Biomedical subjects

B Timothy Walsh

Publications and source records attributed to B Timothy Walsh.

At least 19 recordsLinked to original sources

PubMed2007

Placebo response in binge eating disorder.

OBJECTIVE: Placebo response in studies of binge eating disorder (BED) has raised concern about its diagnostic stability. The aims of this study were (1) to compare placebo responders (PRs) with nonresponders (NRs); (2) to investigate the course of BED following placebo response; and (3) to examine attributions regarding placebo response. METHOD: The baseline placebo run-in phase (BL) was part of a RCT investigating sibutramine hydrochloride for BED; it included 451 participants, ages 19-63, diagnosed with BED. Follow-up (FU) included 33 PRs. RESULTS: : In this study, 32.6% of participants responded to placebo (PRs = 147; NRs = 304). PRs exhibited significantly less symptom severity. At FU (n = 33), many PRs reported continued symptoms. CONCLUSION: PRs exhibited significantly less severe pathology than NRs. Placebo response in BED may transitory or incomplete. The results of this study suggest variable stability in the BED diagnosis.

Adolescent↗

PubMed2006

Expectancies, dietary restraint, and test meal intake among undergraduate women.

This study investigated the relationship between self-reported dietary restraint and expectancies about caloric content on test meal consumption among undergraduate women. Participants completed two test meal sessions during which they were asked to consume as much milkshake from a covered opaque container as they wished. In one session, participants were instructed that the milkshake was made with high-calorie ingredients, and in the other that the milkshake was made with low-calorie ingredients. The milkshakes in both sessions were actually made with the same ingredients. Participants' mean consumption was less on the low-calorie instruction day (402 g) than on the high-calorie instruction day (382 g), but the difference was not statistically significant. In addition, few significant relationships were observed between dietary restraint measures and total intake on either the low- or high-calorie instruction days. Thus, this study supports a growing body of literature indicating that scores on measures of dietary restraint are not related to the actual restriction of food intake.

Adult↗

PubMed2006

Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial.

CONTEXT: Antidepressant medication is frequently prescribed for patients with anorexia nervosa. OBJECTIVE: To determine whether fluoxetine can promote recovery and prolong time-to-relapse among patients with anorexia nervosa following weight restoration. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled trial. From January 2000 until May 2005, 93 patients with anorexia nervosa received intensive inpatient or day-program treatment at the New York State Psychiatric Institute or Toronto General Hospital. Participants regained weight to a minimum body mass index (calculated as weight in kilograms divided by the square of height in meters) of 19.0 and were then eligible to participate in the randomized phase of the trial. INTERVENTIONS: Participants were randomly assigned to receive fluoxetine or placebo and were treated for up to 1 year as outpatients in double-blind fashion. All patients also received individual cognitive behavioral therapy. MAIN OUTCOME MEASURES: The primary outcome measures were time-to-relapse and the proportion of patients successfully completing 1 year of treatment. RESULTS: Forty-nine patients were assigned to fluoxetine and 44 to placebo. Similar percentages of patients assigned to fluoxetine and to placebo maintained a body mass index of at least 18.5 and remained in the study for 52 weeks (fluoxetine, 26.5%; placebo, 31.5%; P = .57). In a Cox proportional hazards analysis, with prerandomization body mass index, site, and diagnostic subtype as covariates, there was no significant difference between fluoxetine and placebo in time-to-relapse (hazard ratio, 1.12; 95% CI, 0.65-2.01; P = .64). CONCLUSIONS: This study failed to demonstrate any benefit from fluoxetine in the treatment of patients with anorexia nervosa following weight restoration. Future efforts should focus on developing new models to understand the persistence of this illness and on exploring new psychological and pharmacological treatment approaches. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00288574.

Adolescent↗

PubMed2006

Binge-eating disorder as a distinct familial phenotype in obese individuals.

