Outcome in bulimia nervosa

An antigen-coated cloth segment was placed onto a blotting pad. The cloth was blotted with one drop of an antibody sample, immediately washed with five drops of a washing solution, exposed to one drop of an anti-antibody-peroxidase conjugate, washed, and finally exposed to a peroxidase substrate. The colored peroxidase product was determined either visually or colorimetrically with the color intensity being correlated to the antibody concentration. This rapid assay would facilitate field serodiagnosis of human and animal diseases.     

Psychopharmacologic treatment of bulimia nervosa

Since the inclusion of Bulimia Nervosa (BN) in DSM-III as a nosological entity, it has been a focus of attention in the literature. To the present day several therapeutical approaches have been developed, pharmacological, psychological either separated or combined with diverse results. We have studied 20 patients diagnosed of BN according to DSM-III-R diagnostic criteria, from a psychopathological, and evolution point of view, the therapeutical response to a fixed daily dose of Fluoxetine 80 mg., during three months, with evaluations on days: 0-14-30-90. The mean age of the sample was 19.5 years; in 70% at the onset of the illness the Anorexia Nervosa symptomatology was prominent; there was a predominance of affective-obsessive previous personality traits in 60%, 100% showed unsatisfied or altered body image. We want to point out the quick improvement of various parameters such as: the constant eating desire, the binge eating episodes, the vomiting, the misuse of laxatives and the affective and anxious symptomatology. We compare our results with previous studies and make a review of the literature on this topic, we also give an efficacy profile of the different psychopharmacological drugs used in the treatment of eating disorders and a clinical guide to identify those patients who could improve with a psychopharmacological treatment.     

Prior treatment received by patients with bulimia nervosa

The purpose of this study was to investigate and compare the effects of paclitaxel and its water-soluble conjugates (sodium-pentetic acid-paclitaxel; polyethylene glycol-paclitaxel, and poly[L-glutamic acid]-paclitaxel) on chromosome morphology and induction of apoptosis in a metastatic murine melanoma cell line (K1735 clone X-21). For this, murine melanoma cells were treated continuously for 72 h with three concentrations (1.2 microM, 2.4 microM, and 4.8 microM) of each of paclitaxel, and conjugates. Another set of cells were pulse-treated at 2.4 microM, 4.8 microM and 9.6 microM concentrations of each of these drugs for 4 h and the recovered cells were examined after 72 h. Control cultures received only the solvents (dimethyl sulfoxide or water). Our results showed a significant increase in the frequencies of telomeric associations, chromosome aberrations, polyploidization, distorted and disintegrated chromosome morphology, and reduced telomeric signal intensity by fluorescence in situ hybridization, in treated cultures as compared to the controls. However, we detected no change in telomerase activity. In addition, the majority of interphase nuclei in treated cells showed apoptotic bodies, with chromatin condensation. These in vitro results suggest that cell death induced by paclitaxel and its water-soluble conjugates is due to the loss of telomeric repeats, as shown by reduced signal flourescence and increased telomeric associations.     

Biological aspects of anorexia nervosa and bulimia nervosa.

In this article, we review biological factors relevant to the understanding of anorexia nervosa and bulimia nervosa. We consider the physical presentation of these disorders; the medical complications of starvation, binging, and purging; and the cognitive and behavioral effects of starvation. We also review neurophysiological and neurochemical aspects of these illnesses and their biological treatments. These biological variables are most prominent in the perpetuation of the eating disorders. Effective treatment approaches must consider psychosocial as well as biological variables to be optimally effective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multifactorial assessment of bulimia nervosa.

