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Biomedical subjects

B T Walsh

Publications and source records attributed to B T Walsh.

At least 73 records · Page 4Linked to original sources
PubMed1990

Hyperamylasemia in bulimia nervosa.

To determine the value of total serum amylase levels and salivary and pancreatic isoenzyme levels as biologic indices of behavioral disturbance in bulimia nervosa, the authors monitored these levels in 40 bulimic patients participating in a placebo-controlled trial of desipramine and in 25 controls. In the patients, the total and salivary amylase levels were significantly elevated and a significant correlation existed between the frequencies of binge eating and vomiting and the level of salivary amylase. However, the ability to discriminate patients from controls on the basis of serum amylase levels was limited. In addition, a significant positive relationship between binge frequency and level of serum amylase was observed in less than one quarter of 22 patients with five or more amylase determinations. Therefore, although hyperamylasemia is associated with bulimia nervosa, we believe that serum amylase determinations have limited utility in the assessment of patients with this syndrome.

Adolescent↗
PubMed1989

Eating behavior of women with bulimia.

To obtain objective information about binge- and non-binge-eating behavior, 12 women with bulimia and ten women without eating problems (controls) were asked to eat four meals in a structured laboratory setting, on separate nonconsecutive days. The same instructions were given to both groups. On two days, they were asked to eat a normal amount, and on two days, they were asked to eat as much as they could, ie, to binge. For each type of instruction, they were given a single- and a multiple-course meal. The patients ate significantly more than the controls when asked to binge, both on the multiple-course meals that they rated as typical of binges and on the single-course meals. When they were asked to eat normally, there was no significant difference in intake between patients and controls on either single- or multiple-course meals. After all meals, hunger ratings of patients were significantly higher than hunger ratings of controls. There was also a significant positive correlation between intakes of single- and multiple-course binge meals and an inverse correlation between intake of multiple-course binge meals in bulimic patients and their rating of how well they controlled their eating. Thus, a structured laboratory eating situation can be used to reveal differences between bulimic and normal individuals and has the potential for assessing clinical status and exploring mechanisms responsible for binge eating.

Adult↗
PubMed1989

Hypothalamic-pituitary-gonadal function in anorexia nervosa and bulimia.

Patients with anorexia nervosa (AN) exhibit neuroendocrine abnormalities that may result solely from emaciation or may reflect defective endocrine mechanisms which are intrinsic to disordered eating even in the absence of starvation. To distinguish these possibilities, we have studied indices of hypothalamic-pituitary-gonadal (HPG) function in 9 patients with AN, 12 normal weight patients with bulimia and recent or current oligomenorrhea, and 8 normal weight controls. Measurement of 24-hour luteinizing hormone (LH) secretion with 30-min sampling revealed significantly fewer LH secretory spikes and a trend toward lower mean 24-hour LH levels in both bulimic and anorectic patients than in controls. Stimulation with gonadotropin releasing hormone produced elevated LH responses in the bulimic group and blunted LH responses in the anorectic group. Stimulation with estradiol revealed diminished LH augmentative responses and a trend toward diminished follicle stimulating hormone augmentative responses among bulimic as well as AN patients compared to controls. In each instance, the bulimic group tended to show within-group heterogeneity, with some individuals falling within the AN range. These findings suggest that HPG axis abnormalities in eating disordered patients cannot entirely be attributed to emaciation and that factors other than subnormal weight contribute to disturbed hypothalamic-pituitary functioning in these patients.

Amenorrhea↗
PubMed1989

The struggle to be thin: a survey of anorexic and bulimic symptoms in a non-referred adolescent population.

Ninety-one per cent of a county-wide high school population (N = 5596) completed the Eating Symptoms Inventory (ESI) and the Eating Attitudes Test (EAT). Being female, older and heavier are far more strongly associated with anorexic and bulimic symptoms than is social class. ESI approximations of the DSM-III criteria for anorexia nervosa or bulimia suggest that while both conditions are rare (less than 1%), bulimia is the more prevalent disorder.

Adolescent↗
PubMed1989

Patterns of food selection during meals in women with bulimia.

Eating behavior of women with bulimia was compared with that of control subjects who had no eating disorders. Both groups were presented with two buffet-style multiple-item meals. In one meal subjects were instructed to eat normally and in the other they were instructed to eat as much as they could. The eating patterns of patients differed from control subjects in the quantity of food selected and in the rate of eating. During the binge meal, patients spent more of their meal time eating dessert and snacks than did control subjects and began their dessert and snack consumption earlier than control subjects. Patients distributed their meat consumption more evenly across the meal, whereas control subjects ate meat predominantly early in the meals. Most patients consumed either more or less than control subjects when not binge eating, indicating that the eating disturbances in bulimic patients are not confined to episodes of binge eating.

Adult↗
PubMed1989

Eating behavior in bulimia.

