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Biomedical subjects

P F Sullivan

Publications and source records attributed to P F Sullivan.

At least 55 records · Page 3Linked to original sources
PubMed1998

The role of exposure with response prevention in the cognitive-behavioural therapy for bulimia nervosa.

BACKGROUND: One hundred and thirty-five women with bulimia nervosa participated in a randomized clinical trial designed to determine whether the addition of exposure with response prevention to a core of cognitive-behavioural therapy (CBT) leads to greater clinical improvement and lower risk of relapse. We present results from the end of treatment and 6- and 12-month follow-up. METHODS: Participants received eight sessions of CBT and were then randomized to either exposure to pre-binge cues (B-ERP), exposure to pre-purge cues (P-ERP), or a relaxation training control condition (RELAX). RESULTS: CBT produced significant clinical change. At the end of the behavioural treatments, there were no significant differences across the three groups on abstinence (66% in B-ERP, 45% in P-ERP and 47% in RELAX), or frequency of bingeing and purging. B-ERP, but not P-ERP, significantly reduced anxiety on the cue reactivity assessment, food restriction, body dissatisfaction and depression. These differences were not maintained at 6-month follow-up. At 12-months, B-ERP was independently associated with lower food restriction and better global functioning. CONCLUSIONS: CBT is a highly effective treatment for bulimia nervosa. B-ERP was modestly superior to P-ERP at post-treatment; however, the advantage did not remain throughout the follow-up interval. ERP for bulimia nervosa is an expensive and logistically complicated treatment that does not appear to offer any significant additive benefits that are proportional to the amount of effort required to implement the treatment.

Adolescent↗
PubMed1998

No association between novelty seeking and the type 4 dopamine receptor gene (DRD4) in two New Zealand samples.

OBJECTIVE: In 1986 and 1987, Cloninger postulated the existence of the heritable behavioral trait of novelty seeking and its putative underpinnings in the dopaminergic systems of the ventral midbrain. Two widely reported studies found significant associations between novelty seeking and the type 4 dopamine receptor gene (DRD4), although a more recent study did not. The authors' objective was to investigate this association in two New Zealand samples. METHOD: The authors studied two nonoverlapping samples: subjects in a depression treatment trial (N = 86) and subjects from 14 pedigrees dense with alcoholism (N = 181). DRD4 genotyping was based on a standard protocol. RESULTS: Novelty seeking and DRD4 were not statistically associated. CONCLUSIONS: In these samples, there was no suggestion that the DRD4 polymorphism contributed to individual differences in the behavioral trait of novelty seeking.

Adult↗
PubMed1998

Latent class analysis of lifetime depressive symptoms in the national comorbidity survey.

OBJECTIVE: Although clinical trials have documented the importance of identifying individuals with major depression with atypical features, there are fewer epidemiological data. In a prior report, the authors used latent class analysis (LCA) to identify a distinctive atypical depressive subtype; they sought to replicate that finding in the current study. METHOD: Using the National Comorbidity Survey data, the authors applied LCA to 14 DSM-III-R major depressive symptoms in the participants' lifetime worst episodes (N=2,836). Validators of class membership included depressive disorder characteristics, syndrome consequences, demography, comorbidity, personality/attitudes, and parental psychiatric history. RESULTS: The best-fitting LCA solution had six classes. Four were combinations of atypicality and severity: severe atypical, mild atypical, severe typical, and mild typical. Syndrome severity (severe atypical and typical versus mild atypical and typical classes) was associated with a pronounced pattern of more and longer episodes, worse syndrome consequences, increased psychiatric comorbidity, more deviant personality and attitudes, and parental alcohol/drug use disorder. Syndrome atypicality (severe and mild atypical versus severe and mild typical classes) was associated with decreased syndrome consequences, comorbid conduct disorder and social phobia, higher interpersonal dependency and lower self-esteem, and parental alcohol/drug use disorder. CONCLUSIONS: As in prior reports, the atypical subtype of depression can be identified in epidemiological samples and, like typical depression, exists in mild and severe variants. Atypical depressive subtypes were characterized by several distinctive features. However, the correspondence between epidemiologically derived typologies of atypical depression and DSM-IV major depression with atypical features is not yet known.

Adolescent↗
PubMed1998

Outcome of anorexia nervosa: a case-control study.

