Biomedical subjects

B Timothy Walsh

Publications and source records attributed to B Timothy Walsh.

36 records · Page 2Linked to original sources

PubMed2005

Placebo control groups in trials of major depressive disorder among older patients.

BACKGROUND: Ethical concerns have been raised regarding the continued use of placebo control groups in randomized controlled trials of antidepressant medications for major depressive disorder. These concerns may be especially relevant for geriatric patients who may experience significant morbidity related to major depressive disorder. METHODS: Sixty-eight randomized placebo-controlled trials of antidepressant medication for major depressive disorder were examined, 6 of which measured response to medication and placebo in elderly patients. RESULTS: Although this review is limited by the small number of studies focusing on older individuals, there are a number of similarities and some differences in geriatric studies in comparison to other studies of adults with major depressive disorder. In comparison to studies of younger adults, the proportion of patients responding to placebo in studies of older individuals was slightly higher, and the proportion of patients responding to active medication was lower, leading to a significantly reduced effect size. CONCLUSIONS: The scientific importance of using control groups in studies of major depression poses ethical challenges. However, the substantial and variable response to placebo and the inability to predict accurately the response to placebo or medication raise serious doubts about the scientific value of trials of new medications in which there is no placebo group.

Adult↗

PubMed2004

Report of the National Institutes of Health workshop on overcoming barriers to treatment research in anorexia nervosa.

OBJECTIVE: Anorexia nervosa (AN) is associated with serious medical morbidity and has the highest mortality rate of all psychiatric disorders. The National Institutes of Health (NIH) Workshop on Overcoming Barriers to Treatment Research in Anorexia Nervosa convened on September 26-27, 2002 to address the dearth of treatment research in this area. The goals of this workshop were to discuss the stages of illness and illness severity, pharmacologic interventions, psychological interventions, and methodologic considerations. METHOD: The program consisted of a series of brief presentations by moderators, each followed by a discussion of the topic by workshop participants, facilitated by the session chair. RESULTS: This report summarizes the major discussions of these sessions and concludes with a set of recommendations related to the development of treatment research in AN based on these findings. DISCUSSION: It is crucial that treatment research in this area be prioritized.

Anorexia Nervosa↗

PubMed2004

A comparison of the binge eating scale, questionnaire for eating and weight patterns-revised, and eating disorder examination questionnaire with instructions with the eating disorder examination in the assessment of binge eating disorder and its symptoms.

OBJECTIVE: The current study assesses concordance between self-administered measures and a diagnostic standard for assessment of binge frequency and diagnosis of binge eating disorder (BED) in a sample of binge eaters. METHOD: The Questionnaire for Eating and Weight Patterns-Revised (QEWP-R), Binge Eating Scale (BES), two items from the Eating Disorder Examination Questionnaire with Instructions (EDE-Q-I), and the Eating Disorder Examination (EDE) were administered. Participants were 157 adults volunteering for a clinical study, of whom 129 (79%) were diagnosed with BED using the EDE as the diagnostic standard. RESULTS: In the identification of BED, the QEWP-R yielded a sensitivity value of .74 and a specificity value of .35. The BES yielded a sensitivity value of .85 and a specificity value of .20. Frequency of binge eating days and episodes on the EDE-Q-I correlated highly with the EDE (.65 and .48, respectively; p < .001). DISCUSSION: The accuracy of diagnosis and symptomatology among self-administered questionnaires is variable. The BES and the QEWP-R performed satisfactorily as initial screens for the diagnosis of BED, but were less accurate in identifying non-BED individuals and the frequency of binge eating. The EDE-Q-I most accurately assessed the frequency of binge eating.

Adult↗

PubMed2004

The future of research on eating disorders.

In the last several decades, research on the eating disorders has yielded important new knowledge, especially regarding the clinical characteristics and the treatment of individuals with Bulimia Nervosa. Challenging issues now confronting the field include how the eating disorders should be categorized, what factors underlie their development and persistence, and how they are best treated. New efforts based on the analysis of genetic factors, on the use of brain imaging and on the detailed analysis of behavioral disturbances hold promise for significantly advancing our understanding of these disorders in the next decade.

Brain↗

PubMed2004

Eating disorders: clinical features and pathophysiology.

Anorexia nervosa (AN) and bulimia nervosa (BN) are disorders of eating and weight-related behavior that together afflict some 1-3% of women in the United States. One of the remarkable features about each of the eating disorders is how persistent the disordered eating behavior becomes once it has begun. Substantial psychological, social, and physiological disturbances are associated with eating disorders, and it has been very difficult to disentangle those factors that may result from the disturbed behavior from the factors that may have predisposed individuals to, or precipitated the development of, the disorder. This article will briefly review the definitions, phenomenology, and identified risk factors for development of each of the major eating disorders. Pathophysiology will be discussed, with a particular focus on candidate factors that might sustain disordered eating behavior, as informed by clinical and basic science research. Future research directions will be suggested.

