Serotonin, a major player in the regulation of feeding and affect.
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Affect↗
Biomedical subjects
R C Casper
Publications and source records attributed to R C Casper.
Behavioral activation and lack of concern, core symptoms of anorexia nervosa?
OBJECTIVE: The core symptoms of anorexia nervosa have remained points of debate. The goal of this paper is a close study of unexpected and paradoxical symptoms in anorexia nervosa which are described in the literature but which, for the most part, have escaped the attention of investigator. METHOD: Following a brief examination of psychological influences: developmental psychodynamics issues, psychiatric comorbidity and personality features, as well as the physical consequences of starvation, all of which are considered probable contributors to the pathological process, the symptoms of denial, lack of concern, contentment, liveliness, and overactivity in anorexia nervosa are discussed. RESULTS: If these symptoms are accepted as specific for anorexia nervosa, their presence suggests that starvation might generate in individuals with a vulnerability for anorexia nervosa a condition of mental and physical activation. DISCUSSION: Areas of research to test this hypothesis, positing starvation-induced arousal or activation as a physiological dysregulation in anorexia nervosa which would powerfully support food avoidance, are discussed.
Anorexia Nervosa↗
Recognizing eating disorders in women.
Anorexia nervosa (AN) and bulimia nervosa (BN) are currently classified as eating disorders. Both disorders are the product of a complex interaction between psychological and physiological processes and both show considerable comorbidity with other psychiatric disorders. Physiological and endocrine abnormalities, including primary or secondary amenorrhea and menstrual dysfunction, are common and for the most part a function of the severity of weight loss, malnutrition and/or abnormal eating habits. Therefore, assessment needs to include several steps: (1) Clinical evaluation to ascertain the diagnosis, including weight and height measurements; (2) Determination of co-existing psychiatric illnesses; and (3) Physical examination and evaluation of the physiological and endocrine status. Eating disorders interfere with reproductive function. In view of the fact that dieting has reached epidemic proportions among the young female population, and given the high association between eating disorders and endocrine abnormalities as well as menstrual disturbances, all women participating in research studies should be screened for the presence of eating disorders, disordered eating, and excessive exercise.
Feeding and Eating Disorders↗
Depression and eating disorders.
Both depressive disorders and eating disorders are multidimensional and heterogeneous disorders. This paper examines the nature of their relationship by reviewing clinical descriptive, family-genetic, treatment, and biological studies that relate to the issue. The studies confirm the prominence of depressive symptoms and depressive disorders in eating disorders. Other psychiatric syndromes which occur with less frequency, such as anxiety disorders and obsessive-compulsive disorders in anorexia nervosa, or personality disorders, anxiety disorders, and substance abuse in bulimia nervosa, also play an important role in the development and maintenance of eating disorders. Since few studies have controlled for starvation-induced physical, endocrine, or psychological changes which mimic the symptoms considered diagnostic for depression, further research will be needed. The evidence for a shared etiology is not compelling for anorexia nervosa and is at most suggestive for bulimia nervosa. Since in contemporary cases dieting-induced weight loss is the principal trigger, women with self-critical or depressive features will be disproportionately recruited into eating disorders. The model that fits the data best would accommodate a relationship between eating disorders and the full spectrum of depressive disorders from no depression to severe depression, with somewhat higher rates of depression in bulimic anorectic and bulimia nervosa patients than in restricting anorexia nervosa patients, but the model would admit a specific pathophysiology and psychopathology in each eating disorder.
Adolescent↗
Individual psychopathology relative to reports of unwanted sexual experiences as predictor of a bulimic eating pattern.
OBJECTIVE: The goal of this study was to determine whether family and individual psychopathology mediate the relationship between unwanted sexual experiences and bulimic eating behavior. METHOD: Sixty-one women diagnosed with bulimia nervosa and 92 women students and university staff who had never met critia for an eating disorder completed standardized questionnaires on eating behavior, sexual abuse, individual psychopathology, and family psychopathology. RESULTS: Linear regression showed bulimic eating behavior to be significantly related to sexual abuse (beta = .40; p < .0001; R2 = 8.9%). However, multiple regression analyses with family and individual psychopathology as independent variables in addition to sexual abuse showed only individual psychopathology to predict significantly abnormal eating behavior (beta = .53, p < .0001; overall R2 = 49.6%). Specifically, depressive symptoms, suicidality, and impulsive behavior, but not substance abuse, were the components of individual psychopathology most directly associated with bulimia. DISCUSSION: The findings suggest that the primary focus in treatment should not be the traumatic events themselves, but their long-term consequences for the individual.
Adolescent↗
Body perception and emotional health in athletes: a study of female adolescents involved in aesthetic sports.
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Adolescent↗
Carbohydrate metabolism and its regulatory hormones in anorexia nervosa.
