Radial artery compliance in patients with peripheral vascular disease

In order to evaluate serotonergic function in obsessive-compulsive disorder (OCD), plasma cortisol response to d-fenfluramine (30 mg p.o.) was examined in 20 drug-free obsessive-compulsive patients (10 males and 10 females) and in 20 age- and sex-matched healthy subjects, under double-blind, placebo-controlled conditions. We found that: (a) baseline plasma cortisol secretion was significantly increased in patients with OCD; (b) in healthy subjects, the cortisol response to d-fenfluramine was evident in women, but no in men; (c) plasma cortisol response to the serotonergic challenge did not differ between patients and controls, but it was significantly reduced in female patients as compared to healthy women. These results demonstrate a hyperactivity of the hypothalamo-pituitary-adrenal axis in obsessive-compulsive patients and suggest a dysfunction of 5-HT transmission in female patients.     

Structural analysis of parent–child relationships in eating disorders.

Tested the psychodynamic formulation that binge eating in bulimia reflects familial and intrapsychic deficits in nurturance, empathy, and to some extent, affective regulation. Parental relationships and introjects were compared among 60 women (aged 15–23 yrs) with bulimia, bulimia-anorexia, or anorexia and 20 normal controls using L. S. Benjamin's (see record 1975-02991-001) Structural Analysis of Social Behavior model and rating scales. The results reveal that the 2 bulimic subgroups experienced deficits in parental nurturance and empathy, relative to normal controls. However, only the deficits in perceived nurturance were specific to bulimia, that is, were also more severe than in classical anorexia. In addition, both bulimics and anorexics viewed their parents as more blaming, rejecting, and neglectful toward them relative to normal controls, and they treated themselves with the same hostility and deprivation. Findings are interpreted as partially supportive of the psychoanalytic hypothesis of binge eating in bulimia. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cytotoxicity of Kuwait weathered lake crude oil on rat hepatocytes: a histological and ultrastructural study

BACKGROUND: We sought to determine whether there was empirical support for the diagnostic thresholds of DSM-IV bulimia nervosa (BN) and whether an empirically derived typology resembled the diagnostic categories of DSM-IV. METHODS: Detailed information about bulimic behaviours were assessed via personal interview in a population-based sample of 1897 Caucasian female twins. We assessed the lifetime prevalence of the component bulimic behaviours and DSM-IV and DSM-III-R BN. Latent class analysis of nine separate bulimic symptoms was used to develop an empirical typology of bulimic behaviour. RESULTS: Although the lifetime prevalences of bingeing (23.6%) and vomiting (4.8%) were relatively common, DSM-IV BN was distinctly uncommon (0.5%). The criterion that specified the frequency and duration of bingeing and vomiting was an important limiting condition. Analysis of alternative thresholds found little support for the DSM-IV thresholds requiring an average of twice per week for 3 months. Latent class analysis yielded an interpretable four class solution that had little overlap with the DSM-IV typology. CONCLUSIONS: As in other studies of unselected samples of women, the lifetime presence of bulimic behaviours are relatively high. Our results suggest that the DSM-IV approach to categorizing bulimic behaviour inadequately captures the spectrum of lifetime bulimic behaviours in the general population.     

A comparison of different methods for assessing the features of eating disorders in patients with binge eating disorder.

The authors compared 3 methods for assessing the features of eating disorders in patients with binge eating disorder (BED). Participants were administered the Eating Disorder Examination (EDE) interview and completed the EDE Questionnaire (EDE-Q) at baseline. Participants prospectively self-monitored their eating behaviors daily for 4 weeks and then completed another EDE-Q. The EDE and the EDE-Q were significantly correlated on frequencies of objective bulimic episodes (binge eating) and on the Dietary Restraint, Eating Concern, Weight Concern, and Shape Concern subscales. Mean differences in the EDE and EDE-Q frequencies of objective bulimic episodes were not significant, but scores on the 4 subscales differed significantly, with the EDE-Q yielding higher scores. At 4 weeks, the EDE-Q retrospective 28-day assessment was significantly correlated with the prospective daily self-monitoring records for frequency of objective bulimic episodes, and the mean difference between methods was not significant. The EDE-Q and self-monitoring findings for subjective bulimic episodes and objective overeating differed significantly. Thus, in patients with BED, the 3 assessment methods showed some acceptable convergence, most notably for objective bulimic episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating behavior of bulimics, self-identified binge eaters, and non-eating-disordered individuals: what differentiates these populations?