Anorexia Nervosa↗

PubMed2004

Exercise "addiction" in anorexia nervosa: model development and pilot data.

BACKGROUND: Excessive exercise has long been observed to be a problematic behavior of many patients with anorexia nervosa (AN). However, many questions remain as to the exact role exercise plays in this disorder. In particular, it has been suggested that exercise holds "addictive" properties in persons with AN, but that remains to be demonstrated. OBJECTIVE: The aim of this study was to adapt and apply a scale used in addictions research to determine whether symptoms of "dependence" to exercise could be measured in a group of women with AN. RESULTS: Forty-eight percent of individuals assessed endorsed symptoms consistent with exercise dependence in the previous month. The number of criteria met for exercise dependence was directly correlated with a clinical measure of anxiety. CONCLUSION: Results support further investigation into addictive properties for exercise in individuals with AN and its relationship to anxiety

Adolescent↗

PubMed2004

Prediction of outcome in bulimia nervosa by early change in treatment.

OBJECTIVE: The authors' goal was to identify predictors of treatment response in bulimia nervosa and, in particular, to attempt to replicate and extend the observation that early change predicts outcome. METHOD: Predictors of response at the end of treatment and 8-month follow-up were sought from a group of 220 women treated with either cognitive behavior therapy or interpersonal psychotherapy. RESULTS: Early change in frequency of purging was the best predictor of response at the end of treatment and at 8-month follow-up. CONCLUSIONS: Early change in treatment is a robust and potent predictor of immediate and longer-term outcome in bulimia nervosa.

Body Mass Index↗

PubMed2004

Treatment of bulimia nervosa in a primary care setting.

OBJECTIVE: The authors' goal was to determine whether treatments known to be effective for bulimia nervosa in specialized treatment centers can be used successfully in primary health care settings. They examined the benefits of two treatments for bulimia: 1) fluoxetine, an antidepressant medication, and 2) guided self-help, an adaptation of cognitive behavior therapy. METHOD: Ninety-one female patients in two primary care settings were randomly assigned to receive fluoxetine alone, placebo alone, fluoxetine plus guided self-help, or placebo and guided self-help. RESULTS: The majority of the patients did not complete the treatment trial; many patients found the treatment program too demanding, but others indicated it was not sufficiently intensive. Patients assigned to fluoxetine attended more physician visits, exhibited a greater reduction in binge eating and vomiting, and had a greater improvement in psychological symptoms than those assigned to placebo. There was no evidence of benefit from guided self-help. CONCLUSIONS: The treatment of patients with bulimia nervosa in a primary care setting is hampered by a high dropout rate. Guided self-help, a psychological treatment based on cognitive behavior therapy, appears ineffective, but treatment with fluoxetine is associated with better retention and substantial symptomatic improvement.

Adult↗

PubMed2003

A disturbance of gastric function in bulimia nervosa.

BACKGROUND: Because the stomach plays an important role in the development of satiety, gastric function was examined in bulimia nervosa (BN). METHODS: Sixteen patients with BN and 16 controls swallowed an inflatable bag, which was positioned in the proximal stomach. Minimal distending pressure (MDP), the pressure needed to overcome intraabdominal pressure, was determined. Gastric volume was recorded after subjects drank a liquid meal. RESULTS: MDP was similar in patient and control groups (7.56 +/- 2.13 vs. 7.13 +/- 2.06 mmHg; t =.57, df = 30, p =.58). Average postmeal gastric relaxation was significantly lower in the patient group (29.7 +/- 97.8 vs. 105.1 +/- 103.3 mL; t = 2.13, df = 30, p =.042). CONCLUSIONS: Stomach relaxation following food consumption is significantly diminished in patients with BN. Physiologic abnormalities of stomach function in BN may contribute to the perpetuation of disturbances in behavior in this disorder.

Adult↗

PubMed2003

Laboratory studies of binge eating disorder.

INTRODUCTION: Because of questions about the accuracy of reported food intake, and in order to study psychological and environmental factors which might affect eating, a number of investigators have examined the eating behavior of individuals with binge eating disorder (BED) under controlled conditions that permit food consumption to be measured. METHODS: Published studies that evaluated the eating behavior of individuals with BED in a laboratory were reviewed. RESULTS: In laboratory meals, individuals with BED consumed more kilocalories than individuals of similar weight who did not meet criteria for BED. These differences are observed consistently when subjects are asked to binge eat and when they are not. CONCLUSIONS: In a laboratory setting, individuals with BED exhibit objectively abnormal eating behavior. These data support, but do not prove, the validity of BED as a diagnostic entity.

