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Biomedical subjects

B T Walsh

Publications and source records attributed to B T Walsh.

At least 19 recordsLinked to original sources
PubMed2000

Influence of shape and weight on self-evaluation in bulimia nervosa.

OBJECTIVE: To compare three related but different measures of excessive concerns about shape and weight in bulimia nervosa (BN): influence of shape and weight (influence; DSM-IV Criterion D), overconcern with shape and weight (overconcern; DSM-III-R Criterion E), and dissatisfaction with shape and weight (dissatisfaction). METHOD: One-hundred twenty BN patients, 27 restrained eaters (RE), and 28 normal controls (NC) were assessed via the Eating Disorders Examination and self-report measures. RESULTS: Influence and overconcern, but not dissatisfaction, successfully discriminated BNs from NCs but not from REs. A minority of patients with BN obtained low scores on both influence and overconcern. However, there were few differences between those patients with low scores and those with high scores on numerous clinical characteristics. DISCUSSION: Influence and overconcern are equally valid measures of the excessive concerns about shape and weight characteristic of BN.

Adolescent↗
PubMed2000

Establishing guidelines for pharmacotherapy trials in bulimia nervosa and anorexia nervosa.

OBJECTIVE: This paper addresses the lack of a standard protocol for pharmacotherapy trials for patients with bulimia nervosa (BN) and anorexia nervosa (AN). METHOD: Twenty-two surveys were sent to established researchers in the field of eating disorders to elicit their opinions regarding medication trials, including baseline laboratory tests, the optimal length/frequency of medication management sessions, and the information that should or should not be included in these sessions. RESULTS: Sixteen of 22 researchers completed and returned the survey. Their answers are the basis of the data presented. DISCUSSION: We propose a battery of screening laboratory tests for both conditions. We suggest 30-45-min initial medication management sessions in both AN and BN trials with 15-min follow-ups to be held weekly for AN subjects, and weekly for 2 weeks, then biweekly for 2 weeks, then monthly, for BN subjects. We also recommend that published trials should include explicit details of medication management.

Anorexia Nervosa↗
PubMed1999

Open trial of fluoxetine in children and adolescents with dysthymic disorder or double depression.

BACKGROUND: Chronic depressions commonly present in youth and cause significant morbidity. No treatment studies in this age group are currently available. METHODS: 19 pediatric subjects with dysthymic disorder or 'double depression' were recruited. After four weeks of psychosocial treatment, subjects failing to improve began open treatment with fluoxetine (20 mg) for eight weeks. Subjects were then reassessed for treatment response. RESULTS: Fifteen subjects entered the medication phase, and eleven (73%) no longer met criteria for dysthymic disorder or Major Depression at final assessment. CONCLUSIONS: Fluoxetine shows promise as a safe and effective treatment for youth with chronic depressions. Controlled trials are indicated. LIMITATIONS: Open label design, no comparison treatment condition. CLINICAL RELEVANCE: As in adults, treatment with antidepressants may prove to be a useful intervention with children and adolescents with chronic forms of depression.

Adolescent↗
PubMed1999

Psychological versus pharmacological treatments of bulimia nervosa: predictors and processes of change.

This article extends the acute outcome findings from a study comparing psychological and pharmacological interventions for bulimia nervosa (B.T. Walsh et al., 1997) by examining 3 additional domains: predictive factors, therapeutic alliance, and time course of change. One hundred twenty women were randomized to cognitive-behavioral therapy (CBT), supportive psychotherapy (SPT) plus antidepressant medication or a placebo, or a medication-alone condition. Results indicate that high baseline frequencies of binge eating and vomiting, as well as a positive history of substance abuse or dependence, are negative prognostic indicators. Although a greater overall therapeutic alliance may increase the likelihood of remission, symptom change over the course of treatment may have as much of an impact on patient ratings of alliance as the reverse. CBT was significantly more rapid than SPT in reducing binge eating and vomiting frequencies.