CONTEXT: Binge-eating disorder (BED)-a syndrome that only recently has attracted scientific attention-is often seen in obese individuals, especially those with severe obesity. However, it remains unclear whether BED represents an etiologically distinct behavioral phenotype of obesity or simply a nonspecific eating pattern sometimes seen in obese individuals. OBJECTIVE: To test whether BED aggregates in families independently of obesity, and if so, whether familial factors for BED also independently increase the risk of obesity. DESIGN, PATIENTS, AND SETTING: Blinded family interview study of overweight or obese probands with (n = 150) and without (n = 150) BED, and their first-degree relatives (n = 888) in a community setting evaluated between October 2002 and July 2004. MAIN OUTCOME MEASURES: Lifetime diagnosis of BED; current and highest lifetime body mass index (calculated as the weight in kilograms divided by the square of the height in meters). RESULTS: Binge-eating disorder aggregated strongly in families independently of obesity (odds ratio, 2.2; 95% confidence interval, 1.4-3.6; P<.001). Furthermore, relatives of probands with BED displayed a markedly higher prevalence of severe obesity in adulthood (body mass index >/=40) than relatives of probands without BED even when controlling for proband body mass index (odds ratio, 2.5; 95% confidence interval, 1.4-4.4; P = .002). CONCLUSIONS: Binge-eating disorder is a familial disorder caused in part by factors distinct from other familial factors for obesity. Furthermore, these BED-specific familial factors may independently increase the risk of obesity, especially severe obesity. It follows that targeted interventions capable of preventing or treating traits influenced by these BED-specific familial factors could reduce the public health burden of obesity.

Adolescent↗

PubMed2006

Early response to desipramine among women with bulimia nervosa.

OBJECTIVE: Numerous trials have demonstrated the efficacy of antidepressant medications for the treatment of bulimia nervosa (BN). The current study examined whether early response to medication predicted response to medication at the end of a controlled trial. METHOD: Data from two previously published studies of desipramine (DMI) were used. Seventy-seven patients with BN were included in the analysis. Receiver operating characteristic (ROC) curves were constructed to examine the relation between the percentage reduction in symptoms at each week and failure to respond to antidepressant medication at the end of the trial. RESULTS: Eventual nonresponders to DMI could be reliably identified in the first 2 weeks of treatment. CONCLUSION: The current study provides preliminary evidence that patients with BN who will not respond to antidepressant medication can be identified in the first 2 weeks of treatment.

Adult↗

PubMed2006

Habit learning and anorexia nervosa: a cognitive neuroscience hypothesis.

OBJECTIVE: Anorexia nervosa (AN) is characterized by abnormal behaviors involving eating and weight that are impressively resistant to change. The persistence of these behaviors likely plays an important role in the high relapse rate after initial treatment. Persistent, stereotyped behaviors are also characteristic of obsessive-compulsive disorder (OCD). This article presents a neurocognitive model of AN, based on comparisons with OCD. METHOD: This article reviews clinical, neuropsychological, and neuroimaging findings in both OCD and AN relevant to a neurobiological understanding of a potential mechanism of the perpetuation of AN. RESULTS: The identification of specific neurocognitive disturbances in individuals with OCD has led to a compelling hypothesis of the neural mechanisms mediating this disorder. Evidence suggests that similar disturbances, involving neural circuits between the cortex and the basal ganglia, may be present in individuals with AN. CONCLUSION: Research on such neurocognitive disturbances has the potential both to inform understanding of neural mechanisms underlying AN and to lead to advances in treatment.

Anorexia Nervosa↗

PubMed2006

Artificial sweetener use among individuals with eating disorders.

UNLABELLED: Women with eating disorders report using large quantities of artificially sweetened products, but this has not been quantified. OBJECTIVE: The authors assessed the use of selected artificially sweetened low-calorie products among women with eating disorders compared with controls. METHOD: Thirty women with anorexia nervosa (18 with the restricting subtype [AN-R] and 12 with the binge/purge subtype [AN-B/P]), 48 women with bulimia nervosa (BN), and 32 healthy control women completed a survey of frequency and amount of consumption of chewing gum, artificially sweetened low-calorie beverages, and packets of artificial sweetener in the previous month. RESULTS: A greater proportion of women with AN-B/P and BN reported use of each product, compared with women with AN-R and control participants. Among product users, patients with eating disorders reported using greater amounts than controls. Among patients who reported binge eating and/or purging, the quantity of each product used was inversely correlated with body mass index (BMI). CONCLUSION: These data suggest an increased drive for sweet orosensory stimulation in women with AN and BN.

Adult↗

PubMed2006

Set shifting deficit in anorexia nervosa.

