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Biomedical subjects

J H Lacey

Publications and source records attributed to J H Lacey.

At least 19 recordsLinked to original sources

Season of birth and bulimia nervosa.

OBJECTIVE: Previous studies suggest season of birth variation in eating disorders akin to those of psychoses. We studied season of birth variation in bulimia nervosa. METHOD: Season of birth variation in 935 patients was examined after adjustment for population trends. Variation was also examined for subgroups by age and previous anorexia nervosa. RESULTS: Season of birth did not differ significantly from population norms among bulimics (p >.30), contrasting with studies of other eating disorders. With a history of anorexia nervosa (n = 227), peak season of birth was in March (p <.05). This is consistent with previous studies and also with seasonal birth variation for psychoses. DISCUSSION: Overall, we find no evidence of season of birth variation in bulimia nervosa, and suggest any positive findings be treated with caution. We discuss a number of confounding influences and argue that one explanation remains shared trait vulnerability between anorexia nervosa and psychoses.

Adolescent↗

Blood-letting in anorexia nervosa: a case study.

BACKGROUND: Deliberate blood-letting has been characterized as an alternative to purging behavior in bulimia. METHOD: We describe a female healthcare worker with an 8-year history of restrictive anorexia nervosa, who initially presented with anemia, using blood-letting, cold baths, and starvation to control her mental state. RESULTS: In contrast with the previous cases of bulimia, the aim of blood-letting in this case of anorexia nervosa was to achieve anemia. She compared the psychic correlates of anemia to emaciation, rather than to deliberate self-harm or purging. DISCUSSION: We note that mainstream 19th century psychiatry prescribed "baths, blood-letting and diet" as a treatment of "madness."

Anemia↗

"Spiritual starvation?": a case series concerning christianity and eating disorders.

METHOD: We describe the cases of four patients with eating disorders in whom complex interactions occurred among religious faith, pathogenesis of the eating disorder, and clinical management. RESULTS: In some of the cases, religious beliefs seemed to provide a containment of maladaptive behaviors, partly through prayer and through a sense of belonging to the religious community. In other cases, it proved difficult to separate the concept of a punitive God from the illness process. DISCUSSION: The cases are discussed with reference to a limited empirical literature. Similarities are noted between some religious institutions and eating disorder treatment regimes. This paper explores management issues, including the use of pastoral counseling and the ethics of addressing religious beliefs in therapy. We note the benefits of a rapprochement between psychiatry and religion.

Adult↗

Scratching and fasting: a study of pruritus and anorexia nervosa.

An association between pruritus and eating disorders has been suggested. This study examined changes in pruritus during weight restoration in a homogeneous group of women with severe anorexia nervosa (n = 19), using a structured questionnaire, visual analogue scale, clinical examination and a range of serological markers. We demonstrated that itching is a clinical feature of anorexia nervosa, associated with low weight and resolving on weight restoration. Some 58% of the sample suffered pruritus at low weight in a stable hospital environment. There was a significant association between changes in body mass index and severity of pruritus (P = 0.033), with reduced itching on weight restoration. Pruritus occurred in the absence of abnormalities in thyroid, renal and hepatic function, serum androgens, oedema, dermatoses or compulsive washing. Scratching was manifest as 'scratch prurigo' in five cases. Where itching was present, it was experienced as severe. We discuss a variety of possible explanations, including psychopathology, endocrine factors, regional blood flow variation, eczema and the role of central opioid and serotonergic activity. We argue that anorexia nervosa should be considered in all patients at low weight presenting with pruritus, and pruritus should be considered to be a physical symptom of anorexia nervosa.

Adult↗

Impact of pregnancy on bulimia nervosa.

