Timothy M. Rivinus

Amitriptyline in the Treatment of Anorexia Nervosa: A Double-blind, Placebo-controlled Study

The tricyclic antidepressant drug amitriptyline was evaluated as a short-term treatment of anorexia nervosa patients. In a 5-week double-blind, placebo-controlled study 11 patients were given amitriptyline and 14 received placebo. In addition, 18 patients who refused to participate in the drug trial and received only psychosocial treatment were used as an additional comparison group. Overall, patients in the three groups showed little improvement. No statistically significant differences favoring amitriptyline were found in any of the outcome variables. Plasma levels varied widely among patients receiving similar doses. No association was found between plasma levels and improvement in either psychiatric symptomatology or weight. Amitriptyline patients did not manifest any tendency for a reduction of depressive symptomatology. In addition, amitriptyline treatment was associated with substantial discomfort and adverse affects.

Psychiatric effects of the anticonvulsant regimens.

The necessity for and efficacy of the anticonvulsant regimens are undisputed. However, inasmuch as epileptic patients are prone to psychiatric disorders, neurologists, psychiatrists, and others working with epileptic patients need to be aware of the role that anticonvulsant regimens may play in causing or exacerbating psychiatric disorders. Additionally, some of the anticonvulsants are thought to have potent positive psychotropic effects. The current literature on this important bio-psychosocial topic is reviewed with the purpose of suggesting helpful clinical and research approaches to patients treated by such methods.

Urinary MHPG in anorexia nervosa patients with and without a concomitant major depressive disorder

Twenty-four hour urinary MHPG excretion was measured in a group of anorexia nervosa patients before and after five weeks of treatment and in matched normal control subjects. A sub-group of anorexia nervosa patients who met research diagnostic criteria (RDC) for a concomitant major depressive disorder (AN-RDC +) was found to have, both initially and after treatment, significantly lower mean urinary MHPG levels than the normal control subjects. In contrast, mean urinary MHPG levels in anorexia nervosa patients who did not meet criteria for major depressive disorder (AN-RDC +) were similar to values in normal controls. Utilizing the median value of all urinary MHPG samples as the cut-off point, it was found that significantly more AN-RDC + patients excreted low MHPG compared with AN-RDC-patients and normal control subjects. The manifestation of a major depressive disorder according to RDC was found to be more important than body size variables in predicting the variance of MHPG. It is suggested that urinary MHPG levels may be useful in discriminating between sub-types of anorexia nervosa patients.

Concurrent Validation of a Behavior Problems Scale to Use with 3-Year-Olds

Abstract A 12-item behavior questionnaire adapted for a parent interview is shown to represent a valid index of current behavioral adjustment in preschool children. The validity of the questionnaire is checked against the clinical judgment of six psychiatrists and psychologists using data derived from a total population sample of 3-year-old children. The data are comprised of information gathered in parent interviews and home-based play sessions with the children. Using an epidemiologic approach, the sensitivity and specificity of the questionnaire are determined. Recommendations are made regarding the use of the questionnaire for different public health and clinical purposes.

MMPI profiles in anorexia nervosa patients with and without major depression

Anorexia nervosa patients with (AN-RDC+) and without (AN-RDC-) a current episode of nonbipolar major depression (MDD) differed with respect to their Minnesota Multiphasic Personality Inventory (MMPI) profiles. Mean MMPI scores in AN-RDC+ significantly differed from AN-RDC-patients in all but two MMPI scales. AN-RDC+ patients had a significantly higher number of abnormal (T greater than 70) MMPI scales per subject and significantly more subjects with greater than or equal to 3 abnormal scales compared with AN-RDC-patients. These MMPI data suggest that the presence or absence of MDD in anorectic patients may distinguish meaningful subtypes and provide further support for the validity of the stratification of anorectic patients into those with and without nonbipolar MDD.