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Biomedical subjects

B T Walsh

Publications and source records attributed to B T Walsh.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1995

Behavioral and neuroendocrine responses to metaCPP in anorexia nervosa.

In response to the partial serotonin agonist meta-chlorophenylpiperazine (metaCPP), patients with obsessive-compulsive disorder have been reported to exhibit an increase in obsessive symptoms and a diminished release of prolactin and/or cortisol compared to controls. We examined the response to metaCPP of 10 patients with anorexia nervosa, before and after weight gain, and of eight healthy controls. Prior to weight gain, the patients exhibited a greater behavioral response to metaCPP than the controls and diminished prolactin and cortisol responses. Only the prolactin abnormality persisted after weight gain. These observations suggest that, in patients with anorexia nervosa, weight loss is associated with the development of neurobiological disturbances which are in some ways similar to those of obsessive-compulsive disorder.

Adult↗
PubMed1994

Assessment of diagnostic features of bulimia nervosa: interview versus self-report format.

In order to determine the clinical severity of bulimia nervosa and to measure symptomatic improvement during treatment, the behavioral and psychological features of the syndrome must be assessed. Focused semistructured interviews have recently been designed for this purpose, but such instruments can be time-consuming and costly. The present study compared the assessment of the key symptoms of bulimia nervosa using the Eating Disorder Examination with data obtained in self-report inventories and in patients' diaries of binge eating and purging. Results suggest that once the diagnosis has been established and patients have been instructed in the construct of a binge, the essential features of bulimia nervosa (frequency of binge eating and purging, and overconcern with body shape and weight) can be evaluated with self-report measures. These findings may be useful for the purposes of repeated assessment of progress and measurement of outcome in treatment studies.

Adult↗
PubMed1994

Binge eating behavior in patients with eating disorders.

The purpose of this study was to determine whether the objectively observed binge eating behavior of obese subjects meeting the proposed DSM-IV criteria for binge eating disorder would be similar to that observed in patients with bulimia nervosa. Non-obese patients with bulimia nervosa (BN), obese subjects with binge eating disorder (BED), obese and non-obese women without eating disorders were each instructed to binge eat single- and multiple-item meals. In the multiple-item meal, the obese subjects with BED ate significantly more (1515 kcal) than obese subjects without BED (1115 kcal), but they ate less than the normal-weight bulimic patients (2680 kcal). The non-obese controls ate amounts similar to the obese non-binge-eating-disordered group (1093 and 1115.2 kcal, respectively). In the single-item meal, consisting of ice cream, patients with BN ate significantly more than any other group (1307 kcal), while obese subjects with or without binge-eating disorder ate significantly more (762 kcal) than non-obese controls (308 kcal). This study has demonstrated that although both BN and BED are characterized by recurrent episodes of binge eating, quantitatively there appear to be differences between the eating disturbances in the two disorders. Because single- and multiple-item meals differ in external cues, these results also suggest that the obese subjects with BED may be disinhibited by external cues, while obese subjects without BED may be inhibited by external cues.

Adolescent↗
PubMed1994

Binge eating disorder: reliability and validity of a new diagnostic category.

This study examined the reliability and validity of binge eating disorder (BED), which has been proposed for inclusion in the Diagnostic and Statistical Manual of Mental Disorders ([DSM] 4th ed.; American Psychiatric Association, in press). The interrater reliability of the BED diagnosis compared favorably with that of most diagnoses in the revised third edition of the DSM. To assess validity, we compared obese individuals with and without BED and bulimia nervosa patients. BED subjects differed from the non-BED obese group on variables related to dieting and weight histories but did not differ significantly on other important variables, including measures of psychopathology. When compared with bulimia nervosa patients, subjects with BED had significantly less psychopathology and reported significantly less dietary restraint. This study lends some support to the concept of BED but suggests that additional studies of the characteristics of this disorder at different degrees of obesity would be useful.

Adult↗
PubMed1994

Effects of desipramine on autonomic control of the heart.

OBJECTIVE: To assess the effects of desipramine (DMI) on autonomic control of the heart. METHODS: Blood pressure, RR interval (the time between successive heart beats), and RR interval variability, a noninvasive measure of autonomic control of the heart, were assessed in 13 subjects younger than 30 years old. RESULTS: DMI treatment was associated with an increase in blood pressure, a decrease in RR interval, and a decline in low and high frequency RR interval variability. CONCLUSIONS: These preliminary data suggest that, in young people, DMI treatment produces a substantial decrease in parasympathetic input to the heart and an increase in the ratio of sympathetic to parasympathetic input, changes that in certain circumstances have been associated with an increased risk of arrhythmia. In exploring the cardiac effects of the tricyclic antidepressants (TCAs) in young people, the impact of TCAs on autonomic input to the heart should be examined.

Adolescent↗
PubMed1993

Eating behavior in binge eating disorder.

In order to examine the eating behavior of individuals with the newly proposed diagnosis, binge eating disorder (BED), standardized meals were served to 20 obese women, 10 with BED and 10 without BED. When asked to binge eat from a multiple-item array of foods, obese subjects with BED consumed significantly more calories than did obese subjects without BED. Significant differences between the two groups were also found on several of the self-report measures.

Adult↗
PubMed1992

The single-item meal as a measure of binge-eating behavior in patients with bulimia nervosa.

To determine whether the characteristics of binge eating could be observed in a single-item meal, in a laboratory, patients with bulimia nervosa and controls ate two single-item meals and two multiple-item meals. When they were instructed to binge eat, the patients ate significantly more and for a longer time on both single- and multiple-item meals than did controls. When they were instructed not to binge, intakes of the two groups did not differ. Controls, but not most of the patients, showed deceleration in their eating rate when they were asked to binge. Intakes of the single- and multiple-item meals were significantly correlated for the patients under both sets of instructions. These results are consistent with previous reports in indicating that patients with bulimia nervosa eat differently from controls and suggest that a single-item meal can be used to examine the characteristics of binge eating in patients with bulimia nervosa.

Adult↗