BACKGROUND: Bulimia nervosa affects women at a peak age of reproductive functioning, but few studies have examined the impact of pregnancy on bulimia. AIM: To examine the impact of pregnancy on symptoms of bulimia nervosa and associated psychopathology. METHOD: Women actively suffering from bulimia nervosa during pregnancy (n = 94) were interviewed using the eating disorder examination (12th edn) and structured clinical interview for DSM-III-R, with additional structured questions. Behaviours were recorded at conception, each trimester and postnatally. Relative risks were calculated for prognostic factors. RESULTS: Bulimic symptoms improved throughout pregnancy. After delivery, 57% had worse symptoms than pre-pregnancy, but 34% were no longer bulimic. Relapse was predicted by behavioural severity and persistence, previous anorexia nervosa ('Type II' bulimia), gestational diabetes and 'unplanned' pregnancy. Unplanned pregnancies were the norm, usually resulting from mistaken beliefs about fertility. 'Postnatal depression' was suggested in one-third of the sample, and in two-thirds of those with'Type II' bulimia, and was predicted by alcohol misuse, symptom severity and persistence. CONCLUSIONS: Postnatal treatment intervention should focus on women 'at risk' of relapse, but all women with bulimia should be assessed for postnatal depression.

Adolescent↗

HIV-1 seropositivity and eating disorders: a case report.

We report a case of bulimia nervosa in a 21-year-old HIV-positive woman whose seropositivity provoked sustained motivation for recovery from her eating disorder. To the authors' knowledge, this is the first report of HIV-1 seropositivity leading to a clinical improvement in an eating disorder. We review the literature, in which the negative impact of seropositivity has been emphasized, and we explore the complex interaction between eating disorders and HIV-1 infection, considering both nutritional and psychological factors.

Adult↗

A case report of Usher's syndrome and anorexia nervosa.

OBJECTIVE: This report describes the rare combination of anorexia nervosa, deafness, and visual impairment with a particular emphasis on management issues. To the author's knowledge, this is the first report of an eating disorder in a patient who is deaf with a visual impairment. DISCUSSION: It describes the history of such a patient and the difficulties encountered in her treatment.

Adult↗

Gender issues in the management of multi-impulsive bulimia: a case-study.

We describe the management of multi-impulsive bulimia nervosa in a 27-year-old man. Inpatient treatment was attempted using a standardized focal-interpretative (psychodynamic) and cognitive-behavioral approach, with an emphasis on ward milieu. The value of this approach has been proved for female patients in the past. To our knowledge, this is the first report of its usage for a male with multi-impulsive bulimia, and the problems encountered highlight the impact of gender on behavioral symptoms, ward culture, and the predominantly female patient group.

Adult↗

Disordered eating: a defense against psychosis?

The authors present four cases suffering with either bulimia nervosa or anorexia nervosa in conjunction with a psychotic illness. In all cases there appeared to be a reciprocal relationship between the eating disorder and psychosis such that improvement in eating precipitated or exacerbated the psychotic symptoms. We suggest that disordered eating serves as a defense against psychosis. Difficulties in treating such patients are discussed.

Adolescent↗

Diet-induced loss of cyclic ovarian function at normal body weight in a rodent model for bulimia nervosa.

A bulimic rat model was used to test whether type and frequency of food intake mimicking that in human bulimia nervosa could disrupt oestrous cyclicity, induce an effect on glycoprotein (LH) structure, or affect both processes and if so, to determine whether any such effects were acute, or persisted after return to normal eating patterns. Voluntary hyperphagia was induced by offering female rats a varied and palatable choice of human food items--the 'cafeteria diet'. There were four groups: control (normal chow), obese (continuous cafeteria diet), post-obese (cafeteria diet, then fasted to reduce weight to that of controls) and binge (cafeteria alternated with normal diet every few days). Animals were maintained on these diets for 60 days (phase I). They were then given a GnRH challenge on day 2 of dioestrus of the cycle. Twenty-four hours later, half of the animals in each group were killed for assessment of effects on their reproductive organs. The remaining animals were returned to normal diets and kept for a further 40 days, when the GnRH challenge was repeated and the animals were killed 24 h later (phase II). All animals on the cafeteria diet in phase I exhibited significant disruption of oestrous cyclicity irrespective of body weight. LH released in response to the first GnRH challenge showed a prolonged half-life, and/or increased rate of secretion in the obese and post-obese groups but in the binge group the secretory/clearance properties resembled those of control animals. After the second GnRH challenge at the end of phase II, however, the LH of the binge group appeared to have different secretory or clearance characteristics, whereas that of the previously obese animals had returned to normal. These data show ovarian cyclicity was disrupted by hyperphagia and irregular eating, even at normal body weight. Relating ovarian function to pituitary output in terms of LH, the effects of the continuous cafeteria diet did not appear to persist in the animals that returned to normal diets, but in the binge group the effect, presumably of the diet manipulation, was manifested after return to a normal eating pattern. This finding suggests that irregular eating habits may exert a direct (and acute) effect on the ovary, but that effects on the pituitary (and LH glycoforms) take longer to be expressed, explaining many features of bulimia nervosa.