Adolescent↗
PubMed1999

Cardiovascular effects of desipramine in children and adults during exercise testing.

OBJECTIVE: In light of recent reports of sudden death in children being treated with desipramine (DMI), 3 of which were associated with physical exercise, the authors examined the effects of DMI on exercise in children and adults before and during DMI treatment. METHOD: Before treatment, 22 subjects (9 children, 13 adults) participated in a graded treadmill exercise test. Outcome measures included exercise tolerance, cardiovascular, and electrocardiographic parameters at progressive intensity levels and serum norepinephrine (NE) levels before and after exercise testing. Subjects were then treated with DMI, titrated to an average DMI dosage of 3 mg/kg, and underwent repeated exercise testing. RESULTS: DMI treatment was associated with a significant elevation of circulating NE levels in the pre-exercise assessment. Exercise tolerance was not affected by DMI, and blood pressure and heart rate effects were modest. The cardiovascular impact of DMI treatment was similar in children and adults. One 31-year-old subject exhibited a brief episode of ventricular tachycardia associated with exercise during DMI treatment. CONCLUSIONS: DMI has only minor effects on the cardiovascular response to exercise, and these effects do not appear age-related. However, DMI may increase the risk of exercise-associated arrhythmias in rare individuals.

Adolescent↗
PubMed1999

Critical review of tricyclic antidepressant use in children and adolescents.

OBJECTIVE: To provide a critical review of the role of tricyclic antidepressant (TCA) medications in children and adolescents. METHOD: Multiple resources including a Medline search (1966-1998) were used. RESULTS: There were few double-blind, placebo-controlled studies of TCAs, and even fewer with positive results. Also, potentially serious cardiovascular side effects have been described. CONCLUSIONS: The future therapeutic role of TCAs for children and adolescents needs to be seriously weighed against lethality of overdose, the unresolved issue of possible sudden unexplained death, and the availability of safer and easier to monitor medications. Ongoing future research on heart rate variability and epidemiology of psychotropic medication-related deaths will address developmental aspects of TCA use.

Adolescent↗
PubMed1999

Effects of desipramine on autonomic input to the heart.

OBJECTIVE: To examine the impact of age on the effects of desipramine (DMI) on autonomic input to the heart. METHOD: Twenty-four-hour electrocardiograms were obtained from 42 subjects, aged 7 to 66 years, while off and on DMI. To obtain measures of autonomic input to the heart, heart rate variability was assessed via spectral analysis of RR interval variability. RESULTS: DMI treatment was associated with a significant increase in 24-hour mean heart rate and significant decreases in RR interval variability in all spectral bands, including in the high-frequency band, which provides a measure of parasympathetic input to the heart. RR interval variability was greater in younger individuals both off and on DMI. CONCLUSIONS: DMI treatment was associated with a marked decline in RR interval variability, indicating that DMI affects autonomic input to the heart. Specifically, DMI reduced parasympathetic input, which, in theory, may increase vulnerability to arrhythmias. However, the magnitude of DMI's impact on RR interval variability did not vary with age.

Adolescent↗
PubMed1999

Testosterone and depression in aging men.

In men, testosterone secretion affects neurobehavioral functions such as sexual arousal, aggression, emotional tone, and cognition. Beginning at approximately age 50, men secrete progressively lower amounts of testosterone; about 20% of men over age 60 have lower-than-normal levels. The psychiatric sequelae are poorly understood, yet there is evidence of an association with depressive symptoms. The authors reviewed 1) the physiology of the hypothalamic-pituitary-gonadal axis and its changes with age in men; and 2) the evidence linking testosterone level and major depression in men. Data on this relationship are derived from two types of studies: observational studies comparing testosterone levels and secretory patterns in depressed and non-depressed men, and treatment studies using exogenous androgens for male depression. The data suggest that some depressed older men may have state-dependent low testosterone levels and that some depressed men may improve with androgen treatment.

Adult↗
PubMed1998

Eating disorders: progress and problems.

