Regina C. Casper

Personality features of women with good outcome from restricting anorexia nervosa

&NA; Personality characteristics were assessed in women who had physically and, in the majority, psychologically recovered from restricting anorexia nervosa at an 8‐ to 10‐year follow‐up. Personality dimensions were evaluated using the Multidimensional Personality Questionnaire, the California Personality Inventory, and the Reid‐Ware Scale. Women who had recovered from anorexia nervosa rated higher on risk avoidance, displayed greater restraint in emotional expression and initiative, and showed greater conformance to authority than age‐matched normal women. On comparison with their sisters, the recovered women reported a greater degree of self‐ and impulse control and less enterprise and spontaneity; sisters, however, endorsed equally high moral standards. The differences in personality characteristics remained significant after statistically controlling for depressive symptoms and eating behavior. The results suggest that a temperamental disposition toward emotional and behavioral restraint combined with a strong sense for traditional values may be psychological risk factors for the development of the restricting type of anorexia nervosa.

Hyperactivity in patients with anorexia nervosa and in semistarved rats: evidence for a pivotal role of hypoleptinemia.

Patients with anorexia nervosa (AN) often show normal to elevated physical activity levels despite severe weight loss and emaciation. This is seemingly in contrast to the loss of energy and fatigue characteristic of other starvation states associated with weight loss. Despite the fact that historical accounts and clinical case studies of AN have regularly commented on the elevated activity levels, the behavior has become only recently the subject of systematic study. Because rodents and other species increase their activity upon food restriction leading to weight loss when given access to an activity wheel--a phenomenon referred to as activity-based anorexia or semi-starvation-induced hyperactivity (SIH)-it has been proposed that the hyperactivity in AN patients may reflect the mobilization of phylogenetically old pathways in individuals predisposed to AN. Exogeneous application of leptin in this animal model of AN has recently been shown to suppress completely the development of SIH. Hypoleptinemia, as a result of the food restriction, may represent the initial trigger for the increased activity levels in AN patients and in food-restricted rats. In the first and second parts of our review, we will summarize the relevant findings pertaining to hyperactivity in AN patients and in the rat model, respectively. We conclude with a synopsis and implications for future research.

The timing, specificity and clinical prediction of tricyclic drug effects in depression

This research was aimed at studying the rate of action of tricyclic drugs in depressive disorders, specifying the behavioural effects associated with recovery, and predicting clinical response. The research design involved comparison of a recovered group with a group treated for the equivalent four weeks, who showed minimal to no response. The findings indicated significant differences in baseline characteristics between responders and non-responders. Further, the drugs were found to act early in the responders, within the first week of treatment. Specific changes at one week which distinguished responder and non-responder groups occurred in the disturbed affects, and in cognitive functioning. Improvements also occurred in somatic symptoms, but these latter changes were general and not associated with later recovery. At 2 1/2 weeks, all facets of the depressed condition showed positive change in the responders. Implications of the results for assessing rate of tricyclic drug actions, their effects on the interaction of affect and neurochemistry, and the practical application of the results for the clinical situation, are discussed.

Personality dimensions in eating disorders and their relevance for subtyping

Personality dimensions and psychopathological symptoms were assessed in 50 female patients hospitalized for the treatment of anorexia nervosa or bulimia nervosa and in 19 healthy female controls of similar age. Restricting anorexia nervosa patients, who had lost weight by consistently reducing their food intake, reported significantly greater self-control, inhibition of emotionality, and conscientiousness than controls or bulimia nervosa patients, before and after the data were corrected for depressive and eating pathology. Both nonbulimic and bulimic anorexia nervosa patients expressed stronger than normal conformance to moral and family values. On the impulsivity dimension, bulimia nervosa patients scored in the high normal range, whereas bulimic anorexia nervosa patients rated in the low normal range. The results suggest that a personality disposition toward overcontrol and reserve might constitute a risk factor for the restricting type of anorexia nervosa through fostering restrictive behavior toward food and avoidance of personal relationships.

Antipsychotic Drugs: Clinical Pharmacology and Therapeutic Use

SummaryNo specific treatment of the schizophrenias and other psychoses was available until Laborit’s discovery of chlorpromazine as the first antipsychotic agent. Since then the introduction of widespread use of antipsychotic drugs has led to a marked reduction in the number of hospitalised shizophrenic patients. Hundreds of controlled studies have demonstrated the superiority of antipsychotic drugs over placebo in the treatment of schizophrenia.Different classes of antipsychotic drugs are equally effective in the treatment of psychoses when administered in adequate doses, but they differ in range and severity of side-effects. For the average schizophrenic patient, mega doses of antipsychotic drugs do not produce greater improvement than conventional doses. The same dose of antipsychotic drugs leads to widely divergent drug blood levels in individual patients, due to differences in absorption, and rate of elimination of the drug.Maintenance treatment with antipsychotic drugs reduces the relapse rate in schizophrenic patients.Side-effects of antipsychotic drugs involve the autonomic nervous system and the cardiovascular system, as well as the CNS with the development of extrapyramidal symptoms; in addition skin and eye changes, as well as allergic and endocrine changes, occur. Late or tardive dyskinesia is an extrapyramidal syndrome which can occur after long-term antipsychotic treatment and may be reversible when recognised in the initial stages.

