Herbert Weiner

Hyperactivity in Anorexia Nervosa: A Fundamental Clinical Feature

Abstract Toward the goal of assessing the prevalence and chronology of heightened physical activity in primary anorexia nervosa, we reviewed the charts of 33 patients hospitalized with this illness during the past 10 years. Fifteen of these patients, or their parents, were also interviewed at least 1 year after the hospitalization. In 25 of the 33 charts, the presence of “hyperactivity” during the present illness was recorded; only one patient was specifically noted to show unremarkable physical activity. Twenty-one of the 25 patients were also described as having been unusually active physically prior to the onset of dieting and weight loss. The 15 follow-ups revealed two deaths, one patient by suicide and the other from complications of malnutrition. Among the 13 patients interviewed directly, ten described themselves as continuing to be highly active physically—this despite significant weight gain in eight and complete subsidence of both eating symptomatology and amenorrhea in three. Physical activity appeared to be more extensive, disorganized, and aimless during the acute phase of anorexia nervosa, when excessive and bizarre dieting and rapid weight loss are occurring, than during the premorbid or weight recovery phases. However, these preliminary findings suggest that “hyperactivity” is an early and enduring clinical feature of anorexia nervosa and not merely secondary to either a conscious attempt to lose weight or weight loss per se.

PSYCHOENDOCRINE CONSIDERATIONS IN CANCER OF THE BREAST

On the basis of empirical steroid analysis, Bulbrook and his coworkers in England have found that women with cancer of the breast fall into two groups: In one, the ratio of corticoid to androgenic steroids is relatively high, and the prognosis of the illness and the response to treatment are poor; in the other, the ratio between these steroids is lower, and the prognosis and response to treatment are better. The underlying basis for this differential prognosis remains unclear, although Bulbrook speculates that implicit in this ratio characteristic of the poorprognosis group may be some decreased efficiency in immunologic functioning or increased vulnerability to estrogens. It is not known why differences in this ratio occur. Genic, constitutional, and possibly perinatal factors have been postulated to account for them, and starvation or a rise in body temperature can transiently alter the ratio. Breast neoplasms themselves have not, we might add, been found to account for the elevation of the corticosteroids by virtue of any adrenocorticotropic hormone (ACTH) secretion. However, in view of the now well-established fact that psychological events can influence corticosteroid levels, it seems legitimate to ask whether they cannot significantly affect this ratio, either acutely or in a more enduring manner. With this question in mind, we have been studying a group of women with breast tumors by making assessments of their psychological state and then investigating possible correlations with production rates of hydrocortisone and excretion of the principle hydrocortisone and androgen metabolites and the ratio between these hormones. Methods

Intracerebroventricular pentagastrin fails to affect feeding and acid secretion in the rat

Abstract The recent finding of immunoreactive gastrin in the pituitary and hypothalamus of the pig, cow and rat suggests that this peptide may have a physiologic function in the central nervous system. Because gastrin is an important regulator of gastric acid secretion, and may also affect food intake, we tested the hypothesis that direct intracerebroventricular injection of pentagastrin may also affect these variables. The results fail to support the hypothesis.

Psychobiological variables in the onset and recurrence of gouty arthritis: a chronic disease model.

Abstract Sixteen men, all with documented gout, were interviewed in depth toward the goal of elucidating dietary, medical, social, psychological, and behavioral events that were associated with arthritic episodes. All 16 reported that some of their attacks ‘came out of the blue’ but that other attacks seemed to have definite and reliable precipitants. The most commonly described precipitants included alcohol and dietary indiscretion, local joint trauma, surgery and infection, not taking prescribed medication, and life experiences that were usually associated with feelings of tense anticipation. However, the last of these was also commonly associated with several of the other precipitants, whose mechanisms for triggering an acute arthritis are generally definable. Whether there is a specific affect, such as tense anticipation, which is most likely to trigger an attack, perhaps even independently of any concomitant behavioral variables, is not clear; however, catecholamine and hydrocortisone release, which can accompany such emotional arousal, could be mediating variables. The variety of precipitants described, operating via different mechanisms to aggravate the underlying metabolic abnormality, compromise compensatory reserve, or set off local changes which provide a milieu favorable to the diseases expression, hopefully provide some insight into why chronic diseases tend to run such variable courses between and within patients.