Recent research on Anorexia Nervosa and Bulimia Nervosa has yielded an increasingly detailed understanding of the range of biological and psychological abnormalities associated with these eating disorders. Inherited vulnerabilities, cultural pressures, and adverse individual and family experiences all appear to contribute to the onset of extreme dieting, binge eating, and purging. Once initiated, these behaviors give rise to multiple physiological disturbances, some of which may serve to perpetuate the illness. Although there have been substantial advances in the management of Bulimia Nervosa, the goal of offering effective treatment to all individuals with eating disorders remains elusive. This article reviews current thinking on the etiology and treatment of the two major eating disorders and a related syndrome, Binge Eating Disorder.

Anorexia Nervosa↗
PubMed1998

Does fluoxetine augment the inpatient treatment of anorexia nervosa?

OBJECTIVE: While pharmacological interventions are of established utility in bulimia nervosa, medications have no clear role in the treatment of anorexia nervosa. Because patients with anorexia nervosa frequently exhibit mood disturbances and symptoms of obsessive-compulsive disorder, the authors tested the utility of fluoxetine in the treatment of women participating in an inpatient program for anorexia nervosa. METHOD: The authors conducted a randomized, placebo-controlled, double-blind, 7-week study of fluoxetine at a target daily dose of 60 mg in 31 women with anorexia nervosa receiving treatment for their eating disorder on a clinical research unit. Body weight and measures of eating behavior and psychological state were obtained at baseline and at termination. RESULTS: There were no significant differences in clinical outcome on any measure between patients receiving fluoxetine and patients receiving placebo. CONCLUSIONS: Fluoxetine does not appear to add significant benefit to the inpatient treatment of anorexia nervosa.

Adolescent↗
PubMed1998

The use of selective serotonin reuptake inhibitors in eating disorders.

The introduction of selective serotonin reuptake inhibitors (SSRIs), which are, in general, safer and more easily tolerated than conventional antidepressants, has had a profound effect on the treatment of affective illnesses and obsessive-compulsive disorder (OCD). A number of symptoms associated with eating disorders overlap those of depression and OCD, suggesting a theoretical and practical case for evaluating the SSRIs in the treatment of anorexia nervosa, bulimia nervosa, binge-eating disorder, and obesity. Despite the expectations for SSRIs in the treatment of eating disorders, clinical investigations have yielded mixed results. In this paper, results from clinical studies of SSRIs (with and without concomitant psychotherapy) in the treatment of anorexia and bulimia nervosa, binge eating disorder, and obesity are reviewed, directions for future research are suggested, and practical recommendations for the clinician are provided.

Anorexia Nervosa↗
PubMed1997

Patterns of food selection during binges in women with binge eating disorder.

OBJECTIVE: The aim of this study was to determine whether temporal patterns of food selection during binges in obese subjects with binge eating disorder (BED) differ from those of patients with bulimia nervosa (BN). METHOD: Ten obese women with BED and 10 weight-matched women without BED each consumed a multiple-item meal identical to that used in previous studies with bulimics, and all subjects were instructed to binge. An experimenter recorded the subjects' food choices every 10 s throughout the meal via a closed-circuit TV camera. RESULTS: Subjects with BED consumed significantly more meat than subjects without BED (397.78 vs. 270.64 kcal), but the food choices and percentages of time spent eating each of the foods were similar among BED, non-BED, and normal weight controls. While bulimics ate dessert foods earlier in the meals, all other groups ate meat towards the beginning of their meal and ate more dessert foods towards the end of the meal. DISCUSSION: Food selection patterns during binges in subjects with BED are more similar to eating patterns of noneating disordered subjects, than to patterns seen in patients with BN. These data suggest that binge episodes between different groups of eating-disordered populations are qualitatively different.

Adult↗
PubMed1997

Postprandial cholecystokinin release and gastric emptying in patients with bulimia nervosa.