This article reviews and critiques the eating behavior literature comparing the binge and non-binge-eating episodes of three populations of normal-weight women: bulimics, self-identified binge eaters, and non-eating-disordered women. The specific behaviors evaluated are number of calories consumed during different types of eating episodes, frequency of binge eating, number of eating episodes, rate of food consumption, the macronutrient composition of the food ingested, and context and duration of eating. Differences in these populations' eating behavior are analyzed in terms of their theoretical contribution. It is concluded that differences in the observed behavior of these groups are consistent with restraint theory, purge opportunity, and the forbidden foods hypothesis. Conversely, results do not support carbohydrate craving theory or a deficit in the satiety mechanisms of bulimics. Suggestions for future research are presented.     

A study of personality in eating disorders

Some evidence suggests that temperament and personality traits could influence the development and severity of eating disorders. This study was designed to study these aspects. METHODS: 72 patients with DSM-IV eating disorders including 25 anorexia nervosa restricting type, 17 with anorexia nervosa binge eating-purging type and 30 with bulimia nervosa were studied and compared with thirty healthy controls. Personality disorders and temperament were studied with the Eysenck's EPQ, Cloninger's TCI and SCID-II. Impulsive and clinical features were studied with specific rating scales. RESULTS: 61.8% of patients had at least one personality disorder. Avoidant personality disorder was the most commonly diagnosed in anorexia restricting type (25%). Borderline personality disorder was the most frequent in bulimia nervosa and in the binge eating-purging type of anorexia nervosa. Dimensionally, the group of eating disorders presented high scores in neuroticism and low scores in self-directedness. Higher harm avoidance was found in bulimic patients and higher persistence was associated with anorectic patients. Bulimic patients were significantly more impulsive than anorectic and controls. CONCLUSIONS: Temperament and personality traits differ in anorectic and bulimic patients. Bulimic symptoms are linked to impulsive temperament traits and to impulsive personality features. Anorectic symptoms are linked to persistent temperament traits and anxious personality features.     

Plasma amino acid ratios related to brain serotonin synthesis in response to food intake in bulimia nervosa

Fifteen bulimic women (BN) and 19 healthy female controls (CO) were studied. The subjects were cross-over treated with either fluoxetine (FXT) or placebo during 4 days. They received, in randomized order, a breakfast containing pure carbohydrate (CHO) or a protein-rich (PROT) breakfast following day 3 and 4 of each treatment period. Twenty-nine different food items were offered for lunch. The fasting serum glucose and insulin concentrations and the fasting plasma tryptophan (Trp)/large neutral amino acid (LNAA) ratio were slightly higher in BN. The changes of these metabolic parameters in response to a CHO or PROT breakfast were similar in both groups. Across breakfast type, the plasma (Trp)/(LNAA) ratio at 120 min after breakfast was higher in BN. Total caloric intake at lunchtime was less in BN. In CO, less carbohydrate was selected at lunchtime following the CHO breakfast, an effect that was abolished by FXT. Breakfast type or FXT did not have any apparent effect on food intake at lunchtime in BN. This might indicate that bulimic subjects are less sensitive to serotoninergic stimuli than control subjects.     

