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Biomedical subjects

K A Halmi

Publications and source records attributed to K A Halmi.

At least 19 recordsLinked to original sources
PubMed1995

Ten-year follow-up of anorexia nervosa: clinical course and outcome.

The clinical course and outcome of anorexia nervosa are presented in a 10-year follow-up study of 76 severely ill females with anorexia nervosa who met specific diagnostic criteria and had participated in a well-documented hospital treatment study. Information was obtained on 100% of the subjects. A comprehensive assessment was made in 93% of the living subjects in specific categories of weight, eating and weight control behaviours, menstrual function, anorexic attitudes, and psychological, sexual, social and vocational adjustment. Five subjects had died, which gives a crude mortality rate of 6.6%. Standardized mortality rates demonstrated an almost 13-fold increase in mortality in the anorexia nervosa subjects. Only eighteen (23.7%) were fully recovered. Sixty-four per cent developed binge-eating at some time during their illness, 57% at least weekly. Twenty-nine (41%) were still bulimic at follow-up. The high frequency and chronicity of the bulimic symptoms plus the high rate of weight relapse (42% during the first year after hospital treatment) suggest that intensive intervention is needed to help anorexics restore and maintain their weight within a normal range and to decrease abnormal eating and weight control behaviours.

Adolescent↗
PubMed1995

Anorexia nervosa and bulimia nervosa in adolescence: effects of age and menstrual status on psychological variables.

OBJECTIVE: To compare, in adolescents and adults with anorexia nervosa and bulimia nervosa, eating disorder symptomatology and comorbid affective and anxiety states. METHOD: Two hundred fifty consecutive, female inpatients on an eating disorders unit were studied. They were given the Beck Depression Inventory; the Depression, Obsessive-Compulsive, Anxiety, and Phobic Anxiety scales from the Symptom Checklist 90; and the Eating Disorder Inventory. Patients were divided into categories based on age, diagnosis, and menstrual status. RESULTS: Onset of anorexia nervosa before age 14 and primary amenorrhea were associated with the greatest maturity fears during acute illness. For patients with restricting anorexia, adolescents aged 17 through 19 years had the highest drive for thinness compared to adolescents aged 13 through 16 years and adults. The lowest levels of depression and anxiety were seen in patients younger than age 14 with restricting anorexia. CONCLUSION: Overall, few psychological differences between adults and adolescents with eating disorders were found, with the exceptions of the youngest restricting anorectic patients at the time of treatment and both restricting and bulimic-anorectic patients who had a very early onset of their illness. Younger patients with acute anorexia nervosa may not require pharmacotherapy for anxiety and depression and may benefit from a focus on maturity fears in psychotherapy.

Adolescent↗
PubMed1994

Psychiatric comorbidity in patients with eating disorders.

The Structured Clinical Interview for DSM-III-R (SCID and SCID II) was administered to 105 eating disorder in-patients in order to examine rates of comorbid psychiatric disorders and the chronological sequence in which these disorders developed. Eighty-six patients, 81.9% of the sample, had Axis I diagnoses in addition to their eating disorder. Depression, anxiety and substance dependence were the most common comorbid diagnoses. Anorexic restrictors were significantly more likely than bulimics (all subtypes) to develop their eating disorder before other Axis I comorbid conditions. Personality disorders were common among the subjects; 69% met criteria for at least one personality disorder diagnosis. Of the 72 patients with personality disorders, 93% also had Axis I comorbidity. Patients with at least one personality disorder were significantly more likely to have an affective disorder or substance dependence than those with no personality disorder.

Adolescent↗
PubMed1992

Relationship of perceived macronutrient and caloric content to affective cognitions about food in eating-disordered, restrained, and unrestrained subjects.

Cognitive sets concerning food were examined in eating-disorder patients and in restrained and unrestrained control subjects. Subjects rated 38 common foods for preference, presence or absence of guilt and danger, preferred monthly frequency, and caloric, fat, and carbohydrate content. Cognitive ratings were examined based upon the individual's perceived amounts of calories and macronutrients. Hedonic ratings of foods perceived as high in fat or calories were different in patients with current or past anorexia and did not change with treatment. The fat-calorie aversions seen in these patients, therefore, appear to be stable trait characteristics of the disorder. Guilt and danger were perceived as separate constructs by unrestrained and restrained control subjects but not by patients. Perceived high amounts of calories or fat triggered stronger feelings of guilt and danger for restrained control subjects and patients (especially bulimic patients) as compared with unrestrained control subjects. The patients' expressions of guilt and danger improved with treatment.

