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Biomedical subjects

D C Jimerson

Publications and source records attributed to D C Jimerson.

At least 37 records · Page 2Linked to original sources
PubMed1992

Low serotonin and dopamine metabolite concentrations in cerebrospinal fluid from bulimic patients with frequent binge episodes.

Cerebrospinal fluid neurotransmitter metabolite levels were studied to assess whether measures of central serotonin, dopamine, or norepinephrine function are associated with severity of abnormal eating patterns in patients with bulimia nervosa. In comparison with healthy controls (N = 17), hospitalized bulimic patients with a history of binge eating more frequently than twice daily (N = 11) had significantly lower CSF concentrations of 5-hydroxyindoleacetic acid and homovanillic acid. For the total patient group (N = 29), levels of both metabolites were significantly inversely correlated with binge frequency. On the basis of preclinical studies, these results were examined in the context of speculative models in which low central serotonin function might contribute to blunted satiety responses in bulimic patients, while low central dopamine activity might play a role in abnormal hedonic responses to food.

Adult↗
PubMed1992

Neuroendocrine responses to m-chlorophenylpiperazine and L-tryptophan in bulimia.

Preclinical and clinical evidence supports a theory of serotonin (5-hydroxytryptamine [5-HT]) dysregulation in bulimia. We therefore studied the prolactin (PRL) and cortisol responses following challenges with the postsynaptic 5-HT receptor agonist m-chlorophenylpiperazine (m-CPP), 0.5 mg/kg orally, the 5-HT precursor L-tryptophan, 100 mg/kg intravenously, and placebo in a group of 28 normal weight bulimic patients and 16 healthy controls. Patients with bulimia, regardless of the presence of major depression, had significantly blunted PRL responses following m-CPP administration compared with those in controls. In contrast, only bulimic patients with concurrent major depression had significantly blunted PRL responses following L-tryptophan administration compared with those in nondepressed bulimic patients and controls. Cortisol responses following m-CPP were not significantly different for bulimic patients vs controls, although there was a trend toward blunted cortisol responses following L-tryptophan administration in the depressed bulimic patients. These differences in neuroendocrine responses were not related to differences in age, percent of average body weight, medications, time of day, peak plasma drug levels, or baseline estradiol levels. Seasonal variations in PRL responses to both agents were identified, although covariation for season did not alter the group differences. The PRL responses following m-CPP administration were inversely correlated to baseline cortisol levels in the bulimic patients, but not in the controls, suggesting a dampening effect by hypothalamic-pituitary-adrenal axis dysfunction on postsynaptic 5-HT receptor sensitivity. The reasons for the differing hormonal responses to these two serotonergic agents may relate to differential involvement of presynaptic and postsynaptic mechanisms, 5-HT receptor subtypes, and anatomical loci of action. The blunted PRL responses to m-CPP administration suggest that postsynaptic 5-HT receptor sensitivity is altered in bulimia nervosa, and that similar alterations in 5-HT receptors at or above the level of the hypothalamus may contribute to binge eating and other behavioral symptoms.

Adult↗
PubMed1992

Pharmacotherapy of depression in the medically ill: directions for future research.

A common problem facing the psychiatric consultant and the medical practitioner is evaluating depression in patients with concurrent medical illnesses. Depression is difficult to recognize in the medically ill, often presenting with "masked" symptoms and organized into unique syndromes. A primary concern of the clinician is identifying those patients who are likely to benefit from an antidepressant trial. Although antidepressants have been shown to sometimes be of benefit in medical populations, the symptoms predicting antidepressant response remain poorly defined. Important directions for future research include 1) evaluating the safety and efficacy of newer antidepressants in the medically ill and 2) identifying those depressive syndromes that may be responsive to pharmacotherapy.

Adult↗
PubMed1992

Headache responses following m-chlorophenylpiperazine in bulimics and controls.

We have previously reported that the serotonin (5-HT) agonist meta-chlorophenylpiperazine (m-CPP) induced late occurring migraine-like headaches in a group of patients with eating disorders and controls (n = 52). In this report, we extend our analyses of these data and describe results indicating that headache responses following m-CPP are greater in patients with bulimia nervosa than controls, regardless of the presence of anorexia nervosa or major depression. Although patients with severe migraine-like headaches had higher peak m-CPP levels than patients without severe headaches, these levels are not higher than other groups studied who did not get headaches. These findings suggest that post-synaptic 5-HT receptor sensitivity is altered in the vascular tissues of bulimic patients. Additional disturbances in 5-HT function, perhaps presynaptic ones, may be associated with anorexia nervosa and major depression. Similar alterations in other 5-HT pathways at or above the level of the hypothalamus may contribute to binge eating and other behavioral symptoms of bulimia nervosa. Further studies exploring the functional integrity of 5-HT receptors and their subtypes are warranted in bulimic patients, as well as in patients with nonbulimic anorexia nervosa, minor and major depression without an eating disorder, and migraine and other headache patients.

