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Biomedical subjects

J M Jonas

Publications and source records attributed to J M Jonas.

At least 19 recordsLinked to original sources
PubMed1998

Fluvoxamine in the treatment of binge-eating disorder: a multicenter placebo-controlled, double-blind trial.

OBJECTIVE: The purpose of this study was to assess the efficacy of fluvoxamine in the treatment of binge-eating disorder. Binge-eating disorder is a newly described eating disorder characterized by recurrent episodes of binge eating but without purging behaviors. Uncontrolled reports have suggested that serotonin selective reuptake inhibitors (SSRIs) may be effective in treating this disorder. METHOD: Eighty-five outpatients with a DSM-IV diagnosis of binge-eating disorder were randomly assigned to receive either fluvoxamine (N=42) or placebo (N=43) in a 9-week, parallel-group, double-blind, flexible dose (50-300 mg) study at three centers. The primary outcome measures were frequency of binge eating, expressed as log ([binges/week]+1), and Clinical Global Impression (CGI) scale ratings. Secondary measures included the level of response (based on the percentage change in frequency of binges), body mass index, and Hamilton Rating Scale for Depression score. Except for the level of response, the outcome measures were analyzed by random regression methods; the treatment-by-time interaction was the measure of treatment effect. RESULTS: Compared with placebo, fluvoxamine was associated with a significantly greater rate of reduction in the frequency of binges, rate of reduction in CGI severity scores, rate of increase in CGI improvement scores, level of response for patients who completed the 9-week study, and rate of reduction in body mass index. There was no significant difference between placebo and fluvoxamine groups in the rate of decrease in Hamilton depression scale scores. A significantly greater proportion of patients receiving fluvoxamine than those receiving placebo discontinued treatment because of an adverse medical event. CONCLUSIONS: In this placebo-controlled trial, fluvoxamine was found to be effective according to most outcome measures in the acute treatment of binge-eating disorder.

Adolescent↗
PubMed1996

Alprazolam and suicidal ideation: a meta-analysis of controlled trials in the treatment of depression.

A meta-analysis of well-controlled studies of alprazolam in depression was performed to assess the possible association of alprazolam and suicidal ideation. Pooled data from 3,217 patients (alprazolam, placebo, and various active-comparative agents) who were enrolled in 22 placebo- and/or active drug-controlled depression studies were retrospectively analyzed to evaluate the emergence, worsening, and improvement of suicidal ideation during treatment with alprazolam, placebo, or other active drugs. Item 3 of the Hamilton Rating Scale for Depression was used to evaluate these events. Neither the risk of emergence nor the risk of worsening of suicidal ideation was significantly different for alprazolam than for placebo; however, alprazolam was significantly superior to placebo in producing improvement of suicidal ideation. There was no significant difference between alprazolam and the active-comparator group in the risk of emergence of suicidal ideation. The risk of worsening of suicidal ideation was significantly less for the active-comparator group (the majority of patients in this group received amitriptyline or imipramine) than for alprazolam, and improvement of suicidal ideation occurred significantly more frequently in that group than in the alprazolam group. Use of alprazolam in depressed patients is not associated with any particular increased risk of suicidality.

Alprazolam↗
PubMed1993

Triazolam.

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Clinical Trials as Topic↗
PubMed1993

A comparison of the safety and efficacy of alprazolam versus other agents in the treatment of anxiety, panic, and depression: a review of the literature.

A review of the worldwide published literature was conducted to assess the efficacy and safety of alprazolam for the treatment of anxiety disorders, panic disorder, and depression in comparison with those of other active drugs (including other benzodiazepines and antidepressant medications). In all, a total of 8878 patients participated in the 84 active-drug-controlled studies that were reviewed: 3574 were treated with alprazolam, 3666 were treated with another active drug, and 1638 were treated with placebo. Two general findings emerged: (1) Alprazolam demonstrates efficacy for the treatment of anxiety disorders, panic disorder, and depression in the large majority of studies; for these illnesses, it appeared equal in efficacy to the active agents with which it was compared. (2) Medical events, such as depression, suicidality, hostility/aggression, mania/psychosis, abuse, withdrawal reactions, and seizures, were reported infrequently or not at all for alprazolam and the comparator drugs; there were no marked differences between drug classes in the frequencies of these events.