Body Weight↗

PubMed2003

An open trial of fluoxetine for adolescents with bulimia nervosa.

OBJECTIVE: This open clinical trial examined the feasibility, tolerability, and efficacy of treating adolescents who suffer from bulimia nervosa with fluoxetine. METHODS: Ten adolescents, ages 12-18 years received 8 weeks of fluoxetine 60 mg/day with supportive psychotherapy. Primary outcome measures included frequencies of binge eating and purging and ratings on the Clinical Global Impressions-Improvement scale (CGI-I). Secondary outcome measures included self-report measures of eating disorder, depression, and anxiety symptoms. Safety and tolerability of this dose of fluoxetine were also assessed. RESULTS: Average weekly binges decreased significantly from 4.1 +/- 3.8 to 0 (p < 0.01). Average weekly purges decreased significantly from 6.4 +/- 5.2 to 0.4 +/- 0.9 (p < 0.005). All patients improved on the CGI-I scale, with 20% rated as much improved, 50% improved, and 30% slightly improved. All subjects tolerated the 60-mg dose of fluoxetine, and there were no dropouts due to adverse effects from the medication. DISCUSSION: Fluoxetine is generally well tolerated and may be an effective treatment option for adolescents with bulimia nervosa.

Adolescent↗

PubMed2003

Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa.

OBJECTIVE: This study provides what the authors believe is the first empirical evaluation of cognitive behavior therapy as a posthospitalization treatment for anorexia nervosa in adults. METHOD: After hospitalization, 33 patients with DSM-IV anorexia nervosa were randomly assigned to 1 year of outpatient cognitive behavior therapy or nutritional counseling. RESULTS: The group receiving nutritional counseling relapsed significantly earlier and at a higher rate than the group receiving cognitive behavior therapy (53% versus 22%). The overall treatment failure rate (relapse and dropping out combined) was significantly lower for cognitive behavior therapy (22%) than for nutritional counseling (73%). The criteria for "good outcome" were met by significantly more of the patients receiving cognitive behavior therapy (44%) than nutritional counseling (7%). CONCLUSIONS: Cognitive behavior therapy was significantly more effective than nutritional counseling in improving outcome and preventing relapse. To the authors' knowledge, these data provide the first empirical documentation of the efficacy of any psychotherapy, and cognitive behavior therapy in particular, in posthospitalization care and relapse prevention of adult anorexia nervosa.

Adolescent↗

PubMed2003

Gastrointestinal disturbances in anorexia nervosa and bulimia nervosa.

Disturbances in the functioning of the upper gastrointestinal (GI ) tract have been described in both Anorexia Nervosa (AN) and Bulimia Nervosa (BN). Patients with AN experience substantial delays in gastric emptying as well as constipation. These problems may give rise to significant medical complications and may contribute to increased difficulties with refeeding and weight restoration. Reported GI disturbances in BN include increased gastric capacity, diminished gastric relaxation, delayed gastric emptying, diminished release of cholecystokinin (CCK) and abnormalities of enteric autonomic function, all of which may play a role in perpetuation of the syndrome. This article reviews evidence for the most common disturbances of GI function in AN and BN and discusses potential GI targets for therapeutic intervention.

Animals↗

PubMed2002

Placebo response in studies of major depression: variable, substantial, and growing.

CONTEXT: Intense debate persists about the need for placebo-controlled groups in clinical trials of medications for major depressive disorder (MDD). There is continuing interest in the development of new medications, but because effective antidepressants are already available, ethical concerns have been raised about the need for placebo groups in new trials. OBJECTIVE: To determine whether the characteristics of placebo control groups in antidepressant trials have changed over time. DATA SOURCES AND STUDY SELECTION: We searched MEDLINE and PsychLit for all controlled trials published in English between January 1981 and December 2000 in which adult outpatients with MDD were randomly assigned to receive medication or placebo. Seventy-five trials met our criteria for inclusion. DATA EXTRACTION: Data were extracted from the articles by 2 of the authors and discrepancies were resolved via discussion and additional review by a third author. DATA SYNTHESIS: The mean (SD) proportion of patients in the placebo group who responded was 29.7% (8.3%) (range, 12.5%-51.8%). Most studies examined more than a single active medication, and, in the active medication group with the greatest response, the mean (SD) proportion of patients responding was 50.1% (9.0%) (range, 31.6%-70.4%). Both the proportion of patients responding to placebo and the proportion responding to medication were significantly positively correlated with the year of publication (for placebo: n = 75; r = 0.45; 95% confidence interval [CI], 0.25-0.61; P<.001; for medication: n = 75; r = 0.26; 95% CI, 0.03-0.46; P =.02). The association between year of publication and response rate was more statistically robust for placebo than medication. CONCLUSIONS: The response to placebo in published trials of antidepressant medication for MDD is highly variable and often substantial and has increased significantly in recent years, as has the response to medication. These observations support the view that the inclusion of a placebo group has major scientific importance in trials of new antidepressant medications and indicate that efforts should continue to minimize the risks of such studies so that they may be conducted in an ethically acceptable manner.

