Biomedical subjects

James E Mitchell

Publications and source records attributed to James E Mitchell.

At least 55 records · Page 3Linked to original sources

PubMed2004

Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa.

OBJECTIVE: The current study examined the change in bulimic symptoms as well as alcohol, drug, and tobacco use during pregnancy in subjects with bulimia nervosa. METHOD: A self-report questionnaire was used to collect retrospective data on eating disorder symptoms and substance use during pregnancy from 129 participants in a long-term study of bulimia nervosa. Follow-up data were collected for a total of 322 pregnancies occurring over a 10-15-year period. RESULTS: Overall, subjects reported that body dissatisfaction worsened, but binge eating and purging improved during pregnancy. However, the number of women completely abstinent from bulimic symptoms did not change significantly with pregnancy. Body esteem often worsened with pregnancy, particularly for women with active bulimia symptoms. Self-reported alcohol use significantly declined with pregnancy. DISCUSSION: In general, bulimia nervosa symptoms decreased during pregnancy, although the number of women completely abstinent did not change significantly.

Adult↗

PubMed2004

The use of alternative delivery systems and new technologies in the treatment of patients with eating disorders.

OBJECTIVE: The purpose of the current article is to review the literature regarding the use of alternative delivery systems, such as telemedicine, and new technologies, such as the use of hand-held computers, in the treatment of patients with eating disorders. METHOD: The literature is reviewed in the following areas: self-help (supervised and unsupervised), telemedicine, telephone therapy, e-mail, internet, computer software, CD-ROMs, portable computers, and virtual reality techniques. RESULTS: A growing literature suggests a number of alternative delivery systems hold promise, in particular permitting patients to access services who otherwise would not be able to receive treatment. Although most of these areas are early in their development, a growing literature supports the utility of several of these approaches. DISCUSSION: Although the literature in this area is limited, and the research base is small, a number of these technologies appear to hold substantial promise for the treatment of patients with eating disorders.

Computers↗

PubMed2004

Alcohol use disorder comorbidity in eating disorders: a multicenter study.

BACKGROUND: Eating disorders and alcohol use disorders (AUDs) commonly co-occur, although the patterns of comorbidity differ by eating disorder subtype. Our aim was to explore the nature of the co-morbid relation between AUDs and eating disorders in a large and phenotypically well-characterized group of individuals. METHOD: We compared diagnostic and personality profiles of 97 women with lifetime anorexia nervosa only, 282 women with lifetime bulimia nervosa only, and 293 women with a lifetime history of both anorexia nervosa and bulimia nervosa or anorexia nervosa with binge eating (ANBN) (DSM-IV criteria). All individuals were participants in a multicenter study of the genetics of anorexia nervosa and bulimia nervosa. We explored pattern of onset, Axis I and II comorbidity, and personality characteristics of individuals with and without AUDs by eating disorder subtype. Personality characteristics were assessed with the Multidimensional Perfectionism Scale, the Temperament and Character Inventory, and the Barratt Impulsivity Scale. RESULTS: Alcohol use disorders were significantly more prevalent in women with ANBN and bulimia nervosa than in women with anorexia nervosa (p =.0001). The majority of individuals reported primary onset of the eating disorder, with only one third reporting the onset of the AUD first. After eating disorder subtype was controlled for, AUDs were associated with the presence of major depressive disorder, a range of anxiety disorders, and cluster B personality disorder symptoms. In addition, individuals with AUDs presented with personality profiles marked by impulsivity and perfectionism. CONCLUSIONS: Individuals with eating disorders and AUDs exhibit phenotypic profiles characterized by both anxious, perfectionistic traits and impulsive, dramatic dispositions. These traits mirror the pattern of control and dyscontrol seen in individuals with this comorbid profile and suggest that anxiety modulation may be related to alcohol use in this group.

Age of Onset↗

PubMed2003

The eating disorders medicine cabinet revisited: a clinician's guide to appetite suppressants and diuretics.

OBJECTIVE: This article explores the frequencies of use of alternative medications, available products, and their potential toxicities. METHOD: Survey data were gathered from 39 consecutive patients diagnosed with bulimia nervosa who were seeking treatment. A survey of area outlets (health food stores, pharmacies, grocery stores) was conducted to establish a database of available agents. Putative active ingredients were identified. MEDLINE literature searches, as well as reviews of specialized texts, were performed to identify the potential toxicities of the ingredients. RESULTS: Diet pill use was found in 64% of patients; 18 % reported use in the past month. The survey identified 167 products. Diuretic use was found in 31% of patients; 21% reported use in the past month. Twenty-five diuretic products were identified. DISCUSSION: Alternative medicines are frequently used in the population of patients seeking treatment for bulimia nervosa. An abundance of products are available with potentially significant toxicities.