OBJECTIVE: Although there have been many studies of the outcome of anorexia nervosa, methodological weaknesses limit their interpretation. The authors used a case-control design to try to improve knowledge about the outcome of anorexia nervosa. METHOD: All new female patients referred to an eating disorders service between Jan. 1, 1981, and Dec. 31, 1984, who had probable or definite anorexia nervosa were eligible for inclusion. Of these women, 86.4% (N = 70) were located and agreed to participate. The comparison group (N = 98) was a random community sample. All subjects were interviewed with a structured diagnostic instrument. RESULTS: A minority of the patients (10%) continued to meet the criteria for anorexia nervosa a mean of 12 years after initial referral. Even among those who no longer met these criteria, relatively low body weight and cognitive features characteristic of anorexia nervosa (perfectionism and cognitive restraint) persisted. The rates of lifetime comorbid major depression, alcohol dependence, and a number of anxiety disorders were very high. CONCLUSIONS: In the managed care/brief treatment era, therapeutic approaches with an excessive focus on weight gain that neglect the detection and treatment of associated psychological features and comorbidity may be inappropriate. Anorexia nervosa is a serious psychiatric disorder with substantial morbidity.

Adolescent↗
PubMed1998

Genetic epidemiology of binging and vomiting.

BACKGROUND: Bulimia nervosa is typically defined as the combination of the behaviours of binging and vomiting. We sought to clarify the relationship of these behaviours from a genetic epidemiological perspective. METHOD: Using data on the lifetime history of binging and vomiting from a personally interviewed population-based sample of female twins (n = 1897), we applied bivariate twin modelling to estimate the sources of variation for these traits. RESULTS: The association between having ever binged (23.6%) and having ever induced vomiting (4.8%) was very strong (odds ratio = 8.78, P << 0.0001). The best-fitting model indicated that lifetime binging and vomiting were both heritable (46% and 72%) and influenced by individual-specific environmental factors (54% and 28%). The overlap between the genetic (ra = 0.74) and individual-specific environmental factors (re = 0.48) for the two traits was substantial. No violations of the equal environmental assumption were evident. CONCLUSIONS: Including binging and vomiting under the rubric of bulimia nervosa appears to be appropriate. Our data are consistent with the identification of binging and vomiting as complex traits resulting from the interplay of multiple genes and individual-specific environmental influences. In contrast to 'environmentalist' theories, our results suggest that genetic influences may be of particular relevance to the aetiology of binging and vomiting.

Adult↗
PubMed1998

Typology of common psychiatric syndromes. An empirical study.

BACKGROUND: Diagnostic comorbidity is prevalent in psychiatry and may be inadequately captured by the DSM-III/III-R nosology. METHODS: The lifetime presence of II psychiatric diagnoses was determined by structured personal interviews of a population-based sample of 1898 female twins. We used latent class analysis to derive an empirical typology. RESULTS: Six classes provided the best fit to the data. Their mnemonics were: minimal disorder (60% of the sample), major depression-generalised anxiety disorder (19%), alcohol-nicotine (7%), highly comorbid major depression (5%) and eating disorders (3%). The validity of this typology was strongly supported by demographic, health, personality and attitudinal validators along with the significant monozygotic twin concordance for class membership. The typology superficially resembled DSM-III-R, but contained many differences. Major depression appeared in three forms (alone, with generalised anxiety disorder and with considerable comorbidity). Alcoholism-nicotine dependence and the various anxiety disorders formed discrete classes, but were also prominent in other classes. Bulimia and anorexia were exceptional in their appearance in a single class. CONCLUSIONS: The DSM-III-R and closely related DSM-IV nosology did not capture the natural tendency of these disorders to co-occur. Fundamental assumptions of the dominant diagnostic schemata may be incorrect.

Adult↗
PubMed1998

Relationship between interpersonal psychotherapy problem areas with temperament and character: a pilot study.

OBJECTIVE: To examine the relationships between dimensions of personality assessed by using the Temperament and Character Inventory and presenting problem areas in Interpersonal Psychotherapy. METHOD: One hundred two depressed patients completed the Temperament and Character Inventory (TCI), and Interpersonal Psychotherapy (IPT) problem areas were assessed using a clinician-rated questionnaire. RESULTS: Following multiple regression analysis, patients rated as having problems with grief scored low on self transcendence, those with disputes had low cooperativeness, those with role transitions had low novelty seeking, and those with deficits had low reward dependence. CONCLUSIONS: Both temperament and character may be relevant to the nature of presenting problems related to Interpersonal Psychotherapy. An understanding of how personality is relevant to presenting interpersonal problems may provide both a framework and a focus with which to work in this form of psychotherapy.

Adult↗
PubMed1997

Initial manifestations of disordered eating behavior: dieting versus binging.

