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Biomedical subjects

J E Mitchell

Publications and source records attributed to J E Mitchell.

At least 19 recordsLinked to original sources
PubMed1992

Binge eating in the obese.

This review will first describe problems in the definition of the term binge eating, especially in the absence of purging (vomiting, laxative abuse). We highlight current approaches in the classification of obesity, and then provide an overview of the available literature on differences between obese binge eaters and obese non-binge eaters. Many studies indicate that binge eating is common among the female obese, with a frequency ranging from 23 to 46% among those seeking treatment for weight reduction. Despite differences in the definitions of binge eating and variability among the samples investigated, there is strong evidence that binge eaters represent a distinct subgroup among the obese. Binge eating obese exhibit significantly more eating and weight-related pathology, as well as more psychopathology compared to their non-binge eating obese counterparts.

Age Factors↗
PubMed1992

Opiate antagonists and eating behavior in humans: a review.

Animal studies have demonstrated a robust role for the endogenous opioid system in the control of food intake. In humans, selective opioid antagonists such as naloxone, naltrexone, and nalmefene have been shown in some studies to reduce total food intake by up to 30% and to alter food preferences in short-term experimental trials in normal-weight subjects, as well as in obese and bulimic patients. The value of naloxone and naltrexone in the long-term treatment of eating disordered patients, however, must be considered very limited. The published treatment studies do not justify the routine use of naloxone and naltrexone in patients with Prader-Willi syndrome, obesity, bulimia nervosa, or anorexia nervosa because of their unprofitable risk/benefit ratios, although further work, particularly focused on some of the newer antagonists, should be undertaken.

Appetite Depressants↗
PubMed1991

Sauna abuse as a clinical feature of bulimia nervosa.

The authors describe a series of 14 patients with bulimia nervosa who regularly spent long periods of time in saunas as a weight-control technique. This practice is probably more common in parts of the world where Finnish saunas are in widespread use. Many of these patients also engaged in other behaviors that resulted in dehydration, such as diuretic abuse and laxative abuse.

Adolescent↗
PubMed1991

A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania.

OBJECTIVE: It has been proposed by some investigators that trichotillomania, a disorder of chronic hair pulling, is a variant of obsessive-compulsive disorder, and some studies have suggested that the antiobessional agents clomipramine and fluoxetine are useful in treating this disorder. The authors investigated the efficacy of fluoxetine in the treatment of trichotillomania. METHOD: Twenty-one adult chronic hair pullers were recruited into an 18-week placebo-controlled, double-blind crossover study of fluoxetine, in doses up to 80 mg/day. The fluoxetine and placebo treatment phases consisted of 6-week trials of each agent separated by a 5-week washout period. Fifteen subjects (14 female and one male) completed the study; an additional female subject dropped out at 16 weeks after developing a drug reaction. RESULTS: No significant Drug by Period interactions were found in weekly subject ratings of hair pulling, weekly subject ratings of the urge to pull hair, weekly assessments of the number of hair-pulling episodes, or the estimated amount of hair pulled per week. CONCLUSIONS: The short-term efficacy of fluoxetine in the treatment of trichotillomania was not demonstrated in this study.

Adult↗
PubMed1991

Characteristics of 60 adult chronic hair pullers.

OBJECTIVE: This study was constructed to detail the demographic and phenomenological features of chronic hair pullers as well as to assess psychiatric comorbidity in a sizable study group. METHOD: Subjects were drawn from an outpatient population of chronic hair pullers who had been referred to a trichotillomania clinic or had responded to a newspaper advertisement announcing a treatment study of adults who pull out their hair. Sixty adult chronic hair pullers completed a semistructured interview that focused on their hair-pulling behavior and demographic characteristics and that incorporated screening questions for DSM-III-R axis I disorders. The data were tabulated to derive a comprehensive picture of this group. RESULTS: The typical subject was a 34-year-old woman who had pulled hair from two or more sites for 21 years. All subjects described either tension before or relief/gratification after pulling hair from the primary site, but 17% (N = 10) failed to describe both of these characteristics and thus failed to fulfill the DMS-III-R criteria for trichotillomania. Forty-nine subjects (82%) qualified for past or current axis I diagnoses other than trichotillomania. Several characteristics of the study group suggested phenomenological differences between obsessive-compulsive disorder and trichotillomania. CONCLUSIONS: Adult trichotillomania is a chronic disorder, frequently involving multiple hair sites, and is associated with high rates of psychiatric comorbidity. Its relation to obsessive-compulsive disorder requires further clarification. The tension-reduction requirement in DSM-III-R for the diagnosis of trichotillomania may be overly restrictive.

Adult↗
PubMed1991

Bone mineral density and anorexia nervosa in women.

OBJECTIVE: A review of reports of reduced bone mineral density in women with anorexia nervosa was undertaken in order to profile specific risk factors, which could then be used as the basis for suggestions for future research and treatment. METHOD: Thirteen research studies and four case studies of reduced bone mineral density and fractures in women with anorexia nervosa were reviewed. The relationships between bone mineral density and amenorrhea, estrogen, calcium intake, physical activity, parathyroid hormone, alkaline phosphatase, 1,25-dihydroxyvitamin D, cortisol, and growth hormone were examined in the reports of these studies and other reports of altered physiology during anorexia nervosa. RESULTS: The average spinal, radial, and femoral bone mineral density in anorexic women was significantly lower than it was in normal control subjects. Concurrent with the low intake of nutrients by individuals with anorexia nervosa, low body weight, early onset and long duration of amenorrhea, low calcium intake, reduced physical activity, and hypercortisolism appeared more likely to contribute to decreased bone mineral density than did other abnormal aspects of the disorder. CONCLUSIONS: Future research needs to address how such factors as amenorrhea and hypercortisolism affect bone mineral density in anorexia nervosa. Since no controlled trials of estrogen replacement or calcium supplementation in anorexia nervosa have been reported, the proper treatment for decreased bone mineral density is not known. However, the most obviously important intervention is to encourage medical stabilization and weight gain.