Normal bone mass in bulimic women

The aim of this study was to examine the relationship among exercise, menstrual function, and bone mineral density (BMD) in different groups of age-matched patients with eating disorders. Dieting and eating disorder history, physical activity history, and menstrual history were assessed by clinical interview in 43 bulimic and 13 anorectic young women as well as in 17 healthy control subjects (18-29 yr). BMD was assessed by dual x-ray absorptiometry. All the anorectics but only 30% of the bulimics exercised regularly from the onset of their eating disorder (P < 0.01), mainly using aerobic dancing and running. All of the anorectics had been amenorrheic since the start of their symptoms, and 68% of the bulimics had a history of menstrual dysfunction. Within the exercise subgroups of bulimic patients, there was no significant relationship between BMD and current or previous menstrual function. Anorectic patients had lower BMD than bulimics and controls in all skeletal regions studied (P < 0.01). Bulimic patients who had exercised regularly during their illness had higher total body BMD than bulimics classified as sedentary (P < 0.01). Bulimics who had exercised regularly or intermittently since the onset of their eating disorder had higher BMD than sedentary bulimics in the lumbar vertebrae, femoral neck, and legs (P < 0.05). It appears that weight-bearing exercise can prevent or attenuate bone loss at specific skeletal sites in normal weight bulimic patients, but not in anorectics.     

Brain serotonin (5-HT) neuroendocrine function in patients taking cholesterol-lowering drugs

Brain serotonin (5-HT) neuroendocrine function, plasma tryptophan, and platelet 5-HT content were examined in 20 patients treated in a lipid clinic for hypercholesterolaemia with combined drug and diet therapy and in 20 healthy matched controls. Treatment had produced a substantial decrease in total cholesterol concentrations in the patients, but they still had higher cholesterol and triglyceride levels than control subjects. The patients were somewhat more depressed than controls but did not differ from them in degree of hostility, free or total plasma tryptophan, or prolactin response to 30 mg of d-fenfluramine. This study does not reveal evidence of abnormal brain 5-HT neuroendocrine function in hypercholesterolaemic patients receiving cholesterol-lowering medications and diet.     

Nausea in bulimic women in response to palatable food.

Nausea in response to an appetizing food stimulus was assessed in bulimic women and healthy control subjects. Nausea was assessed via subjects' self-report and changes in levels of plasma arginine vasopressin (AVP), a hormonal correlate of nausea. Converging evidence was obtained indicating that bulimic women experienced nausea in response to the sight, smell, or taste of the palatable food stimulus. The possibility that the observed nausea is a learned response that may contribute to the bulimic binge/purge pattern is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dopamine function in obsessive-compulsive disorder: growth hormone response to apomorphine stimulation

Indirect observations suggest that the dopaminergic system may be involved in the pathophysiology of obsessive-compulsive disorder (OCD). The dopaminergic function of 15 patients with OCD and 15 age/sex-matched controls was evaluated by measuring the growth hormone (GH) responses to stimulation with the dopaminergic agonist apomorphine (APO), which increases growth hormone-releasing hormone (GHRH), GH, and somatomedine C (SMD-C) secretions. Therefore, we measured basal plasma GH and SMD-C concentrations and GH responses to GHRH stimulation to exclude that a downstream pathology of the somatotropic axis could obscure the significance of the results of the APO test. The response of prolactin (PRL) to APO inhibition were also measured. Basal plasma levels of GH, SMD-C, and PRL, GH responses to GHRH stimulation, and PRL responses to APO inhibition did not differ in the two groups of subjects. GH responses to APO stimulation were blunted in obsessive-compulsive (OC) patients. The emetic response to the same stimulation was stronger in patients than in controls. These responses suggest that in our OC patients there is a dysregulation of the dopaminergic system, which is possibly expressed in different ways in the various areas of the central nervous system.     

