Biomedical subjects
Publications and source records attributed to H G Pope.
Comparing 15 consecutive male bulimic patients to a female bulimic control group, the authors found no differences on demography, associated psychopathology, family history, or treatment response. In contrast to a previous report, the authors found little evidence of increased homosexuality or "sexual conflict" in these men.
Twenty-five pathological gamblers were examined for additional DSM-III diagnoses and family history of psychiatric illness. Eighteen subjects (72%) had experienced at least one episode of major depression, and 13 (52%) had recurrent major affective episodes. A high prevalence (20%) of panic disorder and/or agoraphobia was also found.
Research suggests that attention deficit disorder (ADD) may persist into adulthood, perhaps predisposing certain individuals to stimulant abuse. The authors describe two adults with chronic cocaine abuse and apparent residual ADD. After failing to respond to conventional treatment modalities, these patients were administered magnesium pemoline. Both displayed a sustained reduction in their cocaine use, without abusing pemoline. This finding suggests that the diagnostic assessment of cocaine abusers should include a search for a history of ADD. A carefully selected subgroup of this population may benefit from treatment with other stimulant medications.
In 1903 Pierre Janet published perhaps the first detailed descriptions of patients with bulimia. Janet's observations, although anecdotal, are consistent with modern studies suggesting an association between bulimia and major affective disorder and between bulimia and anxiety disorders. Janet's writings also support the belief that bulimia is more prevalent today than a century ago.
To assess the nature and prevalence of psychotic symptoms in borderline personality disorder, the authors reviewed the cases of 33 patients meeting DSM-III criteria for borderline personality disorder, using both "narrow" and "broad" definitions of psychosis. Only eight patients displayed psychotic symptoms meeting the "narrow" DSM-III definition; in all of these cases, the symptoms appeared to be attributable to either severe drug abuse or major affective disorder, present simultaneously with borderline personality disorder. The remaining patients displayed only "broadly defined" psychotic symptoms or symptoms that appeared to be under voluntary control. These findings weigh against the assumption that borderline personality disorder lies "on the border" of classical psychotic disorders.
Fibromyalgia is a form of nonarticular rheumatism characterized by diffuse musculoskeletal pain. To investigate the relationship between fibromyalgia and major affective disorder, the authors evaluated 31 patients with fibromyalgia and 14 patients with rheumatoid arthritis for rates of current or past major affective disorder and family history of major affective disorder. Both the rate of major affective disorder and the familial prevalence of major affective disorder were significantly higher in the fibromyalgia patients than the rheumatoid arthritis patients. The results suggest that fibromyalgia may be related to major affective disorder.
The combination of monoamine oxidase inhibitors and tryptophan--a recognized antidepressant regimen--has been reported to cause behavioral or neurologic toxicity. The authors present eight cases of delirious syndromes apparently attributable to this combination of agents.
Follow-ups for periods of up to 2 years on 20 bulimic subjects treated with antidepressants are reported. At the time last seen in follow-up, 19 (95%) of the subjects had experienced at least a partial improvement in their bulimia, and 10 (50%) had experienced a complete remission of bulimic symptoms. In addition, most subjects displayed a marked reduction in depressive symptoms. This suggests that antidepressants do not merely reduce binge eating per se, but produce a more general therapeutic effect for bulimic patients. However, these promising findings must be tempered by the fact that antidepressant treatment is not always simple and may require extensive management over the long term.
To assess the prevalence of anorexia nervosa and bulimia among young diabetic women, a questionnaire was sent to 264 young women with insulin-dependent diabetes mellitus in two clinical settings. Among the women who responded (30%), none reported a history of anorexia nervosa, but 28 (35%) reported a history of bulimia. These results suggest that bulimia represents a common problem among young women with diabetes.
Nine patients with anorexia nervosa were treated with antidepressant medications from three classes: tricyclics, monoamine oxidase inhibitors, and triazolopyridines. A tenth patient was treated with the combination of lithium carbonate and carbamazepine. With either the initial or a subsequent medication trial, four patients had displayed significant improvement in weight and in other anorexic and bulimic symptoms. Three additional patients had a marked or moderate improvement in bulimic symptoms, one with moderate and two without any weight gain. Two other patients had moderate weight gain. Side effects were a significant problem in many of the patients. These preliminary results suggest that antidepressants may be of benefit in the treatment of some patients with anorexia nervosa.
Sodium valproate, a medication sometimes effective in bipolar disorder, produced a rapid remission of previously refractory bulimia and affective symptoms in a young woman. Like other medications used to treat major affective disorder, valproate may benefit certain patients with bulimia.
Of 300 female shoppers who responded to a questionnaire on anorexia nervosa and bulimia, 0.7% reported a history of anorexia nervosa and 10.3% reported a history of bulimia. The data support the belief that these disorders may be increasing in prevalence.
Bulimia, believed to occur primarily in young women, is rarely suspected in older individuals. The authors report on a 56-year-old woman with rapid cycling bipolar disorder, whose unexplained vomiting proved attributable to bulimia.
In a sample of 130 consecutive patients with a lifetime diagnosis of anorexia nervosa and/or bulimia, 17 displayed psychotic symptoms. In 16 patients, these symptoms appeared attributable to major affective disorder or schizo-affective disorder, while in one, they appeared to represent factitious psychosis. No cases of schizophrenia or organic psychosis were identified.
Do patients with borderline personality disorder (BPD) display psychotic symptoms as part of their syndrome? This question has important theoretical significance, since it bears on the question of whether BPD lies 'on the border' of psychotic functioning, or whether it is unrelated to psychotic disorders. A review of available evidence suggests that 'narrowly defined' psychotic symptoms, such as those included under the DSM-III definition of psychosis, are rare in BPD. Furthermore, when such symptoms have been reported in BPD, they may have been attributable to a concomitant, possibly independent, disorder suffered by the patient, such as substance abuse or major affective disorder. Broadly defined psychotic symptoms, such as depersonalization, are much more often reported in BPD, but many of these symptoms have also been reported frequently in patients with non-psychotic disorders and in normals. Finally, the prevalence of factitious psychotic symptoms in BPD has not been systematically investigated. Thus, the evidence for psychotic symptoms in BPD remains equivocal.
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Familial hyperkalemic periodic paralysis and bipolar disorder are both hereditary disorders, characterized by episodes of illness separated by periods of remission, and possibly related to abnormalities in cellular ion transport. Recently we discovered a patient who suffered from both illnesses, as did his mother and grandmother. However, a detailed investigation of the pedigree suggested that these two disorders are not linked genetically. Furthermore, a placebo-controlled double-blind trial of lithium carbonate in this patient found lithium ineffective in preventing the attacks of paralysis, in contrast to another recent study which found lithium effective in hypermagnesemic periodic paralysis.
To test the validity of the DSM-III diagnosis of borderline personality disorder (BPD), we examined the phenomenology, family history, treatment response, and four-to-seven-year long-term outcome of a cohort of 33 patients meeting DSM-III criteria for BPD. We found that (1) BPD could be distinguished readily from DSM-III schizophrenia; (2) BPD did not appear to represent "borderline affective disorder," although many patients displayed BPD and major affective disorder concomitantly; and (3) BPD could not be distinguished on any of the indices from histrionic and antisocial personality disorders.