Investigated a multifactorial approach to the assessment of bulimia nervosa by means of hierarchical factor analysis. 245 bulimia nervosa patients and 68 patients with either anorexia nervosa or eating disorders not otherwise specified were administered a self-report battery that was organized into 21 dimensions relevant to eating disorder patients. When dimensions from this battery were subjected to hierarchical factor analysis, support for bulimia nervosa as a unique diagnostic category was obtained. However, the emergence of 3 secondary factors and 6 primary factors suggests that bulimia nervosa can also be described more complexly. The emergence of a multifactorial model of bulimia nervosa that incorporates several existing unidimensional models suggests the potential for both divergent and complicated clinical presentation in bulimia nervosa patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and treatment of bulimia nervosa

Bulimia nervosa is characterized by binge eating and inappropriate compensatory behaviors, such as vomiting, fasting, excessive exercise and the misuse of diuretics, laxatives or enemas. Although the etiology of this disorder is unknown, genetic and neurochemical factors have been implicated. Bulimia nervosa is 10 times more common in females than in males and affects up to 3 percent of young women. The condition usually becomes symptomatic between the ages of 13 and 20 years, and it has a chronic, sometimes episodic course. The long-term outcome has not been clarified. Other psychiatric conditions, including substance abuse, are frequently associated with bulimia nervosa and may compromise its diagnosis and treatment. Serious medical complications of bulimia nervosa are uncommon, but patients may suffer from dental erosion, swollen salivary glands, oral and hand trauma, gastrointestinal irritation and electrolyte imbalances (especially of potassium, calcium, sodium and hydrogen chloride). Treatment strategies are based on medication, psychotherapy or a combination of these modalities.     

Diagnosis and treatment of bulimia nervosa

Physiologic replacement of insulin in patients with type 1 (insulin-dependent) diabetes following pancreas allograft transplantation results in normoglycaemia during fasting and postprandial states. However, this is achieved at the expense of peripheral hyperinsulinaemia in the heterotopic pancreas allograft recipients with systemic insulin drainage. In addition, the pancreas allograft is denervated and thus devoid of autonomic nervous regulation of pancreatic beta-cell secretion. Recent reports of hypoglycaemia (symptomatic and asymptomatic), which can be fatal, have raised serious concerns regarding the aetiology of the hypoglycaemic epiphenomenon in type 1 diabetic pancreas allograft recipients. Although the prevalence of significant hypoglycaemia following pancreas transplantation remains unknown, it is important to conduct studies to determine the mechanisms, the natural history, predictors and treatment as well as the long-term prognosis (graft and patient survival rates) of type 1 diabetic patients who develop pancreas-allograft-associated hypoglycaemia. Indeed, predictors of hypoglycaemia following pancreas allograft could significantly impact on the selection of appropriate therapeutic options for pancreas allograft transplantation. Finally, whether postpancreas allograft transplantation-associated hypoglycaemia in type 1 diabetic patients carries greater morbidity and mortality when compared to those without hypoglycaemia deserves to be investigated.     

A comparison of ever-married and never-married women with anorexia nervosa or bulimia nervosa

OBJECTIVE: The results of the scant research on anorexia nervosa and marriage suggest that married anorexics may exhibit more severely disordered eating. However, past research has not controlled for the greater age of married versus unmarried anorexics, and very little research has been conducted on marriage and women with bulimia nervosa. We investigated differences in disordered eating and clinical traits between ever-married and never-married women with anorexia nervosa or bulimia nervosa and statistically controlled for age. METHOD: Adult women ages 20-45, who were assessed in an outpatient eating disorders clinic and diagnosed with anorexia nervosa (n = 91) or bulimia nervosa (n = 223), completed several measures of disordered eating and related traits at the point of initial evaluation. RESULTS: In simple comparisons, ever-married women differed from their never-married peers with regard to several indices of symptom history and severity. However, after controlling for age, ever-married women differed only with regard to an earlier onset of menarche and, for women with bulimia nervosa, an earlier onset of sexual intercourse. DISCUSSION: Results are discussed with regard to possible explanation and directions for future research.     