Despite our strong belief in the utility of laboratory studies of eating behavior, we also note several caveats on the data thereby obtained. First, it must be assumed that subjects' behavior is influenced by the laboratory environment and is not identical to eating behavior in a "normal" setting. Second, not all bulimic subjects who were screened for these studies actually participated, so that it is possible that the sample of patients from whom we obtained data differed in some ways from a general clinical population of women with bulimia. Nonetheless, we believe that our data provide compelling evidence that the disturbed eating behavior characteristic of bulimia nervosa can be profitably studied in the laboratory. Even under structured laboratory conditions, most bulimic patients rated one of their multicourse meals as typical of a binge, and, during that meal, consumed a much larger amount of food and ate more rapidly than did controls who were asked to overeat. The significant correlations between the sizes of the multicourse and single-course binge meals and between the size of laboratory binge meals and the size of the "naturally occurring" binge meals reported to the dietician suggest that a reproducible phenomenon is being examined. The results of our studies suggest that the abnormalities of eating behavior in bulimia nervosa cannot be viewed simply as a disturbance of carbohydrate consumption or even as the episodic consumption of a certain type of food. Rather, eating behavior in this syndrome appears more generally disturbed. The most striking difference between the binge and the nonbinge meals of bulimic patients and between the binge eating of patients and the overeating of normal persons is the amount of food consumed, not the macronutrient composition of the meals. In addition, for all four meal types, the patients were hungrier after the end of the meal than were the controls, even though the patients' average caloric intakes were generally larger and their average hunger ratings before the meals did not differ from those of the controls. Certainly, self-induced vomiting may contribute to this abnormality, but it was also observed after nonbinge meals when vomiting did not occur. Together, these data are consistent with the notion that the essential appetitive abnormality in bulimia nervosa lies in the control of the amount of food consumed, not in the consumption of a particular macronutrient or type of food. Patients with bulimia nervosa appear less responsive than normal to the signals that lead to the termination of a meal.(ABSTRACT TRUNCATED AT 400 WORDS)

Body Weight↗
PubMed1988

Heavy smokers, smoking cessation, and clonidine. Results of a double-blind, randomized trial.

Seventy-one heavy smokers who had failed in previous attempts to stop smoking participated in a randomized clinical trial to test the efficacy of clonidine as an aid in smoking cessation. The success rate in clonidine-treated subjects (verified by serum cotinine concentration) was more than twice that in the placebo-treated subjects. When the data were stratified by gender, a strong effect present in women was not apparent in men. After six months, cessation rates remained significantly higher among smokers treated with clonidine than those receiving placebo. The data also revealed an unexpectedly high prevalence (61%) of a history of major depression in this sample and a significant negative effect of such a history on cessation regardless of treatment. These findings, highly suggestive of an important role of clonidine in smoking cessation, warrant further studies to establish the long-term (greater than or equal to 12 months) efficacy of this drug and to replicate the association between nicotine dependence and depression.

Adolescent↗
PubMed1988

Phenelzine vs placebo in 50 patients with bulimia.

To examine the efficacy of the monoamine oxidase inhibitor phenelzine sulfate in the treatment of bulimia, a double-blind, placebo-controlled trial was conducted. In 50 women who completed the trial, phenelzine was significantly superior to placebo in the reduction of binge frequency (64% vs 5%), in the fraction of patients who had ceased bingeing at the end of the trial (35% vs 4%), and in several measures of psychological state. The superiority of phenelzine over placebo was not confined to a depressed subgroup of patients. Although no patient experienced a hypertensive crisis during the study, other side effects of phenelzine were problematic and limit the usefulness of phenelzine in this population.

Adolescent↗
PubMed1988

Lactate infusions in patients with bulimia.

We performed lactate infusions in 18 bulimic patients and 11 normal controls. On the basis of blind ratings, bulimic patients appeared to react to the infusion with greater anxiety than controls. The frequency of lactate-induced panic, per se, was lower in bulimic patients than rates reported for panic disorder patients. However, it would be premature to conclude that bulimia is not a heterogeneous syndrome which includes a group of patients who panic with lactate.

Adolescent↗
PubMed1988

'Spontaneous' hypertensive episodes with monoamine oxidase inhibitors.

Hypertensive reactions occurred without obvious cause in two patients receiving monoamine oxidase inhibitors (MAOIs) while being monitored in a hospital. These patients appear to have experienced "spontaneous" hypertensive episodes temporally related to the ingestion of the MAOIs. Similar occurrences in outpatients reported in the literature are reviewed.

Adult↗
PubMed1987

Tricyclic antidepressants in depressed patients with cardiac conduction disease.

