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Biomedical subjects

K A Halmi

Publications and source records attributed to K A Halmi.

At least 73 records · Page 4Linked to original sources
PubMed1983

The state of research in anorexia nervosa and bulimia.

Recent studies suggest that some of the DSM III criteria for anorexia nervosa require revision. In particular exclusion for onset beyond 25, and a requirement for 25 per cent weight loss appear inappropriate, whereas amenorrhoea correlates better with anorectic psychology than weight. Although an increased incidence of affective disturbance among the relatives of anorectics and bulimics has been shown, the precise relationship with affective disorder remains unclear. Cortisol non-suppression and low MHPG excretion are related to weight loss. However, some areas of hypothalamic dysfunction cannot be explained by emaciation or diet. Pre-pubertal LH secretion patterns, absence of estrogen positive feedback on LH, and failure of LH response to clomiphene can persist despite normalisation of weight. Furthermore 1-dopa fails to induce the normal growth hormone response in weight restored anorectics, suggesting impairment at post-synaptic dopamine receptors. Body image studies have been varied, suggesting heterogeneity of body image distortion among anorectic subgroups. The role of family environment in the pathogenesis of anorexia nervosa has not been fully elucidated, although such a role in the relationship between bulimic symptomatology and personality disturbance have been suggested. Of the behavioral therapies, operant positive reinforcement that restores weight in a hospital setting has had the best results. Successful pharmacological approaches have included cyproheptadine (a serotonin antagonist), chlorpromazine and metoclopramide.

Adolescent↗
PubMed1982

Pragmatic information on the eating disorders.

Anorexia nervosa and bulimia are the prevalent eating disorders in adolescence and can well be regarded as a public health problem. Information on weight history, menstrual history, eating behavior, purging behavior, preoccupation with and fear of weight gain, activity level, depressive symptomatology, and impulsive behaviors is necessary in order to make the diagnosis of anorexia nervosa or bulimia. It is important to remember that bulimia patients have a fluctuation of weight within a normal weight range and usually do not have amenorrhea. The treatment of anorexia nervosa must include medical management, psychotherapy, behavioral therapy, and family therapy. Beginning treatment with outpatient therapy may be successful in adolescents who have a good prognosis and whose parents are willing to cooperate in family therapy. If a patient remains underweight, then she is not being effectively treated for the anorexia nervosa. Most patients will need an initial hospitalization for nutritional rehabilitation and continued outpatient therapy. Recently, bulimia has been recognized as a discrete disorder. Treatment approaches are currently being developed for this disorder and include behavioral techniques, group therapy, antidepressant and anticonvulsant medication, and psychotherapy.

Adolescent↗
PubMed1982

Amenorrhea in anorexia nervosa: examination of the critical body weight hypothesis.

In order to examine the relevance of the critical body weight hypothesis to menstrual regulation in anorexia nervosa, extensive physical, dietary, and behavioral assessments were made in 40 anorexia nervosa patients immediately before and after treatment, and at 3-month intervals up to 1 year posttreatment. Fifteen patients recovered menses; the body weights of these patients agreed with weights predicted by the critical body weight hypothesis. However, 12 patients with continuing amenorrhea had also achieved similar body weights. Clinical assessment showed that patients with continuing amenorrhea, both of normal and low weights, had significantly more "anorectic" attitudes and behaviors than the menstruating patients.

Adolescent↗
PubMed1981

Prediction of outcome in anorexia nervosa from neuropsychological status.

To evaluate the possibility that subtle brain dysfunction may exist in anorexia nervosa and indicate a poor prognosis, 20 anorexia nervosa patients received neuropsychological assessments covering a broad array of cognitive performances. The patients were examined at admission and again at the end of an inhospital treatment program when they were at normal weight for their age and height. Pretreatment performance on the assessment battery was not associated with outcome 1 year after discharge. However, posttreatment performance and significantly associated with outcome. A majority (71%) of patients with two or more cognitive deficits showed an unfavorable outcome (i.e., did not maintain their weight). In contrast, a majority (85%) of patients with less than two cognitive defects had a favorable outcome (i.e., maintained or increased their weight). The findings suggest that the hypothesis of a central nervous system disorder limiting the capacity for anorectics to recover deserves further exploration.

Adolescent↗
PubMed1981

Binge-eating and vomiting: a survey of a college population.

