Biomedical subjects

J E Mitchell

Publications and source records attributed to J E Mitchell.

At least 55 records · Page 3Linked to original sources

PubMed1998

Feeding laboratory studies in patients with eating disorders: a review.

OBJECTIVE: The authors review the available literature on feeding lab studies in individuals with anorexia nervosa, bulimia nervosa, and binge eating disorder. METHOD: Studies were grouped by the research groups which have conducted such studies since these studies have tended to cluster in certain research settings, using specific methodologies at each sites. RESULTS: The results of this review indicate that although there are several inherent limitations in this type of research, various groups of investigators have demonstrated that eating disorder patients will engage in pathological eating behaviors in structured laboratory settings and that results can be obtained fairly consistently. Also interesting clinically significant differences have emerged across groups. Subtle differences in technique, such as the instructions regarding eating behavior, probably result in different behavioral responses. DISCUSSION: Feeding laboratory studies provide useful information that can validate, suggest, or challenge established clinical assumptions and diagnostic criteria. However, there are limitations to these methodologies.

Anorexia Nervosa↗

PubMed1998

Group cognitive-behavioral treatment of binge eating disorder: a comparison of therapist-led versus self-help formats.

OBJECTIVE: The purpose of this study was to compare three group cognitive-behavioral therapy (CBT) treatment models and a waiting list control condition (WL). METHOD: Sixty-one women who met DSM-IV criteria for binge eating disorder (BED) received treatment with the same cognitive-behavioral treatment manual in 14 one-hour sessions over an 8-week period. All sessions consisted of psychoeducation for the first 30 min and group discussion for the second half hour. In the therapist-led condition (TL; n = 16), a doctoral therapist led both the psychoeducational component and group discussion. In the partial self-help condition (PSH; n = 19), participants viewed a 30-min psychoeducational videotape, followed by participation in a therapist-led discussion. In the structured self-help condition (SH; n = 15), subjects viewed the 30-min psychoeducational videotape and subsequently led their own 30-min discussion. Eleven subjects were assigned to a wait-list control condition (WL). The primary outcome variables were frequency and duration of self-reported binge eating episodes. RESULTS: A mixed effects linear modeling (random regression) analysis indicated that subjects in all three active treatment conditions showed a decrease in binge eating symptoms over time. No group differences in rates of change over time were observed, although analysis of covariance indicated that all three treatment conditions showed significantly greater improvement in binge eating compared to the WL condition. DISCUSSION: The findings from this preliminary study suggest that CBT for BED can be delivered effectively in a structured group self-help format.

Adolescent↗

PubMed1998

Binge eating disorder with and without a history of purging symptoms.

OBJECTIVE: The purpose of this study was to evaluate whether a history of purging behaviors in individuals with binge eating disorder (BED) is associated with increased comorbid psychopathology, dietary restraint, severity of eating pathology, and attitudinal disturbance in self-esteem and body image. METHOD: Sixty-three women meeting DSM-IV criteria for BED who were participating in a psychotherapy treatment study were subclassified according to whether they reported a history of purging behavior using self-induced vomiting or laxatives (HP; N = 24) or no such history (NHP; N = 39). The two groups were compared on the following variables: DSM-IV Axis I Lifetime diagnoses, Hamilton Depression Rating Scale, Body Shape Questionnaire, Three Factor Eating Questionnaire, Binge Eating Scale, and the Rosenberg Self-Esteem Scale. RESULTS: Data analyses revealed no significant differences between the two BED subgroups on any of the measures. DISCUSSION: These findings indicate that a history of purging behavior in BED is not associated with increased rates of comorbid psychopathology, severity of eating problems, dietary restraint, or attitudinal disturbance. Purging history does not appear to be a clinically meaningful variable with which to subclassify individuals with BED.

Adult↗

PubMed1998

Fluvoxamine in the treatment of binge-eating disorder: a multicenter placebo-controlled, double-blind trial.