OBJECTIVE: We examined the onset of binge eating and dieting in 108 women with bulimia nervosa to determine whether (1) dieting always preceded binge eating; (2) dieting always preceded the onset of bulimia nervosa; and (3) individuals who manifested early initial binge eating differed from those whose earliest manifestation of disordered eating behavior was dieting in terms of lifetime psychopathology and temperament. METHOD: One hundred eight women were assessed at entry to a randomized clinical trial of cognitive-behavioral therapy for bulimia nervosa using structured diagnostic methodology. Retrospective recall of the onset of disordered eating behavior was used to categorize individuals as initial binge eaters or initial dieters. We then compared lifetime psychopathology and temperament across the two groups. RESULTS: Seventeen percent of women reported early binge eating prior to any dieting behavior. The mean age of onset of binging in this group was approximately 10 years. Neither the clinical picture of bulimia nervosa nor lifetime psychopathology differed between initial binge eaters and initial dieters. Individuals with early binge eating endorsed higher novelty seeking and lower harm avoidance. CONCLUSION: In a minority of women with bulimia nervosa, binge eating precedes dieting. These women display markedly higher novelty seeking and lower harm avoidance. Possible links between the dopamine system, novelty seeking, and appetitive behavior are discussed.

Adolescent↗
PubMed1997

Food cravings in women with a history of anorexia nervosa.

OBJECTIVE: The objective of the present study was to determine the prevalence and characteristics of food cravings in women with a history of anorexia nervosa. METHOD: One hundred one control women selected at random and 64 women with a diagnosis of anorexia nervosa 10 to 14 years earlier (cases) completed the Diagnostic Interview for Genetic Studies, a food craving questionnaire, the Temperament and Character Inventory and the Three-Factor Eating Questionnaire. RESULTS: A similar proportion of cases and controls reported food cravings. A greater proportion of cases reported strong cravings with two or more features of intensity (p = .02). Cravings in the cases were more likely to be characterized by difficulty resisting the craved food (p = .0008), anxiety when the craved food was unavailable (p = .002), and a high frequency of occurrence (p = .001). The cases who craved were significantly more likely to have had lifetime BN (p = .02). CONCLUSION: A similar prevalence of food craving in cases as in controls suggests that successful control of food intake and/or denial of hunger overrides dietary restriction as a precondition for craving in anorexia nervosa. A dysfunction in the serotonergic system, the provision of intermittent reinforcement by binge episodes, and/or frustration due to unsuccessful attempts at dietary restraint may mediate the association of cravings with the presence of lifetime bulimia.

Adolescent↗
PubMed1997

Impact of definition on prevalence of food cravings in a random sample of young women.

The objective of this study was to determine the characteristics of food cravings in a random sample of young women and to evaluate the impact of the definition used in food craving research. The Diagnostic interview for Genetic Studies and a questionnaire about food craving experiences were completed by 101 women aged between 18 and 45 years. Of this sample, 58% of respondents reported having ever experienced food cravings. Of these, 7% had experienced food cravings only during pregnancy. Fewer women met criteria for craving as the definition narrowed; 28% reported moderate to strong cravings with two features of intensity; 6% reported moderate to strong cravings with three features of intensity and 4% reported strong cravings with three features of intensity. Features of intensity or "core features" were those that related to strength of craving and were difficulty resisting eating, feeling anxious when the craved food was unavailable and a change in speed of consumption. Of strong cravers, 86% experienced at least two core features, compared with 48% of moderate and 10% of mild cravers. These features may aid in defining the craving state and should be taken into consideration in studies on food cravings.

Adolescent↗
PubMed1997

The hypothalamic-pituitary-thyroid axis in major depression.

We investigated the capacity of several thyroid-axis measures to distinguish between depressed and control subjects and determined whether these variables were related to antidepressant treatment response. We studied 105 subjects who fulfilled the DSM-III-R criteria for a current major depressive episode and 41 volunteers with no current mental disorder. The following thyroid-axis variables were measured: difference between T4 levels at 09.00 hours and 13.00 hours; baseline TSH; maximal TSH response to 400 micrograms TRH (delta max TSH); and presence of a blunted delta max TSH. The T4 difference variable alone distinguished between depressed and control subjects. In multivariate analyses, T4 difference and delta max TSH were independently related to antidepressant-treatment outcome, and predicted a modest proportion (14%) of the variance in outcome. The relationship between these two variables and treatment outcome was particularly strong in depressed male subjects who were receiving desipramine, for whom they accounted for 36% of the variance in treatment outcome. The T4 difference variable both distinguished between depressed and control subjects and was related to treatment outcome. Although this finding requires replication, it is consistent with other reports of the usefulness of thyroid-axis indices measured at different times of day in depressed patients.

