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Biomedical subjects

E M Goldner

Publications and source records attributed to E M Goldner.

At least 19 recordsLinked to original sources
PubMed2001

Sertraline treatment of generalized social phobia: a 20-week, double-blind, placebo-controlled study.

OBJECTIVE: The authors evaluated the efficacy, safety, and tolerability of sertraline, a selective serotonin reuptake inhibitor, in the treatment of generalized social phobia. METHOD: Adult outpatients with generalized social phobia (N=204) from 10 Canadian centers were randomly assigned to receive sertraline or placebo in a 2:1 ratio for a 20-week double-blind study following a 1-week, single-blind, placebo run-in. The initial dose of sertraline was 50 mg/day with increases of 50 mg/day every 3 weeks permitted after the fourth week of treatment (dosing was flexible up to a maximum of 200 mg/day). Primary efficacy assessments were the percentage of patients rated much or very much improved on the Clinical Global Impression (CGI) improvement item and the mean changes from baseline to study endpoint in total score on the social phobia subscale of the Marks Fear Questionnaire and total score on the Brief Social Phobia Scale. RESULTS: In intent-to-treat endpoint analyses of 203 of the patients, significantly more of the 134 patients given sertraline (N=71 [53%]) than of the 69 patients receiving placebo (N=20 [29%]) were considered responders according to their CGI improvement scores at the end of treatment. The mean reductions in the social phobia subscale of the Marks Fear Questionnaire and in the total score on the Brief Social Phobia Scale were 32.6% and 34.3% in the sertraline group and 10.8% and 18.6% in the placebo group, respectively. Analysis of covariance showed superiority of sertraline over placebo on all primary and secondary efficacy measures. Sertraline was well tolerated: 103 (76%) of the 135 sertraline-treated patients and 54 (78%) of the 69 placebo-treated patients completed the study. CONCLUSIONS: Sertraline is an effective treatment for patients with generalized social phobia.

Adult↗
PubMed2000

Inhibited expression of negative emotions and interpersonal orientation in anorexia nervosa.

OBJECTIVE: This study examined inhibited expression of negative feelings and interpersonal orientation in women with anorexia nervosa. METHOD: Twenty-one women meeting DSM-IV criteria for anorexia nervosa were compared with 21 psychiatric and 21 normal control women matched on education. Two measures were used to assess inhibited expression of negative feelings and interpersonal orientation: the State-Trait Anger Expression Inventory assesses the suppression and expression of anger and the Silencing the Self Scale assesses four cognitive schemas involving the repression of needs and feelings to protect interpersonal relationships. RESULTS: Women with anorexia nervosa reported significantly higher scores on the four Silencing the Self schemas and on suppressed anger after controlling for age. These group differences were maintained for two of the cognitive schemas (Care and Silence) after controlling for depression, self-esteem, and global assessment of functioning. Inhibited expression of negative emotion and interpersonal orientation scores were also significantly related to cognitive and affective components of body image dissatisfaction and to trait and self-presentational dimensions of perfectionism. DISCUSSION: These findings are reviewed in the context of health psychology, as well as feminist and temperament theories. Implications for treatment are addressed.

Adolescent↗
PubMed2000

Comparison of shoplifting behaviours in patients with eating disorders, psychiatric control subjects, and undergraduate control subjects.

Shoplifting behaviours were examined in an eating disorder group (EDG, n = 48), a psychiatric control group (PCG, n = 46), and an undergraduate control group (UCG, n = 82). They were examined in relation to self-esteem, depression, and eating disorder symptomatology. The 3 groups did not differ in overall history of shoplifting, but EDG women were more likely to have shoplifted in the past 6 months (current shoplifting) and to have shoplifted often than were women from the PCG or UCG. Across all 3 groups, current shoplifting was associated with low self-esteem, elevated depression, and purging behaviours at the time of the assessment. The implications of these findings with regard to the relationship between shoplifting and eating disorder symptomatology will be addressed.

Adolescent↗
PubMed1999

Dimensional assessment of personality pathology in patients with eating disorders.