Analysis of Variance↗

Eating disorder in women admitted to hospital following deliberate self-poisoning.

Measures of abnormal eating behaviour in 48 women referred for psychiatric assessment following an act of deliberate self-poisoning (subjects) were compared with those in 50 women attending an accident and emergency department following minor accidental injury (controls). Disordered eating behaviour was significantly more prevalent in the subject group, even when the effect of depression was removed. Four subjects fulfilled the diagnostic criteria for bulimia nervosa, but none of the subjects met the diagnostic criteria for anorexia nervosa. The prevalence of obesity was the same in both subject and control groups. The degree of abnormal eating was very strongly correlated with a measure of inwardly directed irritability in both subjects and controls, and was strongly associated with measures of impulsiveness, outwardly directed irritability and anxiety in subjects.

Adolescent↗

Anorexia nervosa and steroid withdrawal.

We report a case of anorexia nervosa in a 14-year-old girl following withdrawal of oral prednisolone used in the treatment of asthma. The patient exhibited depressed affect and disturbance of body image prior to onset of anorexia. To the authors' knowledge this is the first report of anorexia nervosa precipitated by steroid withdrawal. The pathogenesis is discussed with reference to recent literature, considering both the physiological and psychological impact of steroid withdrawal.

Adolescent↗

Ovarian morphology and insulin sensitivity in women with bulimia nervosa.

OBJECTIVE: Hyperinsulinaemia has a role in the development of hyperandrogenism and polycystic ovary syndrome in women of normal weight. Polycystic ovaries are common in women with bulimia nervosa and this study aimed to determine whether women with bulimia nervosa are insulin resistant and to examine the relation between insulin sensitivity and ovarian morphology. DESIGN: A short intravenous insulin tolerance test was used as a direct measure of insulin sensitivity in a group of women with bulimia nervosa and a control group. PATIENTS: A series of 12 women with bulimia nervosa and normal weight was compared with a control group of 9 healthy women who had no clinical signs of eating disorder or hyperandrogenism and did not have polycystic ovaries. MEASUREMENTS: Bulimic behaviour was assessed using the BITE (Bulimia Investigation Test, Edinburgh) questionnaire and clinical interviews. Ovarian morphology was assessed using transabdominal ultrasonography. Insulin sensitivity and serum insulin, fasting glucose, LH, FSH, prolactin, testosterone, androstenedione and sex hormone binding globulin (SHBG) were measured and compared between the two groups. RESULTS: Ten of the 12 women with bulimia nervosa underwent ovarian ultrasound examination and they all had polycystic ovaries. There was no difference in serum LH, FSH, testosterone, androstenedione of SHBG concentrations between the women with bulimia nervosa and the non-bulimic control group. Fasting blood glucose concentrations were normal in all the women studied and did not differ between the women with bulimia nervosa and the control women. There was also no difference in fasting serum insulin or insulin sensitivity between the women with bulimia nervosa and the nonbulimic women. CONCLUSIONS: Bulimia nervosa is not associated with insulin resistance and chronic hyperinsulinaemia.

Adult↗

Kallmann's syndrome and anorexia nervosa: a diagnostic dilemma.

Kallmann's syndrome is a rare cause of primary amenorrhea, with impairment of release of gonadotropin-releasing hormone and anosmia. We present a case in which Kallmann's syndrome had been diagnosed, but who also fulfilled the diagnostic criteria for anorexia nervosa. We discuss the diagnostic dilemma.

Adult↗