Affect↗
PubMed1991

Comorbidity of psychiatric diagnoses in anorexia nervosa.

The comorbidity of psychiatric diagnoses was examined with the Diagnostic Interview Schedule in 62 women who participated in a 10-year follow-up study of anorexia nervosa. Sixty-two age- and sex-matched controls, their parents, and parents of the anorectic probands were also interviewed with the Diagnostic Interview Schedule. There was a statistically significant comorbidity of the affective and anxiety disorders with anorexia nervosa. The first-degree relatives of the anorectic probands had significantly more alcoholism and total number of psychiatric diagnoses compared with the first-degree relatives of controls. There were two mothers with bulimia nervosa, two cases of anorexia nervosa and two of bulimia nervosa in other first-degree relatives of anorectic probands, and no cases of eating disorders in the first-degree relatives of controls.

Adult↗
PubMed1991

Temporal patterns of hunger and fullness ratings and related cognitions in anorexia and bulimia.

Hunger and fullness during an experimental liquid meal were evaluated by ratings in 84 eating-disordered patients, including three diagnostic subgroups, and in 19 controls who were normal in weight and eating healthily. Anorectic-restrictors had lower hunger ratings and higher fullness ratings than controls. The same tendency was present in anorectic-bulimics. These ratings were relatively unaffected by treatment. Anorectic-restrictors had longer meals than the anorectic-bulimics and normal-weight bulimics. The anorectic-restrictors also tended to eat more slowly than did the bulimic patients. These groups did not, however, differ in amount consumed. At the end of the experimental meal, the anorectic-bulimics were more preoccupied with thoughts of food and anorectic-restrictors had a lower urge to eat, as compared with the controls. Hunger and fullness ratings were negatively correlated for all diagnostic groups; however, these correlations were less pronounced for the eating disorder groups. The eating-disordered patients had predominantly "abnormal" patterns of hunger and fullness curves, indicating a confusion of these concepts.

Adult↗
PubMed1991

Serotonergic responsivity in eating disorders.

Evidence suggests that serotonin may play a role in the pathogenesis of eating disorders. In this ongoing study, serotonin-mediated physiological responses and whole-blood serotonin content are measured in young women with an eating disorder during the active phase of the illness and at the conclusion of inpatient treatment. The responsivity of central nervous system (CNS) serotonergic pathways is assessed by neuroendocrine challenge with a 60-mg oral dose of dl-fenfluramine, an indirect serotonin agonist, whereas the responsivity of the platelet serotonin2 (5-HT2) receptor complex is evaluated by measurement of the magnitude of serotonin-amplified platelet aggregation. Compared with normal controls, eating-disorder patients have exhibited a trend toward reduced prolactin responses to fenfluramine challenge at both the initial and followup assessments. Patients also have exhibited a substantially wider range of serotonin-amplified platelet aggregation responses than have controls; normal-weight bulimic patients have had significantly greater responses than both anorexic restrictors and normal subjects. These preliminary results suggest potential alterations in serotonin-mediated responses in eating-disorder patients that may vary with the diagnostic subgroup.

Adolescent↗
PubMed1990

Taste perceptions and hedonics in eating disorders.

Hedonic and intensity ratings of 20 dairy solutions, with varying levels of fat and sucrose, were obtained before and after treatment for anorectic-restrictors, anorectic-bulimics, normal-weight bulimics, and control subjects. There were no differences between diagnostic groups in ability to rate sweetness intensity; all subjects were able to correctly assess increasing sucrose concentration. During the pretreatment test, both bulimic groups showed elevated intensity ratings of lower fat solutions and solutions which contained no sugar as compared with the other two groups. These differences were not present after treatment. There were differences in hedonic ratings between the anorectic groups and the controls, which persisted even after treatment. Both groups of patients showed an aversion to high fat solutions; anorectic-restrictors also demonstrated an aversion to all solutions which contained no sugar. The stability of these hedonic profiles suggests that these responses may be trait characteristics of anorexia nervosa.

Adolescent↗
PubMed1989

Relationship of bone density to estradiol and cortisol in anorexia nervosa and bulimia.