Anorexia Nervosa↗

PubMed2003

Psychological and dietary treatments of binge eating disorder: conceptual implications.

OBJECTIVE: The authors review the available literature on psychological and dietary treatment approaches for binge eating disorder (BED). METHODS: Studies were grouped according to psychological versus dietary approaches to BED. Studies were reviewed in terms of general implications, but particular emphasis was placed on drop-out rates, abstinence from binge eating, and weight loss. RESULTS: Drop-out rates from psychological or dietary approaches to treatment averaged 20% and the presence of binge eating did not confer a greater risk of drop-out among obese individuals. Both psychological and dietary approaches to treatment produced abstinence rates from binge eating of approximately 50% at the 12-month follow-up. Both psychological and dietary approaches show modest efficacy of short-term weight loss, but these effects are generally not sustained in long-term follow-up assessments. DISCUSSION: Psychological and dietary approaches to BED treatment show reasonable efficacy in binge eating reduction, but limited efficacy in weight loss. These findings are discussed in terms of the validity of the BED construct and the need for more psychopathology studies of BED.

Behavior Therapy↗

PubMed2003

Predictors of disordered eating in a sample of elite Division I college athletes.

OBJECTIVE: The present study sought to investigate the relationship between a number of areas of elite student-athletes' lives and disordered eating. METHOD: We surveyed 1445 elite Division I athletes at 11 different institutions and in 11 different sports. Hierarchical regression was used to indicate specific areas of the participants' collegiate experience that may be associated with disordered eating attitudes and symptomatology. RESULTS: Results demonstrate that the variables entered into each model predicted between 40.5% and 46.4% of the variance for the restriction of food, body dissatisfaction, and drive for thinness. Categories of variables that generally predicted the most variance for each dependent measure were demographics, athletic involvement, and personality. Of the 11 sports included in the analysis, wrestling and gymnastics demonstrated elevated levels of drive for thinness, food restriction, and purging behavior compared to other athletes. DISCUSSION: Findings suggest that in elite athletes gender, ethnicity, sport, and self-esteem are associated with several behaviors and attitudes indicative of disordered eating.

Journal Article↗

PubMed2003

Psychopathology and sexual trauma in childhood and adulthood.

This study evaluates the occurrence of psychopathology among 97 women who (1) experienced sexual abuse in childhood only, (2) were raped in adulthood only, (3) experienced both childhood sexual abuse and rape in adulthood, or (4) experienced no sexual trauma. Women were recruited from advertisements and assessed using the Structured Clinical Interview for DSM-IV (SCID-I/P) and the Modified PTSD Symptom Scale Self-Report. Women who reported sexual trauma were significantly more likely to exhibit psychopathology than controls. Being sexually victimized in childhood and raped in adulthood was associated with a particular risk for substance dependence.

Adolescent↗

PubMed2003

Impact of weight loss and regain on quality of life: mirror image or differential effect?

OBJECTIVE: To compare the impact of weight regain and weight loss on health-related quality of life. RESEARCH METHODS AND PROCEDURES: Subjects were 122 (106 women, 16 men) overweight and obese participants in a weight reduction program (phentermine-fenfluramine and dietary counseling) who had initially lost at least 5% of their total body weight and then regained at least 5% of their weight during the follow-up period. Follow-up periods ranged from 10 to 41 months (mean, 28 months). Participants completed the Impact of Weight on Quality of Life-Lite, an obesity-specific health-related quality of life (HRQOL) measure, at 3-month intervals. RESULTS: Mean BMI at baseline was 40.9 +/- 6.6 kg/m(2) (range, 29.2 to 63.7 kg/m(2)). Average weight loss from entry was 18.8 +/- 6.7% (range, 6.0% to 43.7%), and average regain was 10.1 +/-4.4% of baseline weight (range, 5.0% to 30.6%). The effects of weight regain on HRQOL mirrored the effects of weight loss-rates of HRQOL change were similar in magnitude but different in direction for comparable weight loss and regain. Those with more severe initial impairments in HRQOL experienced greater improvements in HRQOL during weight loss as well as greater deterioration during weight regain than those with less severe impairments. DISCUSSION: Weight loss and regain produced mirror image changes in HRQOL. The initial severity of HRQOL impairment had a greater impact on the magnitude of HRQOL change than the direction of weight change. Findings underscore the importance of maintaining weight loss for the purposes of retaining obesity-specific HRQOL benefits.

Adult↗

PubMed2003

Effects of sibutramine on binge eating, hunger, and fullness in a laboratory human feeding paradigm.