Blood pressure-related hypoalgesia in bulimia nervosa

Monoclonal antibody B3 (MAb B3) reacts with many epithelial cancers. It recognizes a carbohydrate antigen (Ley) which is expressed in a variety of solid tumors including breast and colon. We have used the Fab portion of MAb B3 and a portion of the constant domain of human IgG1 to make recombinant immunotoxins of different compositions. The toxin component employed is a truncated form of Pseudomonas exotoxin (PE38). The light chain or Fd of the antibody was cloned from hybridoma RNA and fused to PE38. Immunotoxin (IT) was then expressed in Escherichia coli as a fusion protein and refolded with either the Fd or the light chain. We have also made B3(Fab) immunotoxins of different sizes ranging 85-140 kDa, by introducing different portions of the constant domain of human IgG1 at the junction of Fd and PE38 fusion site. We compared the properties of the resulting immunotoxins with existing anti-Ley immunotoxins side by side. All recombinant Fab-immunotoxins made in this study were cytotoxic to antigen-positive cancer cell lines. However, in contrast to the B3(scFv) immunotoxin, the B3(Fab) immunotoxins are very stable, retaining 90% of their activity after 24 h of incubation in human serum albumin at 37 degreesC. A pharmacokinetics study with these immunotoxin molecules showed a longer survival in the circulation of mice compared to the smaller Fv immunotoxins. The smaller size of the Fab immunotoxins compared to B3Lys-PE38 and the increased T1/2 value compared to B3(scFv)-PE38 and B3(dsFv)-PE38 make these recombinant immunotoxins alternative therapeutic agents to treat Ley antigen positive cancers.     

Elevated total cholesterol in bulimia nervosa

c-erbB-2, a member of the tyrosine kinase oncogene family, is overexpressed in about 30% of human breast tumors where it correlates with poor prognosis. In vitro studies have suggested that increased expression of the receptor plays an important role in malignant progression. To better understand the direct effects of p185HER2 overexpression, a human c-erbB-2 expression vector was transfected into the hormone-dependent MCF-7 human breast carcinoma cell line and cell growth was analysed. Unexpectedly, colony formation assay revealed a reduction in the number and size of colonies as compared with mock-transfected cells. In hormone-deprived medium, c-erbB-2 transfected cells acquired growth capability, consistent with previous reports. By contrast, two c-erbB-2-transfected clones grown in complete medium showed a reduced proliferation rate despite the activation of a fully functional oncoprotein capable of autophosphorylation and induction of the MAPK pathway. The number of c-erbB-2-overexpressing cells in the S phase of the cell cycle was about one-half the number of control and mock-transfected cells. Also, overexpression of c-erbB-2 induced overexpression of p21WAF1, pRB hypophosphorylation and a mature differentiated cell phenotype with production of lipid droplets. Functional inactivation of p185HER2 by means of a specific single chain antibody indicated the c-erbB-2-dependence of the observed alterations. These data show that the exogenous overexpression of the c-erbB-2 gene in hormone-dependent breast cancer cells inhibits proliferation and induces differentiation.     

Anorexia nervosa and bulimia nervosa: I. Diagnosis and treatment

Disturbed eating behaviour and disturbed body experience are important features for the differential diagnosis of eating disorders from other disorders. Eating disorders occur mainly in young females. The one-year prevalence of anorexia nervosa is 0.4% and that of bulimia nervosa 1.5% among young females. To motivate patients for treatment it is important to discuss physical problems and the high risk of severe complications with them. It is difficult to motivate patients for treatment, because anorexia nervosa patients deny their illness and bulimia nervosa patients are ashamed and hide their disturbed eating behaviour. The treatment of anorexia nervosa consists of two partly overlapping phases: normalizing the eating pattern to improve weight restoration and psychotherapeutic treatment for underlying emotional problems. Family therapy is effective for patients younger than 18 years with a short duration of illness. Cognitive behaviour therapy is the most important form of treatment for bulimia nervosa.     

Patterns and predictors of recovery in anorexia nervosa and bulimia nervosa

OBJECTIVE: The purpose of this study was to assess the course and outcome of anorexia nervosa and bulimia nervosa at 1 year in a large cohort of women with eating disorders. METHOD: A prospective, naturalistic, longitudinal design was used to map the course of 225 women with anorexia nervosa, bulimia nervosa, and mixed anorexia and bulimia nervosa. Structured interviews were conducted quarterly. Follow-up data are presented in terms of patterns of recovery, clinical features predictive of time to recovery, and the role of comorbid disorders as fixed predictors. RESULTS: The recovery rate of bulimics was significantly better than that of anorexic or mixed subjects, yet nearly half the anorexic and mixed subjects no longer met full DSM-III-R criteria for at least 8 consecutive weeks during the first year of follow-up. Percent ideal body weight and type of eating disorder were significantly associated with outcome. CONCLUSIONS: Our findings suggest that the diagnosis of anorexia nervosa has severe implications.     

