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Biomedical subjects

Michael J Devlin

Publications and source records attributed to Michael J Devlin.

12 recordsLinked to original sources
PubMed2006

Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial.

CONTEXT: Antidepressant medication is frequently prescribed for patients with anorexia nervosa. OBJECTIVE: To determine whether fluoxetine can promote recovery and prolong time-to-relapse among patients with anorexia nervosa following weight restoration. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled trial. From January 2000 until May 2005, 93 patients with anorexia nervosa received intensive inpatient or day-program treatment at the New York State Psychiatric Institute or Toronto General Hospital. Participants regained weight to a minimum body mass index (calculated as weight in kilograms divided by the square of height in meters) of 19.0 and were then eligible to participate in the randomized phase of the trial. INTERVENTIONS: Participants were randomly assigned to receive fluoxetine or placebo and were treated for up to 1 year as outpatients in double-blind fashion. All patients also received individual cognitive behavioral therapy. MAIN OUTCOME MEASURES: The primary outcome measures were time-to-relapse and the proportion of patients successfully completing 1 year of treatment. RESULTS: Forty-nine patients were assigned to fluoxetine and 44 to placebo. Similar percentages of patients assigned to fluoxetine and to placebo maintained a body mass index of at least 18.5 and remained in the study for 52 weeks (fluoxetine, 26.5%; placebo, 31.5%; P = .57). In a Cox proportional hazards analysis, with prerandomization body mass index, site, and diagnostic subtype as covariates, there was no significant difference between fluoxetine and placebo in time-to-relapse (hazard ratio, 1.12; 95% CI, 0.65-2.01; P = .64). CONCLUSIONS: This study failed to demonstrate any benefit from fluoxetine in the treatment of patients with anorexia nervosa following weight restoration. Future efforts should focus on developing new models to understand the persistence of this illness and on exploring new psychological and pharmacological treatment approaches. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00288574.

Adolescent↗
PubMed2006

Artificial sweetener use among individuals with eating disorders.

UNLABELLED: Women with eating disorders report using large quantities of artificially sweetened products, but this has not been quantified. OBJECTIVE: The authors assessed the use of selected artificially sweetened low-calorie products among women with eating disorders compared with controls. METHOD: Thirty women with anorexia nervosa (18 with the restricting subtype [AN-R] and 12 with the binge/purge subtype [AN-B/P]), 48 women with bulimia nervosa (BN), and 32 healthy control women completed a survey of frequency and amount of consumption of chewing gum, artificially sweetened low-calorie beverages, and packets of artificial sweetener in the previous month. RESULTS: A greater proportion of women with AN-B/P and BN reported use of each product, compared with women with AN-R and control participants. Among product users, patients with eating disorders reported using greater amounts than controls. Among patients who reported binge eating and/or purging, the quantity of each product used was inversely correlated with body mass index (BMI). CONCLUSION: These data suggest an increased drive for sweet orosensory stimulation in women with AN and BN.

Adult↗
PubMed2005

Eating Disorder Examination-Questionnaire with and without instruction to assess binge eating in patients with binge eating disorder.

OBJECTIVE: The current study examined whether adding written definitions and examples of binge eating to the Eating Disorder Examination-Questionnaire enhances its utility to assess binge frequency in patients with binge eating disorder (BED). METHOD: Eighty-nine women and men with BED completed the EDE-Q (without instruction; n = 37) or the EDE-Q-I (with instruction; n = 52) before receiving the EDE interview. Binge frequency was measured as the number of binge days (days on which one or more objective binge episodes occurred) over the past 28 days. RESULTS: Binge frequency correlations between the EDE and EDE-Q-I were strongly significant (r = .543, p = .000), whereas correlations between the EDE and EDE-Q were not significant (r = .197, p = .242). DISCUSSION: Providing brief detailed instructions improves the performance of the EDE-Q when evaluating binge eating in patients with BED. This suggests that, with relatively minor modifications, the EDE-Q may be a viable alternative to the EDE in assessing binge frequency in this population.

Adolescent↗
PubMed2005

Cognitive behavioral therapy and fluoxetine as adjuncts to group behavioral therapy for binge eating disorder.

