David S. Goldbloom

The association between bulimic symptoms and reported psychopathology

Findings from the current study were derived from 50 bulimia nervosa patients participating in a short-term psychotherapy trial. Multivariate analyses revealed that patients with good and poor outcome were indistinguishable on most measures at pretreatment and that those who evidenced the greatest reduction in eating symptoms also experienced a marked improvement on a wide range of self-report personality and adjustment measures

A randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa: Short-term outcome

This study compared and combined fluoxetine and individual cognitive behavioral therapy in the treatment of bulimia nervosa. Participants were 76 women who sought treatment at the Eating Disorders Program of the Toronto Hospital and who met DSM-III-R criteria for bulimia nervosa. Subjects were randomly assigned to receive fluoxetine alone, cognitive behavior therapy alone, or the two in combination and were treated over 16 weeks. Short-term outcome revealed that all three treatment conditions were associated with clinical improvement across a wide range of parameters. The combination of pharmacotherapy and psychotherapy was superior to pharmacotherapy alone on specific parameters and there was no statistically significant advantage to the combination over psychotherapy alone. Limitations to the study include the absence of a placebo pill group and a waiting list control group as well as a substantial dropout rate across all three treatment conditions.

Purging and nonpurging forms of bulimia nervosa in a community sample

OBJECTIVEnRecent consensus on the subclassification of the eating disorder bulimia nervosa into purging and nonpurging forms is examined in the context of a large psychiatric epidemiological survey in Ontario, Canada.nnnMETHODnAmong a sample of 8,116 individuals, 62 met criteria for bulimia nervosa. Of these, the 17 who were of the purging subtype could be distinguished from the nonpurging group on a variety of parameters of comorbidity, family history, and childhood environment.nnnRESULTSnThe purging subtype was distinguishable on the basis of early age of onset, and high rates of affective disorders and anxiety and alcoholism, sexual abuse, and parental discord.nnnDISCUSSIONnThe data support the taxonomy and point to the need for better understanding of the meaning of purging behavior.

THE SEROTONIN HYPOTHESIS OF BULIMIA NERVOSA : THEORY AND EVIDENCE

Bulimia nervosa is an eating disorder with multiple causes that has been the object of extensive research since it was first described in 1979. This review evaluates both the theoretical rationale and empirical evidence for a model which suggests that disturbed serotonin activity is involved in the development of this disorder. Limitations of the hypothesis and prospects for the future are considered.

Current Perspectives on Drug Therapies for Anorexia Nervosa and Bulimia Nervosa

SummaryAnorexia nervosa and bulimia nervosa are eating disorders that strike a significant number of adolescent and young adult women and carry a significant morbidity and mortality. Over the last 30 years, virtually every class of psychiatric drug as well as atypical agents have been tested in the management of these vexing and often chronic disorders. For anorexia nervosa, there is in 1991 little if any role for pharmacotherapy. Drugs used to promote food intake and weight gain, such as cyproheptadine, amitriptyline, clonidine and opiate antagonists, have provided disappointing results. For bulimia nervosa, double-blind placebo-controlled clinical trials have confirmed an antibulimic effect for tricyclic antidepressants, such as imipramine and desipramine. Monoamine oxidase inhibitors, while having a significant antibulimic effect, require careful adherence to a dietary regimen which may limit patient compliance. Newer antidepressants such as trazodone, amfebutamone and fluoxetine may prove useful if further study substantiates preliminary beneficial results. Other agents such as anticonvulsants, benzodiazepines, lithium, fenfluramine and opiate antagonists also require additional study, indicating that the optimal integration of pharmacotherapies with other treatments awaits further research

Estimating prevalence of anxiety and mood disorder in survey data using the GHQ12: Exploration of threshold values

Background and Objectives: Our study explored the validity of different threshold values on the 12-item version of the General Health Questionnaire (GHQ12) for estimating the prevalence of anxiety and mood disorders (AMD) in Ontario population survey data. a Funding and support: This research has been supported by funding from the Ontario Ministry of Health and Long-Term Care. The views expressed here do not necessarily reflect those of the Ministry. 82 ROBERT E. MANN ET AL.

The clinician-investigator interface in psychiatry. I: Values and problems

The two following papers describe some of the benefits and problems involved in integrating clinical and investigative work. It is stressed that there are a number of advantages to such integration. Researchers especially benefit from the proximity to patients and clinicians. Education can be significantly enhanced when researchers and clinicians are in one setting and this can benefit residents, medical students and non-medical health personnel. There are a number of problems to such clinical research in psychiatry. These are discussed especially as they relate to senior faculty and their resistances to research. The shortage of clinician scientists in teaching positions means that most residents are not involved with such people as mentors early in their training and do not consider this as a career option after their residency training. Reductionistic thinking on the part of some researchers and when researchers are not first-rate clinicians both contribute to residents not becoming involved in clinical investigation. Funding policies as well as chairmens hiring policies also play a role here.

ELECTROCONVULSIVE THERAPY TRAINING IN CANADA : A SURVEY OF SENIOR RESIDENTS IN PSYCHIATRY

Despite the enduring use and efficacy of electroconvulsive therapy (ECT) over the last half century, training in the theory and administration of ECT in the United States and the United Kingdom has been substandard and erratic. This survey of senior residents across Canada reveals limitations in the ECT training received by Canadian psychiatrists and the need to set academic standards.

The early Canadian history of anorexia nervosa

Objective: To examine several early Canadian descriptions of anorexia nervosa (AN) in light of modern understanding of the disorder. Method: Two clinical reports of AN from the late 19th century and early 20th century in Canada are cited and summarized. These original case descriptions are then compared with late 20th century knowledge of the disorder. Results: Both of these early descriptions contain many astute and prescient observations on the etiology and sequelae of AN and reveal a compassionate approach to patient care. Conclusions: Canadian contributions to the medical literature on AN prior to 1970 merit both careful scrutiny and appreciation in the world literature on this disorder.

The clinician-investigator interface in psychiatry: II--The role of the Clinical Investigation Unit.

The Clinical Investigation Unit has served as a natural focus for clinical research; as such it has a number of advantages and specific problems. On such units a variety of themes may occur. Some of these have the potential to interfere with the integration of clinical and research work. These include the theme that the research itself is therapy, or that research will find all the answers. Both may result in problems for the functioning of the ward. Most problematic of all is the theme that research is harmful and exploitative. Optimally, the unit develops an attitude that the research is compatible with excellent patient care. Problems of patients, staff, ethical issues, admissions policies and problems of the clinician-scientists are reviewed with recommendations on how to minimize difficulties.