The observation that fatalities from tricyclic antidepressant (TCA) overdose are associated with heart block and/or arrhythmias has led to concern about the cardiovascular effects of TCAs. Contrary to expectations, studies have shown TCAs to be relatively safe in patients without heart disease. However, it is unclear whether these drugs are also safe in patients with heart disease. This prospective study compared the risk of cardiovascular complication at therapeutic plasma concentrations of TCAs in 196 depressed patients, 155 with normal electrocardiograms and 41 with either prolonged PR interval and/or bundle-branch block. The prevalence of second-degree atrioventricular block was significantly greater in patients with preexisting bundle-branch block (9%) than in patients with normal electrocardiograms (0.7%). Orthostatic hypotension occurred significantly more frequently with imipramine than with nortriptyline, and in patients with heart disease.

Antidepressive Agents, Tricyclic↗
PubMed1987

Dexamethasone suppression test and plasma dexamethasone levels in bulimia.

A 1-mg dexamethasone suppression test (DST) was carried out in 66 women with bulimia and in 26 age- and sex-matched controls. Blood samples were obtained at 4 PM on the day following dexamethasone ingestion, and levels of cortisol and of dexamethasone in the plasma were measured. Thirty-two percent of the patients vs only 7% of the controls had plasma cortisol levels of 140 nmol/L (5 micrograms/dL) or greater following the DST (a positive DST). The plasma levels of dexamethasone varied substantially, and there was a significant inverse relationship between the plasma level of cortisol and that of dexamethasone. Patients with positive DST results had lower levels of plasma dexamethasone than did those with negative DST results, and the mean plasma level of dexamethasone was lower in the bulimic group than in the control group. These results suggest that factors other than a disturbance of hypothalamic-pituitary-adrenal activity may contribute to positive DST results in bulimia.

Adult↗
PubMed1987

Hypothalamic-pituitary-adrenal-cortical activity in anorexia nervosa and bulimia.

We studied hypothalamic-pituitary-adrenal-cortical (HPA) activity in nine underweight women with anorexia nervosa, 12 women of normal body weight with bulimia, and nine control subjects. The measures of HPA activity were the pattern of plasma cortisol secretion over 24 hr and the responses of plasma cortisol to dexamethasone suppression and to low dose ACTH stimulation. The patients with anorexia nervosa had significantly elevated 24 hr concentrations of plasma cortisol compared to the controls and showed significantly less cortisol suppression following dexamethasone. There was no difference between patients with anorexia nervosa and controls in the rise in plasma cortisol following ACTH. On most measures of HPA activity, the normal weight patients with bulimia were indistinguishable from the controls. These results suggest that HPA activity is normal in most patients of normal body weight with bulimia and that the psychological and behavioral disturbances common to both anorexia nervosa and bulimia are, in the absence of significant weight loss, insufficient to produce major alterations in HPA activity.

Adrenocorticotropic Hormone↗
PubMed1987

Food intake and mood in anorexia nervosa and bulimia.

It is clear that patients with anorexia nervosa and bulimia have disturbances of mood, and it is likely that the mood disturbances bear an important relationship to the disturbances of eating behavior. We have as many questions, however, about the relationship between mood and eating behavior in these syndromes as we have answers. Although patients with anorexia nervosa and bulimia are frequently depressed, they fail to exhibit many of the biological characteristics of typical depressive illness, suggesting that these eating disorders are probably not simply variants of depression. Patients with bulimia appear to binge in response to dysphoric emotional states and to derive some transient relief from their bingeing. But it is unclear what facet or facets of the binge produce the alteration in emotional state, and thereby may serve to reinforce the behavior. A more detailed examination of this issue may significantly advance our understanding of the relationship between mood and food in eating disorders.

Anorexia Nervosa↗
PubMed1987

Premenstrual exacerbation of binge eating in bulimia.

Several studies have suggested an association between the premenstrual phase of the menstrual cycle and changes in appetite and eating behavior. This study examined the relation between phase of menstrual cycle and frequency of binge eating in 15 normal-weight women with bulimia whose eating behavior had been unaffected by placebo treatment during a medication study. There was a modest but statistically significant premenstrual exacerbation of binge eating.

Adult↗
PubMed1987

Cardiovascular effects of imipramine and bupropion in depressed patients with congestive heart failure.

There has been a long-standing concern over the cardiovascular effects of tricyclic antidepressants, particularly in patients with preexisiting cardiac disease. Recent studies have demonstrated that imipramine causes no deleterious effect on ejection fraction as determined by radionuclide angiography in patients with impaired left ventricular function (LVF). However, the high rate of severe orthostatic hypotension induced by imipramine makes use of the drug problematic in these patients. Bupropion is a new antidepressant of the aminoketone class which is structurally unrelated to the tricyclics and which is relatively free of cardiac side effects in healthy depressed patients. We compared imipramine and bupropion in 10 depressed patients with impaired LVF in a random, double-blind crossover study. Neither imipramine nor bupropion adversely affected ejection fraction or other indices of LVF. However, as previously reported, severe orthostatic hypotension requiring discontinuation of drug developed in 50% of patients on imipramine. This difficulty did not occur with bupropion. From a cardiac perspective, bupropion may offer a safe alternative to imipramine in depressed patients with congestive heart failure.

Aged↗