Alprazolam↗
PubMed1992

Comparative clinical profiles of triazolam versus other shorter-acting hypnotics.

The efficacy, safety, and performance of triazolam was compared with those of other shorter-acting hypnotics acting on the gamma-aminobutyric acid (GABA) receptor--zopiclone, zolpidem, midazolam, brotizolam, temazepam, lormetazepam, and loprazolam. In all, 5506 patients participated in 38 clinical and epidemiologic studies, of whom 2462 were treated with triazolam in parallel-design and crossover studies. To provide clinically relevant comparisons, only studies using comparator agents in doses equipotent to the triazolam doses were included. Two general findings emerged. First, "serious" central nervous system side effects, such as excitement and violence, were not demonstrated for any of the hypnotic agents, including triazolam. Other central nervous system side effects, such as depression and irritability, were reported with equal frequencies for all the hypnotics reviewed. Rebound insomnia, reported intermittently with most of these agents, was short-lived and not clinically significant. So-called early morning insomnia was noted only once and does not appear to be a valid clinical entity. Daytime anxiety was not observed in large numbers of triazolam-treated subjects studied, which is contrary to claims that the drug is anxiogenic. Second, a remarkable similarity was found among all of these shorter-acting agents in terms of efficacy, side effects, and performance-related effects. This was particularly of note for zopiclone and zolpidem. Although claims have been made suggesting differences, evaluation of the studies herein showed that these nonbenzodiazepine hypnotics were indistinguishable from triazolam and other benzodiazepine hypnotics in their clinical and pharmacologic activity. Thus, different chemical structures did not a priori predict different clinical profiles when drugs share a similar mechanism of action.

Azabicyclo Compounds↗
PubMed1992

The pharmacologic treatment of alcohol and cocaine abuse. Integration of recent findings into clinical practice.

The clinical evidence available to date does not yet support the routine use of pharmacologic interventions in the majority of cases of alcohol or cocaine abuse. The available data suggest, however, that interventions should be considered, especially in patients who relapse or drop out of treatment, in more difficult cases, and in instances in which there are associated psychiatric disorders. Education and prevention should be reconsidered as the important "treatments" they are today.

Adolescent↗
PubMed1989

Urinary basal body temperature in anorexia nervosa.

Measurements of basal body temperature obtained from first-morning voided urine were followed longitudinally in 23 individuals with anorexia nervosa. In each of 10 hypothermic individuals, we found that basal body temperature was significantly correlated with weight gain, whereas in most normothermic individuals, no relationship was found. This suggests that measurement of basal body temperature may provide a convenient means of assessing clinical improvement and nutritional rehabilitation in some patients with anorexia nervosa. Differences in neuroendocrine measures and weight gain were also studied. Thyroid functions did not differ significantly between groups, and no differences were found in dexamethasone suppression or in the thyrotropin-releasing hormone (TRH) stimulation test. Hypothermic individuals, however, were significantly younger and significantly more likely to gain weight in response to treatment.

Anorexia Nervosa↗
PubMed1988

The use of opiate antagonists in treating bulimia: a study of low-dose versus high-dose naltrexone.

Sixteen individuals with bulimia consented to a 6-week trial of naltrexone, receiving either standard dosages of 50-100 mg each day or high dosages of 200-300 mg each day. At the end of 6 weeks, individuals in the low-dose group had no significant change in their frequency of binge eating or purging, while individuals in the high-dose group had significant reductions in both behaviors. Four individuals in the low-dose group who were crossed over to high-dose naltrexone at the end of the study went on to experience significant reductions in binge eating and purging. These findings support the potential utility of opiate blockade in treating bulimia, but suggest that dosages of naltrexone greater than those needed to block exogenous opiates may be required for therapeutic efficacy in reducing binge eating and purging.