Serotonergic function and negative and depressive symptomatology in schizophrenia and major depression

BACKGROUND: Serotonergic abnormalities are found in both major depressive disorder (MDD) and schizophrenia. Depressive symptoms commonly occur alongside the negative or defect symptoms in schizophrenia and antiserotonergic drugs may be particularly effective in their treatment. We wished to explore whether these symptoms could be distinguished biologically by directly comparing serotonergic function in these two illnesses. METHOD: Fifteen patients with MDD and 13 patients with schizophrenia underwent testing with the specific serotonin releasing agent D-fenfluramine (D-FEN). Prolactin and cortisol responses were measured to ascertain central serotonergic function. Individual patient results were compared with their own carefully matched control to correct for the effect of age, sex, weight and menstrual cycle, before the two patient groups were then compared. RESULTS: Prolactin responses differed significantly between the two patient groups, being lower in MDD patients and higher in schizophrenia patients than their individually matched controls. Cortisol responses did not differ. Within the schizophrenia group, increased serotonergic function correlated positively with depressive symptoms, but there was no such correlation with defect symptoms. Depressive scores were negatively correlated with the presence of negative symptoms in the schizophrenic group. CONCLUSIONS: Schizophrenia and MDD have distinct and opposite neuroendocrine responses to D-FEN. There is no evidence that depressive symptoms in these two conditions have a common serotonergic basis. Moreover, these responses distinguished between negative and depressive symptoms in our schizophrenic group.     

Revisiting the affect regulation model of binge eating: A meta-analysis of studies using ecological momentary assessment.

The affect regulation model of binge eating, which posits that patients binge eat to reduce negative affect (NA), has received support from cross-sectional and laboratory-based studies. Ecological momentary assessment (EMA) involves momentary ratings and repeated assessments over time and is ideally suited to identify temporal antecedents and consequences of binge eating. This meta-analytic review includes EMA studies of affect and binge eating. Electronic database and manual searches produced 36 EMA studies with N = 968 participants (89% Caucasian women). Meta-analyses examined changes in affect before and after binge eating using within-subjects standardized mean gain effect sizes (ESs). Results supported greater NA preceding binge eating relative to average affect (ES = 0.63) and affect before regular eating (ES = 0.68). However, NA increased further following binge episodes (ES = 0.50). Preliminary findings suggested that NA decreased following purging in bulimia nervosa (ES = –0.46). Moderators included diagnosis (with significantly greater elevations of NA prior to bingeing in binge eating disorder compared to bulimia nervosa) and binge definition (with significantly smaller elevations of NA before binge vs. regular eating episodes for the Diagnostic and Statistical Manual of Mental Disorders definition compared to lay definitions of binge eating). Overall, results fail to support the affect regulation model of binge eating and challenge reductions in NA as a maintenance factor for binge eating. However, limitations of this literature include unidimensional analyses of NA and inadequate examination of affect during binge eating, as binge eating may regulate only specific facets of affect or may reduce NA only during the episode. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Seasonal affective disorder

Seasonal affective disorder (SAD) is a form of recurrent depressive or bipolar disorder, with episodes that vary in severity. Seasonal patterns of depressive episodes are common, but SAD seems to be less common than such patterns suggest. SAD was at first believed to be related to abnormal melatonin metabolism, but later findings did not support this hypothesis. Studies of brain serotonin function support the hypothesis of disturbed activity. The short-allele polymorphism for serotonin transporter is more common in patients with SAD than in healthy people. Atypical depressive symptoms commonly precede impaired functioning, and somatic symptoms are frequently the presenting complaint at visits to family physicians. The best treatment regimens include 2500 Ix of artificial light exposure in the morning. When patients seem to have no response or to prefer another treatment, antidepressants should be considered.     

Bulimia and binge eating in college women: A comparison of personality and behavioral characteristics.

