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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper reviews four areas of research into anorexia nervosa (AN) and bulimia nervosa (BN). First, in terms of diagnosis, the psychological concerns about weight and shape are now addressed in BN, bringing it more in line with the related disorder, anorexia nervosa. Second, studies of psychiatric comorbidity confirm the overlap between eating disorders and depression, obsessive compulsive disorder, substance abuse, and personality disorder. Nevertheless, there are reasons to accept the distinct qualities of each syndrome, and eating disorders are not merely a variant of these other conditions. Third, treatment advances in BN involve mainly cognitive-behavioural or interpersonal psychotherapies and pharmacotherapies primarily with antidepressants. The effect of combining more than one approach is beginning to be addressed. Finally, outcome studies involving people with both AN and BN have shown that the disorders "cross over" and that both conditions have a high rate of relapse. A renewed interest in the treatment of AN is needed.
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PMID:Advances in diagnosis and treatment of anorexia nervosa and bulimia nervosa. 163 54

Twenty women with bulimia nervosa (BN) and 20 women with obsessive-compulsive disorder (OCD) were compared on responses to the Minnesota Multiphasic Personality Inventory (MMPI), Symptom Checklist-90-Revised (SCL-90-R), and the Beck Depression Inventory (BDI). Multivariate analyses showed no significant differences between bulimic and OCD women on the MMPI, although a greater number of bulimic women showed significant elevations on several of the clinical scales. Analyses of SCL-90-R profiles indicated higher scores on somatization, interpersonal sensitivity, and psychoticism in the BN sample. Bulimic women did not differ significantly from OCD women on either obsessive-compulsive measures or other measures of anxiety. Similarities and differences in symptom profiles between these two groups are discussed, as well as their implications for alternative treatment approaches for BN.
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PMID:Comparative psychopathology of women with bulimia nervosa and obsessive-compulsive disorder. 164 68

Plasma alpha 1-acid glycoprotein (AGP) levels were measured in 49 subjects with major depressive disorder, 15 subjects with anorexia nervosa and 18 subjects with bulimia nervosa, together with age- and sex-matched controls. AGP levels were elevated in depression and bulimia compared to controls. They were particularly elevated in depressed subjects who proved unresponsive to treatment with a standard course of antidepressants. In the depressed subjects, elevated AGP levels returned to control levels after treatment whether or not treatment was successful. There was a correlation between AGP and post-dexamethasone plasma cortisol levels in depression but not in bulimia and a correlation with age in depressed subjects only. There was no correlation between AGP values and tritiated imipramine binding parameters. Further studies are suggested to explore the issue of whether variations in AGP level are responsible for the abnormalities in platelet 5HT uptake and tritiated imipramine binding that have been reported in depression or for treatment non-response.
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PMID:Alpha-1-acid glycoprotein in major depressive and eating disorders. 165 2

In a comparison of nutritional management (NM) and stress management (SM) for treatment of bulimia nervosa, 55 female patients were randomly assigned to either treatment. Therapy consisted of 15 sessions in a group over three months, by the end of which, patients under both treatment conditions showed a significant reduction in the frequency of binge eating and vomiting and a significant improvement in various psychopathological features such as body dissatisfaction and depression. All improvements were maintained over 12-month follow-up NM produced a more rapid improvement in general eating behaviour, a faster reduction in binge frequency and a higher abstinence rate from binge eating. SM led to greater positive changes in certain psychopathological features such as feelings of ineffectiveness, interpersonal distrust and anxiety. NM should be regarded as a necessary first intervention in all bulimic patients. Further psychological therapy, such as SM, is indicated as well for some patients, depending on their specific psychological difficulties.
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PMID:A comparison of nutritional management with stress management in the treatment of bulimia nervosa. 177 42

Female runners (n = 174) were assessed on their levels of dietary restraint, depression, and binge eating, as well as a number of exercise variables. Thirty-eight (19%) of the women in the sample were found to meet diagnostic criteria for DSM-IIIR Bulimia Nervosa. The level of exercise was unassociated with any of the affective and eating variables as was the risk for meeting diagnostic criteria for bulimia nervosa. Severity scores for depression in bulimic runners were notably lower than in earlier nonexercising samples. The relationships between the variables were similar to those found in previous research, with dietary restraint, particularly in interaction with depression, predicting the severity of binge eating in both bulimic and nonbulimic runners. These data suggest that bulimia, rather than anorexia, may be the most prevalent eating problem in female runners.
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PMID:Depression, dietary restraint, and binge eating in female runners. 177 45