Adult↗

PubMed2002

Binge size increases with body mass index in women with binge-eating disorder.

OBJECTIVE: To determine whether meal size is related to body mass index (BMI) in obese subjects with binge-eating disorder (BED). RESEARCH METHODS AND PROCEDURES: Five groups of subjects each consumed two laboratory-test meals on nonconsecutive days. Forty-two women, categorized by BMI and BED diagnosis, were instructed to "binge" during one meal and to eat "normally" during another. Eighteen women had BMI values >38 kg/m(2) (more-obese) and 17 had BMI values between 28 to 32 kg/m(2) (less-obese). Twelve of the more-obese and nine of the less-obese individuals met Diagnostic and Statistical Manual (DSM)-IV criteria for BED. Seven normal-weight women also participated as controls. RESULTS: Subjects with BED ate significantly more in both meals than subjects without BED. Binge meals were significantly larger than normal meals only among subjects with BED. The more-obese subjects with BED ate significantly more than the less-obese subjects with BED, but only when they were asked to binge. Intake of the binge meal was significantly, positively correlated with BMI among subjects with BED. Subjects with BED reported significantly higher satiety ratings after the binge than after the normal meal, but subjects without BED reported similar ratings after both meals. Regardless of instructions and diagnosis, obese subjects consumed a significantly higher percentage of energy from fat (38.5%) than did normal-weight subjects (30.8%). DISCUSSION: During binge meals, the energy intake of subjects with BED is greater than that of individuals of similar body weight without BED and is positively correlated with BMI.

Adolescent↗

PubMed2002

Side effects of desipramine and age.

INTRODUCTION: The treatment response of children and adolescents to tricyclic antidepressants differs from that of adults. Few data exist on the impact of age on side effects. This study compares desipramine-associated side effects in children, adolescents, and adults. METHODS: Data from three trials of desipramine were combined to produce a sample of 148 subjects, aged 7 to 66 years. Pulse and blood pressure were measured at baseline and while participants were receiving desipramine. Side effects were rated by a clinician. For data analysis, subjects were divided into two groups, younger patients (18 and younger) and older patients (19 and older). Group means of side effect ratings and vital signs were compared. Results were also analyzed covarying for plasma levels of desipramine. RESULTS: There were significant differences between younger and older patients in pulse and blood pressure at baseline, on desipramine, and in changes in vital signs between baseline and medicated states. Younger patients had significantly lower mean ratings for constipation and dry mouth. DISCUSSION: Treatment with desipramine results in differing degrees of subjective side effects and changes in vital signs across the life cycle. Physicians should not assume that side effects experienced by children and adolescents are identical to those experienced by adults.

Adolescent↗

PubMed2002

Pharmacologic treatment of eating disorders.

OBJECTIVE: Eating disorders are a serious group of conditions that affect 3% of women in industrialized nations over their lifetimes. Recent years have seen considerable progress in the treatment of these disorders. This article reviews the current body of evidence for the pharmacologic treatment of eating disorders. METHODS: We undertook a literature review. RESULTS: For patients with anorexia nervosa (AN), drug trials have been disappointing. In contrast, numerous studies have demonstrated a clear role for antidepressants in the treatment of bulimia nervosa (BN). Pharmacologic investigations of binge eating disorder (BED), a more recently defined entity, have identified several promising drugs. There is also support for the utility of combined medication and psychotherapy. CONCLUSION: Continued research efforts are necessary, particularly regarding the long-term effects of therapy and the development of new pharmacologic strategies.

Anorexia Nervosa↗

PubMed2002

Cognitive-behavioral therapy for bulimia nervosa: time course and mechanisms of change.

Cognitive-behavioral therapy (CBT) is an effective treatment of bulimia nervosa, but its mechanisms of action have not been established. In this study the authors analyzed the results of a randomized control trial comparing CBT with Interpersonal Psychotherapy (IPT) to identify possible mediators of change of CBT for BN and its time course of action. Reduction in dietary restraint as early as Week 4 mediated posttreatment improvement in both binge eating and vomiting. Measures of self-efficacy concerning eating behavior, negative affect, and body shape and weight at midtreatment were also significantly associated with posttreatment outcome at 20 weeks. No evidence was found that the therapeutic alliance mediated treatment outcome. CBT had a significantly more rapid treatment effect than IPT, with 62% of posttreatment improvement evident by Week 6.

Adult↗