Arthur G. Blouin

Computerized administration of the diagnostic interview schedule

The National Institute of Mental Health (NIMH) Diagnostic Interview Schedule (DIS) is a highly structured interview designed to be administered by lay interviewers and to yield psychiatric diagnoses. While the DIS has been used widely in large research centers, its use has been limited due to its complexity and need for extensive training to administer. In the present study 100 volunteers consisting of 80 psychiatric patients and 20 normal controls completed a self-administering computerized version of the DIS on two occasions. A standardized Computer Attitude Scale (CAS) was administered to each volunteer before the first and after the second computerized DIS (C-DIS). The C-DIS yielded acceptable test-retest reliability. Certain diagnoses were found to yield high test-retest reliability while reliability was lower for others. This general pattern was similar to the results of previous procedural validity studies. Patients found the C-DIS generally easy to use and operate, and after using the C-DIS, felt that their level of expertise in using computers had improved. Generally, the results support the use of computerized administration of the DIS.

Treatment of bulimia with fenfluramine and desipramine

Desipramine and fenfluramine were administered to bulimic patients in a 15-week study of double-blind, placebo-controlled, crossover design. The 22 patients in the study met DSM-III criteria for bulimia and were of normal weight. Twelve subjects were randomly allocated to the fenfluramine group, and 10 subjects received desipramine. Half the subjects in each group received the active drug in the first 6 weeks and half received placebo. There was a 3-week washout period, after which subjects were crossed over for the remaining 6 weeks. The Eating Disorder Inventory, profile of Mood States, bulimia symptom checklists, and Hopkins Symptom Checklist were administered at weeks 0, 2, 4, 6, 9, 11, 13, and 15. Subjects maintained a daily record of bingeing, vomiting, and laxative/diuretic abuse. Results indicated that both drugs had beneficial effects on bingeing and vomiting frequency, although a greater proportion of patients were identified who responded to fenfluramine than to desipramine. Fenfluramine and desipramine were also effective in reducing the psychological symptoms of bulimia, such as the urge to binge, and feelings of depression. Results suggest that direct alteration of central food intake regulatory centers can effectively control bulimia.

Treatment of bulimia with desipramine: a double-blind crossover study.

The purpose of this study was to evaluate the effect of desipramine, a tricyclic antidepressant with relatively specific noradrenergic effects, on bulimic behaviour, eating attitudes, and mood. Using a double-blind crossover design, 47 normal weight bulimics were randomly assigned to receive either desipramine (150 mg/day)for six weeks, no drug for three weeks, followed by placebo for six weeks, or the reverse sequence. At weeks 0, 2, 4, 6, 9, 11, 13, and 15, each subject was assessed using the EDI, SCL-90, POMS and binge records. Plasma desipramine levels were obtained at weeks 4 and 13. Twenty-four subjects completed the entire fifteen week protocol, while 23 dropped out. Desipramine was significantly more effective than placebo in reducing the frequency of weekly hinging, weekly vomiting, and the fatigue scale of the POMS. No significant effect of the drug was obtained on the EDI or the SCL-90. The clinical effect was modest. Desipramines antibulimic effects were not associated with an alleviation of depressive symptoms.

Body Image, Binge Eating, and Bulimia Nervosa in Male Bodybuilders

Objective: Male bodybuilders (MBB) exhibit more severe body dissatisfaction, bulimic eating behaviour, and negative psychological characteristics, compared with male athletic and nonathletic control subjects, but few studies have directly compared MBB and men with eating disorders. This study compared men with bulimia nervosa (MBN), competitive male bodybuilders (CMBB), and recreational male bodybuilders (RMBB) on a broad range of eating attitudes and behaviours and psychological characteristics to more accurately determine similarities and differences among these groups. Method: Anonymous questionnaires, designed to assess eating attitudes, body image, weight and shape preoccupation, prevalence of binge eating, weight loss practices, lifetime rates of eating disorders, anabolic androgenic steroid (AAS) use, and general psychological factors, were completed by 22 MBN, 27 CMBB, and 25 RMBB. Results: High rates of weight and shape preoccupation, extreme body modification practices, binge eating, and bulimia nervosa (BN) were reported among MBB, especially among those who competed. CMBB reported higher rates of binge eating, BN, and AAS use compared with RMBB, but exhibited less eating-related and general psychopathology compared with MBN. Few psychological differences were found between CMBB and RMBB. Conclusions: MBB, especially competitors, and MBN appear to share many eating-related features but few general psychological ones. Longitudinal research is needed to determine whether men with a history of disordered eating or BN disproportionately gravitate to competitive bodybuilding and (or) whether competitive bodybuilding fosters disordered eating, BN, and AAS use.

Light therapy in bulimia nervosa: a double-blind, placebo-controlled study.

