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Biomedical subjects

T D Brewerton

Publications and source records attributed to T D Brewerton.

At least 19 recordsLinked to original sources
PubMed2000

Comorbidity of bulimia nervosa and alcohol use disorders: results from the National Women's Study.

OBJECTIVE: The nature of the relationship between bulimia nervosa (BN) and alcohol abuse/alcohol dependence (AA/AD) and the extent to which women with BN+AA differ from women with BN-AA were examined in a national sample of women (N = 3,006). METHOD: The sample of was generated by multistage geographic sampling and interviews were conducted by telephone. RESULTS: AA was higher in women with BN compared to women without BN or binge eating disorder, only when the influence of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) was controlled. Prevalence rates of AA and AD were similar in women with BN, MDD, and PTSD. Analyses indicated that the relationship between BN and AA/AD may be indirect and influenced by associations with MDD and PTSD. Women with BN+AA did not differ from those with BN-AA on most variables concerning victimization, family of origin, and disordered eating. DISCUSSION: Evaluation of MDD and PTSD in women presenting for treatment of BN and/or alcohol use disorders (AUDs) is recommended.

Adult↗
PubMed2000

Establishing guidelines for pharmacotherapy trials in bulimia nervosa and anorexia nervosa.

OBJECTIVE: This paper addresses the lack of a standard protocol for pharmacotherapy trials for patients with bulimia nervosa (BN) and anorexia nervosa (AN). METHOD: Twenty-two surveys were sent to established researchers in the field of eating disorders to elicit their opinions regarding medication trials, including baseline laboratory tests, the optimal length/frequency of medication management sessions, and the information that should or should not be included in these sessions. RESULTS: Sixteen of 22 researchers completed and returned the survey. Their answers are the basis of the data presented. DISCUSSION: We propose a battery of screening laboratory tests for both conditions. We suggest 30-45-min initial medication management sessions in both AN and BN trials with 15-min follow-ups to be held weekly for AN subjects, and weekly for 2 weeks, then biweekly for 2 weeks, then monthly, for BN subjects. We also recommend that published trials should include explicit details of medication management.

Anorexia Nervosa↗
PubMed2000

Which comes first in the pathogenesis of bulimia nervosa: dieting or bingeing?

OBJECTIVE: Clinical experience has indicated that dieting usually precedes the onset of binge eating in the development of bulimia nervosa (BN). However, data confirming this in nonclinical, representative samples are lacking. METHOD: Using results obtained from the National Women's Study (NWS), we were able to determine the chronological relationship between age of onset of significant dieting (attempting to lose 15 lbs) and onset of bingeing in 85 respondents who met DSM-III-R criteria for BN. These respondents were a subset of over 3,000 female adult U.S. women who completed a random telephone interview (averaging 40 min and including screenings for rape, sexual molestation, aggravated assault, posttraumatic stress disorder [PTSD], and BN). RESULTS: We found that the age of first serious attempt to diet preceded the age of first binge in 46% of cases. There were no significant differences in histories of victimization experiences among the groups. First binge preceded first serious diet in 37% of cases, and these behaviors occurred during the same age in 17% of cases. DISCUSSION: These data confirm that dieting is more likely to precede binge eating, although binge eating precedes significant dieting in a substantial proportion of bulimic respondents.

Adolescent↗
PubMed2000

Reduced plasma leptin concentrations in bulimia nervosa.

Leptin is a protein produced by the ob-ob gene which inhibits food intake. Plasma levels have previously been reported to be altered in obesity and anorexia nervosa (AN) but not bulimia nervosa (BN). We measured fasting plasma leptin levels by radioimmunoassay in 53 subjects carefully studied at NIMH, including 37 women meeting DSM-III-R criteria for BN [10 with concurrent AN (body mass index (BMI)=14.1+/-1.4), 27 without AN (BMI=20.4+/-1.6)] and 16 normal control women (NCs) (BMI=21.1+/-2.0). Patients were medication-free and abstinent from bingeing and purging for three to four weeks prior to study. Plasma leptin levels were significantly correlated to BMI (r=0.41, P<0.002), weight (kg, r=0.43, P<0.001), and percent average body weight (%ABW, r=0.45, P<0.001) in the total group. Plasma leptin levels were lower in the BN subjects (3.4+/-2.5 ng/ml) compared to the NCs (6.1+/-2.6 ng/ml, P<0.001, ANCOVA) even after controlling for BMI and weight. There was no significant difference between BN subjects with AN (n=10, 2.6+/-2.6 ng/ml) and those without AN (n=27, 3.8+/-2.4 ng/ml), despite lower BMI in BN with AN. Furthermore, leptin levels were decreased in BN without AN compared with healthy controls, even though BMI was comparable in these two subgroups. Plasma leptin concentrations were negatively correlated with baseline plasma cortisol levels (n=49, r=-0.49, P<0.001) and positively correlated with prolactin responses following L-tryptophan (n=49, r=0.37, P<0.009) and m-chlorophenylpiperazine (n=52, r=0.24, P<0.09). This is the first known report of decreased plasma leptin levels in BN. The decrement in leptin concentration is not related to BMI, body weight, or the presence or absence of BN. HPA axis activation as well as serotonin dysregulation may be related to decreased leptin levels, which may in turn contribute to disinhibited eating in BN. Although current leptin levels were not correlated with self-reported previous binge frequency, the role of leptin in the pathophysiology of BN deserves further study.

