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Biomedical subjects

T D Brewerton

Publications and source records attributed to T D Brewerton.

At least 37 records · Page 2Linked to original sources
PubMed1995

Comparison of eating disorder patients with and without compulsive exercising.

Several studies have examined the occurrence of eating disorders in athletes. However, little has been written about the frequency and phenomenology of compulsive exercising in eating disorder (ED) patients. Given this, we studied a series of 110 patients who presented to the Medical University of South Carolina Eating Disorders Program and met lifetime DSM-III-R criteria for bulimia nervosa (n = 71), anorexia nervosa (n = 18), or both disorders (n = 21). All patients completed the Diagnostic Survey of the Eating Disorders (DSED), a self-report measure of demographic and clinical characteristics including time spent exercising daily. Thirty-one (28%) of the 100 patients reported that they exercised > or = 60 min every day (M +/- SD = 105 +/- 48 min) and were defined as compulsive exercisers (CEs). In addition, 3 CE patients with a DSM-III-R diagnosis of eating disorder not otherwise specified (EDNOS) were included for comparison with non-CEs on a number of variables. CEs had significantly greater ratings of body dissatisfaction (p < .01) than non-CEs. Non- CEs were significantly more likely than CEs to vomit and use laxatives (p < .01, chi 2), and they had a higher frequency of binge eating ( p < .006, Kruskal-Wallis). There was a trend for a significantly higher frequency of compulsive exercising in the patients with anorexia nervosa (38.5%) than those with bulimia nervosa (22.5%) (p < or = .06, chi 2).

Adolescent↗
PubMed1995

Toward a unified theory of serotonin dysregulation in eating and related disorders.

Patients with eating disorders (EDs) exhibit several clinical features and biologic findings indicative of serotonin (5-hydroxytryptamine, 5-HT) dysregulation. These include feeding disturbances, depression and suicide, impulsivity and violence, anxiety and harm avoidance, obsessive-compulsive features, seasonal variation of symptoms, as well as disturbances in neuroendocrine and vascular tissues, as well as other neurochemical systems linked to 5-HT, such as temperature. This review attempts to integrate available results from controlled studies in humans, with particular focus on cerebrospinal fluid (CSF), platelet and plasma studies, as well as pharmacologic challenge strategies using a variety of serotonergic agents. Taken together, these findings support the concept of altered post-synaptic, hypothalamic 5-HT receptor sensitivity in bulimia nervosa (BN), regardless of the presence of anorexia nervosa (AN) or major depression (MD), although these conditions may be associated with other disturbances in 5-HT function, perhaps pre-synaptic ones. The observation that different response measures of 5-HT function in the same subjects may be simultaneously increased, decreased and no different in patients compared to controls is consistent with a 5-HT dysregulation hypothesis. It may be that a variety of psychobiological stressors, such as dieting, binge-eating, purging, drug abuse, photoperiodic changes, as well as psychosocial-interpersonal stressors, perturb and interact with an already vulnerable 5-HT system.

Anorexia Nervosa↗
PubMed1995

Delirium associated with clozapine and benzodiazepine combinations.

Delirium has many organic causes, one of which is the combination of medications. This is sometimes difficult to differentiate in the psychotic individual. To our knowledge there are no published cases of delirium definitively established by "rechallenge" with a combination of clozapine and benzodiazepines. Lorazepam was given for agitation in two individuals on clozapine. Because of either the short half-life, or the lack of knowledge about this interaction, multiple doses were given. Clonazepam was given to a third individual. Two of the reported individuals developed a delirium associated with the administration and onset of lorazepam. These patients had received both lorazepam and clozapine singularly in the past without the adverse effects seen with the combination. Both patients were rechallenged with second doses of lorazepam, when they again developed a delirium. In one case the patient was admitted on clonazepam and then started on clozapine. A delirium developed at a clozapine dose of 150 mg/day; she was not rechallenged. In all three cases the patients' sensorium cleared when benzodiazepines were discontinued. The combination of benzodiazepines and clozapine should be avoided if possible, and if they are used in combination, it should be with great caution.