OBJECTIVE: Although binge eating disorder is a common and distressing concomitant of obesity, it has not yet been established whether affected individuals presenting to behavioral weight control programs should receive specialized treatments to supplement standard treatment. This study was designed to examine the added benefit of two adjunctive interventions, individual cognitive behavioral therapy (CBT) and fluoxetine, offered in the context of group behavioral weight control treatment. RESEARCH METHODS AND PROCEDURES: One hundred sixteen overweight/obese women and men with binge eating disorder were all assigned to receive a 16-session group behavioral weight control treatment over 20 weeks. Simultaneously, subjects were randomly assigned to receive CBT+fluoxetine, CBT+placebo, fluoxetine, or placebo in a two-by-two factorial design. Outcome measures, assessed at the end of the 16-session acute treatment phase, included binge frequency, weight, and measures of eating-related and general psychopathology. RESULTS: Overall, subjects showed substantial improvement in binge eating and both general and eating-related psychopathology, but little weight loss. Subjects who received individual CBT improved more in binge frequency than did those not receiving CBT (p<0.001), and binge abstinence was significantly more common in subjects receiving CBT vs. those who did not (62% vs. 33%, p<0.001). Fluoxetine treatment was associated with greater reduction in depressive symptoms (p<0.05). The 54 subjects who achieved binge abstinence improved more on all measures than the 62 subjects who did not. In particular, these subjects lost, on average, 6.2 kg compared with a gain of 0.7 kg among non-abstainers. DISCUSSION: Adjunctive individual CBT results in significant additional binge reduction in obese binge eaters receiving standard behavioral weight control treatment.

Adult↗
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

Surgical management of obese patients with eating disorders: a survey of current practice.

BACKGROUND: This study examined the current practice of bariatric surgeons and their colleagues regarding patients with binge eating disorder (BED) and night eating syndrome (NES) who present for Roux-en-Y gastric bypass (RYGBP) for obesity. METHOD: We conducted a 9-item internet survey of American Society for Bariatric Surgery (ASBS) members. For each item, the numbers of respondents endorsing each possible response, including "Other" and "Unknown or not applicable," were tabulated, and percentages of the total sample of respondents were calculated. RESULTS: Most respondents' screening process included mental health (82.0%) and nutritional (78.0%) evaluations. Most inquired about binge eating (88.0%) and other eating disturbances (83.3%), while fewer respondents (52.7%) screened for night eating. Management of patients with eating disorders varied widely. For patients with binge eating, 20.0% of respondents proceeded with surgery, 2.7% recommended against surgery, and 27.3% postponed surgery, with the remainder (50.0%) reporting that their management varied. For night eating and other eating disturbances, responses were similarly diverse. Respondents who postponed surgery reported a wide range of estimates of how often patients with eating disorders follow through with treatment for their eating problem and return for surgery: 16% (always/almost always), 36% (usually), 24% (sometimes), 12% (occasionally), and 12% (never/almost never). CONCLUSION: Although bariatric surgeons commonly screen for eating disorders such as BED, there are limited empirical data and no consensus regarding the optimal management of these patients.

Bulimia↗
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

What is this thing called BED? Current status of binge eating disorder nosology.

OBJECTIVE: Although binge eating has been recognized as a clinically relevant behavior among the obese for more than four decades, the concept of binge eating disorder (BED) as a distinct psychiatric diagnosis is of much more recent origin. This article presents four ways of conceptualizing BED: a distinct disorder in its own right, as a variant of bulimia nervosa, as a useful behavioral subtype of obesity, and as a behavior that reflects psychopathology among the obese. It also summarizes the evidence supporting and disconfirming each model. METHOD: The literature subsequent to the development of DSM-IV regarding the reliability and validity of BED and related conditions was reviewed selectively. RESULTS: The preponderance of the evidence suggests that BED differs importantly from purging bulimia nervosa and that BED is not a strikingly useful behavioral subtype of obesity. DISCUSSION: Further study is needed to definitively determine the validity of BED as a distinct eating disorder.

Bulimia↗
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

Emerging psychotherapies for eating disorders.

Eating disorders are serious illnesses associated with significant medical and psychological sequelae and, in the case of anorexia nervosa, significant mortality. Established psychotherapies such as cognitive-behavioral therapy and interpersonal therapy are effective for many patients with eating disorders. However, these treatments fail to yield full long-term remission in a substantial number of patients. There is a need for novel psychotherapeutic approaches for patients with eating disorders. The authors review three promising new treatment approaches in the field of eating disorders. Motivational enhancement therapy is based on established motivational principles for treating patients with addictive disorders and has been adapted as an early component of treatment for patients with anorexia nervosa and bulimia nervosa. Dialectical behavioral therapy was initially developed for the treatment of borderline personality disorder and has been successfully applied to patients with binge eating. A novel form of family therapy, the Maudsley family treatment for adolescents with anorexia nervosa, has been newly manualized, and studies using this treatment are ongoing. For each treatment, the authors review the theory and techniques of treatment and then go on to review existing data on treatment efficacy.

Journal Article↗
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↗