Adult↗
PubMed1998

Family characteristics of binge-eating disorder patients.

Binge-eating disorder (BED) has been described and proposed as a new eating disorder diagnosis. Although studies have examined the characteristics of the family members of patients with anorexia nervosa (AN) and bulimia nervosa (BN), little is known about the characteristics of family members of BED patients. The Family Environment Scale (FES) was administered to 88 patients with a DSM-III-R diagnosis of an eating disorder (23 AN, 45 BN, 20 BN + AN), as well as 43 patients with BED as defined by DSM-IV criteria. Statistically significant differences were found among the groups on the cohesion, expressiveness, and active-recreational subscales of the FES by analysis of variance (ANOVA). On the cohesion subscale, significant differences were noted between AN and BED, p < .019, with AN scoring higher than BED. On the expressiveness subscale, significant differences were noted for BED and BN, p < .016, with BN scoring higher than BED. On the active-recreational subscale, there were significant differences for BED versus BN, BED versus AN, and BED versus AN + BN (p < .0001), with BED scoring lower than all other groups. Comparison of BED data to existing normative data yielded significant differences on the cohesion, expressiveness, conflict, independence, intellectual-cultural, active-recreational, and control subscales, with BED patients scoring higher than controls on the conflict and control subscales and lower than controls on all others. These data represent the first study of family characteristics of BED patients utilizing DSM-IV criteria, and provide a beginning understanding of family factors that may be useful in treatment.

Analysis of Variance↗
PubMed1997

The National Women's Study: relationship of victimization and posttraumatic stress disorder to bulimia nervosa.

OBJECTIVE: In recent years there has been increased interest regarding the role of crime victimization in the development and/or maintenance of eating disorders, particularly bulimia nervosa. METHOD: To examine the relationship among assault, bulimia nervosa, and binge eating disorder, a national, representative sample of 3,006 women completed structured telephone interviews. RESULTS: Lifetime prevalence of completed, forcible rape for respondents with bulimia nervosa was 26.6%, as compared with 11.5% for respondents with binge eating disorder and 13.3% for respondents without bulimia nervosa or binge eating disorder. Compared to respondents without bulimia nervosa or binge eating disorder, aggravated assault history was significantly more prevalent in women with bulimia nervosa (26.8%), as was a lifetime history of posttraumatic stress disorder (36.9%). Characteristics of sexual assault experiences were not associated with dysfunctional eating patterns. Specific types of disordered eating such as compensatory behaviors in bulimia nervosa were associated with higher rates of victimization. CONCLUSIONS: In sum, the significantly higher rates of both sexual and aggravated assault among women with bulimia nervosa compared with women without such a diagnosis support the hypothesis that victimization may contribute to the development and/or maintenance of bulimia nervosa.

Adult↗
PubMed1997

The phenomenology of psychosis associated with complex partial seizure disorder.

Psychosis commonly occurs as a direct result of complex partial seizure disorder (CPSD). This organic mental disorder is indeed "complex" and is easily and frequently misdiagnosed as a variety of functional disorders, including schizophrenia, schizoaffective disorder, bipolar illness, psychotic depression, and, at best, "atypical psychosis." However, this important clinical syndrome has several clinical features that suggest its presence and which often permit it to be distinguished from other forms of psychosis. Furthermore, this disorder can be successfully treated with limbic anticonvulsants, with or without neuroleptics and/or lithium, but it is generally refractory to neuroleptic medications alone. In this paper, the author reviews the available literature relevant to the clinical phenomenology and treatment of this topic and illustrates the clinical profiles of 10 treatment-refractory patients admitted to a state hospital with previously undiagnosed psychoses secondary to CPSD. This illness needs to be seriously considered in the differential diagnosis of severely ill patients with atypical psychoses refractory to traditional treatments.

Adolescent↗
PubMed1997

Relationship of childhood sexual abuse and eating disorders.