Adolescent↗
PubMed1997

Eating disorders and antecedent anxiety disorders: a controlled study.

We compared the prevalence and age of onset of adult and childhood anxiety disorders relative to the primary diagnosis in 68 women with anorexia nervosa (AN), 116 women with bulimia nervosa (BN), 56 women with major depression with no eating disorder (MD) and 98 randomly selected controls (RC) in order to determine whether antecedent anxiety disorders are plausible risk factors for AN and BN. Comorbid anxiety disorders were common in all three clinical groups (AN, 60%; BN, 57%; MD, 48%). In 90% of AN women, 94% of BN women and 71% of MD women, anxiety disorders preceded the current primary condition (P = 0.01), although panic disorder tended to develop after the onset of AN, BN or MD. In multivariate logistic regressions, the odds ratios (ORs) for overanxious disorder (OR = 13.4) and obsessive-compulsive disorder (OR = 11.8) were significantly elevated for AN. The ORs for overanxious disorder and social phobia were significantly elevated for BN (OROAD = 4.9; ORSP = 15.5) and MD (OROAD = 6.1; ORSP = 6.4). These data suggest that certain anxiety disorders are non-specific risk factors for later affective and eating disorders, and others may represent more specific antecedent risk factors.

Adolescent↗
PubMed1997

Low persistence predicts relapse in alcohol dependence following treatment.

OBJECTIVE: To investigate the relationship between personality measures and alcohol dependence relapse in a treatment sample of men with alcohol dependence. METHOD: Alcohol dependent men (N = 87) without a primary diagnosis of antisocial personality disorder, recruited consecutively from a 3-week abstinence-focused therapeutic program, along with informants, completed the Structured Clinical Interview for DSM-III-R Personality Disorders (self-report questionnaire) (SCID-PQ) and the Tridimensional Personality Questionnaire (TPQ) and were followed-up for 6 months. Drinking outcomes were based on multiple sources of data and subjects categorized as relapsed or not. Personality was investigated according to traditional DSM-III-R/DSM-IV clusters, as well as conduct disorder and obsessionality separately, in addition to the four major temperament dimensions of the TPQ. RESULTS: Cluster B personality disorder symptoms, conduct disorder symptoms and novelty seeking were not associated with relapse. However, the temperament trait of persistence predicted relapse. CONCLUSIONS: Personality features associated with onset of alcohol dependence do not appear to be the same as those associated with relapse in a sample of alcohol dependent men that excludes severe antisocial personality disorder. It is speculated that what might be considered low motivation when applied to alcohol dependent patients who relapse following treatment, may in part reflect low persistence, a personality trait.

Adult↗
PubMed1996

Family history of depression in clinic and community samples.

Because most published family studies of depression ascertained subjects from treatment settings, the reported familial aggregation of depression could be an artifact if a family history of depression increased the likelihood of seeking treatment. To investigate this possibility, we compared the family history of depression in three groups of probands aged 18-44; 54 women randomly selected from the community with depression in the prior year, 41 women who entered a clinical trial for depression and 37 women randomly selected from the community who had not been depressed in the prior year. The presence of depression in the parents and siblings of the probands was assessed by the family history method and quantified via family history scores which took the age, gender and number of relatives into account. Depressed probands ascertained from clinical sources had markedly higher family history scores of depression than other two groups (P < 0.00005 in each instance). In the absence of direct interviews with relatives, we cannot exclude the impact of differential reporting. A family history of depression might be associated with an increased probability of treatment or the differential reporting of family history. It is thus possible that the familial aggregation of depression observed in probands from treatment settings is an artifact.

Adolescent↗
PubMed1996

Intimate bonds in depression.

There is considerable interest in the relationship between interpersonal relationships and mood disorders. The Intimate Bond Measure (IBM) assesses the respondent's perception of their partner over recent times. IBM care scores have been reported to be independent of depression severity and personality, to distinguish between melancholic and non-melancholic depressives, and to predict treatment outcome. In a sample of 105 depressed patients, IBM care measures were independent of depression severity and personality measures, but they did not distinguish between melancholic and non-melancholic depressives, and did not predict treatment outcome. When the sample was restricted to individuals who had been previously treated, IBM care measures did distinguish between melancholic and non-melancholic depressives, although they still did not predict treatment outcome. Possible implications of these findings are discussed.

Adolescent↗