This study examined patients with eating disorders on personality pathology using a dimensional method. Female subjects who met DSM-IV diagnostic criteria for eating disorder (n = 136) were evaluated and compared to an age-controlled general population sample (n = 68). We assessed 18 features of personality disorder with the Dimensional Assessment of Personality Pathology - Basic Questionnaire (DAPP-BQ). Factor analysis and cluster analysis were used to derive three clusters of patients. A five-factor solution was obtained with limited intercorrelation between factors. Cluster analysis produced three clusters with the following characteristics: Cluster 1 members (constituting 49.3% of the sample and labelled 'rigid') had higher mean scores on factors denoting compulsivity and interpersonal difficulties; Cluster 2 (18.4% of the sample) showed highest scores in factors denoting psychopathy, neuroticism and impulsive features, and appeared to constitute a borderline psychopathology group; Cluster 3 (32.4% of the sample) was characterized by few differences in personality pathology in comparison to the normal population sample. Cluster membership was associated with DSM-IV diagnosis -- a large proportion of patients with anorexia nervosa were members of Cluster 1. An empirical classification of eating-disordered patients derived from dimensional assessment of personality pathology identified three groups with clinical relevance.

Adolescent↗
PubMed1999

Chest pain in anorexia nervosa.

OBJECTIVE: To determine the incidence and characteristics of chest pain in patients with anorexia nervosa. METHOD: A cross-sectional survey of 54 patients. A pain history according to a diagnostic algorithm that was constructed from a Medline search (1966-1996) was used. RESULTS: Eighty-seven percent of patients had experienced chest pain. The most common diagnosis was idiopathic, occurring in 38% of participants. The incidence of typical and atypical angina was 11% and 9%, respectively. Increasing age, smoking history, and a family history of chest pain were more common in those with the atypical or typical angina. CONCLUSIONS: Chest pain is a common symptom in patients with eating disorders, and the incidence of typical and atypical angina is surprisingly high. All patients with eating disorders should be screened for chest pain and other risk factors for coronary heart disease.

Adolescent↗
PubMed1998

Shape- and weight-based self-esteem and the eating disorders.

OBJECTIVES: To determine the psychometric properties of the Shape- and Weight-Based Self-Esteem (SAWBS) Inventory in women with eating disorders, and to compare SAWBS scores in women who have eating disorders with women from psychiatric and normal control groups. METHOD: Women with eating disorders (n = 48), women with other psychiatric disorders (n = 44), and undergraduate control women (n = 82) completed the SAWBS Inventory and measures of depression, self-esteem, and eating disorder symptomatology. Twenty women from the eating disorder group completed the SAWBS Inventory a second time 1 week later. RESULTS: Similar to previous work in undergraduate samples, SAWBS scores were stable over 1 week, and demonstrated concurrent and discriminant validity in women with eating disorders. In between-group comparisons, SAWBS scores were higher among women with eating disorders than in either control group, even after controlling for age, socioeconomic status, body mass index, and self-esteem. A differing relationship between depression and SAWBS emerged as a function of group; SAWBS scores differed significantly among depressed, but not nondepressed women from the three groups. CONCLUSION: The psychometric properties of the SAWBS Inventory were established in women with eating disorders. As expected, SAWBS scores were higher in women with eating disorders than in the control groups. Clinical implications of these findings are discussed.

Adult↗
PubMed1998

Randomized trial of measures of body fat versus body weight in the treatment of anorexia nervosa.

OBJECTIVE: To determine whether treatment goals based on body weight or body fat assessed by anthropometrics caused a larger reduction in the Eating Disorder Examination (EDE) over 3 months during the treatment of anorexia nervosa (AN). METHODS: Randomized trial comparing the use of body weight versus measures of body fat by anthropometrics, with the EDE as the outcome measure. Of 23 patients enrolled, 11 subjects who met diagnostic criteria for AN (DSM-IV) and received outpatient treatment from the Eating Disorders clinic of a university teaching hospital completed the study. RESULTS: Comparison of the 2 methods by independent t-tests, verified by Mann-Whitney and Sign tests, suggests no difference (p = 0.33). Due to the small sample size, statistical significance could not be assured. A cross-sectional survey of 48 clinic users found the majority of patients preferred to be followed by skinfold measurements and felt they were more helpful than weight. DISCUSSION: Regardless of which measurement is used, if the clinic staff firmly believe that a method is more helpful and more useful, it is likely that the patients will find it acceptable.

Adult↗
PubMed1996

Seasonality of symptoms in anorexia and bulimia nervosa.