A survey of 355 college students was carried out to determine the prevalence of the psychiatric disorder bulimia (the binge-eating syndrome). Results of the survey indicate that, within the normal college population, 13% experienced all of the major symptoms of bulimia as outlined in the DSM-III. Within the bulimia population, 87% were females (19% of the female population) and 13% were males (5% of the male population). Although self-induced vomiting may accompany other symptoms of bulimia, the result suggest that self-induced vomiting is not a necessary symptom for diagnosis. A significant relationship between laxative use and self-induced vomiting was detected. These forms of behaviour, termed purging behaviour, occurred in an average of 10% of the students. Individuals who experienced the symptoms of bulimia had a history of being overweight or tended to be in the upper portion of their normal weight range (age, sex, and weight corrected) when compared with those individuals who had not experienced the symptoms of bulimia. No significant weight history differences were detected between vomiters and non-vomiters.

Adolescent↗
PubMed1981

Catecholamine metabolism in anorexia nervosa.

Studies are reviewed that address the question of whether anorexia nervosa is associated with abnormalities in central nervous system catecholamine metabolism. There is some support for the hypothesis that norepinephrine and dopamine metabolism are altered in this disorder.

Anorexia Nervosa↗
PubMed1981

Appetitive behavior after gastric bypass for obesity.

Eating behavior patterns were studied in 80 gastric bypass patients at 6, 12, and 24 months postoperatively. Significant reduction occurred in the amount of food eaten and in the frequency of eating. An unexpected result was the selective reduction of food eaten in certain food categories. The reduction of calorically-dense high carbohydrate foods indicates that gastric bypass surgery may have an effect on the digestion and absorption of food as well as the mechanical impairment of food intake secondary to the small stomach pouch.

Adolescent↗
PubMed1980

Bulimia. Its incidence and clinical importance in patients with anorexia nervosa.

Among the various eating patterns encountered in anorexia nervosa, the occurrence of bulimia (rapid consumption of large amounts of food in a short period of time) is a perplexing phenomenon, because its presence contradicts the common belief that patients with anorexia nervosa are always firm in their abstinence from food. We studied the eating habits of 105 hospitalized female patients within the context of a prospective treatment study on anorexia nervosa: 53% had achieved weight loss by consistently fasting, whereas 47% periodically resorted to bulimia. The two groups were contrasted with regard to their developmental and psychosocial history, clinical characteristics, and psychiatric symptomatology. Fasting patients were more introverted, more often denied hunger, and displayed little overt psychic distress. In contrast, bulimic patients were more extroverted, admitted more frequently to a strong appetite and tended to be older. Vomiting was frequent, and kleptomania almost exclusively present in bulimic patients, who manifested greater anxiety, depression, guilt, interpersonal sensitivity, and had more somatic complaints. This association of bulimia with certain personality features and a distinct psychiatric symptomatology suggests that patients with bulimia form a subgroup among patients with anorexia nervosa.

Adolescent↗
PubMed1980

Factors influencing hospital differences in weight gain in anorexia nervosa.

In a study of 105 anorexia nervosa patients, large hospital differences were found in weight gain which corresponded exactly to the amount of experience that each hospital had had in treating this disorder, and also corresponded to the degree of milieu structure imposed by each hospital. A further hypothesis to account for the hospital differences was in terms of the prognostic quality of the patients recruited to each hospital. To test the latter hypothesis, a number of prognostic indicators which had already been shown to be related to weight gain were statistically controlled by means of partial correlation. When this was done, the large hospital differences vanished, indicating that they were indeed a function of the qualities the patients brought with them to the hospital rather than what the hospital and its staff did to the patients. The results also indicate that the more experienced investigators seem to be able to recruit patients with better prognoses, whereas the less experienced ones are referred other clinicians' treatment failures.

Anorexia Nervosa↗
PubMed1980

Psychiatric diagnosis of morbidly obese gastric bypass patients.

Eighty morbidly obese patients who had had gastric bypass operations were interviewed for psychiatric diagnoses using DSM-III criteria. The lifetime prevalence of Axis I clinical psychiatric diagnoses was 47.5%, with depressive disorders occurring in 28.7% of the total sample. No other diagnosis exceeded a 2.5% prevalence. The authors believe there is no evidence of an increased prevalence of major psychiatric disorder in obese persons when strictly defined diagnostic criteria are used.

Adolescent↗