Anorexia nervosa (AN) is a severe mental illness characterized in part by rigid thinking and ritualized behaviors involving eating and weight. Cognitive rigidity may play a role in the perpetuation of symptoms, and may provide information as to important brain-based abnormalities. Neuropsychological studies of patients with AN have shown cognitive dysfunction, but few have focused on cognitive flexibility. This study assessed set shifting in patients with AN, as a measure of cognitive flexibility. In this study, 15 patients with AN were compared with 11 healthy controls using a neuropsychological battery including the Wisconsin Card Sort Test (WCST). While patients with AN did not differ from controls on 5 measures of neuropsychological function, they made significantly more perseverative errors on the WCST, indicating a problem in set shifting. This finding suggests that patients with AN have a specific neurocognitive abnormality that may play a role in the development and persistence of this disorder.

Adult↗

PubMed2005

Gastric compliance in bulimia nervosa.

Bulimia nervosa (BN) is a psychiatric illness characterized by eating binges followed by inappropriate behavioral attempts to compensate for the binges, usually vomiting or laxative abuse. Patients with BN have disturbances in the development of satiety during a meal as well as disturbances in functions of the upper gastrointestinal tract such as slowed gastric emptying, impaired gastric accommodation reflex and blunted cholecystokinin release. The present study examined gastric compliance and sensory responses to gastric distention in women with BN and controls. Sixteen women with BN and 13 healthy control subjects swallowed an inflatable bag that was placed in the proximal stomach. The bag was inflated to produce increasing steps of pressure against the stomach wall, before and after consumption of a 200 ml (200 Kcal) liquid meal. Pressure and volume were recorded for 2-min periods, beginning at 0 mm Hg pressure and increasing in steps of 2 mm Hg until subjects reported discomfort, gastric volume reached 600 ml, or pressure reached 20 mm Hg. At each pressure step subjects made sensory ratings. Gastric compliance was calculated as the slope of the best-fit straight line of each subject's gastric volume vs. gastric pressure. There was a significant postmeal increase in gastric compliance in both groups of subjects but there was no difference in compliance between patients with BN and controls. Patients with BN appeared to have diminished sensitivity to gastric distention. In conclusion, although other studies have described gastrointestinal abnormalities associated with BN, the current study found gastric compliance of patients with BN to be normal.

Adult↗

PubMed2005

Plasma tryptophan during weight restoration in patients with anorexia nervosa.

BACKGROUND: Anorexia nervosa (AN) is a mental disorder characterized by low weight and concerns about body shape and weight. Disturbance in serotonin function has been described as central to the psychobiology of this disorder. Plasma tryptophan (TRP), the essential amino acid needed for serotonin production, is known to be low following acute caloric restriction but has not been measured during the course of refeeding. METHODS: Plasma TRP and other large neutral amino acids (LNAA) levels were measured in 26 female patients with AN and 15 control subjects. Patient levels were measured at admission for inpatient treatment, after 1 week of treatment, and upon weight restoration to weight > or =90% ideal body weight (IBW). For 17 patients, an additional assessment was made when weight reached 80% IBW. Plasma levels were obtained on one occasion from healthy control subjects. RESULTS: Plasma TRP and TRP/LNAA ratio increased significantly during refeeding process. Plasma TRP in patients was 46.88 nmol/mL (SD = 19.59) on admission and 55.54 nmol/L/mL (SD = 8.1) at normal weight, p < .05. The ratio of TRP to LNAA was .11 (SD = .03) on admission and .13 (SD = .02) at normal weight, p < .05. Plasma TRP is significantly lower in low-weight patients than in healthy control subjects (TRP = 53.73 [SD = 8.21]), but there was no significant difference between control subjects and normal-weight patients. CONCLUSIONS: Plasma TRP normalizes during the course of refeeding, supporting the hypothesis that serotonin function is disturbed in patients with anorexia nervosa.

Adult↗

PubMed2005

Assessment of patients with anorexia nervosa: interview versus self-report.

OBJECTIVE: The current study compared the agreement between the Eating Disorders Examination (EDE) and the Eating Disorders Examination-Questionnaire (EDE-Q) in the diagnosis and assessment of eating disorder pathology in a sample of women with anorexia nervosa. METHOD: First, a physician administered a clinical interview to each patient. Then, before hospital admission, all subjects were given the EDE-Q and the EDE interview. RESULTS: Results indicate that agreement between the EDE and the EDE-Q on the individual items informing the overall diagnosis of anorexia nervosa ranges from low to moderate. Agreement for the overall diagnosis of anorexia nervosa and for the binge/purge subtype was more impressive. Although correlations between subscale scores as well as eating disorder behaviors were strong, higher levels of disturbance were consistently reported on the EDE-Q than on the EDE interview. DISCUSSION: The pattern of findings suggests that the EDE-Q may be used in place of the interviewer-based measure when assessing overall diagnosis and subtype, as well as specific, well-defined features (vomiting/laxative use). However, there was a low level of agreement with respect to less-defined features, like binge eating, for which significantly higher frequencies were generated by the self-report questionnaire.

