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Biomedical subjects

L K Hsu

Publications and source records attributed to L K Hsu.

At least 19 recordsLinked to original sources
PubMed1997

Eating disturbances and outcome of gastric bypass surgery: a pilot study.

OBJECTIVE: We examined how the outcome of gastric bypass surgery (GBP) was effected by the interaction between presurgery eating disturbance status and length of time since surgery. METHOD: Subjects were recruited from a list of patients who received GBP in the last 3 years. Twenty-seven patients 20.8 +/- 11.0 months postsurgery were interviewed. RESULTS: Both current eating disturbance status and weight regain were predicted by the interaction between presurgical eating disturbance status and length of time since surgery. The significant time period in this interaction was 2 years or more postsurgery. DISCUSSION: Patients with a presurgical eating disorder may experience a short-term improvement in their eating disorder following GBP that erodes on or after 2 years and is related to weight regain. Methods for improving surgical outcome in this population are discussed.

Adult↗
PubMed1997

Somatoform disorders in Caucasian and Chinese Americans.

Somatization, broadly defined as the presentation of one or more medically unexplained somatic symptoms, refers both to the presentation of somatic symptoms in diagnosable psychiatric disorders such as major depression or anxiety as well as to the presentation of such symptoms in somatoform disorders. Although no comparative data exist, somatization is considered by many clinical investigators to be more common among Chinese than Caucasian patients, but it is unclear if this occurs because somatoform disorders are more prevalent among the Chinese or because Chinese patients with major depression or anxiety more often present with somatic complaints. We examined 85 consecutive Chinese American and 85 consecutive Caucasian American patients referred for psychiatric consultation and found the following: a) True somatization was significantly more common among Chinese American patients referred for psychiatric consultation; b) The somatoform symptom profiles of the two cohorts were different: Chinese American somatizers complained predominantly of cardiopulmonary and vestibular symptoms, whereas their Caucasian counterparts had symptoms that corresponded well with the categories listed in DSM-IV; c) In both cohorts of somatizers, a concurrent psychiatric disorder, most commonly major depression, was almost always present; and d) Among the Chinese American somatizers, pseudoneurological symptoms occurred most commonly in the form of abnormal sensations, whereas abnormal motor functions were more common among Caucasian Americans. Implications of the findings with respect to pathogenesis, treatment, and classification of somatization are discussed.

Adult↗
PubMed1996

Eating disturbances before and after vertical banded gastroplasty: a pilot study.

OBJECTIVE: We interviewed 24 female patients who had undergone vertical banded gastroplasty (VBG) to examine what effect eating disturbances have on weight loss outcome after VBG. METHOD: Subjects were recruited from 120 patients who had undergone VBG in the last 3 1/2 years. Subjects were asked questions relating to past and present weight status, weight loss methods, eating behaviors, and psychiatric status. RESULTS: Eating disturbances before VBG in the form of binge eating disorder (BED), bulimia nervosa (BN), night eating syndrome, and drinking large quantities of fluids were very common (75%), and they tended to persist after VBG. Although VBG led to varying weight loss, some patients exhibited a weight regain as postoperative time increased. Patients currently diagnosed with an eating disturbance were more likely to exhibit weight regain than people without these disturbances. VBG did not affect psychiatric status. DISCUSSION: VBG appears to be successful in producing weight loss in the morbidly obese, but less successful in altering eating behavior or psychiatric status. Future studies should aim to clarify the role of eating behavior in determining the outcome of bariatric surgery and examine whether treatments such as cognitive behavior therapy targeted specifically at the eating disturbance can improve surgical outcome.

Adult↗
PubMed1996

Epidemiology of the eating disorders.

Recent studies on the epidemiology of anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorders in special populations and in other cultures are reviewed. In addition, studies on the epidemiology of dieting behavior and longitudinal studies of the outcome of dieting behavior are reviewed. It is concluded that anorexia and bulimia nervosa are uncommon disorders but probably have increased in incidence in recent years. However, they are one of the most common psychiatric disorders to affect young women in the west. Dieting behavior is a major risk factor in the pathogenesis of the eating disorders. The prevalence of the eating disorders in a given community is, therefore, correlated with the prevalence of dieting behavior in the community.