Bulimia↗
PubMed1987

Sleep EEG in bulimia.

To evaluate the sleep electroencephalogram (EEG) characteristics of bulimia, all-night sleep EEGs were performed on 11 women meeting DSM-III criteria for bulimia. Comparison groups consisted of young women outpatients with major depression (n = 44) and young normal women (n = 20). The sleep EEGs of the bulimic patients were largely indistinguishable from those of the normal controls, except for a trend toward increased rapid eye movement (REM) density in the first REM period among the bulimic subjects. No differences in any sleep EEG measure were observed between bulimic patients with major depression and those without affective disorder. By contrast, the outpatients with major depression displayed marked sleep continuity disturbances, as well as significantly increased REM intensity and REM density, as compared to normal controls. Implications of these results with respect to the hypothesis that bulimia is related to major affective disorder are discussed.

Adolescent↗
PubMed1987

A controlled family history study of bulimia.

Using the family history method, we assessed the morbid risk for psychiatric disorders in the first-degree relatives of 69 probands with bulimia, 24 probands with major depression, and 28 nonpsychiatric control probands. The morbid risk for major affective disorder among the first-degree relatives of the bulimic probands was 32%, significantly greater than that found in the nonpsychiatric control probands. The rate of familial major affective disorder was significantly greater in bulimic probands who had a history of major affective disorder themselves than in bulimic probands without such a history - but the latter group, in turn, displayed significantly higher rates than the nonpsychiatric control probands. Eating disorders were slightly, but not significantly, more prevalent in the families of bulimic probands than nonpsychiatric control probands. We present two alternative hypotheses which might explain these findings.

Adolescent↗
PubMed1987

A controlled study of lifetime prevalence of affective and other psychiatric disorders in bulimic outpatients.

The authors used structured diagnostic interviews to assess the lifetime prevalence of psychiatric disorders, by DSM-III criteria, among 70 women: 51 outpatients with active bulimia and 19 nonpatient subjects with remitted bulimia. Comparison groups consisted of 24 female outpatients with major depression and 28 nonpsychiatric control subjects. The active and remitted bulimic subjects closely resembled each other, with high lifetime rates of major affective disorder, anxiety disorders, and substance use disorders. Atypical depression was equally common among subjects with major affective disorder in all groups. These results are consistent with previous studies suggesting a phenomenologic relationship between bulimia and major affective disorder.

Adolescent↗
PubMed1987

Naltrexone treatment of bulimia: clinical and theoretical findings linking eating disorders and substance abuse.

Eating disorders and substance abuse may occur together frequently. Studies have demonstrated that 25%-50% of individuals with anorexia nervosa and bulimia will have a history of substance abuse, and that certain groups of drug abusers may have elevated rates of eating disorders. One mechanism which may explain this relationship is the role of endogenous opiate peptides in triggering the compulsion to binge-eat. The authors report the successful use of the long-acting opiate antagonist naltrexone in treating a group of bulimic individuals, and discuss the implications of these findings.

Adult↗
PubMed1987

Eating disorders and cocaine abuse: a survey of 259 cocaine abusers.

A structured clinical interview designed to diagnose eating disorders was administered to 259 consecutive callers to the National Cocaine Hotline who met DSM-III criteria for cocaine abuse. Thirty-two percent of those surveyed met DSM-III criteria for either anorexia nervosa, bulimia, or both disorders. The prevalence rates for each of these disorders in this sample appeared elevated even when narrow diagnostic criteria were applied. The data suggest that drug abusers should be screened carefully for the presence of an eating disorder and that abnormalities of eating behaviors seen among these individuals should not be attributed simply to drug use.

Adolescent↗