Assessed 9 behavioral and personality characteristics—restraint, binge eating, high self-expectations, demand for approval, body attitude, assertion, dating, self-esteem, and depression—that have been implicated in studying the onset of bulimia. Ss were 30 women who fulfilled an operationalized definition of the DSM-III criteria for bulimia (bulimics), 22 women who reported binge eating 8 or more times per month but did not fulfill the criteria for bulimia (binge eaters), and 28 women who did not binge eat (controls). Ss completed measures that included the Beck Depression Inventory, a self-esteem index, and the short form of the Personality Attributes Questionnaire. In comparison to controls, bulimics were more depressed and had lower self-esteem, poorer body image, higher self-expectations, higher need for approval, greater restraint, and higher binge-eating scores. Binge eaters exhibited higher restraint and binge-eating scores than controls. Bulimics and binge eaters differed significantly on all but a few variables. Results suggest that treatment for bulimics should extend beyond the disturbed eating pattern and that the distinction between binge eating and bulimia is an important one. Some empirical support for the DSM-III definition of bulimia was found. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypothalamic paraventricular nucleus lesions differentially affect serotonin-1A (5-HT1A) and 5-HT2 receptor agonist-induced oxytocin, prolactin, and corticosterone responses

A number of receptor subtypes mediate hormonal responses to serotonin (5-HT). To test the hypothesis that the hypothalamic paraventricular nucleus (PVN) mediates 5-HT1A and 5-HT2 receptor-mediated oxytocin, PRL, and corticosterone responses, we studied the effects of the 5-HT1A agonist ipsapirone and the 5-HT2A/2C agonist 1-(2,5-dimethoxy-4-iodophenyl)2-aminopropane (DOI) after surgical PVN lesions or sham operations. Chronically cannulated, conscious, freely moving, male Wistar rats were injected iv (1 mg/kg) shortly after (3-4 days) and 5 weeks after (35-37 days) the operations. In sham-operated rats, ipsapirone caused marked elevations in plasma PRL and corticosterone, but not oxytocin concentrations, whereas DOI increased plasma concentrations of all three hormones. Short term PVN lesions prevented ipsapirone-induced corticosterone and DOI-induced oxytocin responses. DOI-induced PRL and corticosterone responses were also markedly inhibited 3-4 days after lesioning, although small rises over the baseline values were still observed. The ipsapirone-induced PRL response was unaffected by the lesioning. Five weeks after PVN lesioning, partial recoveries were observed in ipsapirone- and DOI-induced corticosterone and DOI-induced oxytocin responses, whereas DOI-induced PRL responses remained suppressed. The present findings suggest that the PVN or neural pathways close to it mediate oxytocin, PRL, and corticosterone responses to the 5-HT2 receptor agonist DOI as well as corticosterone, but not PRL, responses to the 5-HT1A receptor agonist ipsapirone. The results after long term PVN lesioning show that the oxytocin and corticosterone responses may be partially restored with time after lesioning.     

Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment.

The relation of mood and stress to binge eating and vomiting in the natural environments of patients with bulimia nervosa (BN) was examined using real-time data collection. Women (n = 131; mean age = 25.3 years) with BN carried a palmtop computer for 2 weeks and completed ratings of positive affect (PA), negative affect (NA), anger/hostility (AH), and stress (STRS); they also indicated binge or vomit episodes (BN-events) 6 times each day. Mixed models were used to compare mood and STRS between and within days when BN-events occurred. Between-days analyses indicated that binge and vomit days both showed less PA, higher NA, higher AH, and greater STRS than days with no BN-events. Within-day, decreasing PA, and increasing NA and AH, reliably preceded BN-events. Conversely, PA increased, and NA and AH decreased following BN-events. Demonstration of the temporal sequencing of affect, STRS, and BN-events with a large BN sample may help advance theory and clinical practice, and supports the view that binge and purge events hold negatively reinforcing properties for women with BN. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alterations in serotonergic responsiveness during cocaine withdrawal in rats: similarities to major depression in humans