Adolescent↗
PubMed1995

Development of an eating disorder in a 40 year-old male lung transplant candidate: a case study.

This paper presents the treatment of a lung transplant candidate suffering from an eating disorder who refused communication between the Eating Disorders Clinic and the transplant team. The importance of psychiatric evaluation in transplantation and the need for the free flow of information among all health professionals working with the transplant patient are discussed. Explanations are proposed for the role of dieting in the development of the eating disorder and the patient's continued food restriction, vomiting, and laxative abuse after transplantation.

Adult↗
PubMed1993

Are the eating disorders related to obsessive compulsive disorder?

The evidence supporting the idea that the eating disorders of anorexia and bulimia nervosa may be related to obsessive compulsive disorder is reviewed with respect to studies in phenomenology, comorbidity, neurotransmitters, central nervous system functional metabolism, and treatment and outcome. Although no definitive conclusion can be drawn, research generated from the idea has refined our thinking on the eating disorders.

Brain↗
PubMed1993

Fat phobic and non-fat phobic anorexia nervosa: a comparative study of 70 Chinese patients in Hong Kong.

A mixed retrospective-prospective study of 70 Chinese anorexic patients in Hong Kong shows that although they were similar to Western anorexics in most other ways, 41 (58.6%) of them did not exhibit any fear of fatness throughout their course of illness. Instead, these non-fat phobic patients used epigastric bloating (31.4%), no appetite/hunger (15.7%) or simply eating less (12.9%) as legitimating rationales for food refusal and emaciation. Compared to fat phobic anorexics, they were significantly slimmer pre-morbidly (P < 0.0001) and were less likely to exhibit bulimia (P = 0.001). The possible explanations for the absence of fat phobia and the interpretive dilemma this provokes are discussed from historical, pathoplastic and cultural anthropological perspectives. It is argued that anorexia nervosa may display phenomenological plurality in a Westernizing society, and its identity may be conceptualized without invoking the explanatory construct of fat phobia exclusively. As non-fat phobic anorexia nervosa displays no culturally peculiar features, it is not strictly speaking a Western culture-bound syndrome, but may evolve into its contemporary fat phobic vogue under the permeative impact of Westernization. Its careful evaluation may help clarify the aetiology and historical transformation of eating disorder, foster the development of a cross-culturally valid taxonomy of morbid states of self-starvation, and exemplify some of the crucial issues that need to be tackled in the cross-cultural study of mental disorders.

Adult↗
PubMed1993

Is weight phobia always necessary for a diagnosis of anorexia nervosa?

Several reviews of the history of anorexia nervosa have concluded that weight phobia, a basic diagnostic criterion for the disorder, did not emerge as a predominant motive for food refusal until around 1930. In addition, investigators have reported cases of self-starvation without apparent weight phobia in non-Western cultures. Three explanations have been proposed for these findings: 1) patients who do not demonstrate a definite weight phobia are in fact suffering from an eating disorder not otherwise specified, 2) weight phobia has been overlooked or concealed, and 3) there has been a transformation in the content of anorexia nervosa in the West and an analogous situation may be occurring in the developing countries. The authors conclude that a change in the core features of anorexia nervosa in Western cultures since 1930 can be demonstrated. They explore the question of whether anorexia nervosa would be the same illness if the criterion of weight phobia were not required and conclude that anorexia nervosa may be conceptualized in several different ways without including the phenomenon of weight phobia or body image disturbance. Finally, they recommend that because the desire for thinness appears to be culture-bound, anorexia nervosa is the best disorder to use in examining the influence of culture on psychopathology. Therefore, cases of self-starvation in non-Western cultures should be studied carefully because they may clarify the core features of anorexia nervosa.

Anorexia Nervosa↗
PubMed1993

Amount of calories retained after binge eating and vomiting.