Adult↗
PubMed1995

Comorbidity of axis I psychiatric disorders in bulimia nervosa.

BACKGROUND: The coexistence of other psychiatric disorders in patients with bulimia nervosa is of major clinical and theoretical interest. We therefore studied a group of consecutively evaluated bulimic patients. METHOD: The Structured Clinical Interview for DSM-III-R (SCID) was administered to a sample of 59 female patients with DSM-III-R-defined bulimia nervosa. RESULTS: The following frequencies of lifetime Axis I comorbid diagnoses were found (in decreasing frequency): any affective disorder (75%), major depressive disorder (63%), any anxiety disorder (36%), any substance abuse disorder (20%), social phobia (17%), generalized anxiety disorder (12%), and panic disorder (10%). In the 44 cases with an affective disorder, 27 (61%) had the onset of affective disorder, 27 (61%) had the onset of their affective disorder prior to the onset of their bulimia, 15 (34%) afterward, and 2 (5%) concurrently. In the 21 cases with any anxiety disorder, 15 (71%) had the onset of their anxiety disorder prior to the onset of their bulimia, 4 (19%) afterward, and 2 (10%) concurrently. CONCLUSION: These data confirm previous reports of a strong association between bulimia nervosa and affective illness, which in most cases precedes the eating disorder. In addition, a high frequency of anxiety disorders, particularly social phobia, is seen in bulimic patients.

Adult↗
PubMed1994

Findings from the Seasonal Pattern Assessment Questionnaire in patients with eating disorders and control subjects: effects of diagnosis and location.

We previously reported a high degree of seasonality as measured by the Seasonal Pattern Assessment Questionnaire (SPAQ) in 41 patients with eating disorders (ED) compared with control subjects and patients with five other affective spectrum disorders. To clarify the relationship of the specific ED diagnosis and latitude to seasonal variation in a larger sample, we administered the SPAQ to 159 women with ED as defined by DSM-III-R. Subtype diagnoses were as follows: bulimia nervosa (BN), n = 109; anorexia nervosa (AN), n = 30; BN+AN, n = 20. Patients were studied at three locations: National Institute of Mental Health (NIMH), n = 46; Medical University of South Carolina (MUSC), n = 53; University of Michigan (UM), n = 60. The control group comprised 50 female normal volunteers studied at NIMH. There was a statistically significant difference in Global Seasonality Scale (GSS) scores among the four diagnostic groups, and all ED subtypes had significantly higher GSS scores than control subjects after post hoc Bonferroni t tests. Higher GSS scores were also found in patients with BN+AN compared with patients with BN or AN alone. The patterns of change were similar to those observed in winter seasonal affective disorder (SAD). Thirteen percent of the total sample of ED patients met SPAQ criteria for winter SAD, with 2.5% each for summer SAD and subsyndromal SAD. UM BN patients (latitude 42 degrees N) had higher GSS scores and a higher prevalence of winter SAD than MUSC BN patients (latitude 33 degrees N), but this difference was not statistically significant. These data support the hypothesis that ED and SAD may involve similar pathophysiological mechanisms, possibly related to serotonin dysregulation.

Adolescent↗
PubMed1994

Testmeal responses following m-chlorophenylpiperazine and L-tryptophan in bulimics and controls.