OBJECTIVE: The purpose of this study was to evaluate the effects of sibutramine vs. placebo on binge-eating behavior, hunger, and satiety in patients who had problems with binge eating. RESEARCH METHODS AND PROCEDURES: Seven adult subjects who had problems with binge eating (mean age, 42 years) were randomly assigned to receive alternating sibutramine and placebo in a double-blind placebo-controlled crossover study. This involved two 4-week dosing periods separated by a 2-week washout. RESULTS: Subjects lost weight on sibutramine but not on placebo. There was a significant difference in the number of kilocalories consumed between the sibutramine and placebo conditions, with a significant reduction of intake during binge-eating episodes on sibutramine. DISCUSSION: Sibutramine suppresses intake during binge-eating episodes. This effect is demonstrable in a human feeding laboratory paradigm.

Adult↗

PubMed2003

Towards the pharmacotherapy of eating disorders.

The purpose of this review is to discuss pharmacological options for the treatment of patients with eating disorders. Sequentially described are pharmacotherapy studies of anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED). The quantity of drug trials performed with AN patients has been very limited. While the majority of studies have failed to show medication efficacy for the acute treatment of AN, there is data which suggests that fluoxetine hydrochloride may play a role in preventing relapse during maintenance therapy. Atypical antipsychotics, most often olanzapine, have shown promise in a number of uncontrolled studies. BN has been most extensively studied, with the majority of pharmacological trials focusing on antidepressants. Fluoxetine, at a dose of 60 mg/day, is FDA-approved for the treatment of BN. Psychotherapy, particularly cognitive behavioural therapy (CBT) is of well-established utility in BN and data suggests that the combination of an antidepressant plus CBT is superior to either treatment alone. Recently, there has been interest in the 5-HT3 antagonist, ondansetron, and the anticonvulsant, topiramate. BED investigators have focused largely on antidepressants, which may reduce symptoms of depression and augment psychotherapy. While sibutramine and topiramate have both been associated with weight loss in controlled trials, the former appears to be fairly well-tolerated and the latter appears to be responsible for the emergence of significant cognitive and peripheral nervous system side effects in some patients. Further pharmacological research with eating disorder patients is needed, particularly in the areas of AN and BED. Also, pharmacological augmentation strategies for those not responding to primary therapies should be explored.

Anorexia Nervosa↗

PubMed2002

Long-term impact of treatment in women diagnosed with bulimia nervosa.

OBJECTIVE: Both cognitive-behavioral therapy (CBT) and antidepressant medication have demonstrated efficacy in the treatment of bulimia nervosa. However, data concerning the long-term impact of such treatments have been limited. This study sought to determine if treatment with CBT and antidepressant medication was associated with better long-term outcome among women diagnosed with bulimia nervosa. METHOD: Women (N = 101) who completed a controlled treatment study of bulimia nervosa participated in follow-up assessments approximately 10 years later. RESULTS: Women who received treatment with CBT or antidepressant medication or both reported improved social adjustment at long-term follow-up compared with women randomized to the placebo condition. DISCUSSION: Treatments with demonstrated efficacy for short-term outcome appear to improve psychosocial function at long-term follow-up among women initially diagnosed with bulimia nervosa.

Adult↗

PubMed2002

Research on energy expenditure in individuals with eating disorders: a review.

OBJECTIVE: This study reviews the published research on energy expenditure in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHOD: Individual studies are reviewed and their results summarized. RESULTS: The most consistent finding is evidence of reduction in resting energy expenditure (REE) in patients with AN, which increases with increased energy intake and body weight. Data regarding BN are inconsistent. Three available studies in subjects with BED have not found evidence of changes in energy expenditure corrected for lean body mass compared with obese non-binge eaters. DISCUSSION: The ability to reliably and cost-effectively measure REE may aid in the refeeding of patients with AN where REE is reduced. Changes in BN and BED subjects have yet to be identified consistently.

Anorexia Nervosa↗

PubMed2002

The relationship between compulsive buying and eating disorders.

OBJECTIVE: Compulsive buying has received increased research attention in the last decade. The disorder has high rates of comorbidity for other disorders, including eating disorders. This study explored the possible relationship between compulsive buying and eating disorders. METHOD: Twenty women who scored in the pathological range on a measure of compulsive buying and 20 controls were recruited via the media. Various measures of psychopathology and eating disorder symptoms were administered to both groups. RESULT: Compulsive buyers were significantly more likely to have a higher lifetime history of substance abuse or dependence. No differences existed between normal controls and compulsive buyers in prevalence of current or lifetime eating disorders, nor were there differences in scores of eating-related psychopathology. DISCUSSION: This work failed to demonstrate an increased risk for eating disorder in compulsive buyers, although a higher rate of substance dependence or abuse and higher scores on pathological personality dimension scales were seen.

Aged↗

PubMed2002

Research on energy expenditure in individuals with eating disorders: a review.

