title: Anticipatory nausea in cyclical vomiting.
abstract: BACKGROUND
  Cyclical Vomiting Syndrome (CVS) is characterised by discrete, unexplained episodes of intense nausea and vomiting, and mainly affects children and adolescents. Comprehending Cyclical Vomiting Syndrome requires awareness of the severity of nausea experienced by patients. As a subjective symptom, nausea is easily overlooked, yet is the most distressing symptom for patients and causes many behavioural changes during attacks.
  
  
  METHODS
  This first-hand account of one patient's experience of Cyclical Vomiting Syndrome shows how severe nausea contributed to the development of anticipatory nausea and vomiting (ANV), a conditioned response frequently observed in chemotherapy patients. This conditioning apparently worsened the course of the patient's disease. Anticipatory nausea and vomiting has not previously been recognised in Cyclical Vomiting Syndrome, however predictors of its occurrence in oncology patients indicate that it could complicate many cases.
  
  
  CONCLUSIONS
  We suggest a model whereby untreated severe and prolonged nausea provokes anxiety about further cyclical vomiting attacks. This anxiety facilitates conditioning, thus increasing the range of triggers in a self-perpetuating manner. Effective management of the nausea-anxiety feedback loop can reduce the likelihood of anticipatory nausea and vomiting developing in other patients.
authors.affiliation: Department of Clinical Dental Sciences, University of Liverpool, Daulby Street, Liverpool, L69 3GN, UK. f.e.mcronald@bham.ac.uk
authors.forename: Fiona E
authors.initials: FE
authors.lastname: McRonald
authors.forename: David R
authors.initials: DR
authors.lastname: Fleisher
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use; D001007:Anxiety / Q000523:psychology*; D003214:Conditioning, Classical; D005260:Female; D006801:Humans; D009325:Nausea / Q000523:psychology; D010507:Periodicity; D014840:Vomiting, Anticipatory / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy
chemical_list: D000932:Antiemetics