OBJECTIVE: Recent research has suggested that a large proportion of patients with bulimia nervosa have seasonal (winter) worsening of mood symptoms similar to seasonal affective disorder (SAD). The objectives of this study were to determine the specificity of this finding in anorexia and bulimia nervosa, and to further delineate the seasonal mood and eating patterns in bulimia nervosa. METHOD: A modified Seasonal Pattern Assessment Questionnaire (SPAQ) was administered to consecutive female patients assessed at an Eating Disorders Clinic with DSM-III-R diagnoses of bulimia nervosa (BN, N = 60) and anorexia nervosa (AN, N = 31), and to female nonclinical comparison subjects (NC, N = 50). RESULTS: The BN group had higher global seasonality scores and more presumptive diagnoses of SAD than the other two groups; the AN patients, whether they had the restricting or binge eating/purging subtype, did not differ from the NC subjects. Thirty-two percent of the identified seasonal BN patients did not have parallel worsening of mood and eating symptoms in the same season. DISCUSSION: These results suggest that seasonality of symptoms is specific to BN and that there may be separate mechanisms for the seasonality of mood and eating symptoms in some BN patients.

Adult↗
PubMed1996

The reliability of bioelectrical impedance analysis for measuring changes in the body composition of patients with anorexia nervosa.

OBJECTIVE: To determine whether bioelectrical impedance analysis (BIA) is a valid measure of change in body fat in anorexia nervosa (AN) patients during refeeding, as compared to skinfold calipers (SF). METHODS: Prospective cohort study with measures of BIA and SF performed once a month for 3 months on patients meeting the DSM-III-R criteria for AN who received treatment from the Eating Disorders Clinic of a university teaching hospital as inpatients or outpatients. RESULTS: Twenty patients completed the study. Comparison of the two methods by the Pearson correlation coefficient showed a weak negative correlation of r = -.305. Analysis by a graphical method confirmed the poor agreement that exists between the two methods. DISCUSSION: The inability of BIA to detect changes in body composition due to altered hydration, and to accurately assess the distribution of water between intracellular and extracellular compartments, limits its clinical usefulness in AN. It appears that SF measurements are preferable to BIA as a measure of body fat change in patients with AN.

Adipose Tissue↗
PubMed1996

Anorexia nervosa: refeeding and hypophosphatemia.

A case of anorexia nervosa (AN) is reported where heart failure occurred secondary to severe hypophosphatemia despite oral phosphate supplementation. We recommend starting patients with AN on oral phosphate when refeeding is begun, monitoring serum phosphate every 1 to 2 days for at least the first week of refeeding, and discontinuation of refeeding during phosphate supplementation should severe hypophosphatemia develop.

Administration, Oral↗
PubMed1995

Evidence-based psychiatry.

OBJECTIVE: To apply the evidence-based medicine paradigm to the domain of psychiatric practice and to bring out the consequences for psychiatry of this approach in order to foster the emergence of an evidence-based psychiatry. METHODS: The basic assumptions of traditional and evidence-based paradigms, as delineated by the Evidence-Based Working Group, are used to structure an exploration of the evidence-based approach to psychiatry. Theoretical and practical issues are considered and an example of evidence-based decision making is given. RESULTS: An evidence-based approach to psychiatry is described as one that emphasizes the importance of systematic observation and the use of rules of evidence in hypothesis testing. It is suggested that psychiatrists using this approach will be in a position to provide superior patient care. DISCUSSION: The application of scientific method to psychiatric problems is discussed as the essence of an evidence-based approach. The common error of "scientism" is described. The authors identify advantages and limitations of an evidence-based approach to psychiatric practice and advocate a decision-making process that balances individualized clinical acumen (phronesis) and information derived from empirical study of groups of patients (techne).

Canada↗
PubMed1995

Olfactory identification ability in anorexia nervosa.

OBJECTIVE: The hypothesis tested was that patients with severe eating disorders would demonstrate olfactory identification deficits as a result of zinc deficiency or malnutrition. METHOD: The University of Pennsylvania Smell Identification Test (UPSIT) was administered to 27 hospitalized female patients with anorexia nervosa and 50 normal control female subjects. For a subgroup of patients, serum zinc levels and body mass indices were obtained at pre- and post-nutritional repletion phases. RESULTS: UPSIT scores for patients with eating disorders were equivalent to normal control subjects in spite of the fact that the patients were nutritionally compromised as determined by body mass index. Serum zinc levels were not significantly different at pre- and post-nutritional repletion. CONCLUSIONS: In contrast to patients with schizophrenia, patients with severe eating disorders have intact olfactory function. This finding suggests that transient metabolic or nutritional disturbances alone cannot account for previously reported olfactory deficits.