Anorexia Nervosa↗
PubMed1991

The effects of carbamazepine on resting metabolic rate and thyroid function in depressed patients.

Resting metabolic rate and thyroid hormone levels were studied in 11 patients with affective disorders before and during treatment with carbamazepine (CBZ). CBZ has been previously reported to reduce thyroid hormones, but the metabolic consequence of this effect has not been explored. During CBZ treatment, thyroid hormones decreased significantly (T4, 7.53 versus 5.74 micrograms/dl, p less than 0.001), whereas the resting metabolic rate (RMR) did not (31.6 versus 30.7 kcal/m2/hr). Baseline RMRs were low and the expected positive relationship between RMR and weight was disrupted in females. The extent of previous exposure to tricyclic and monoamine oxidase inhibitors antidepressant treatment was significantly associated with lower baseline RMRs. We conclude that CBZ has no significant effect on RMR despite robust decreases in thyroid function.

Adult↗
PubMed1991

Measurement of CSF dynorphin A 1-8 immunoreactivity in anorexia nervosa and normal-weight bulimia.

Twenty-one patients with anorexia nervosa and 35 normal-weight patients with bulimia underwent a series of CSF studies involving measurement of CSF dynorphin A 1-8 immunoreactivity during hospitalization in an eating-disorder treatment and research program. The control group consisted of 17 healthy volunteers. There were no statistically significant differences in CSF dynorphin A 1-8 measurements among groups or within a group at various stages of treatment. These results regarding dynorphin A 1-8 immunoreactivity are discussed in light of other evidence for altered opiate function in some eating-disorder patients.

Adult↗
PubMed1991

Reduced resting metabolic rate in patients with bulimia nervosa.

To determine whether there was a metabolic basis for recent reports that bulimic patients had low energy requirements for weight maintenance, energy expenditure measurements were made in 15 women with bulimia nervosa during abstinence from bingeing and vomiting. Resting metabolic rate, adjusted for differences in lean body mass, was significantly lower in bulimics (mean +/- SE, 4201 +/- 126 kJ/d) than healthy volunteers (4694 +/- 172 kJ/d). Bulimic patients had a blunted increase in oxygen consumption in response to low and moderate levels of exercise (421 +/- 16 and 689 +/- 17 mL/min) compared with values for healthy volunteers (491 +/- 28 and 795 +/- 26 mL/min). Plasma triiodothyronine (1.1 +/- 0.07 vs 1.4 +/- 0.08 nmol/L) levels, plasma norepinephrine levels in supine (0.58 +/- 0.04 vs 1.06 +/-0.17 nmol/L) and standing (1.34 +/- 0.15 vs 2.46 +/- 0.30 nmol/L) subjects, and the increase in norepinephrine levels during orthostatic challenge (0.76 +/- 0.15 vs 1.40 +/- 0.25 nmol/L) all were significantly less in bulimics than volunteers. These results are consistent with previous reports of decreased energy requirements for weight maintenance and decreased plasma levels of metabolism-related hormones in patients with bulimia. However, the effects of reduced energy intake in metabolic studies of patients with bulimia need to be further investigated.

Adult↗
PubMed1990

Eating disorders and depression: is there a serotonin connection?

Central serotonin pathways modulate eating patterns, and may also participate in the regulation of behavioral impulsivity and mood. Recent studies lend support to the hypothesis that impaired postingestive satiety in bulimia nervosa is associated with reduced hypothalamic serotonergic responsiveness. Serotonin dysregulation has been implicated in major depression, and may play a role in the increased prevalence of depressive episodes in patients with eating disorders. This review compares evidence for alterations in central serotonin regulation in patients with anorexia nervosa, bulimia nervosa, and depression. It is proposed that impaired synaptic transmission in functionally distinct serotonin pathways may result in concurrent or sequential periods of binge eating, behavioral impulsivity, and depression in patients with eating disorders.

Anorexia Nervosa↗
PubMed1990

Disturbances of noradrenergic systems in normal weight bulimia: relationship to diet and menses.