OBJECTIVE: This study reviews the published research on energy expenditure in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHOD: Individual studies are reviewed and their results summarized. RESULTS: The most consistent finding is a reduction in resting energy expenditure (REE) in patients with AN, which increases with increased energy intake and body weight. Data regarding BN are inconsistent. Three available studies in subjects with BED have not found evidence of changes in energy expenditure corrected for lean body mass compared with obese non-binge eaters. DISCUSSION: The ability to measure REE reliably and cost-effectively may aid in the refeeding of patients with AN in whom REE is reduced. Changes in individuals with BN and BED have yet to be consistently identified.

Energy Metabolism↗

PubMed2002

An evaluation of the relationship between mood and binge eating in the natural environment using ecological momentary assessment.

OBJECTIVE: Although many current theories of disordered eating focus on affective mechanisms, relatively little is known about the covariation of mood and eating in peoples' natural environments. This study examined the relationship between mood and binge eating behavior in the natural environment. METHOD: Twenty-seven college students with subclinical binge eating behavior self-monitored their mood on a handheld computer seven times daily for 2 weeks. RESULTS: On binge days, participants reported having significantly worse mood than on nonbinge days. When the trajectory of mood around the time of a binge was examined, no significant differences between prebinge and postbinge time were found when the entire binge day was examined. No mood differences were found between just prior to the binge (30-60 min prior to binge) compared with just after the binge (also within 30-60 min). A postbinge report indicated that reported mood immediately after a binge was worse than mood just prior to the binge. DISCUSSION: This study provides evidence that the affective experience of binge eating, when assessed in the natural environment, is negative. Furthermore, there was no evidence that binge eating was a response to an immediate or transient negative mood state or that binge eating provided relief from negative mood.

Bulimia↗

PubMed2002

Full syndromal versus subthreshold anorexia nervosa, bulimia nervosa, and binge eating disorder: a multicenter study.

OBJECTIVE: The diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) establish symptom severity levels, which are used to separate full cases from partial cases. However, the value of these distinctions is unclear. METHOD: Three hundred eighty-five women with full or partial AN, BN, or BED were assessed at entry into a longitudinal study of eating disorders. RESULTS: Stepwise discriminant analysis revealed that full and partial BN were discriminated by the Yale-Brown-Cornell Eating Disorders Scale total scores (kappa =.46). However, it was not possible to discriminate between full and partial AN or BED. Discriminant analysis also demonstrated clear differences between full AN, BN, and BED. DISCUSSION: Full BN can be differentiated from partial BN by more severe eating disorder symptoms, whereas both full and partial AN and full and partial BED appear quite similar. These results emphasize the distinct nature of AN, BN, and BED, as well as the similarities between full and partial cases.

Adolescent↗

PubMed2002

A randomized secondary treatment study of women with bulimia nervosa who fail to respond to CBT.

OBJECTIVE: Since the description of bulimia nervosa as a distinct diagnostic entity in 1979, several psychological and pharmacological interventions have been developed and empirically tested. The existence of several effective treatments, none of which is completely effective, is common to most psychiatric conditions. The research question that flows from such findings is whether second-level treatments would be effective for those who fail initial treatment. METHOD: In the case of bulimia nervosa, the research findings suggest that cognitive behavioral therapy (CBT) is the first level of treatment and that both antidepressant medication and interpersonal psychotherapy (IPT) may potentially be effective second-level treatments. This was a multicenter study in which 194 patients were initially treated with CBT. Those treated unsuccessfully (n = 62) were then randomized to treatment with IPT or medication management. RESULTS: Of those assigned to secondary treatment, 37 completed such treatment and 25 dropped out or were withdrawn. The abstinence rate for subjects assigned to treatment with IPT was 16% and for those assigned to medication management was 10%. No significant differences were found between medication and IPT in either the intent-to-treat or completer analysis. DISCUSSION: Dropout rates were high, and response rates were low among BN patients assigned to secondary treatments who failed to achieve remission with CBT. Offering lengthy sequential treatments appears to have little value, and alternative models for therapy need to be tested.

Adult↗

PubMed2002

Effect of a very low calorie diet on the diagnostic category of individuals with binge eating disorder.

OBJECTIVE: This study examined the factors associated with the diagnostic outcome of obese individuals with and without binge eating disorder (BED) 1 year after completing a very low calorie diet (VLCD) program. METHOD: Participants included 63 individuals with BED, 36 individuals with subthreshold BED, and 29 individuals with no binge eating symptoms. Diagnoses before and after VLCD were obtained using the Structured Clinical Interview for DSM-IV (SCID) interviews. The severity of psychiatric symptoms were assessed using various rating scales. RESULTS: Fifty-six percent (n = 36) of the participants who met criteria for BED at baseline did not meet diagnostic criteria 1 year later. None of the baseline factors were statistically associated with outcome. DISCUSSION: Although the main hypothesis was not supported, absence of a BED diagnosis at 12-month follow-up after a VLCD diet appears to be associated with less weight gain at 1-year follow-up regardless of baseline diagnosis.

Adolescent↗