A wealth of data support a role for serotonin (5-HT) function in the mediation of satiety responses, that are impaired in patients with bulimia nervosa. Testmeal results are presented in which 26 bulimic patients and 17 normal controls were given in randomized, double-blind-fashion, placebo, and the 5-HT agents m-chlorophenylpiperazine (m-CPP, 0.5 mg/kg p.o.) and L-tryptophan (L-TRP, 100 mg/kg i.v.). Three and one-half hours after drug administration, subjects were allowed to eat and lib from a standardized testmeal of 3,500 calories, after which postprandial vomiting was not allowed. M-CPP, but not L-TRP, significantly decreased meal size in the combined group, the controls, and to a lesser extent, the bulimics (P < or = .06). Maximum m-CPP concentrations were inversely correlated to the number of calories consumed in the total group. Following m-CPP, there were significant decreases in carbohydrate, protein, and fat intake in the total group of subjects. There were also trends for decreased carbohydrate and protein intake in the bulimics following m-CPP. There were trends for both m-CPP and L-TRP to reduce fat intake in the controls. Differences in the effects between m-CPP and L-TRP are likely due to differential involvement of 5-HT receptor subtypes at presynaptic and postsynaptic sites. These studies in humans confirm reports in animals that m-CPP decreases food intake, including carbohydrates, protein, and fat in a mixed testmeal.

Adult↗
PubMed1994

Prophylaxis of carbamazepine-induced hyponatremia by demeclocycline in six patients.

BACKGROUND: Hyponatremia has been reported to occur in approximately 5% of carbamazepine-treated patients who otherwise do well on that agent. Demeclocycline has been used in the treatment of hyponatremia of various etiologies including one case of carbamazepine-induced hyponatremia. METHOD: We extended these observations by studying the effects of demeclocycline on carbamazepine-induced hyponatremia in six psychiatric inpatients. RESULTS: Once serum sodium concentrations had normalized after carbamazepine discontinuation, demeclocycline prevented further decreases in sodium levels upon rechallenge with carbamazepine in five of six patients. Gender, smoking, and neurologic compromise may have played a role in the development of carbamazepine-induced hyponatremia as well as response to this strategy, although our sample size is too small to make firm conclusions. CONCLUSION: Demeclocycline was successfully used in the prophylaxis of carbamazepine-induced hyponatremia and may be useful in cases that respond best to carbamazepine treatment.

Adult↗
PubMed1993

Is migraine related to the eating disorders?

Migraine and the eating disorders, particularly bulimia nervosa, share some common demographics, phenomenology, psychopathology, and treatments. Bulimics also appear to be more sensitive to the induction of severe migrainous headaches than controls following challenge with the 5-HT agonist, m-chlorophenylpiperazine (m-CPP), but not placebo or L-tryptophan. This supports a common pathophysiological relationship involving postsynaptic 5-HT dysfunction between these disorders. In order to further explore the possible relationship between eating disorders and migraine, we administered a modified version of the Diagnostic Survey of the Eating Disorders (DSED) and the Eating Disorders Inventory (EDI) to a group of female migraine patients attending the Medical University of South Carolina (MUSC) Neurology Clinic (n = 34). Of the 34 migraine patients surveyed, 88% reported dieting behavior, 59% reported binge eating, and 26% reported self-induced vomiting during their lifetimes. Compared to the responses of a group of normal female controls (n = 577), patients with migraine had elevated scores on four of the eight subscales of the EDI: Body Dissatisfaction (p < or = .02), Perfectionism (p < or = .01), Interpersonal Distrust (p < or = .02), and Ineffectiveness (p < or = .06). These findings support the hypothesis that common pathophysiological mechanisms, perhaps involving 5-HT dysregulation, may be involved in these two disorders.

Adult↗
PubMed1993

The Tridimensional Personality Questionnaire in eating disorder patients.