Findings of studies of carbohydrate metabolism in anorexia nervosa are reviewed. Topics covered included fasting blood sugar concentrations; serum insulin concentrations, insulin receptor binding activity, insulin sensitivity, and insulin resistance; plasma ketone bodies and free fatty acids; glucose tolerance tests; growth hormone, cortisol, intestinal hormones, and norepinephrine. Metabolic changes reported in anorexia nervosa are similar to those found in human and animal studies of states of caloric and carbohydrate restriction. Restoration of normal body weight is associated with normalization of virtually all measures. It is concluded that published studies offer no conclusive evidence for a syndrome-specific impairment in carbohydrate metabolism in anorexia nervosa.
Animals↗
Gender differences, but no racial group differences, in self-reported psychiatric symptoms in adolescents.
OBJECTIVE: To study gender differences in psychiatric symptoms and their relationship to minor delinquent behavior in high school seniors. METHOD: This was a cross-sectional study of symptoms experienced during the past 2 weeks and the past year. Male (n = 249) and female (n = 248) high school seniors attending an inner-city and two suburban high schools rated themselves on a 46-item Hopkins Symptom Checklist and a 19-item Delinquency questionnaire. RESULTS: Female adolescents, regardless of race, reported significantly higher levels of emotional distress, in particular depressed mood and anxiety, than did male adolescents. A separate factor analysis of male and female students generated anger-tension, school problems, and sadness-irritation, lethargy, respectively, as the first two factors. Trouble paying attention in school and marijuana, alcohol, and other drug use were associated with significantly higher levels of psychiatric symptoms. Black and white adolescents were similar in psychological adjustment. CONCLUSIONS: This survey confirms sex differences in the level of psychiatric symptoms for 16- to 18-year-old adolescents, suggests gender-related qualitative differences in negative emotions, and emphasizes the importance of controlling for education when studying adolescents from different ethnic or racial backgrounds.
Adolescent↗
The pattern of physical symptom changes in major depressive disorder following treatment with amitriptyline or imipramine.
The study describes a sequential analysis of depression-related physical symptoms and their relationship to imipramine and amitriptyline plasma levels over 4 weeks of treatment in 79 unipolar and bipolar patients hospitalized for major depressive disorder. Insomnia diminished in all patients after 2 weeks of drug administration. After 4 weeks, the sleep of patients whose depressive disorder has significantly improved was nearly normal, whereas patients who remained depressed showed continued sleep impairment. Reductions in loss of appetite, weight and sexual interest paralleled mood improvement. Tricyclic plasma levels significantly correlated with improved sleep. The findings suggest a close link between depressed mood and physical symptoms during recovery from major depressive disorder.
Adult↗
Personality dimensions in eating disorders and their relevance for subtyping.
Personality dimensions and psychopathological symptoms were assessed in 50 female patients hospitalized for the treatment of anorexia nervosa or bulimia nervosa and in 19 healthy female controls of similar age. Restricting anorexia nervosa patients, who had lost weight by consistently reducing their food intake, reported significantly greater self-control, inhibition of emotionality, and conscientiousness than controls or bulimia nervosa patients, before and after the data were corrected for depressive and eating pathology. Both nonbulimic and bulimic anorexia nervosa patients expressed stronger than normal conformance to moral and family values. On the impulsivity dimension, bulimia nervosa patients scored in the high normal range, whereas bulimic anorexia nervosa patients rated in the low normal range. The results suggest that a personality disposition toward overcontrol and reserve might constitute a risk factor for the restricting type of anorexia nervosa through fostering restrictive behavior toward food and avoidance of personal relationships.
Adolescent↗
Risk factors for the development of eating disorders.
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Anorexia Nervosa↗
'La douce indifférence' and mood in anorexia nervosa: neuropsychological correlates.
1. Denial of illness, mood, eating attitudes, and the responses to visual-constructive tasks were assessed in eight right-handed female patients with restricting anorexia nervosa during the acute phase and following weight gain. 2. A lower body weight and more pronounced anorectic symptomatology were associated with increased left hemispheric activation. 3. Weight gain, greater awareness of negative affect, and overestimation of body parts were correlated with an increase in right hemispheric activation. 4. The results suggest a relationship between anorectic symptomatology and asymmetric brain activation.
Adolescent↗
Identifying the specific clinical actions of amitriptyline: interrelationships of behaviour, affect and plasma levels in depression.
Despite increasing knowledge of the neurochemical bases of the action of the tricyclic drugs, little is known about the sequence of psychological effects which precede recovery in drug-responsive patients. This research was aimed at identifying the specific behavioural effects associated with the therapeutic action of amitriptyline in depression. The design involved measurement (post-hoc) of weekly changes in a severely depressed placebo-resistant group who recovered with drug treatment, compared with a group of similar patients treated for the equivalent four weeks, who showed minimal to no clinical response. The research strategy, in accordance with a dose-response paradigm, was to determine which of the early changes in emotion and behaviour found in treatment responders were systematically associated with plasma concentrations of amitriptyline or its major metabolite. Amitriptyline was found to act within seven days on the components of anxiety and on hostility in the responders, and on sleep disorder in all patients. After 12 to 14 days of treatment these effects increased, with improvements in other significant components distinguishing the responders from the non-responders. At the 12th to 14th treatment days when a steady state concentration of drug in plasma was approached, reductions in anxiety and hostility and in certain somatic components correlated significantly with plasma concentrations of amitriptyline. Implications of the findings for clarifying the specificity of clinical actions of the tricyclic drugs, and for understanding the psychobiological dynamics underlying rapid drug-induced recovery in depression, were explored.