OBJECTIVE: To review the literature that has examined the relationship between childhood sexual abuse and the eating disorders. METHOD: Each of the five authors reviewed all identified empirical studies to be certain that inclusion/exclusion criteria were met. Two teams of raters then independently reviewed each study to determine whether it supported any of a series of six hypotheses that had been tested in this literature. RESULTS: This review indicates that childhood sexual abuse is a nonspecific risk factor for bulimia nervosa, particularly when there is psychiatric comorbidity. There is some indication that childhood sexual abuse is more strongly associated with bulimic disorders than restricting anorexia, but it does not appear to be associated with severity of the disturbance. CONCLUSION: Childhood sexual abuse is a risk factor for bulimia nervosa with significant comorbidity. Further study of the nature of this relationship is warranted.

Anorexia↗
PubMed1997

Cerebrospinal fluid leptin in anorexia nervosa: correlation with nutritional status and potential role in resistance to weight gain.

Studies in rodents have shown that leptin acts in the central nervous system to modulate food intake and energy metabolism. To evaluate the possible role of leptin in the weight loss of anorexia nervosa, this study compared cerebrospinal fluid (CSF) and plasma leptin concentrations in anorexic patients and controls. Subjects included 11 female patients with anorexia nervosa studied at low weight and after treatment, and 15 healthy female controls. Concentrations of leptin in blood and CSF were measured by RIA. Patients with anorexia nervosa, compared to controls, had decreased concentrations of leptin in CSF (98 +/- 26 vs. 160 +/- 58 pg/mL; P < 0.0005) and plasma (1.75 +/- 0.46 vs. 7.01 +/- 3.92 ng/mL; P < 0.005). The CSF to plasma leptin ratio, however, was higher for patients (0.060 +/- 0.023) than for controls (0.025 +/- 0.007; P < 0.0001). At posttreatment testing, although patients had not yet reached normal body weight, CSF and plasma leptin concentrations had increased to normal levels. These results demonstrate the dynamic changes in plasma and CSF leptin during positive energy balance in anorexia nervosa. The results further suggest that normalization of CSF leptin levels before full weight restoration during treatment of anorexic patients could contribute to resistance to weight gain and/or incomplete weight recovery.

Adult↗
PubMed1996

Cataplexy and the switch process of multiple personality disorder.

A case history is presented of an 18-year-old male with dissociative disorder and polysubstance abuse. The patient was observed to switch between three personalities, and the personality changes were often associated with symptoms of cataplexy. Both dissociative episodes and cataplexy are associated with strong affective stimuli. Similar reports in the literature are briefly reviewed.

Adolescent↗
PubMed1996

Studies of serotonin function in anorexia nervosa.

Neuroendocrine, temperature, test-meal, and psychometric responses are reviewed following challenges with the post-synaptic 5-HT receptor agonist m-chlorophenylpiperazine (m-CPP), the 5-HT precursor L-tryptophan (L-TRP), and placebo in 12 patients with anorexia nervosa (AN) and 16 healthy controls. A subset of the AN patients (n = 8) were rechallenged 3-4 weeks after attaining a predetermined goal weight. AN patients had blunted prolactin (PRL) responses to both m-CPP and L-TRP at low-weight and at goal-weight in comparison to controls, although there was a tendency toward normalization with weight gain. There were trends for blunted growth hormone (GH) responses following both L-TRP and m-CPP in the low-weight but not the goal-weight AN patients. Cortisol (CORT) responses following m-CPP and L-TRP were not significantly different among any of the groups. Temperature and test-meal measures were largely unaffected by serotonergic agents in the patients, although m-CPP decreased meal size in the controls. Psychometric responses were variable and are briefly described. Taken together, these findings indicate that responsiveness in post-synaptic hypothalamic-pituitary serotonergic pathways is altered in AN patients. Although there were some trends toward normalization of responsiveness following goal-weight attainment, many differences tended to persist in the patients despite an average increase of 13 kilograms. These may represent changes in serotonergic function at levels in the CNS "above" the hypothalamus.

Adolescent↗
PubMed1996

Zolpidem-induced psychosis.

Zolpidem is reported to be a safe and effective hypnotic agent for the short-term treatment of insomnia. There are several case reports of zolpidem causing psychotic reactions in patients with no history of psychosis. We report two additional cases in which zolpidem was implicated in psychotic reactions characterized by auditory and visual hallucinations as well as delusional thinking. Both patient's symptoms resolved with the discontinuation of zolpidem use. It appears that our cases share several features in common with the other reported cases. All were female, there appeared to be some dose dependency involved, and the adverse event resolved fairly quickly upon zolpidem discontinuation. Zolpidem should be used at the lowest effective dose for the least amount of time as necessary. Female patients may possibly require smaller doses. In patients manifesting new-onset or unexplained psychotic symptoms, zolpidem use should be considered in the differential diagnosis.

Adult↗