Some effects of a split litter cross foster design applied to 15 day old rat pups

Rat litters were divided and cross fostered on a postnatal Day 15 so that each mother had 4 of her own pups and 4 pups of a second litter, until weaning at 21 days. Daily weight and body temperature measurements made between Day 15 and 21 showed no differences between foster pups and pups who stayed with their biological mothers. However, by the age of 30 days, foster pups weighed less than pups reared by their own (biological) mothers; and foster pups at that age did not survive food deprivation as well as the pups reared by their biological mothers. In their Day 30 weights and the capacity to survive food deprivation, foster pups resembled pups that had been permanently separated from their mothers on postnatal Day 15. We conclude that the split cross foster design may introduce variability rather than reduce it. Nonetheless, this design may be useful in the experimental investigation of maternal behavior and mother-pup interactions in the rat.

Gastric erosions following sympathetic denervation in the maternally deprived rat

Abstract Gastric sympathetic denervation was used to test the hypothesis that alterations in gastric mucosal blood flow are related to the occurrence of restraint-induced gastric erosions in the rat. The four major test conditions were rats at high risk for restraint erosions (early weaned) and rats at low risk (normally weaned), with and without gastric sympathetic denervation. The completeness of the surgical sympathetic denervation procedure was independently confirmed by finding a mean fall in gastric norepinephrine content from 369.6 ng/gm to 11.2 ng/gm. Surgical sympathectomy had no effect on erosion incidence in either the high risk (80% incidence) or the low risk (5.2% incidence) groups. These findings do not support the hypothesis that changes in gastric mucosal blood flow during restraint are sufficient conditions for the production of mucosal erosions in the rat.

Psychobiological Factors in Bodily Disease

Psychosomatic medicine is based on the axiom that there are no diseases per se but only sick persons. Psychosomatic medicine is not a subspecialty of medicine dedicated to the investigation of one bodily organ or bodily system, nor is it defined by a special technology with which to examine diseased organs or cells. Finally, is is not confined to the study of a small number of diseases (von Uexkull, 1979; Weiner, 1977).

CURRENT STATUS AND FUTURE PROSPECTS FOR RESEARCH IN PSYCHOSOMATIC MEDICINE

Publisher Summary nThis chapter describes the current status and future prospects for research in psychosomatic medicine. The heterogeneity of the subject populations studied has emerged as a major methodological weakness of earlier research that led to hypotheses concerning the role of intrapsychic conflict in the activation of specific organic processes. The naturalistic studies of human subjects have also suggested that bereavement or separation may be the critical antecedents of behavioral disturbances and physiological change both in man and animals. Profound behavioral changes in young primates are known to occur upon separation from their mothers. It is shown that on separating 14-day-old rats from their mothers, a profound fall in heart rate occurred and the heart rate could be restored on feeding rat milk to the pups. Another set of findings that derive from psychophysiologic research in animals and man teaches to look for patterned changes in several endocrine and autonomic variables. From such a pattern, it may be possible to discern mediating mechanisms showed that mental arithmetic produced changes in BP, muscle and splanchnic blood flow, heart rate. and cardiac output in normal and hypertensive subjects, which differed in the two subject populations only in duration and degree.

Current status and future prospects for research in psychosomatic medicine

Publisher Summary This chapter describes the current status and future prospects for research in psychosomatic medicine. The heterogeneity of the subject populations studied has emerged as a major methodological weakness of earlier research that led to hypotheses concerning the role of intrapsychic conflict in the activation of specific organic processes. The naturalistic studies of human subjects have also suggested that bereavement or separation may be the critical antecedents of behavioral disturbances and physiological change both in man and animals. Profound behavioral changes in young primates are known to occur upon separation from their mothers. It is shown that on separating 14-day-old rats from their mothers, a profound fall in heart rate occurred and the heart rate could be restored on feeding rat milk to the pups. Another set of findings that derive from psychophysiologic research in animals and man teaches to look for patterned changes in several endocrine and autonomic variables. From such a pattern, it may be possible to discern mediating mechanisms showed that mental arithmetic produced changes in BP, muscle and splanchnic blood flow, heart rate. and cardiac output in normal and hypertensive subjects, which differed in the two subject populations only in duration and degree.