Several lines of evidence suggest that noradrenergic (NE) disturbances occur in normal-weight bulimic patients. The purpose of this study was to investigate factors that may be related to noradrenergic disturbances. First, we measured plasma NE during bingeing and vomiting. We found that this behavior activated the sympathetic nervous system. Bingeing produced a significant increase in the duration and the peak increase of plasma NE when compared with normal controls eating a large meal. Second, we assessed basal peripheral and central NE levels near in time (within several days of hospital admission) to chronic bingeing and vomiting. At this time, bulimics had normal basal plasma and CSF NE levels. Finally, we restudied the same patients after 30 days of inpatient hospitalization and observed abstinence from bingeing and vomiting. In this last state, bulimics had a reduction of basal plasma and cerebrospinal fluid (CSF) NE levels compared with themselves on admission and compared with healthy controls. This study confirms that reduced noradrenergic activity occurs in normal-weight bulimic women and suggests that this abnormality may emerge during abstinence from bingeing. We hypothesize that dietary intake is related to noradrenergic activity, but cause and effect remain uncertain. Noradrenergic disturbances did not appear to be related to weight, depression, physical activity, or amino acid precursors. Lower CSF NE levels were found in amenorrheic bulimic women in both states, suggesting that a noradrenergic disturbance may be associated with the frequent incidence of amenorrhea in bulimic women.

Adult↗
PubMed1990

Altered norepinephrine regulation in bulimia: effects of pharmacological challenge with isoproterenol.

While abnormalities in central norepinephrine regulation may contribute to abnormal eating patterns in bulimia nervosa, alterations in function of the peripheral sympathetic nervous system could contribute to the decreased metabolic rate and increased anxiety responses previously reported in these patients. To assess beta-adrenergic receptor sensitivity in bulimic patients, we studied cardiovascular and hormonal responses to acute pharmacological challenge with intravenously administered isoproterenol. In comparison to healthy controls, binge-abstinent bulimic patients had significantly reduced mean baseline plasma norepinephrine level, pulse rate, and systolic blood pressure, and significantly increased chronotropic responses to isoproterenol infusion. Decreased sympathoneural activity may contribute to a tendency for bulimic patients to maintain body weight despite low caloric intake.

Adult↗
PubMed1990

Serotonin in human eating disorders.

The onset and progression of symptomatology in patients with anorexia nervosa and bulimia nervosa is complex. It is unlikely that dysregulation of a single neurotransmitter system would be sufficient to explain the pathophysiology of these disorders. The studies reviewed above provide preliminary evidence that decreased central serotonin function may contribute to the onset or persistence of binge eating episodes in patients with bulimia nervosa, including low weight anorexic patients with bulimic symptoms. Future clinical studies will benefit from the availability of selective serotonin receptor agonists and antagonists. Longitudinal studies through progressive phases of treatment and clinical remission will be important to clarify the contribution of dietary and body weight changes to results of neurotransmitter studies with eating disorder patients.

Anorexia Nervosa↗
PubMed1990

CSF oxytocin in anorexia nervosa and bulimia nervosa: clinical and pathophysiologic considerations.

Oxytocin is a hypothalamic neuropeptide with both centrally and peripherally directed pathways. Data from experimental animals indicate that oxytocin impairs consolidation of aversively conditioned behaviors and is released after feeding or experimental gastric distension. The authors report that the mean CSF oxytocin level of five underweight women with restricting anorexia, but not 12 underweight bulimic anorexic women or 35 normal-weight women with bulimia nervosa, was significantly lower than the level of 11 control subjects. Restricting anorexic patients' low CSF oxytocin levels may reflect their persistently low food intake, and this behavior may exacerbate their tendency for perseverative preoccupation with adverse consequences of food intake.

Adult↗
PubMed1990

Isoproterenol infusion test in anorexia nervosa: assessment of pre- and post-beta-noradrenergic receptor activity.

Anorexia nervosa is associated with alterations in sympathetic activity and metabolism that persist during and after weight recovery. This study assessed beta-adrenergic receptor activity, an important modulator of vascular and metabolic function, in anorexic patients studied when underweight and at intervals during recovery, in comparison with healthy volunteer women. An increase in heart rate, in response to increasing doses of isoproterenol, served as an index of postsynaptic activity. Anorexic patients, during refeeding and weight gain, needed a significantly higher dose of isoproterenol to increase basal heart rate by 25 beats/minute, compared with underweight anorexic patients. Down-regulated postsynaptic cardiac beta-adrenoceptors during weight gain may protect against refeeding-induced exaggerated sympathetic activity. Because presynaptic beta-adrenoceptors serve as a positive feedback loop for synaptic catecholamine secretion, the increase in plasma norepinephrine concentrations during the isoproterenol infusion served as an index of presynaptic activity. We found that increasing doses of isoproterenol were associated with a linear increase in plasma norepinephrine in each healthy volunteer. In contrast, anorexic patients at any state had a significantly more erratic secretion of plasma norepinephrine in response to increasing doses of isoproterenol. Altered regulation of presynaptic adrenoceptors may explain, in part, the large variance and little consensus between previous studies as to whether anorexic patients have reduced or normal plasma norepinephrine levels.