Bulimia?=?bulimarexia?=?bulimia nervosa.

S. Cullari and W. K. Redmon (see record 1984-04326-001) suggested that bulimarexia and bulimia nervosa are similar to one another but different from bulimia. The present author argues that given the current state of knowledge, it is conceptually incorrect to consider bulimia and bulimiarexia as separate eating disorders and that such a distinction may lead to serious problems in both clinical research and practice. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anorexia nervosa and bulimia nervosa. II. Somatic complications of undernourishment

In anorexia nervosa and bulimia nervosa, cachexia and deficient nourishment cause various physical abnormalities, especially of the endocrine and digestive systems and the heart. Disorders in the serotoninergic and dopaminergic systems contribute to development of an eating disorder, whereas an acquired deficiency of tryptophan impairs the serotoninergic system. Any problems of nutritional deficiencies, low blood sugar levels and gastrointestinal disorders disappear after normal nourishment is resumed. Hypotension and sinus bradycardia are manifestations of a physiological adjustment to a lower basal metabolism and need no treatment. Osteoporosis occurs from two years after the onset of weight loss; oestrogen supplementation may protect against this. In patients with infections, symptoms such as fever, leukocytosis and high BSE may be lacking. Hypoglycaemia incidentally leads to coma and death, and a lengthened QT interval to acute cardiac death. During restoration of the nutritional status, the intake of fluid and calories should initially be limited. During the first two weeks, the risk of cardiovascular complications is increased.     

Neuropsychological correlates of decision making in patients with bulimia nervosa.

In addition to the core psychopathology of bulimia nervosa (BN), patients with BN often show impulsive behavior that has been related to decision making deficits in other patient groups, such as individuals with anorexia nervosa and pathological gamblers. However, it remains unclear whether BN patients also show difficulties in decision making. In this study, 14 patients with BN and 14 healthy comparison subjects, matched for age, gender, education, body mass index, and intelligence, were examined with the Game of Dice Task (M. Brand, E. Fujiwara, et al., 2005), a gambling task that has fixed winning probabilities and explicit rules for gains and losses, as well as with a neuropsychological test battery and personality questionnaires. On the task, the patients with BN chose the disadvantageous alternatives more frequently than did the comparison subjects. Performance on the Game of Dice Task was related to executive functioning but not to other neuropsychological functions, personality, or disease-specific variables in the BN group. Thus, in patients with BN, decision making abnormalities and executive reductions can be demonstrated and might be neuropsychological correlates of the patients' dysfunctional everyday-life decision making behavior. Neurocognitive functions should be considered in the treatment of BN. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exposure plus response-prevention treatment of bulimia nervosa.

A controlled study evaluating the effectiveness of exposure plus response-prevention treatment of bulimia nervosa was conducted in a sample of 47 women. This was a four-group comparison involving three treatment conditions and a waiting-list control group. The three treatment conditions were (a) exposure plus response prevention conducted in a single setting (clinic), (b) exposure plus response prevention conducted in multiple settings (clinic, patients' homes, and restaurants), and (c) cognitive–behavioral therapy without exposure plus response prevention. All treatment was provided to groups of 3 patients at a time. Outcome was evaluated at posttreatment and at a 6-month follow-up. The three treatment groups improved significantly on most outcome measures, whereas the waiting-list control group showed little change. At follow-up, there was a slightly better outcome on vomiting behavior and amount of food consumed in one of the test meals for the exposure plus response-prevention groups relative to the no-exposure group. However, on all other measures, the degree of improvement from pretreatment to follow-up was the same for all three treatment groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)