OBJECTIVE: The purpose of this study was to assess the efficacy of fluvoxamine in the treatment of binge-eating disorder. Binge-eating disorder is a newly described eating disorder characterized by recurrent episodes of binge eating but without purging behaviors. Uncontrolled reports have suggested that serotonin selective reuptake inhibitors (SSRIs) may be effective in treating this disorder. METHOD: Eighty-five outpatients with a DSM-IV diagnosis of binge-eating disorder were randomly assigned to receive either fluvoxamine (N=42) or placebo (N=43) in a 9-week, parallel-group, double-blind, flexible dose (50-300 mg) study at three centers. The primary outcome measures were frequency of binge eating, expressed as log ([binges/week]+1), and Clinical Global Impression (CGI) scale ratings. Secondary measures included the level of response (based on the percentage change in frequency of binges), body mass index, and Hamilton Rating Scale for Depression score. Except for the level of response, the outcome measures were analyzed by random regression methods; the treatment-by-time interaction was the measure of treatment effect. RESULTS: Compared with placebo, fluvoxamine was associated with a significantly greater rate of reduction in the frequency of binges, rate of reduction in CGI severity scores, rate of increase in CGI improvement scores, level of response for patients who completed the 9-week study, and rate of reduction in body mass index. There was no significant difference between placebo and fluvoxamine groups in the rate of decrease in Hamilton depression scale scores. A significantly greater proportion of patients receiving fluvoxamine than those receiving placebo discontinued treatment because of an adverse medical event. CONCLUSIONS: In this placebo-controlled trial, fluvoxamine was found to be effective according to most outcome measures in the acute treatment of binge-eating disorder.

Adolescent↗

PubMed1998

Cloning of a cDNA encoding ovine keratinocyte growth factor.

A cDNA encoding the ovine keratinocyte growth factor (KGF) has been cloned. A 622-bp cDNA, containing the entire protein coding region, was amplified from an ovine adenocarcinoma fibroblast cell line. The cDNA was found to share 95% nucleotide identity with dog KGF, 94% identity with human KGF, 90% identity with mouse KGF and 88% identity with rat KGF. The predicted ovine amino-acid sequence shares 98.5, 98, 96 and 94% identity, respectively, with the corresponding dog, human, mouse and rat proteins. The KGF gene is present as a single copy in the ovine genome.

Amino Acid Sequence↗

PubMed1997

A comparison of onset of binge eating versus dieting in the development of bulimia nervosa.

OBJECTIVE: This study further investigates the hypothesis that dieting is the precursor to the development of binge eating. METHOD: The temporal relationship of onset of binge eating and dieting is examined from retrospective self-reports collected at baseline from women participating in two bulimia nervosa (BN) treatment studies (N = 221). Twenty women were identified who reported binge eating prior to the onset of dieting ("binged first," BF). For comparison, 20 similar age individuals reporting dieting onset preceding that of binge eating ("dieted first," DF) were selected. RESULTS: A subset of women (8.8%) seeking treatment for BN endorsed the development of binge eating prior to dieting onset. The BF pattern of BN development was associated with earlier age of onset of binge eating, later onset of purging, increased desired weight, and increased actual weight. Binge eating prior to dieting onset was also associated with improved response to group cognitive-behavioral treatment at 6-month follow-up. CONCLUSIONS: This study provides support for the hypothesis that dieting is a risk factor, but not necessarily a precursor, to the development of binge eating in BN. Implications for treatment and future research are discussed.

Adult↗

PubMed1997

Serum electrolytes as markers of vomiting in bulimia nervosa.

OBJECTIVE: Patients with bulimia nervosa often have serum electrolyte abnormalities that result from vomiting and/or laxative or diuretic use. Thus, serum electrolytes could serve as an objective marker of such behaviors. METHOD: This study is a retrospective examination of serum electrolyte levels and vomiting behavior in 138 bulimic women, and of serum electrolyte levels in 70 control women. RESULTS: Logistic regression analyses demonstrated that only potassium values distinguished bulimic subjects from controls. Potassium levels below the lower limit of normal (3.7 mg/l) occurred only in the bulimic group. DISCUSSION: Abnormally low values for potassium are a specific, but not sensitive, predictor of recent vomiting episodes.

Adult↗

PubMed1997

The superior mesenteric artery syndrome and acute gastric dilatation in eating disorders: a report of two cases and a review of the literature.

OBJECTIVE: The pathophysiology and symptomatology of the superior mesenteric artery syndrome (SMA syndrome) is discussed. METHOD: A review of much of the available literature concerning the SMA syndrome and the associated condition acute gastric dilatation is offered. RESULTS: Two new cases of acute gastric dilatation in patients with eating disorders, one of whom was diagnosed with SMA syndrome, are presented, along with a discussion of these conditions in reference to the eating disorders. CONCLUSION: The SMA syndrome and gastric dilatation are rare but potentially a very serious complication of eating disorders, and clinicians who work with these patients should be aware of such problems.