Adolescent↗

PubMed2005

Eating Disorder Examination-Questionnaire as a measure of change in patients with bulimia nervosa.

OBJECTIVE: The current study evaluated the agreement between the Eating Disorder Examination and the Eating Disorder Examination-Questionnaire in assessing eating disorder pathology in a sample of women with bulimia nervosa. METHOD: Patients with broadly defined bulimia nervosa were enrolled in a double-blind, placebo-controlled treatment study of fluoxetine, with and without guided self-help. The current study presents information from 50 patients with data from both the EDE and EDE-Q at study entry and treatment termination. RESULTS: The EDE and EDE-Q produced more similar scores for compensatory behaviors (vomiting/laxative use) than complex eating-disordered features (binge eating/importance of shape and weight) at the pretreatment and posttreatment assessments, and for change during the study. DISCUSSION: The EDE and EDE-Q are highly correlated for many of the behavioral and attitudinal features of bulimia nervosa. There is substantial variability in agreement for individual patients, but on average, the EDE and EDE-Q will yield similar assessments of eating disorder symptoms and change in symptoms over time.

Adolescent↗

PubMed2005

Translational approaches to understanding anorexia nervosa.

Translational research has fostered significant gains in neuroscience and psychiatry and has been identified by the NIMH as a "priority area" for further funding. As applied to anorexia nervosa (AN), "translational research" describes the application of principles and methodologies employed in related fields to advance the understanding, and ultimately treatment and prevention, of this disorder. Several promising areas of translational research in AN are identified. Such research, particularly when linked to a conceptual framework, offers the potential of lending much-needed novel insight into this challenging and enigmatic disorder.

Affect↗

PubMed2005

Therapeutic alliance and treatment adherence in two interventions for bulimia nervosa: a study of process and outcome.

The relationship between therapeutic alliance, therapist adherence to treatment protocol, and outcome was analyzed in a randomized trial of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy for bulimia nervosa. Independent observers rated audiotapes of full-length therapy sessions. Purging frequency was the primary outcome variable. There were no significant therapist or Therapist x Treatment effects on outcome. Although results showed high levels of alliance and adherence across treatments, CBT was associated with greater adherence. Across treatments and time points, better adherence was associated with enhanced alliance. Treatment condition and baseline purging frequency, but not adherence, predicted outcome. Early alliance predicted posttreatment purging frequency. In temporal analyses, prior symptom change assessed early in treatment was significantly related to subsequent adherence at midtreatment.

Adult↗

PubMed2005

Cognitive behavioral therapy and fluoxetine as adjuncts to group behavioral therapy for binge eating disorder.

OBJECTIVE: Although binge eating disorder is a common and distressing concomitant of obesity, it has not yet been established whether affected individuals presenting to behavioral weight control programs should receive specialized treatments to supplement standard treatment. This study was designed to examine the added benefit of two adjunctive interventions, individual cognitive behavioral therapy (CBT) and fluoxetine, offered in the context of group behavioral weight control treatment. RESEARCH METHODS AND PROCEDURES: One hundred sixteen overweight/obese women and men with binge eating disorder were all assigned to receive a 16-session group behavioral weight control treatment over 20 weeks. Simultaneously, subjects were randomly assigned to receive CBT+fluoxetine, CBT+placebo, fluoxetine, or placebo in a two-by-two factorial design. Outcome measures, assessed at the end of the 16-session acute treatment phase, included binge frequency, weight, and measures of eating-related and general psychopathology. RESULTS: Overall, subjects showed substantial improvement in binge eating and both general and eating-related psychopathology, but little weight loss. Subjects who received individual CBT improved more in binge frequency than did those not receiving CBT (p<0.001), and binge abstinence was significantly more common in subjects receiving CBT vs. those who did not (62% vs. 33%, p<0.001). Fluoxetine treatment was associated with greater reduction in depressive symptoms (p<0.05). The 54 subjects who achieved binge abstinence improved more on all measures than the 62 subjects who did not. In particular, these subjects lost, on average, 6.2 kg compared with a gain of 0.7 kg among non-abstainers. DISCUSSION: Adjunctive individual CBT results in significant additional binge reduction in obese binge eaters receiving standard behavioral weight control treatment.