While caloric consumption during binge eating has been measured, it is not known how many of the calories are retained in the gastrointestinal tract after vomiting. In 17 normal weight bulimic patients, there appeared to be a ceiling on the number of calories retained after vomiting. That is, whether or not bulimic patients had small (mean = 1,549 kcal, SD = 505) or large (mean = 3,530 kcal, SD = 438) binges, they retained similar amounts of kilocalories (mean = 1,128, SD = 497, versus mean = 1,209, SD = 574, respectively) after vomiting.

Adolescent↗
PubMed1992

Laboratory assessment of feeding behavior in bulimia nervosa and healthy women: methods for developing a human-feeding laboratory.

We have designed a human-feeding laboratory to be used to study feeding behavior in patients with eating disorders. Twenty-one normal-weight bulimic subjects consumed 29.711 +/- 39.940 MJ (range 0.862-178.632 MJ; 7101 +/- 9546 kcal, range 206 to 42,694 kcal) in 24 h. In comparison, 11 healthy volunteer women, when instructed to eat ad lib for 48 h, ate 7.715 +/- 2.590 MJ (1844 +/- 619 kcal) during the first 24 h and 7665 +/- 1828 MJ (1832 +/- 437 kcal) during the second 24 h. Bulimics and control subjects had a similar number of eating intervals (6.6 +/- 2.6 vs 5.0 +/- 1.7); 72% of the bulimic subjects' meals were similar in size to the meals of the controls [167-4100 kJ (40-980 kcal)] but these meals were higher in carbohydrate and lower in fat in bulemic patients. Excessive caloric intake by bulimic subjects was because 28% of their meals were very large [range 4.427-28.150 MJ (1058-6728 kcal)]. Data gathered in a laboratory setting appears to be a reasonable replication of naturalistic feeding and suggest that such a laboratory may prove useful for future studies of feeding behaviors in humans.

Adult↗
PubMed1992

Long-term mortality in anorexia nervosa. A 20-year follow-up of the St George's and Aberdeen cohorts.

Two cohorts of anorexia nervosa patients were followed up for a mean of 20 years. All except 4% of each cohort was traced. The crude mortalities were: St George's, 4%; Aberdeen, 13%. The SMRs were: St George's, 136; Aberdeen, 471. If the untraced were assumed to be dead, crude mortalities were 7.6% and 15.9% respectively, and SMRs were 276 and 592 respectively. Causes of death were complications of the illness and suicide. Medical treatment may reduce early mortality, while comprehensive medical and psychotherapeutic treatment may reduce late mortality.

Adolescent↗
PubMed1992

Bulimia nervosa in Hong Kong Chinese patients.

In contrast to the West, bulimic disorders are rarer than anorexia nervosa in Hong Kong. Four female normal-weight bulimic patients with mostly typical clinical features and conspicuous morbidity are reported. The case histories support the hypothesis that binge-eating is used to regulate unpleasant effect.

Adult↗
PubMed1991

Feeding patterns in bulimia nervosa.

We characterized the naturalistic feeding patterns of 54 women with bulimia nervosa and 11 matched controls over a continuous 24-hr period in a feeding laboratory. Overall, bulimic women consumed more calories in 24 hr (4446 +/- 584 kcal) than did controls (1845 +/- 649 kcal). Bulimic women consumed a wide range of caloric intake, with 44% overeating and 19% undereating in comparison to the range of controls. In addition, bulimics showed a disruption of circadian feeding patterns. For overeating bulimic women, the majority of meals were of normal size and frequency. Increased caloric intake in the group of overeating bulimic women was mainly due to the fact that 37% of their meals were greater than 1000 calories. Large meals occurred predominantly during the afternoon and evening and consisted primarily of dessert and snack foods. Importantly, the percentage of fat, but not carbohydrates, consumed increased as meal size, and 24-hr caloric intake increased. This study is the first to describe the naturalistic feeding characteristics of a large number of bulimics by direct observation. These findings are consistent with previous self-reports and extend and replicate previous laboratory studies. We think that laboratory studies are a reasonable replica of naturalistic feeding and should facilitate further investigation of the psychological and physiological correlates of feeding behavior in eating disorders.

Adolescent↗