Adult↗

PubMed1997

The relationship between socioeconomic status and eating-disordered behaviors in a community sample of adolescent girls.

OBJECTIVE: Although previous research has demonstrated a relationship between socioeconomic status (SES) and weight, the research has not been consistent regarding the relationship between SES and eating disorders. This analysis was designed to examine this relationship in a large community sample of adolescent girls (Grades 7 to 12). METHOD: Items were selected from a comprehensive self-report health survey completed by 17,571 adolescent girls. The relationships between SES and dieting behaviors and attitudes were examined using chi-square tests and analysis of variance (ANOVA) to control for body mass index. RESULTS: Although there was a significant positive relationship between SES and some of the unhealthy dieting behaviors, there was no relationship between self-report of clinically significant eating-disordered behaviors (e.g., vomiting twice a week or more) and SES in this community sample. DISCUSSION: This study suggests that while there may be a significant relationship between SES and dieting or other behaviors associated with eating disorders, this relationship does not apply to diagnostically significant behaviors. SES may be associated with differences in dieting or eating behaviors; however, among those young women who meet psychiatric criteria for an eating disorder, SES does not appear to be a significant factor.

Adolescent↗

PubMed1997

The selectivity of inclusion and exclusion criteria in bulimia nervosa treatment studies.

OBJECTIVE: To examine the rates of exclusion and inclusion in various research studies for a series of 51 treatment-seeking patients. METHOD: The inclusion and exclusion criteria employed in a sample of 41 studies were applied to a series of 51 treatment-seeking bulimia nervosa patients. RESULTS: Of the sample of 51, 11, (21.6%) would have been excluded from 16 (39%) of the studies because of an age greater than 30; 13 (32%) of the studies would have excluded 8 (16%) of our patients because of weight > 110% ideal body weight. Thirteen (26%) would have been excluded from 22 (54%) of the studies because of active psychotropic drug use, despite the lack of response. DISCUSSION: Some of the patients who may be most difficult to work with may be excluded from treatment studies.

Adolescent↗

PubMed1997

Outcome in bulimia nervosa.

OBJECTIVE: The authors sought to synthesize existing data on outcome for individuals diagnosed with bulimia nervosa in order to better understand long-term outcome and prognostic factors. METHOD: They reviewed 88 studies that conducted follow-up assessments with bulimic subjects at least 6 months after presentation. Findings are summarized for the areas of mortality, recovery, relapse, crossover, and prognostic variables. RESULTS: The crude mortality rate due to all causes of death for subjects with bulimia nervosa in these studies was 0.3% (seven deaths among 2,194 subjects); however, ascertainment rates and follow-up periods were small and likely to produce underestimation. Five to 10 years following presentation, approximately 50% of women initially diagnosed with bulimia nervosa had fully recovered from their disorder, while nearly 20% continued to meet full criteria for bulimia nervosa. Approximately 30% of women experienced relapse into bulimic symptoms, and risk of relapse appeared to decline 4 years after presentation. Few prognostic factors have been consistently identified, but personality traits, such as impulsivity, may contribute to poorer outcome. In addition, participation in a treatment outcome study was associated with improved outcome for follow-up periods less than 5 years. CONCLUSIONS: Treatment interventions may speed eventual recovery but do not appear to alter outcome more than 5 years following presentation. Long-term outcome for women diagnosed with bulimia nervosa remains unclear. However, this disorder may be chronic for at least a subset of women.

Age of Onset↗

PubMed1997

Eating disorders and comorbidity: empirical, conceptual, and clinical implications.

The most common major comorbid disorders associated with eating disorders include substance use disorders, personality disorders, mood disorders, anxiety disorders, and obesity. To test conceptual models of the relationship between the eating disorders and these comorbid disorders, complex research paradigms are needed, including epidemiological studies, behavior-genetic studies, and longitudinal research designs. Comorbidity may be a significant factor to consider as approaches to the treatment of eating disorders continue to evolve.

Comorbidity↗

PubMed1996

Discriminant function analysis of depressive symptoms in binge eating disorder, bulimia nervosa, and major depression.