Adult↗

PubMed2005

Eating behavior among women with anorexia nervosa.

BACKGROUND: Disturbed eating and severe caloric restriction are characteristic features of patients with anorexia nervosa (AN). Despite the importance of eating behavior in the presentation of AN, there have been relatively few objective laboratory studies of eating behavior among persons with eating disorders. OBJECTIVE: The purpose of the study was to obtain objective measures of eating behavior among patients with AN before and immediately after weight restoration and to compare those measures with measures among control subjects. DESIGN: Twelve patients hospitalized for AN and 12 control subjects participated in the study. Eleven of the 12 patients were retested at 90% of ideal body weight. RESULTS: The average meal consumption was 103.97 +/- 102.08 g for patients at low weight and 178.03 +/- 202.97 g after weight restoration (NS). Control subjects consumed significantly more than did AN patients at both time points, and the average meal size was 489.58 +/- 187.64 g. Patients showed significant decreases in psychological and eating-disordered symptoms after weight restoration. CONCLUSION: These data suggest that patients with AN show a persistent disturbance in eating behavior, despite the restoration of body weight and significant improvements in eating-disordered and psychological symptoms.

Adolescent↗

PubMed2005

Body fat redistribution after weight gain in women with anorexia nervosa.

BACKGROUND: Body image distortions are a core feature of anorexia nervosa (AN). Increasing evidence suggests that the fat distribution immediately after weight restoration in patients with AN differs from the distribution typical of healthy adult women. OBJECTIVE: The purpose of this study was to assess body fat distribution before and shortly after normalization of weight in women with AN. DESIGN: Body composition and fat distribution were assessed by anthropometry, dual-energy X-ray absorptiometry, and whole-body magnetic resonance imaging in 29 women with AN before and after weight normalization and at a single time point in 15 female control subjects. Hormone concentrations were also evaluated in patients and control subjects. RESULTS: During approximately 10.1 +/- 2.9 wk (range: 4-17.3 wk) of treatment, patients with AN gained 12.2 +/- 3.6 kg, and refed weight (54.1 +/- 4.2 kg) did not differ significantly from that of control subjects (54.7 +/- 4.4 kg). Waist-to-hip circumference ratio (P < 0.006), total trunk fat (P < 0.003), visceral adipose tissue (P < 0.006), and intramuscular adipose tissue (P < 0.003) were significantly greater in the weight-recovered patients than in the control subjects. In contrast, after refeeding, total subcutaneous adipose tissue and skeletal muscle mass did not differ significantly between the patients and control subjects. In patients with AN, serum cortisol decreased and serum estradiol increased significantly with refeeding but not to control concentrations. CONCLUSIONS: In women with AN, normalization of weight in the short term is associated with an abnormal distribution of body fat. The implications of these findings for the long-term psychological and physical health of women with AN are unknown.

Absorptiometry, Photon↗

PubMed2005

Eating disorder and depressive symptoms in urban high school girls from different ethnic backgrounds.

This study examined ethnic group differences in the rates of eating disorder symptoms (EDS) and depressive disorder symptoms (DDS) with respect to ethnic identity, relative body weight, and abnormal eating behaviors among adolescent girls. A district-wide sample of high school girls (N = 1445) from different ethnic backgrounds was surveyed. EDS were assessed with the Eating Attitudes Test-26, abnormal eating behaviors with the Eating Behaviors Survey, and DDS with the Short Mood and Feelings Questionnaire. Two dimensions of ethnic identity, ethnic identity achievement and other group orientation, were assessed with Multi-Group Ethnic Identity Measure. Hispanic and non-Hispanic white girls had the highest and African-American (AA) and Caribbean girls the lowest rates of EDS. Asian girls reported the highest and AA girls the lowest rates of DDS. Early dieting was associated with EDS and DDS in Caribbean, non-Hispanic white, and mixed background girls. Relative body weight was related to EDS in all ethnic groups except in non-Hispanic white and mixed background girls. The authors did not find an effect of ethnic identity achievement on psychopathology, but there was an effect of other group orientation on both EDS and DDS. Clinicians should inquire about EDS and DDS in girls of all ethnic groups. Prevention efforts to delay unsupervised dieting may protect adolescent girls from the development of EDS and DDS.

Adolescent↗