Other psychiatric disorders among bulimic patients.

Clinical experience suggests that bulimia nervosa is a disorder often accompanied by additional psychiatric symptoms. Based on unstructured clinical interviews, 21 additional Axis I and six Axis II diagnoses were assigned to a sample of 30 bulimic women. The Structured Clinic Interview for DSM-III-Patient Version (SCID-P) generated 47 additional Axis I and 78 Axis II diagnoses. There was little agreement across measures in the assessment of mood disturbance. These results not only suggest a greater degree of pathology in bulimic women, but also raise important questions regarding the measurement and conceptualization of DSM-III-R Axis II disorders.

Receptor-mediated effects of glucocorticoids on inflammation: enhancement of the inflammatory response with a glucocorticoid antagonist.

Glucocorticoids suppress the inflammatory response by altering leukocyte traffic and function, cytokine secretion and action, and phospholipid metabolism. We employed the glucocorticoid receptor antagonist RU 486, to examine whether glucocorticoids suppress the inflammatory response through a receptor-mediated mechanism and whether basal glucocorticoid secretion exerts antiinflammatory effects in the resting (non-stress) state. To test these hypotheses we evaluated the effects of increasing doses of dexamethasone, RU 486, or dexamethasone plus RU 486 on the exudate volume and concentrations of leukocytes, prostaglandin E2, (PGE2) and leukotriene B4 (LTB4) in intact rats that received subcutaneous carrageenin. Exudate volume, leukocyte concentration and LTB4 and PGE2 levels were all suppressed by dexamethasone in a dose-dependent fashion (P less than 0.005). RU 486 was able to antagonize fully the suppressive effects of dexamethasone on the inflammatory response (P less than 0.001) and to cause increases of exudate volume and leukocyte, PGE2 and LTB4 concentrations when given alone (P less than 0.05). These increases ranged between 30 and 100% above the basal inflammatory response. We conclude that glucocorticoids most likely suppress the inflammatory response by a glucocorticoid receptor-mediated mechanism and under basal conditions exert tonic antiinflammatory effects.

Disulfiram treatment of alcoholism. A Veterans Administration cooperative study.

We conducted a controlled, blinded, multicenter study of disulfiram treatment of alcoholism in 605 men randomly assigned to 250 mg of disulfiram (202 men); 1 mg of disulfiram (204 men), a control for the threat of the disulfiram-ethanol reaction; or no disulfiram (199 men), a control for the counseling that all received. Bimonthly treatment assessments were done for one year. Relative/friend interviews and blood and urine ethanol analyses were used to corroborate patients' reports. There were no significant differences among the groups in total abstinence, time to first drink, employment, or social stability. Among the patients who drank and had a complete set of assessment interviews, those in the 250-mg disulfiram group reported significantly fewer drinking days (49.0 +/- 8.4) than those in the 1-mg (75.4 +/- 11.9) or the no-disulfiram (86.5 +/- 13.6) groups. There was a significant relationship between adherence to drug regimen and complete abstinence in all groups. We conclude that disulfiram may help reduce drinking frequency after relapse, but does not enhance counseling in aiding alcoholic patients to sustain continuous abstinence or delay the resumption of drinking.

Long-term stability of aqueous solutions of luteinizing hormone-releasing hormone assessed by an in vitro bioassay and liquid chromatography.

The stability of aqueous solutions of luteinizing hormone-releasing hormone (LHRH) after extended storage at various temperatures was investigated using a newly developed HPLC assay and an in vitro dispersed pituitary cell culture bioassay. Good correlations were obtained between the potency obtained by HPLC and bioassay in samples stored at 37 degrees C or subjected to different stress conditions. No significant decrease in activity of LHRH was observed in aqueous solutions stored at 37 degrees C for up to 10 weeks, at 4 degrees C for 2 years, or subjected to repeated freezing and thawing for 5 d. Heating to 60 degrees C in sterile pH 9.0 buffer up to 11 d and storage at ambient temperature in nonsterile solution for 4 months produced well-distinguished degradation products and a decrease in potency. It is concluded that sterile aqueous solutions of LHRH are stable for at least 10 weeks at 37 degrees C and, thus, could be reliably used for chronic administration when long-term stability at body temperature is important.

Alteration in the plasma testosterone: estradiol ratio: an alternative to the inhibin hypothesis.

The data suggest that in the absence of the testis: (1) testosterone can maintain both FSH and LH concentrations chronically within the physiological range; (2) that estradiol preferentially suppresses plasma LH concentration, indicating that the androgenic component of testosterone modulates FSH secretion; and (3) that subphysiological testosterone concentrations accompanied by physiological estradiol levels permit FSH to escape to midcastrate levels while maintaining LH concentration at intact levels. An alteration in the testosterone: estradiol ratio can account for a selective FSH elevation when testosterone production is low. The data provide an alternative explanation for the inhibin phenomenon.

Effects of behavioral and pharmacological weight loss programs on nutrient intake.

Behavior therapy is a widely used method for short-term weight control. Formal nutrition counseling is not included in many behavioral programs. To determine what types of diets were self-selected by patients and to see how they compared with individuals participating in a relaxation group with anorectic medication, the eating diaries compiled by participants in such a program were analyzed for 20 different nutrients. In general, pretreatment intakes were nutritious and typical for Americans. Both the behavioral and a relaxation-medication treatment produced weight loss and reduction in calorie intake. Both treatments were associated with the consumption of a fairly nutritious diet not much different from the pretreatment intake except for a reduction in the amount eaten.

