David Greenfeld

Definition of a gastric emptying abnormality in patients with anorexia nervosa

Upper gastrointestinal symptoms may be prominent in anorexia nervosa. This study is an investigation of the gastric emptying of solid and liquid meal components in 16 female patients (mean age 20.0 years, range 14–40 years) who met accepted psychiatric diagnostic criteria for anorexia nervosa. The results were compared with those of gastric emptying studies in 10 normal females of ideal body weight (mean age 25.4 years, range 20–35), 13 normal persons (12 males), and six patients (mean age 12 years, range 9–14 years) with weight loss (<90 percent ideal body weight) secondary to Crohns disease with no psychiatric symptoms. A dual-isotope technique using chicken liver intracellularly labeled with technetium-99m (99mTc) bound to sulfur colloid as the solid-phase marker, and indium-111 (111In)-labeled water as the liquid-phase marker was used. Gastric emptying was monitored for 2 hr by gamma camera. In 13 of the 16 anorexia nervosa patients (80%), gastric emptying of solids was slower than the range in the two groups of normal subjects, and mean gastric emptying was significantly slower (P<0.05) than in the weight-loss patients. Liquid emptying (water) in anorexia nervosa was normal and similar to the control groups studied. In 11 of the anorexia nervosa patients with delayed gastric emptying, intramuscular metoclopramide, 10 mg, significantly (P<0.05) accelerated the mean gastric emptying from 60 through 120 min after the meal. We conclude that in anorexia nervosa patients who are symptomatic and seeking medical care: (1) gastric emptying of solids is significantly delayed when compared with female subjects of similar age and normal body weight and with patients of less than 90% ideal body weight but without psychiatric disorder; (2) these data are consistent with an antral motility disturbance, either primary or secondary; and (3) metoclopramide, a gastric prokinetic agent, accelerates (delayed) gastric emptying.

Attitudes of IVF parents regarding the IVF experience and their children.

AbstractPurpose: to assess parental attitudes regarding the IVF experience, the IVF pregnancy, and issues associated with raising their IVF child(ren). Method: parents (184 couples) of IVF children born between 1982 and 1992 were mailed individual anonymous questionnaires. Results: (31%) parents responded: 62 mothers and 41 fathers. One hundred-three (41%) of the mothers felt that our staff could have been more helpful during their pregnancy. Half the women subjects (52%) stated that they wished they had contact with other IVF couples during pregnancy. Fifty-two percent of the mothers reported that IVF created special feelings of attachment to the child, causing some difficulty with their initial separation. This was comparatively less an issue for fathers, with only 19% reporting similar difficulties (X2=8.39, P<0.01). Ninety-eight percent of the subjects have told someone else about the IVF experience. Interestingly, 25% of the parents remained uncertain about whether they would tell the child. Sixteen couples (15%) had already told the child, and of the 57 (66%) who intended to tell the child later, they varied greatly in their views about which age would be appropriate (mean, 7.3 years; SD, 6.5 years; range, 2–21 years). Conclusions: The results suggest that women undergoing IVF might profit from greater contact with staff during pregnancy and, again, later when dealing with issues of separation. A substantial proportion of couples expressed some concerns about the issue of disclosure to the child and might profit from counseling when they feel the issue is current.

Abnormal liver enyzmes in outpatients with eating disorders

OBJECTIVE This study was undertaken to screen a large series of outpatients with anorexia or bulimia for liver enzyme abnormalities, examining their frequency and their clinical correlates. METHOD Eight hundred seventy-nine eating-disordered outpatients presenting at a suburban clinic constituted the subject population. Serum glutamic oxalacetic transaminase, serum glutamic pyruvate transaminase, and gamma glutamyl transpeptidase (SGOT, SGPT, and GGTP, respectively) were drawn at intake. Medical charts were reviewed to obtain further clinical data on all patients with an enzyme elevation. RESULTS Liver enzymes were abnormally high in 36 patients (4.1%). Elevated SGPT was the most frequent enzyme abnormality and was correlated with lower current and past weight and body mass index (BMI). DISCUSSION Hepatic dysfunction in eating-disordered outpatients is neither specific nor common. Low weight alone can cause liver damage, yet elevated liver chemistries in patients with anorexia and especially bulima are often not due to their eating disorder.

Do attitudes toward disclosure in donor oocyte recipients predict the use of anonymous versus directed donation

OBJECTIVE To compare the demographic and psychological characteristics of oocyte recipients and to determine whether the issue of disclosure about the use of a donor is a correlate of the decision to use an anonymous or directed donor. DESIGN Cross-sectional study. SETTING University teaching hospital. PATIENT(S) Ninety consecutive recipients of donated oocytes (64 of whom used anonymous donors and 26 of whom used directed donors). INTERVENTION(S) Pretreatment psychosocial evaluation. MAIN OUTCOME MEASURE(S) Recipient opinions and attitudes regarding the choice of donor type and disclosure to others as determined through a semistructured interview. RESULT(S) There were no statistically significant differences with regard to demographic characteristics between recipients who used anonymous and directed donors. There were statistically significant differences between the groups with regard to the issue of disclosure. Recipients who used directed donors were more likely to have told others about using an oocyte donor and were more likely to indicate that they intended to inform the child about the nature of his or her conception. CONCLUSION(S) Oocyte recipients who use known donors differ significantly from those who use anonymous donors with regard to the issue of disclosure to others. Further studies are needed to determine the causal direction of this relation.

Elevated plasma monoamine metabolites in eating disorders

Mean fasting plasma homovanillic acid (HVA) levels were elevated in females hospitalized with eating disorders (both anorexia and bulimia nervosa) compared with females hospitalized with adjustment disorder. Fasting plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) was elevated in anorectic patients only. Five patients with eating disorder and psychosis had higher values for HVA and MHPG than the remainder of the patients with eating disorder.

Helping Patients End Treatment: The IVF Follow-up Clinic as a Tool for Continuing Psychological Assessment

Many couples enter an IVF/ET program without a clear idea of how many treatment cycles they intend to undergo. Others are determined to continue treatment as long as necessary to achieve a successful outcome. However, following review of patient performance the treatment team may conclude that continued attempts are not advisable. Reasons for recommending discontinuation of IVF/ET treatment include failure to conceive due to lack of response to ovarian stimulation, failed fertilization, and age factors.

Medication and Psychotherapy in Outpatients Vulnerable to Psychosis

The literature dealing with the individual treatment of schizophrenia and related conditions has been derived almost exclusively from work with inpatients. Indeed, before the 1950s, psychotic patients were treated primarily in hospitals. Our field owes a lasting debt to the patience and intuitive genius of the individuals who developed this literature, including Theodore and Ruth Lidz, and others who are contributors at this conference. Working in the days before neuroleptic drugs, and sometimes intentionally without them, these workers described the powerful role of persistent, concerned human contact in the treatment of psychotic disorders.