Anorexia Nervosa↗
PubMed1989

Central and peripheral ACTH and cortisol levels in anorexia nervosa and bulimia.

To explore the relationship of central and peripheral adrenocorticotropic hormone (ACTH, or corticotropin) levels to hypothalamo-pituitary-adrenal axis dysfunction in patients with eating disorders, levels of cerebrospinal fluid (CSF) and plasma ACTH, cortisol, and 24-hour urinary free cortisol were measured in 16 patients with anorexia nervosa (60% +/- 1.1% of ideal body weight), 14 patients with bulimia (93.2% +/- 4.6% of ideal body weight), and 11 healthy age-matched women volunteers. The CSF, plasma, and urinary free cortisol levels were elevated in underweight anorexic patients and showed declines following weight recovery. Cortisol-binding globulin levels were similar in anorexics and controls. In contrast, underweight anorexics showed low CSF ACTH levels that returned to normal following weight recovery, and their plasma ACTH levels were normal. On hospital admission, bulimic patients demonstrated normal ACTH and cortisol levels. After their abstinence from binge-purge episodes, the CSF ACTH levels decreased significantly. Positive relationships were found among CSF, plasma, and urinary cortisol levels, and inverse relationships were seen between cortisol measures and CSF ACTH levels in patients with eating disorders. Secretion of ACTH into the CSF may respond to feedback by cortisol or, alternatively, may be suppressed by the hypersecretion of corticotropin-releasing hormone, leading to the depletion of the pro-opiomelanocortin molecule.

Adolescent↗
PubMed1989

Decreased caloric intake in normal-weight patients with bulimia: comparison with female volunteers.

Patients with bulimia (binge-purge syndrome) frequently complain that they consume a very restrictive diet to avoid gaining weight. To investigate this claim, 23 hospitalized bulimic patients were assessed daily for body weight, caloric intake, macronutrient diet content, activity measures, and body composition estimates during weight-stable periods. Bulimic patients ate fewer kilocalories per kilogram body weight (22.1 +/- 4.6 kcal/kg) than did age-matched normal women (29.7 +/- 6.5 kcal/kg) but had similar activity levels and body composition. Clinical variables, such as history of laxative abuse, anorexia, or obesity, and physiological characteristics, such as body weight, activity level, or dietary content, could not account for this difference in caloric consumption. Bulimic patients tended to eat a diet lower in fat and higher in protein than did control subjects. These results agree with observations of increased efficiency of caloric utilization in obese patients and support patient complaints of a tendency to gain weight easily.

Adolescent↗
PubMed1989

Psychiatric disorders in the first-degree relatives of probands with bulimia nervosa.

Data from a family study of psychiatric disorders showed higher rates of major affective disorders, eating disorders, and alcoholism in first-degree relatives of 40 bulimic probands than in first-degree relatives of 24 control subjects. More importantly, the data showed higher rates of major affective disorders in relatives of bulimic probands who themselves had no history of major affective disorders than in relatives of control subjects. This significant finding indicates a familial relationship between bulimia nervosa and major affective disorders, which suggests the possibility of a common diathesis.

Adult↗
PubMed1989

Hyperamylasemia and its relationship to binge-purge episodes: development of a clinically relevant laboratory test.

Hyperamylasemia and parotid hypertrophy are conditions found in bulimic patients. The authors studied serum amylase levels in 56 underweight anorectics, 24 weight-recovered anorectics, 23 normal-weight bulimics, and 31 volunteer women. Normal-weight bulimic patients had significantly higher admission serum amylase values (mean +/- SE = 73.4 +/- 8.0 IU/L) than controls (40.8 +/- 2.4 IU/L). Additionally, the serum amylase test distinguished between restrictor anorectics (N = 31, 44.7 +/- 4.7 IU/L) and bulimic anorectics (N = 25, 68.8 +/- 8.6 IU/L, p less than .05) with a high degree of specificity and a fair degree of sensitivity. A subsample (N = 7) of bulimics showed twofold to fourfold increases in serum amylase values after a controlled period of binge eating and vomiting, whereas normal volunteers showed no change in serum amylase values (p less than .001) after ingesting a large meal. Serum amylase values declined significantly within 6 to 15 days of admission. However, after passes off the unit, serum amylase values returned to admission values, presumably as a result of binge-vomit episodes. The authors observe that modest increases of serum amylase values appear to be a consequence of binge-vomit behavior and suggest that serial serum amylase determination may be useful in monitoring the degree of patient abstinence in therapeutic programs.

Adult↗