Adolescent↗
PubMed1991

Estimated lifetime prevalence of trichotillomania in college students.

BACKGROUND: Trichotillomania, a disorder of hair pulling, has been considered a rare condition. Estimations of the prevalence of this disorder have been based largely on clinical experience, and there have been no estimates of its prevalence based on data collected from a large, nonclinical population. METHOD: 2579 freshman college students at two state universities and one liberal arts college were asked to provide written responses to questions designed to practically apply DSM-III-R criteria for trichotillomania and estimate the prevalence of trichotillomania in this population. RESULTS: 2534 students (97.9% of the study population) responded. We found a 0.6% lifetime prevalence of DSM-III-R trichotillomania for both male and female respondents. Hair pulling resulting in visible hair loss, but failing to meet full DSM-III-R criteria, was identified in 1.5% of males and 3.4% of females. CONCLUSION: Trichotillomania may not be as rare as previously suspected and may affect males as often as females.

Adolescent↗
PubMed1991

Comorbidity and medical complications of bulimia nervosa.

The syndrome of bulimia nervosa has been associated with a high rate of comorbidity with other psychiatric disorders. In particular, high rates of affective disorders, chemical dependency problems, anxiety disorders, and personality disorders have been described among these patients and, in some studies, among their relatives. The reasons for this elevated comorbidity remain unclear. It is frequently difficult to tell which condition develops first. Bulimia nervosa has also been associated with significant medical complications. Most patients with bulimia evidence metabolic and endocrine changes suggestive of a state of semistarvation. Fluid and electrolyte abnormalities are common, as are dental complications. Gastrointestinal complications are rare, but can be quite serious. A careful physical assessment is indicated for each bulimic patient.

Anorexia Nervosa↗
PubMed1991

Bulimia nervosa.

Bulimia nervosa is a disorder affecting the eating patterns of women in industrialized societies. Medical and dental consequences of the illness often lead patients to seek treatment after about six years. Controlled treatment studies to date utilize outpatient therapy instead of hospitalization. Published literature suggests that the illness is most effectively treated with psychotherapy and antidepressant medications; however, including nutritional intervention in the treatment regimen shows promise. Clearly more studies are necessary.

Bulimia↗
PubMed1990

A comparison study of antidepressants and structured intensive group psychotherapy in the treatment of bulimia nervosa.

Previous research on the treatment of outpatients with bulimia nervosa has focused on two treatment strategies: (1) drug therapy, primarily using tricyclic antidepressants, and (2) psychotherapy, often employing behavioral and cognitive behavioral techniques. We report here the short-term treatment outcome of a 12-week comparison trial of bulimic outpatients who were randomly assigned to one of four treatment cells: (1) imipramine hydrochloride treatment, (2) placebo treatment, (3) imipramine treatment combined with intensive group psychotherapy, and (4) placebo treatment combined with intensive group psychotherapy. All three active treatment cells resulted in significant reductions in target-eating behaviors and in a significant improvement in mood relative to placebo treatment. However, the results also suggested that the amount of improvement obtained with the intensive group psychotherapy component was superior to that obtained with antidepressant treatment alone. The addition of antidepressant treatment to the intensive group psychotherapy component did not significantly improve outcome over intensive group psychotherapy combined with placebo treatment in terms of eating behavior, but did result in more improvement in the symptoms of depression and anxiety.

Adolescent↗
PubMed1990

The influence of prior alcohol and drug abuse problems on bulimia nervosa treatment outcome.

This study examined the impact of prior alcohol/drug abuse problems on long-term outcome for a series of women with bulimia nervosa. The patients with a history of alcohol/drug abuse problems were not more likely to demonstrate a pattern drug use following bulimia treatment, and overall their outcome was comparable to the outcome of those patients who had not had alcohol/drug abuse problems.

Adolescent↗
PubMed1990

Bulimia nervosa with and without a history of overweight.

In a review of the records of 454 patients with bulimia nervosa, 87 (19.2%) reported having a history of weight greater than 130% ideal body weight, although they were normal weight at evaluation. As contrasted to patients who had no history of having been overweight, this group of patients had a later onset of bulimia symptoms, weighed more and were more likely to be very dissatisfied with their current weight and to fear becoming overweight. The eating problems were similar in both groups.

Adult↗
PubMed1990

Bulimia nervosa in overweight individuals.

Patients who have bulimia nervosa and are overweight have received little attention in the medical literature. The authors identified 25 patients who weighed greater than or equal to 130% of their ideal body weight out of a series of 591 patients with bulimia nervosa. This subgroup was contrasted with a sample of 25 patients with bulimia nervosa who were 90% to 110% of their ideal body weight. Members of the overweight bulimia nervosa group were binge-eating and vomiting less frequently than the comparison group but were more likely to be abusing laxatives, and to report a history of self-injurious behavior and suicide attempt(s). Both groups reported frequent binge-eating.

Body Weight↗