Affect↗
Total daily energy expenditure and activity level in anorexia nervosa.
Clinical reports consistently comment on high physical activity for anorexia nervosa patients but provide few quantitative measurements. To assess activity, total daily energy expenditure (TDEE) by doubly labeled water, basal metabolic rate (BMR), and thermic effect of meals (TEM) were measured in six female outpatients with anorexia nervosa (67% of ideal body weight) and age-, sex-, and height-matched to six control subjects. Anorexia nervosa patients expended more energy as physical activity than did control subjects [0.084 +/- 0.012 vs 0.044 +/- 0.008 MJ/kg body wt, respectively (20.1 +/- 3.0 vs 10.5 +/- 1.9 kcal/kg body wt, respectively), P less than 0.04], although they had a lower BMR [4.17 +/- 0.37 vs 5.52 +/- 0.15 MJ/d, respectively (997 +/- 89 vs 1319 +/- 37 kcal/d, respectively), P less than 0.01]. TDEE and TEM were similar in both groups. There was a reduction in serum triiodothyronine (T3; 1.20 +/- 0.15 vs 2.04 +/- 0.13 nmol/L, respectively; P less than 0.003) and a slight reduction in serum thyroxine (T4); reverse T3, thyrotropin, free T4, serum cortisol, and adrenocorticotropin values were normal. BMR correlated with total body weight and fat-free mass. These results provide quantitative evidence for increased physical activity in anorexia nervosa despite profound underweight and hypometabolism.
Adipose Tissue↗
Weight and eating concerns among pre- and young adolescent boys and girls.
The emergence of weight and eating concerns in pre- and young adolescents and the relations of these concerns to daily experience and psychologic adjustment were investigated. Four hundred eighty-one children from fifth to ninth grades completed a Weight and Eating Concerns Scale, a depression inventory, self-esteem and body image scales, and reported their daily experiences by the Experience Sampling Method. Girls tended to report more weight and eating concerns than boys. This discrepancy increased with age. In older girls (eighth and ninth graders) extreme weight and eating concerns were associated with other signs of emotional maladjustment. Girls who experience emotional distress may try to compensate for the strain by controlling body shape and in doing so, may place themselves at risk for developing an eating disorder. Boys currently appear to be protected from this difficulty. Our findings suggest that excessive weight and eating concerns in young adolescent girls signal psychologic maladjustment which may require attention.
Adolescent↗
Weight and dieting concerns in adolescents, fashion or symptom?
Attitudes toward body weight and dieting and the relations of these attitudes to psychological adjustment were investigated in 497 randomly selected adolescents who were in their senior year in one urban and two suburban midwestern high schools. Most students reported feeling physically healthy. Two thirds of female adolescents were preoccupied with weight and dieting compared with only a small number (approximately 15%) of male adolescents. Black female adolescents were found to be less weight- and diet-conscious than white female adolescents. Increased weight and dieting concerns were associated with greater body and self-image dissatisfaction, with a depressed mood, and greater overall symptomatic distress in both male and female adolescents. The fairly common fear of being overweight and thoughts about dieting experienced by contemporary female adolescents, in part, seem to reflect the greater aesthetic value that contemporary society places on thinness for women. Overall, the findings suggest that preoccupation with weight and/or dieting concerns in either male or female adolescents are likely to indicate psychological problems.
Adaptation, Psychological↗
Hormone and metabolite plasma levels after oral glucose in bulimia and healthy controls.
Bulimia patients claim to crave sweets and since as clinical evidence suggests that the food consumed during eating binges often contains large amounts of carbohydrates, hormones involved in carbohydrate metabolism might be affected in bulimia. We therefore performed a 4-hr glucose tolerance test (GTT), using 100 g oral glucose and inquired about attitudes toward sweets. Thirteen female patients, with a mean age of 23.3 years, who had had bulimia from 3 to 7 years but whose binge-eating/vomiting behavior was largely controlled at the time of testing, were compared to 14 age-matched healthy female controls with a mean age of 24.4 years. All bulimic patients and most controls had liked sweets as children and still liked sweets. Significantly more bulimic patients than controls stated they overate on sweets and avoided sweets. Glucose utilization and the insulin, glucagon, growth hormone (GH), and pancreatic polypeptide (PP) response curves in the bulimic patients were within the normal range. Fasting plasma levels of glucose, insulin, glucagon, GH, cortisol, free fatty acids (FFA), and PP were not different from controls. There was a trend in bulimic patients to have lower plasma FFA levels and higher plasma cortisol levels during the GTT than controls. The findings suggest that, given body weight maintenance and adequate nutrition, patients with bulimia nervosa have normal glucose tolerance and normal hormonal responses following an oral glucose load.
Adult↗