Effects of a combined behavioral and pharmacological program on weight loss.

The effects of an 'anorectic' drugs as an adjunct to a behavioral weight-loss programme were investigated. Four groups of 20 began an initial two weeks of instruction. Groups 1, 2, and 3 were instructed in a behavioral programme utilizing a food diary, stimulus control techniques, and reinforcement. Group 4 was instructed in a relaxation programme. Group 1 took phentermine resin 30 mg for eight weeks, followed by a placebo for eight. Group 2 took placebo for eight and phentermine for eight. Group 3 took placebo for 16. Group 4 took placebo for eight and phentermine for eight. All groups were followed for an additional eight weeks. A significant number of subjects in all behavioral groups achieved some weight loss. (A significant difference among the mean percentage body weight reduction for the three behavioral groups was also found.) In addition, a group of 'slow losers' who initially lost less than one half-pound (0.2 kg) per week and were subsequently placed on phentermine lost significantly more weight than a similar group which continued on placebo. These differences were maintained for 24 weeks.

Marijuana: effects on free recall and subjective organization of pictures and words.

The free recall of pictures and words was compared following the administration of marijuana or placebo in a multitrial free recall task. Since pictures are thought to be registered in both visual and verbal memory stores with this encoding being mediated by some form of mental imagery, it was predicted that marijuana would produce a greater deficit in word recall in comparison to picture recall because the drug has been reported to facilitate imagery. A trend in the opposite direction followed intoxication; picture recall was inferior to word recall in the later stages of acquisition. Although overall recall was inferior under marijuana, no differences were found between the treatment conditions in subjective organization as determined by a variety of clustering measures. Recall performance following marijuana intoxication was positively related to level of recall performance in the placebo condition.

Marijuana and memory impairment: effect on free recall and recognition memory.

The effect of marijuana on memory was evaluated by presenting two groups of 17 male volunteers with lists of repeated or nonrepeated words following administration of a single marijuana cigarette containing 14 mg delta9-THC. An immediate free recall, final free recall and recognition memory test followed. Results indicated that marijuana significantly decreased immediate and final free recall but only slightly influenced recognition memory. Rate of acquisition on the repeated lists was the same for both groups. Long term retention of encoded information was not influenced by marijuana. The shape of the serial position curves departed slightly from those reported by other investigators in that some effects of the drug on the recency portion of the curve were noted. Both internal and external intrusions were elevated under marijuana.

Marijuana: effects on storage and retrieval of prose material.

In a two phase design, an attempt was made to differentiate the effect of marijuana on the storage and retrieval of prose material. In the first phase, 40 male subjects were administered a single 500 mg marijuana cigarette containing 2.1%delta9-THC or a placebo cigarette. Fifteen minutes after smoking, they listened to and at the same time read a narrative passage of approximately 200 words in length. Subsequently, an immediate free recall test was given in which subjects were required to write down as much of the story as they could remember. The second phase was conducted 24h later. Marijuana and placebo subjects were randomly subdivided into four groups with half of the subjects participating in the same drug condition as occurred on day one while the others switched drug state. Fifteen minutes after smoking, all subjects recalled the passage presented on day one and then were given 24 questions concerning facts and events in the story which could be answered in a few words. These questions served as retrieval cues. Following this, a new passage was presented in the same manner as occurred on day one. After an immediate free recall test, another cued recall test was administered. Results indicated that marijuana reduced immediate recall under both cued and uncued conditions incomparison to placebo. No relative cued recall advantage was found in the marijuana groups for the old or new story and marijuana produced only a moderate decrement in recall of the old story on day two. However, marijuana given in the second phase significantly reduced memory for items recalled in the initial phase irrespective of drug or cueing condition in phase one, suggesting that retrieval was also affected. Some decrement in recall of the new story did occur as a function of drug state change in group M-P. This effect was related to the serial position of input items. Serial position did not interact with drug state under any other recall condition.

Marijuana: dose-response effects on pulse rate, subjective estimates of potency, pleasantness, and recognition memory.

34 experienced marijuana users were divided into four equated groups of eight subjects each based on recognition memory test performance. One week later each group was retested following administration of marijuana containing 0, 5, 10 or 15 mg delta9-tetrahydrocannabinol. A dose-related effect of marijuana on pulse rate and subjective measures of potency and pleasantness occurred. Ratings of potency and changes in pulse rate were highly correlated, but this relationship did not hold within a given dosage group as determined by partial correlations. No effect of marijuana on the distribution of hit and false alarm rates or confidence ratings during the recognition memory test was noted.

Marijuana and memory impairment: the effect of retrieval cues on free recall.

In an attempt to ascertain the effect of retrieval cues on recall deficits which occur following intoxication with marijuana, 40 male volunteers were presented with word lists following the smoking of a single one gram marijuana (0.94% delta 9 -THC) or placebo cigarette and then were required to recall these words immediately after presentation. Recall occurred under a condition in which cues representative of to-be-remembered words were present or in an uncued condition. Results indicated that recall was depressed following marijuana administration under both cued and uncued conditions with cues being only mildly effective in reversing the recall deficit. There was no increase in the number of internal intrusions under marijuana, but the number of external intrusions was significantly elevated under the cued conditions.

Cancer, emotions and mental illness: the present state of understanding.

The authors review recent and current literature on the relationship between psychological factors and cancer. They discuss the roles of predisposing personality patterns and emotional stress in the development, site, and course of cancer; the influence of awareness of terminal illness on the behavior of cancer patients; and the management of psychiatric symptoms in these patients.