Patients with Major Affective Disorder (MAD), Secondary Depression, Panic Disorder, and bulimia with and without MAD, were given the Eating Disorder Inventory, the Beck Depression Inventory, and the General Behavior Inventory at presentation. It was found that patients with MAD have a triad of eating disorder symptoms: a disturbance in interoceptive awareness, the sense of ineffectiveness, and a tendency toward bulimia. The data supported the concept that the sense of ineffectiveness is secondary to major depression. A disturbance in interoceptive awareness exists independently in bulimia nervosa and in MAD providing a common diathesis from which bulimia may arise given family and social pressure. Bulimics with MAD do not respond to treatment as readily as those without MAD. It is recomended that these two groups be treated separately.
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PMID:Eating disorder symptoms in affective disorder. 178 63

To investigate the predictive value of a wide range of variables for distinguishing subjects who demonstrate a favourable treatment response from those who do not, 86 women with a DSM-III-R diagnosis of bulimia nervosa who completed a group treatment programme for eating disorders were studied. Discriminant-function analysis of demographic variables, weight history, specific eating-disorder psychopathology, mood status and social adjustment before treatment was performed; five factors (depression and core symptoms of eating disorder) best discriminated 'positive' from 'poor' treatment responders, accounting for 44% of the variance.
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PMID:The prediction of treatment response in bulimia nervosa. A study of patient variables. 179 Apr 56

Fluvoxamine is a potent and specific 5-HT reuptake inhibitor which has been available since 1983 and is estimated to have been given to two and a half million patients since it was first investigated in patients with depression in the late 1970s. The effectiveness of fluvoxamine in depression is therefore analysed in this review, on the basis of ten years experience. Results from 10 international double-blind placebo-controlled trials, the large majority of which included a positive control (usually imipramine), have shown that fluvoxamine is as effective as the older tricyclic antidepressants and significantly more effective than placebo. In the majority of twenty direct comparative studies against other antidepressants, fluvoxamine has been found to be as effective and well-tolerated as the reference drug. Effectiveness in the elderly depressed and support for the use of fluvoxamine in tricyclic-resistant depression is discussed. Clinical trials of fluvoxamine conducted in anxiety states and obsessive-compulsive disorder, both of which commonly co-occur with depression, are reviewed, and the efficacy of fluvoxamine in the depressed obese and patients with bulimia nervosa is examined. Reports of adverse experiences, both from clinical trials and clinical practice are discussed, and the overall risk-benefit for fluvoxamine treatment in depression is critically assessed.
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PMID:A review of fluvoxamine and its uses in depression. 180 31

Little is known about prognostic factors in the treatment of bulimic patients. In the context of an ongoing study we looked at 1-year symptomatic outcome of 37 outpatients fulfilling DSM-III-R criteria for bulimia nervosa in relation to a variety of measures at first assessment. These included multiple measures of depression, measures of borderline personality disorder, a personality inventory, a symptom checklist and information about the history and the severity of the illness. Results add evidence to the importance of personality variables in predicting outcome: patients with high scores on the Borderline Syndrome Index indicating a severe disturbance tend to have poorer symptomatic outcome, especially when they also experience themselves as dominant (Giessen-Test). Other factors, including abuse of alcohol and history of anorexia did not allow prediction of outcome.
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PMID:Prognostic factors in outpatient psychotherapy of bulimia. 189 80

The principal psychosocial approach to the treatment of bulimia nervosa has been cognitive-behavioral therapy, the effectiveness of which has been extensively documented in controlled trials, with full recovery (cessation of binge eating and purging) in some 50% to 60% of patients. More recently, interpersonal therapy, first introduced for the treatment of depression, has been shown in preliminary studies to be as effective as cognitive-behavioral therapy, particularly at follow-up. The evidence for effectiveness of psychosocial therapies in bulimia nervosa is first reviewed, and consideration is then given to what is known concerning the combination of psychosocial and psychopharmacologic treatment approaches and to the overall implications for the treatment of bulimia nervosa.
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PMID:Nonpharmacologic treatments of bulimia nervosa. 193 86


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