Adolescent↗
PubMed1994

Polyglandular autoimmune syndrome and anorexia nervosa.

The first case of polyglandular autoimmune syndrome (PAS) in a patient with anorexia nervosa is reported. The association of pernicious anemia with vitiligo and endocrine hypofunction (PAS) is reviewed. Eating disorder patients with B12 deficiency who have vitiligo or a history of endocrine hypofunction should have a Schilling test to exclude pernicious anemia.

Adult↗
PubMed1994

A controlled study of light therapy for bulimia nervosa.

OBJECTIVE: Winter worsening of mood and eating symptoms, similar to that of seasonal affective disorder, has recently been reported in patients with bulimia nervosa. To assess the effectiveness of light therapy for treatment of bulimia nervosa, the authors conducted a study of light therapy during winter comparing an active (bright white light) condition to a control (dim red light) condition in bulimic patients who were not selected for a seasonal pattern of bulimia. METHOD: After a 2-week baseline assessment, 17 female patients with a DSM-III-R diagnosis of bulimia nervosa underwent early morning light treatment with 2 weeks of bright white light exposure (10,000 lux for 30 min/day) and 2 weeks of dim red light exposure (500 lux for 30 min/day) in a counterbalanced, crossover design. Outcome measures included daily binge/purge diaries, objective and subjective measures of mood, and the Eating Attitudes Test. Expectation of response for each condition was also assessed before treatment. RESULTS: Although pretreatment expectation ratings were similar for each condition, the bright white light condition was superior to the dim red light condition for all mood and eating outcome measures. Patients with "seasonal" bulimia (N = 7) had significantly greater improvement after the bright white light treatment than patients with nonseasonal bulimia (N = 10). No significant order effects were noted, nor differential effects for patients taking concurrent antidepressant medications (N = 4). CONCLUSIONS: These data suggest that bright white light therapy is an effective short-term treatment for both mood and eating disturbances associated with bulimia nervosa, although the therapeutic effect may be greater in those patients with a seasonal pattern.

Adult↗
PubMed1994

Controlled trial of zinc supplementation in anorexia nervosa.

Zinc supplementation of anorexia nervosa (AN) patients has been reported to increase the weight gain of AN patients in open trials. In this randomized, double-blind, placebo-controlled trial 100 mg of zinc gluconate, or placebo, was given daily to 35 female AN inpatients until they achieved a 10% increase in body mass index (BMI). The rate of increase in BMI of the zinc supplemented group (n = 16) was twice that of the placebo group (n = 19), and this difference was statistically significant (p = .03). The use of zinc supplementation should be considered in the treatment of AN patients.

Adolescent↗
PubMed1993

Dietary zinc intake of vegetarian and nonvegetarian patients with anorexia nervosa.

Anorexia nervosa (AN) and zinc deficiency, found most frequently in young females, have a number of symptoms in common. These include weight loss, alterations in taste and appetite, depression, and amenorrhea. Approximately half of anorexia nervosa patients (ANs) are vegetarian (VANs), a practice that may increase their risk for zinc deficiency. This study compared the dietary intake of zinc and related nutrients in 9 outpatient VANs with that of 11 outpatient nonvegetarian patients with anorexia nervosa (NVANs). VANs reported significantly lower (p < .05) dietary intakes of zinc, fat, and protein, and a significantly higher (p < .05) intake of calories from carbohydrates than NVANs. There were no significant differences between the groups in dietary intake of calories, calcium, copper, iron, or magnesium. These findings indicate that zinc intake should be routinely assessed in VANs and that zinc supplementation of their diets may be indicated.

Adolescent↗
PubMed1993

Eating attitudes in seasonal affective disorder and bulimia nervosa.

Markedly increased appetite and eating are commonly found in seasonal affective disorder (SAD) and bulimia nervosa (BN). To investigate dysfunctional eating attitudes, we administered the Eating Disorders Inventory (EDI), a self-rating questionnaire that assesses abnormal eating attitudes and behaviours, to 30 female SAD patients, 30 matched BN patients, and 30 non-clinical subjects. The SAD patients had higher scores on most EDI subscales compared to the non-clinical subjects; the BN patients had higher scores than the SAD patients on only two of three EDI subscales that are specific to eating disorders. These data add to the evidence supporting a clinical overlap between SAD and BN.

Adult↗