelin is directly related to the energy balance controlling mechanism. It also influences motoric action of the digestive track, secretion of hydrochloric acid, endo- and exogenic pancreatic function. GHR-S receptors are found in arcuate neurons and other lateral hypothalamus neurons. These areas are critical for the regulation of feeding. Ghrelin stimulates food intake together with other orexy- and anorexygenic peptides like: NPY, AGRP, OXA, and OXB. The plasma ghrelin level depends on the nutrition state. Increased ghrelin levels are observed shortly before food intake, and the decreases can be noted 2 hours after eating. During fasting and/or malnutrition plasma ghrelin level rises. This also happens in eating disorders: anorexia nervosa, bulimia nervosa. This article presents facts and hypotheses supporting the neuroendocrinologic and metabolic mechanisms affecting the plasma ghrelin levels and the role of ghrelin in feeding behaviour.

[The plasma levels of orexigenic peptides and human platelets phospholipase D activity in anorexia nervosa patients]. / Stezenie wybranych peptydów oreksygenicznych w osoczu a aktywnosc fosfolipazy d w plytkach krwi u chorych z jadlowstretem psychicznym.

UNLABELLED: Ghrelin, orexins A and B (OXA, OXB) are neuropeptides engaged in the regulation of energy balance stimulating appetite and feeding. Disturbances in their activity are proposed to be involved in pathomechanism of eating disorders, particularly in anorexia nervosa (AN). The intracellular mechanism of the peptides action remains unclear. It is considered whether the orexigenic peptides may act through second messengers related to phospholipase D (PLD). The aim of the study was to find a hypothetical relation between ghrelin, OXA and OXB levels and human platelets PLD activity. MATERIAL AND METHODS: 25 AN females and 20 healthy controls (mean age 17.6 and 18.6, mean BMI 15.03 and 21.41 kg/m(2), respectively) were examined. OXA and OXB plasma levels and total ghrelin plasma level was determinated with RIA. PLD activity in homogenized blood platelets was assessed with modified fluorometric method. All values are presented as the mean values. The data were analyzed using Student-t test, non-parametric U-Mann-Whitney test and Spearman correlation. The p < 0.05 was accepted as the level of significance. RESULTS: There is a correlation between analyzed neuropeptides and PLD in AN patients. CONCLUSION: In AN patients it is not possible to exclude influence orexins and ghrelin on platelet PLD activity.

[The role of orexines in appetite regulation]. / Rola oreksyn w regulacji laknienia.

Anorexia nervosa (AN) belongs to the group of eating disorders. Many different factors are taken into consideration as far as the origin of this disorder is concerned, among them: individual factors (genetic, biological), personality factors, sociocultural factors, family factors. Among the biological factors, the role of neuropeptides is considered. Last few years (1998) have resulted in the discovery of two neuropeptides--orexines OXA and OXB which--apart from being regarded as appetite stimulants--are also supposed to be responsible for the energy metabolism of an organism. Orexines, a.k.a. hypocretins, arise from the disintegration of their common precursor--the polypeptide: preorexine. Their name derives from the Greek word for appetite: orexis. The orexine A (OXA) is a 33 amino acid peptide consisting of 2 chains connected by the Cys 6--Cys 12 and Cys 7--Cys 14 bridges. It is a potential food intake and gastric juice secretion stimulant. The connecting bridges in OXA play a crucial role in the receptor OXA-1 activation. The orexine B (OXB) is a 28 amino acid peptide with no connecting bridges between the chains. It mainly plays a role in the energy metabolism of an organism and does not influence the secretion of gastric juice. The OXR-1 receptor is a selective receptor for OXA, while the OXR-2 receptor is not privileged for any of the two orexines--both of them can connect to it. Orexines are produced by a small number of hypothalamus neurons, mainly in the lateral hypothalamus (LHA), but also the posterior hypothalamus--the so-called "eating center". Orexines control: the wakefulness-sleep state, food intake (OXA over 100 times stronger than OXB) and the neuroendocrine system. Their discovery may help in understanding the mechanism of anorexia nervosa.