OBJECTIVES: To examine the frequency and distribution of depressive symptoms among subjects with binge eating disorder (BED), bulimia nervosa (BN), and major depression. METHODS: This study examined depressive symptoms from the Hamilton Depression Scale in 122 BED, 142 BN, and 200 major depression subjects using discriminant function analysis. RESULTS: All three groups differed significantly on the Hamilton Depression Scale totals with major depressive disorder (MDD) subjects having the highest and BED subjects the lowest totals. Eighteen items differentiated MDD from the eating disorder groups. Three items-gastrointestinal (GI) somatic symptoms, paranoid symptoms, and obsessional symptoms-distinguished BED and BN. In each case these symptoms were more common in BN subjects. DISCUSSION: This study attempted to differentiate BN from BED on a basis other than eating behavior. The results provide limited support for the hypothesis that BN and BED can be distinguished on the basis of depressive symptoms.

Adult↗

PubMed1996

Research on the psychotherapy of bulimia nervosa: half empty or half full.

OBJECTIVE: The current status of the research knowledge on the psychotherapy of bulimia nervosa is reviewed. METHODS: Published studies using randomization to treatment are discussed. RESULTS: The existing research data speak convincingly to the efficacy of cognitive behavioral treatment (CBT); however, certain important questions remain unanswered. DISCUSSION: The current deficiencies in the field are underscored.

Adolescent↗

PubMed1996

Differences in body image and depression among obese women with and without binge eating disorder.

Obese individuals with binge eating disorder (BED) differ from obese non-binge eating (NBE) individuals in a number of clinically relevant ways. This study examined attitudinal responses to various measures of body image in women seeking obesity treatment, by comparing NBE participants (n = 80) to those with BED (n = 48). It was hypothesized that women with BED would demonstrate greater attitudinal disturbance of body image compared to NBE individuals. It was further hypothesized that significant differences between groups would remain after statistically controlling for degree of depression. Consistent with the primary hypothesis, BED participants reported significantly increased attitudinal disturbance in body dissatisfaction and size perception compared to NBE participants. Although shared variance was observed between measures of depression and body image on some items, several aspects of increased body image disturbance remained after statistically controlling for depression. Treatment implications and recommendations for future research are discussed.

Adolescent↗

PubMed1996

Integrating cognitive therapy and medications in treating bulimia nervosa.

This article addresses the effect of managed care on the treatment of eating disorders. We review strategies for negotiating limitations that managed care reviewers place on treatment. Finally, this article reviews the experiences of a Canadian program that has 10 years of experience in providing low-cost day treatment. While change is frustrating and difficult, it is inevitable and can be rejuvenating. These changes offer opportunities for creative development of quality low-cost care. If we do not adjust to these conditions, patients will not get treatment that they need.

Bulimia↗

PubMed1996

Clinical characteristics associated with binge eating in obese females: a descriptive study.

OBJECTIVE: To investigate differences in clinical characteristics of obese female participants based on presence and degree of binge eating behavior. DESIGN: Descriptive comparison of various clinical characteristics of obese women diagnosed with binge eating disorder (BED) assessed by semi-structured interview to those for similar weight participants reporting subthreshold BED and those who do not binge eat. SUBJECTS. 185 healthy women seeking obesity treatment (age: 20-55 y, BMI: 28.4-51.5 kg/m2). MEASUREMENTS: Baseline self-report questionnaires included the Weight and Eating Patterns (QEWP), Eating Disorders Questionnaire (EDQ), Beck Depression Inventory (BDI); clinical interviews included the Hamilton Depression Rating Scale (HDRS) and Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). RESULTS: In comparison to other obese women, obese participants meeting full BED criteria report an earlier onset of binge eating, increased food cravings, increased diet pill use, decreased fasting, greater fear of gaining weight, increased body perception disturbance, and increased depressive symptomatology and general psychopathology. CONCLUSIONS: Obese women with BED report greater eating-related and general psychopathology than non-binge eating disordered women of comparable weight. Although endorsement of food cravings unrelated to hunger was associated with binge eating diagnosis, the role of dietary restriction among this population remains unclear and requires further investigation. Theoretical and clinical implications that binge eating episodes for individuals with BED may be related to negative affect states and increased dietary disinhibition are discussed.

Adult↗

PubMed1995

Compact structures of d(CNG)n oligonucleotides in solution and their possible relevance to fragile X and related human genetic diseases.

We show that oligonucleotides of CNG tracts readily adopt compact DNA structures that move unusually fast on gels. Base composition does not explain this, and non-CNG triplets (including GNC) do not form such structures. Chemical probing and melting experiments suggest that the structures probably are not hairpins. Although both long and short tracts can adopt compact structures, the structure formed by longer tracts is more compact than that formed by shorter ones. We note the possibility that such structures may form in vivo, and be instrumental in normal and/or abnormal function of human genes.

Base Sequence↗