BACKGROUND: Withdrawal from long-term cocaine use is accompanied by symptoms resembling major depression. Because acute cocaine affects serotonin (5-HT) neurons, and 5-HT dysfunction is implicated in the pathophysiology of depression, we evaluated the effects to 5-HT agonists in rats withdrawn from repeated injections of cocaine (15 mg/kg i.p., b.i.d., 7 days) or saline. METHODS: In the first study, prolactin (PRL) responses elicited by the 5-HT-releasing agent fenfluramine, the 5-HT1A agonist (+/-)-8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), and the 5-HT2A/2C agonist (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane hydrochloride (DOI) were examined as indices of postsynaptic 5-HT receptor function. In a second study, specific responses induced by 8-OH-DPAT, namely inhibition of brain 5-HT synthesis and stimulation of feeding, were examined as correlates of 5-HT1A autoreceptor function. RESULTS: Prior treatment with cocaine did not modify fenfluramine-evoked PRL release; however, the PRL secretory response to 8-OH-DPAT was blunted and the PRL response to DOI was potentiated after chronic cocaine treatment. Cocaine exposure did not alter the inhibitory effect of 8-OH-DPAT on 5-HT synthesis. 8-OH-DPAT-induced feeding was influenced by prior cocaine, but this effect was secondary to pronounced baseline hyperphagia in the cocaine-treated group. CONCLUSIONS: These data indicate that withdrawal from chronic cocaine renders specific subpopulations of postsynaptic 5-HT1A receptors subsensitive and 5-HT2A/2C receptors supersensitive. No evidence for cocaine-induced changes in 5-HT1A autoreceptor responsiveness was found. A survey of the literature reveals similarities in the profile of 5-HT dysfunction between rats withdrawn from cocaine and humans diagnosed with depression. We propose that withdrawal from chronic cocaine in rats may serve as a useful animal model of depressive disorders.     

Clinical utility of CA125 levels in predicting laparoscopically confirmed salpingitis in patients with clinically diagnosed pelvic inflammatory disease

To investigate immune system function in obsessive-compulsive disorder (OCD) we measured plasma levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta) and interleukin-6 (IL-6) in 14 drug-free obsessive-compulsive patients and 14 matched healthy controls. No significant differences were observed between patients and controls in plasma levels of IL-1 beta and IL-6, whereas plasma levels of TNF-alpha were significantly lower (p = 0.001) in the former. Blood levels of prolactin did not differ between the two groups, whereas plasma cortisol concentrations were significantly higher in patients than in healthy subjects (p = 0.02). No significant correlation was found between immune parameters, on the one hand, and endocrine or psychopathological measures on the other. These results suggest that OCD is associated with a decreased production in TNF-alpha, but normal synthesis of IL-1 beta and IL-6.     

A controlled evaluation of the distress criterion for binge eating disorder.

Objective: Research has examined various aspects of the validity of the research criteria for binge eating disorder (BED) but has yet to evaluate the utility of Criterion C, “marked distress about binge eating.” This study examined the significance of the marked distress criterion for BED using 2 complementary comparison groups. Method: A total of 1,075 community volunteers completed a battery of self-report instruments as part of an Internet study. Analyses compared body mass index (BMI), eating-disorder psychopathology, and depressive levels in 4 groups: 97 participants with BED except for the distress criterion (BED–ND), 221 participants with BED including the distress criterion (BED), 79 participants with bulimia nervosa (BN), and 489 obese participants without binge eating or purging (NBPO). Parallel analyses compared these study groups using the broadened frequency criterion (i.e., once weekly for binge/purge behaviors) proposed for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) and the 4th edition (DSM–IV) twice-weekly frequency criterion. Results: The BED group had significantly greater eating-disorder psychopathology and depressive levels than the BED–ND group. The BED group, but not the BED–ND group, had significantly greater eating-disorder psychopathology than the NBPO comparison group. The BN group had significantly greater eating-disorder psychopathology and depressive levels than all 3 other groups. The group differences in eating-disorder psychopathology existed even after controlling for depression levels, BMI, and demographic variables, although some differences between the BN and BED groups were attenuated when controlling for depression levels. Conclusions: These findings provide support for the validity of the “marked distress” criterion for the diagnosis of BED. (PsycINFO Database Record (c) 2011 APA, all rights reserved)