The Tridimensional Personality Questionnaire (TPQ) was developed to measure a variety of personality variants on three biosocial dimensions, harm avoidance (HA), novelty seeking (NS), and reward dependence (RD), which are thought to be related to serotonin (5-HT), dopamine (DA), and norepinephrine (NE) function, respectively. Patients with eating disorders have been reported to have abnormalities in all of these systems, as well as personality variants described by these dimensions. We therefore administered the TPQ to 147 patients with DSM-III-R defined eating disorders (110 bulimia nervosa [BN], 27 with anorexia nervosa [AN], and 10 with BN+AN) and compared their scores to those of 350 female controls. When significant, post hoc Bonferroni t tests were performed using alpha = 0.05. All subtypes of eating disorder patients scored significantly higher on HA than controls (p < or = .0001, analysis of variance. Only patients with BN (+/- AN) had significantly higher degrees of NS (p < or = .0001), particularly on the impulsiveness subscale (NS2), although this may, in part, be due to age. No significant differences in total RD were found, although BN patients scored lower on RD3 (attachment vs. detachment) and higher on RD4 (dependence vs. independence) than controls. In addition, AN patients had significantly higher RD2 (persistence vs. irresoluteness) subscale scores. These data support a theory of 5-HT dysregulation in both types of eating disorders and suggest that further research be done on the role of DA and NE in BN.

Adult↗
PubMed1993

Alexithymia in the eating disorders.

Eating disorder patients appear to have high degrees of alexithymia, a diminished capability to verbally describe feelings, although little data exist. We administered the Toronto Alexithymia Scale (TAS) to 114 females with DSM-III-R defined eating disorders. Patients, regardless of subtype, scored significantly higher than 370 college-aged females. TAS scores were significantly correlated to self-ratings of affective symptoms, but not weight or binge-purge frequency.

Adult↗
PubMed1993

The Kids' Eating Disorders Survey (KEDS): a study of middle school students.

OBJECTIVE: Anorexia nervosa and bulimia nervosa are known to occur in children although prevalence studies are lacking. METHOD: Using a newly developed self-report instrument, the Kids' Eating Disorders Survey (KEDS), 3,175 students (1,610 females, 1,565 males) enrolled in grades 5 to 8 were surveyed. RESULTS: More than 40% of respondents reported feeling fat and/or the wish to lose weight. These frequencies of weight control behaviors were reported, many of which were significantly greater in girls than boys (*p < 0.05, chi-square): dieting (31.4%*), fasting (8.7%*), diet pill use (2.4%*), vomiting (4.8%), diuretic use (1.5%). The effects of age, grade, weight, and race on responses are reviewed. CONCLUSIONS: Findings demonstrate that development of prevention programs aimed at recognizing problem eating behavior in children is indicated.

Anorexia Nervosa↗
PubMed1993

CSF cholecystokinin octapeptide in patients with bulimia nervosa and in normal comparison subjects.

Cholecystokinin octapeptide (CCK-8) appears to modulate appetitive behavior, and in rodents, anxiety-related behavior. The authors studied CCK-8 in patients with bulimia nervosa. CSF concentrations of CCK-8 were measured in 11 drug-free female patients with DSM-III-R-defined bulimia nervosa and in 16 normal subjects. The bulimic patients had significantly lower levels of CCK-8 than the comparison subjects. CCK-8 concentrations were inversely correlated with scores on the anger-hostility, anxiety, and interpersonal sensitivity subscales of the SCL-90-R. They were not significantly correlated with age, percentage of standardized average body weight, or mean weekly frequency of binge eating or vomiting. The results indicate that central CCK-8 abnormalities may play a role in the pathophysiology of bulimia nervosa.

Adult↗
PubMed1992

Low serotonin and dopamine metabolite concentrations in cerebrospinal fluid from bulimic patients with frequent binge episodes.

Cerebrospinal fluid neurotransmitter metabolite levels were studied to assess whether measures of central serotonin, dopamine, or norepinephrine function are associated with severity of abnormal eating patterns in patients with bulimia nervosa. In comparison with healthy controls (N = 17), hospitalized bulimic patients with a history of binge eating more frequently than twice daily (N = 11) had significantly lower CSF concentrations of 5-hydroxyindoleacetic acid and homovanillic acid. For the total patient group (N = 29), levels of both metabolites were significantly inversely correlated with binge frequency. On the basis of preclinical studies, these results were examined in the context of speculative models in which low central serotonin function might contribute to blunted satiety responses in bulimic patients, while low central dopamine activity might play a role in abnormal hedonic responses to food.

Adult↗