The effects of light therapy on food intake and affective symptoms of bulimia nervosa (BN) were examined in a double-blind study. Eighteen women who met DSM-III-R criteria for BN were randomly assigned to receive either 2500 lux of bright light (experimental condition) or < 500 lux of dim light (placebo condition) daily in the early evening for a 1-week period. The Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder Version (SIGH-SAD), the Beck Depression Inventory (BDI), and the Bulimic Symptoms Checklist were administered to subjects before light exposure, after 1 week of light exposure, and after 7 days of withdrawal of light exposure. Throughout the study, the Profile of Mood States and the Daily Binge Record were completed daily. Compared with subjects in the dim light condition, subjects in the bright light condition showed a significant improvement in depressed mood during light exposure, as measured by both the BDI and the SIGH-SAD. There was a return to pretreatment levels of depression after withdrawal of light exposure. No changes in depression were noted in the placebo group. No effect of light therapy was found on the frequency, size, or content of binge-eating episodes. The results are discussed in terms of the physiological processes associated with light therapy and seasonal affective disorder that may underlie the affective and food intake symptoms of BN.

Compliance to referrals from the psychiatric emergency room.

Factors affecting compliance to referrals in the psychiatric emergency room (ER) were studied in a sample of 468 patients referred for ambulatory care. Compliance was defined as attendance at the first appointment. The overall compliance rate was 59%. Compliance rates were higher among those patients who were receiving psychiatric treatment (active) when they visited the ER. Those in treatment tended to have either Schizophrenic or Personality Disorders with fewer social supports. Different factors affected those in treatment and those not in treatment. The results suggest that those not in treatment would comply more frequently with specific instructions outlining the benefits of psychiatric follow-up.

Are bodybuilders at risk for an eating disorder

Abstract Several sports and activities have been associated with an increased risk of eating disorders. Bodybuilding, a sport in which eating, body weight, and shape concerns appear to be prevalent, has grown considerably in popularity with prevalence estimates in excess of 5 million participants in America alone. This article reviews the scientific literature that has examined eating and weight control practices and associated psychological characteristics among bodybuilders. Research indicates that serious recreational and competitive body-building may potentiate the risk of eating disorders. Implications for education and prevention are discussed.

Repeated users of a psychiatric emergency service in a Canadian general hospital

The authors of this study examine the demographic and clinical characteristics of repeated users of psychiatric emergency room services in a general hospital. 37.8% of all the patients (913) seen during one year had one or more visits to the emergency room in the six months preceding the index emergency room consultation. Repeaters were more likely than non-repeaters to be unmarried, self referred and with a history of previous psychiatric treatment for a chronic psychiatric disorder. Factors affecting frequency of use of psychiatric emergency room services among different diagnostic groups were also studied. These results demonstrated the heterogeneity of the needs of the diverse diagnostic groups who over-utilize costly emergency room services. Our findings showed that in a country with universal health insurance, psychiatric emergency services also tend to reflect the gaps in the delivery of health services in the hospital and the community.

A comparison of the manifest content in dreams of suicidal, depressed and violent patients.

The manifest dream content of psychiatric in-patients who had been admitted because of suicidal attempts was compared with three in-patient control groups, patients who had been admitted for: a) depression and suicidal ideation without attempt; b) depression with no suicidal ideation and; c) commission of a violent act without suicidality. Standardized tests of dream content were used as well as the Beck scale for depression and certain subscales of the MMPI. The results confirmed that both suicidal and violent patients have more death content and destructive violence in their dreams, but that this was a function of the severity of depression and certain character traits such as impulsivity rather than being specific to the behaviour itself. The dream content is continuous with, and probably reflects, the waking state in the case of the depressives. On the other hand some of the findings require a more complex dynamic explanation lending some support to the idea that the dream may have an adaptive function.

Physiological and psychological responses to a glucose challenge in bulimia

Twenty females meeting DSM-III criteria for bulimia, and 12 age- and sex-matched controls underwent a 60-min intravenous glucose tolerance test. Blood samples were taken at −10, 0, 5, 10, 20, 30, 45, and 60 min after the glucose injection. At these times, subjects completed a mood rating scale [Profile of Mood States (POMS)] and a subjective self-report questionnaire addressing both food cravings and thirst, as well as the urge to binge and subjective control over food intake. Blood levels of tryptophan, tyrosine, valine, leucine, phenylalanine, and isoleucine were measured at 0 and 60 min after the injection. Although equivalent at baseline, the blood glucose levels of bulimics at 5 min and insulin/glucagon ratio at 20, 30, and 45 min following injection were reduced in comparison to controls. Blood valine levels were also lower among the bulimic group. There were no differences between the bulimics and normal controls at baseline on subjective self-report measures of urge to binge, control over food intake, carbohydrate (CHO) craving or fatigue. following the glucose injection, however, the observed physiological differences between the two groups were accompanied by increased subjective cravings for sweets and fruits, an enhanced urge to binge, and less subjective control over food intake for bulimics as compared with controls. The bulimics also reported increased fatigue in response to glucose, whereas controls reported feeling less fatigued. The results suggest that abnormal physiological responses to blood glucose are accompanied by alterations in both food cravings and mood, which may promote binging among bulimic patients.