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Obesity affects 158 million youth worldwide and is associated with psychosocial comorbidity. This review describes weight management options utilized by adolescents, including both self-directed weight loss and medically supervised obesity treatment interventions, and associated psychosocial impacts. A majority of adolescents with obesity attempt to manage weight on their own, primarily through attempting weight loss, sometimes with supplement use. Approaches such as these are associated with a degree of risk, disordered eating behaviors, and further weight gain. In contrast, medically supervised multicomponent interventions are associated with improved psychosocial health, including quality of life, self-esteem, and body image, and reduced symptoms of depression, anxiety, and eating disorders. Few studies utilizing antiobesity pharmacotherapy have reported psychosocial outcomes, and trials of bariatric surgery show some early improvements with a need for sustained psychological support following surgery. Greater access to medically supervised treatment services is required to facilitate obesity care for adolescents. Early data on psychosocial health and obesity treatment offer promising outcomes; however, larger randomized controlled trials and longer-term data are needed. Future research should include both physiological and psychosocial outcomes to assess impact of interventions on the holistic health of adolescents with obesity. [ABSTRACT FROM AUTHOR]

Decreased sound tolerance (DST) is an underappreciated condition that affects the lives of a significant portion of the general population. There is lack of agreement regarding definitions, specific components, prevalence, methods of evaluation, and methods of treatment. Limited data are available on the results of treatments. Research is scant and constrained by the lack of an animal model. This article proposes a definition of DST and its division into hyperacusis and misophonia. The potential mechanisms of these phenomena are outlined, and the results of treatment performed at Emory University are presented. Out of 201 patients with DST, 165 (82%) showed significant improvement. Of 56 patients with hyperacusis (with or without misophonia), 45 (80%) showed significant improvement. This proportion was higher for the group with hyperacusis and concurrent misophonia (33 of 39, or 85%) and lower for patients with hyperacusis only (13 of 17, or 76%). Effectiveness of treatment for misophonia with or without hyperacusis was identical (152 of 184, 83% and 139 of 167, 83%, respectively, for misophonia accompanied by hyperacusis and for misophonia only). Even with current limited knowledge of DST, it is possible to propose specific mechanisms of hyperacusis and misophonia and, based on these mechanisms, to offer treatments in accordance with the neurophysiological model of tinnitus. These treatments are part of Tinnitus Retraining Therapy (TRT), which is aimed at concurrently treating tinnitus and DST and alleviating the effects of hearing loss. High effectiveness of the proposed treatments support the postulated mechanisms. [ABSTRACT FROM AUTHOR]

There is growing agreement that patient' problems with tinnitus are not due to tinnitus perception per se, but to negative reactions to tinnitus. Patients' complaints include decreased ability to enjoy life's activities as well as difficulty concentrating, relaxing and sleeping. Tinnitus patients frequently experience anxiety, depression and panic. Two methods have been shown to be effective in the managements of tinnitus: Cognitive Behavioral Therapy (CBT) and Tinnitus Retraining Therapy (TRT). The main premise of CBT is that thoughts evoke emotions. In CBT emphasis is placed on cognitive functions, selective attention, and the distorted perception of tinnitus. The Cognitive Behavioral model of tinnitus proposed by McKenna (2014) postulates that patients' interpretation of tinnitus and the behavioral changes caused by it play a central role in creating and maintaining tinnitus-evoked distress. In the neurophysiological model of tinnitus, and consequently in TRT, all factors listed in Cognitive Behavioral model are taken into account; however, the role of the subconscious centers of the brain and the consequences of created conditioned reflexes that connect the auditory system with other systems in the brain are also included. In the initial stage cognitive processes (upper loop on the diagram of the neurophysiological model of tinnitus) play dominant role, but in the chronic stage of tinnitus the subconscious levels (lower loop) become dominant. Connections within the neural networks involved in the adverse effects of tinnitus are governed by the principles of conditioned reflexes. The primary goal of TRT is to disable the functional connections between the auditory and other systems of the brain and consequently to achieve habituation of tinnitus-evoked reactions. Habituation is initiated and further facilitated by the method of modified passive extinction of these conditioned reflexes. This process involves: 1) teaching/counseling aimed at reclassification of the tinnitus signal to the category of neutral stimuli and 2) using sound therapy to decrease the strength of the tinnitus signal by increasing the level of background neuronal activity in the auditory system, achieved by providing an enhanced sound background. Note, that habituation of perception occurs automatically once a sufficient level of habituation of reaction is achieved. It is proposed that because TRT targets both the conscious and subconscious levels of the brain and furthermore takes decreased sound tolerance and hearing loss into account, TRT seems to be more effective than CBT with regard to tinnitus management. This view is supported by the published results of clinical studies. The differences between the neurophysiological model of tinnitus and assumptions of CBT have a significant impact on how counseling is performed in these two approaches. Clinical observations indicate that tinnitus treatment is impaired or blocked if decreased sound tolerance is not treated concurrently with tinnitus. Further systematic clinical studies are needed to clarify specific postulates of CBT and TRT and through this to optimize the treatment of tinnitus patients. [ABSTRACT FROM AUTHOR]