This study was designed to investigate the biological underpinnings of the observed deficit in satiety in patients with bulimia nervosa. Eight women with bulimia nervosa and 10 age- and weight-matched control subjects consumed three laboratory meals consisting of 200, 400, and 600 g of a radiolabeled liquid meal. For 1 h after each meal, blood samples were obtained at 10-min intervals for measurement of cholecystokinin concentration and gastric emptying was measured. Subjects also completed perceptual rating scales at 10-min intervals. Compared with control subjects, patients with bulimia nervosa showed a blunting of postprandial cholecystokinin release, particularly with larger meal sizes, as well as delayed gastric emptying. Increasing meal size was associated with increased desire to binge eat in patients but not in control subjects. These data lend support to a model in which increased gastric capacity, perhaps resulting from repeated binge eating, gives rise to delayed gastric emptying and blunted postprandial cholecystokinin release, leading to an impaired satiety response, which tends to perpetuate the illness.

Adolescent↗
PubMed1997

Medication and psychotherapy in the treatment of bulimia nervosa.

OBJECTIVE: Two treatments for bulimia nervosa have emerged as having established efficacy: cognitive-behavioral therapy and antidepressant medication. This study sought to address 1) how the efficacy of a psychodynamically oriented supportive psychotherapy compared to that of cognitive-behavioral therapy; 2) whether a two-stage medication intervention, in which a second antidepressant (fluoxetine) was employed if the first (desipramine) was either ineffective or poorly tolerated, added to the benefit of psychological treatment; and 3) if the combination of medication and psychological treatment was superior to a course of medication alone. METHOD: A total of 120 women with bulimia nervosa participated in a randomized, placebo-controlled trial. RESULTS: Cognitive-behavioral therapy was superior to supportive psychotherapy in reducing behavioral symptoms of bulimia nervosa (binge eating and vomiting). Patients receiving medication in combination with psychological treatment experienced greater improvement in binge eating and depression than did patients receiving placebo and psychological treatment. In addition, cognitive-behavioral therapy plus medication was superior to medication alone, but supportive psychotherapy plus medication was not. CONCLUSIONS: At present, cognitive-behavioral therapy is the psychological treatment of choice for bulimia nervosa. A two-stage medication intervention using fluoxetine adds modestly to the benefit of psychological treatment.

Adolescent↗
PubMed1996

A direct measure of satiety disturbance in patients with bulimia nervosa.

To determine whether patients with bulimia nervosa (BN) experience the development of satiety during a meal differently than control subjects, a novel laboratory meal procedure was employed. Eleven women with BN and 11 women without eating disorders consumed a yogurt shake meal after being instructed to binge. After each 75-g increment consumed, the subjects were signaled by a tone to fill out a questionnaire on which they were asked to rate various sensations on visual analog scales. The sensations included "Fullness", "Hunger", "Desire" for a favorite food, "Pleasantness" of consuming the shake, "Sickness", and having "Enough" to consume. Although patients, before purging, consumed significantly more food than the controls, who did not purge (1597 +/- 626.5 g vs. 1004 +/- 362.5 g, mean +/- SD), their final questionnaire ratings were not significantly different from the controls' ratings. Patients ate significantly more than the controls before reaching 50% of their range of "Hunger" rating and 75% of their "Full", "Desire", "Sick", and "Enough" rating ranges. The patients also ate significantly more than the controls between 75% and 100% of their "Hunger" rating range. These data suggest that one possible mechanism for overeating in patients with BN may be their failure to perceive or respond as normal subjects do to the range of sensations associated with satiety. Collecting ratings as a function of intake may provide a method for assessing and studying eating disturbances in clinical populations.

Adult↗
PubMed1996

Ethnicity and eating disorders: implications for incidence and treatment.

The focus of this article is the role of ethnicity in the development and treatment of eating disorders. We describe briefly the clinical features of the major eating disorders. Using extant data, we discuss the frequency of eating disturbances and eating disorders in the population and specifically among minority groups. Finally, we address the significance of race in the treatment of eating disorders.

Anorexia Nervosa↗