Dual photon absorptiometry was used to assess the risk of developing osteoporosis in patients with anorexia nervosa and patients of normal weight with bulimia nervosa. Anorectic patients had significantly lower vertebral bone mineral densities compared with healthy controls. Bulimic patients had values similar to those of controls, and the differences between bulimics and anorectics narrowly missed significance. No significant difference was found between patient groups in measurements of serum estradiol, but anorectics, compared with bulimics, had significantly higher values of 24-hour urinary free cortisol. Hypercortisolemia, by diminishing bone formation and increasing bone resorption, is likely to contribute to the development of osteoporosis in patients with eating disorders.

Adult↗
PubMed1988

Fat aversion in eating disorders.

Patients with eating disorders are reported to show an irrational dislike of starchy foods, sometimes described as a "carbohydrate phobia". In the present study, food-related attitudes and self-reported food preferences of women patients with anorexia nervosa (N = 13), anorexia with bulimia (N = 16) and bulimia (N = 14) were mapped using multidimensional scaling (MDS) procedures and compared to those of normal-weight controls (N = 49). Sixteen common food names were rated along 9-point category scales for their nutritional similarity, perceived macronutrient content, caloric density and overall nutritional value. MDS (SINDSCAL) and property fitting (PROFIT) procedures revealed that eating disorder patients associated calories with fat content to a greater extent than did controls, and tended to dislike high-fat foods. In contrast, no differences in perceptions or preferences for carbohydrate foods were observed. Anorectic restrictor patients showed the most rigid attitude structure, expressing preferences only for the lowest calorie and the most nutritious foods. The present multivariate techniques of mapping perceptual space may help to distinguish between diagnostic subgroups in studies of eating disorders.

Adolescent↗
PubMed1988

The endocrinology of anorexia nervosa and bulimia nervosa.

Considerable evidence exists of hypothalamic dysfunction in patients with anorexia nervosa and bulimia nervosa. This dysfunction is reflected in disturbances of endocrine function including abnormalities of gonadotropin, growth hormone, and corticotropin-releasing hormone secretion. Whereas these disturbances are generally reversed with nutritional rehabilitation and weight restoration, it is not evident to what extent nutritional factors are the primary etiology or whether they unmask an otherwise existing but compensated central disturbance. Similarly, endocrine disturbances may be a final common pathway in which disturbances of diet, weight, activity, stress, and mood as well as hypothalamic dysfunction are expressed.

Adrenal Glands↗
PubMed1988

The endocrinology of anorexia nervosa and bulimia nervosa.

Considerable evidence exists of hypothalamic dysfunction in patients with anorexia nervosa and bulimia nervosa. This dysfunction is reflected in disturbances of endocrine function including abnormalities of gonadotropin, growth hormone, and corticotropin-releasing hormone secretion. Whereas these disturbances are generally reversed with nutritional rehabilitation and weight restoration, it is not evident to what extent nutritional factors are the primary etiology or whether they unmask an otherwise existing but compensated central disturbance. Similarly, endocrine disturbances may be a final common pathway in which disturbances of diet, weight, activity, stress, and mood as well as hypothalamic dysfunction are expressed.

Anorexia Nervosa↗
PubMed1987

Relationship of clinical factors to caloric requirements in subtypes of eating disorders.

Caloric requirements for weight gain in subgroups of anorectic patients (anorectic restrictors, anorectic binge-purgers) and weight maintenance in subgroups of anorectic and bulimic patients (bulimics with and without a prior history of anorexia nervosa) were studied in a total of 36 patients. No significant differences were found between subgroups of anorectic patients either in calories to gain weight or to maintain a normal weight. Bulimic patients, as a group, were found to require significantly fewer [corrected] calories than the group of anorectic patients to maintain a normal weight. Bulimic patients with a prior history of anorexia nervosa were found to require more calories for weight maintenance than bulimics with no such prior history. In the entire eating disorder population, there was a significant negative correlation between highest premorbid body mass index (BMI) and calories required to maintain weight. These findings suggest that differences in energy metabolism may be present in the eating disorder subgroups.

Adolescent↗
PubMed1987

Comparison of bulimic and non-bulimic anorexia nervosa patients during treatment.

Bulimic and non-bulimic anorexics were compared on psychological variables during a hospital treatment study. Although before treatment bulimic anorexics displayed more overall psychopathology than non-bulimics, many of the differences disappeared with treatment. There was no difference in severity of depression or body size estimation in these groups both before and with treatment. There was no difference in treatment response as measured by rate of weight gain. More expression of discomfort by bulimic anorexics during the acute phase of illness may in part account for some described differences in these two groups.

Adolescent↗