Weight and eating concerns among pre- and young adolescent boys and girls

The emergence of weight and eating concerns in pre- and young adolescents and the relations of these concerns to daily experience and psychologic adjustment were investigated. Four hundred eighty-one children from fifth to ninth grades completed a Weight and Eating Concerns Scale, a depression inventory, self-esteem and body image scales, and reported their daily experiences by the Experience Sampling Method. Girls tended to report more weight and eating concerns than boys. This discrepancy increased with age. In older girls (eighth and ninth graders) extreme weight and eating concerns were associated with other signs of emotional maladjustment. Girls who experience emotional distress may try to compensate for the strain by controlling body shape and in doing so, may place themselves at risk for developing an eating disorder. Boys currently appear to be protected from this difficulty. Our findings suggest that excessive weight and eating concerns in young adolescent girls signal psychologic maladjustment which may require attention.

Hypothalamic-pituitary-adrenocortical function in mixed and pure mania.

There is little information about hypothalamic‐pituitary‐adrenocortical (HPA) axis function in mania, particularly in mixed states. We therefore investigated HPA function and its relationship to clinical state in 19 hospitalized manic patients meeting Schedule for Affective Disorders and Schizophrenia ‐ Research Diagnostic Criteria for acute manic episodes, compared patients with and without a mixed presentation, and examined correlations between HPA activity and behavior. Data were available from 13–16 patients. Behavioral and biochemical analyses were conducted during a 15‐d placebo period. Patients with mania had elevated cerebrospinal fluid (CSF) and urinary free cortisol excretion compared with healthy subjects, and did not differ from depressed patients in any cortisol measures. Mixed manics had significantly higher morning plasma cortisol, postdexamethasone plasma cortisol and CSF cortisol than pure manics. Five of 7 mixed manics and 3 of 9 pure manics were dexamethasone suppression test (DST) nonsuppressors. Afternoon plasma cortisol and CSF cortisol correlated significantly with depressed mood; urinary free cortisol correlated with anxiety. None of the cortisol measures correlated with mania or agitation scores. These data suggest that increased cortisol secretion is a characteristic of the depressed state in mixed manics, although pure manics may also have increased DST nonsuppression.

Relevance of animal models to human eating disorders and obesity

Background and rationaleThis review addresses the role animal models play in contributing to our knowledge about the eating disorders anorexia nervosa (AN) and bulimia nervosa (BN) and obesity.ObjectivesExplore the usefulness of animal models in complex biobehavioral familial conditions, such as AN, BN, and obesity, that involve interactions among genetic, physiologic, psychological, and cultural factors.Results and conclusionsThe most promising animal model to mimic AN is the activity-based anorexia rodent model leading to pathological weight loss. The paradigm incorporates reward elements of the drive for activity in the presence of an appetite and allows the use of genetically modified animals. For BN, the sham-feeding preparation in rodents equipped with a gastric fistula appears to be best suited to reproduce the postprandial emesis and the defects in satiety. Animal models that incorporate genes linked to behavior and mood may clarify biobehavioral processes underlying AN and BN. By contrast, a relative abundance of animal models has contributed to our understanding of human obesity. Both environmental and genetic determinants of obesity have been modeled in rodents. Here, we consider single gene mutant obesity models, along with models of obesigenic environmental conditions. The contributions of animal models to obesity research are illustrated by their utility for identifying genes linked to human obesity, for elucidating the pathways that regulate body weight and for the identification of potential therapeutic targets. The utility of these models may be further improved by exploring the impact of experimental manipulations on the behavioral determinants of energy balance.

NEUROENDOCRINE AND AMINE STUDIES IN AFFECTIVE ILLNESS

SUMMARY (1) There are limitations to some of these studies because of the small number of patients involved, but our data suggest that maximal Growth Hormone (GH) levels after induced hypoglycemia were lower in depressed patients than in control subjects. (2) Manic patients showed low GH peaks during the Insulin Tolerance Test (ITT), and furthermore urinary 3-methoxy-4-hydroxyphenylene glycol (MHPG) excretion rates in mania were indistinguishable from normals but higher than in depressed patients. (3) The apomorphine-induced GH response was essentially normal in affective disorder patients, while acute schizophrenic patients showed hypersensitivity of postsynaptic dopamine receptors. (4) Confirming previous studies by Maas et aL (1968, 1972), patients with depressive illness were found to have siguicantly lower urinary MHPG excretion, whereas borderline patients with depressive symptomatology had MHPG values similar to control subjects.

On the emergence of bulimia nervosa as a syndrome a historical view

A review of the anorexia nervosa literature suggests that bulimia as a symptom has been known throughout the past century, but that bulimia as a syndrome is of recent origin, around 7940, when it occurred in connection with anorexia nervosa. Comments indicating concern over body shape are infrequent in case reports before the forties, but afterwards become the rule. It is hypothesized that changes in the cultural and economic conditions, such as the rising prosperity after the Depression Years, promoted an increased concern over body weight and recruited not only more, but also women of a psychologically different composition from the traditional anorexia nervosa patient, into dieting. This situation exposed more females to the risk of developing anorexia nervosa and those with a particular vulnerability, for example a tendency for aftective instability, to the risk of developing bulimia nervosa. Similar dynamics might have promoted the unfolding of the bulimia nervosa syndrome in the late fifties and sixties. Bulimia nervosa denotes a condition in dieting teenage girls or young women which is characterized by recurrent episodes of uncontrollable overeating or binge-eating followed commonly by self-induced vomiting or prolonged abstinence from food, vigorous exercise and/or intake of purgatives. As a result of this abnormal eating pattern, the body weight of such patients fluctuates up and down, usually by not more or less than 15% (Diagnostic and