Long-term follow-up of patients' status after gastric bypass.

BACKGROUND: We report a long-term (13-15 year) follow-up of a cohort of 100 patients who underwent gastric bypass for morbid obesity. METHODS: Sources of information include baseline data collected before surgery and information obtained at follow-up interview including data on weight history, psychosocial functioning, and medical complications. RESULTS: Mean age at follow-up was 56.8 years. The mean weight loss at long-term follow-up was 29.5 kg (range -13.6 to 93.6 kg). Three subjects weighed more at long-term follow-up than before the operation. Overall, 74% of those interviewed indicated that the gastric bypass had benefited them in terms of their physical health. However, 68.8% reported continued problems with vomiting and 42.7% with "plugging". Eight had died. CONCLUSION: The findings in this study suggest that at long-term follow-up the majority of individuals who have undergone gastric bypass feel that the procedure benefited them, although some complications including difficulties with "plugging" and vomiting were present at long-term follow-up.

Using interactive voice response technology and timeline follow-back methodology in studying binge eating and drinking behavior: different answers to different forms of the same question?

As part of a study of the relationship of binge eating, alcohol use, mood, and stressors, we compared the results of two forms of reporting on binge eating and drinking behavior. Forty-three first-year college women participated in an interactive voice response (IVR) study for 12 weeks. Participants answered computer-administered questions daily via IVR technology on number of eating binges and number of alcoholic drinks consumed. After 12 weeks, participants completed a Timeline Follow-back (TLFB) interview retrospectively for number of binges and drinks in the past 12 weeks. Results of this distally retrospective methodology (commonly used in drinking research and applied here also to binge eating) were compared to the results of daily IVR reporting. There was convergence across measures for drinking behavior, but divergence between IVR and TLFB for binge eating reports. TLFB reports underrepresented actual binge eating frequency, which calls into question the validity of applying this methodology to the assessment of binge eating.

Metabolic rate in the right amygdala predicts negative affect in depressed patients.

The role of the amygdala in major depression was investigated. Resting regional cerebral metabolic rate (rCMRglu) was measured with [18F]fluorodeoxyglucose positron emission tomography (PET) in two samples of subjects using two different PET cameras. The samples consisted of 10 and 17 medication-free depressives and 11 and 13 controls, respectively. Using coregistration of PET and magnetic resonance images, regions were individually delineated for the amygdala and thalamus, the latter of which was used as a control region. Within the depressed groups, right amygdalar rCMRglu was positively correlated with negative affect. Thalamic rCMRglu was not related to negative affect, and amygdalar rCMRglu accounted for a significant portion of variance in depressives' negative affect scores over and above the contribution of thalamic rCMRglu.

The relationship between intravenous cocaine self-administration and avidity for saccharin.

Two experiments were conducted to determine whether measures of saccharin intake could be used as a predictor of intravenous cocaine self-administration. Saccharin avidity, defined as the ratio of total daily fluid intake when saccharin and water were available to total intake when only water was available, was measured in male rats. Cocaine self-administration (0.4 mg/kg/infusion) was subsequently measured in an initial 18-h session, followed by daily 1-h sessions in which the infusion dose and the reinforcement schedule were varied. In the initial overnight session, some rats obtained the maximum or near-maximum number of infusions; this high level of cocaine intake was unrelated to saccharin avidity. In the remaining rats, there was a pattern somewhat resembling an "inverted-U," in which rats with low or high avidity self-administered less cocaine than those with intermediate avidity. This pattern reemerged later in the experiment when rats were tested at a low cocaine infusion dose combined with a FR-6 reinforcement schedule. In a second experiment, no significant relationship was observed between the self-administration of a lower cocaine dose (0.125 mg/kg/infusion) and avidity for either saccharin or the artificial sweetener SC-45647. Although these results are consistent with a previous report indicating no simple relationship between saccharin preference and the acquisition of cocaine self-administration, they do suggest that a more complex relationship may be observed under some conditions. Additional research with other drugs, as well as with caloric and noncaloric sweeteners, will be needed to determine the usefulness of taste measures in identifying or treating substance abuse.

Sleep-onset rapid eye movement after electroconvulsive therapy is more frequent in patients who respond less well to electroconvulsive therapy.

The response to electroconvulsive therapy (ECT) was monitored with sleep polysomnography studies (SPS) performed pre- and post-ECT, in 25 patients with major depressive disorder (MDD). Patients included in this study met research diagnostic criteria for MDD and had been free of psychotropic medication for at least 10 days before SPS were performed. We compared ECT responders and nonresponders on SPS, demographic, and clinical parameters. Many SPS parameters, regardless of the clinical response, changed significantly with ECT. The presence of delusions was significantly associated with SOREM post-ECT. The presence of sleep-onset REM periods post-ECT was associated with poor response to ECT. SPS performed during a course of ECT may help identify patients at risk of responding less well to this modality of treatment.

Obsessionality in eating-disorder patients: relationship to clinical presentation and two-year outcome.

Obsessionality and obsessive-compulsive symptoms have been regarded as important characteristics in the clinical presentation of the eating disorders. In this report, we examined the relation between obsessionality and the clinical presentation and outcome of a sample of eating-disordered patients. Self-rated obsessional symptoms, defined by the obsessive-compulsive subscale of the Symptom Checklist 90 (revised version), were compared with presenting clinical symptomatology, and scores on the Eating Disorder Inventory (EDI) and Beck Depression Inventory (BDI) in a sample of 110 consecutively evaluated women who met DSM-IIIR criteria for eating disorders. Forty patients were contacted for a follow-up investigation, 2 years after the initial evaluation. Higher obsessive-compulsive subscale scores at presentation were associated with more severe dieting, a greater number of psychiatric hospitalizations, and higher EDI, SCL-90R and BDI scores. Initial obsessive-compulsive scores did not predict the subsequent outcome of a sample of these patients in the community. However, elevated obsessive-compulsive scores obtained at follow-up were associated with the presence of lower body weight and more severe eating-disorder symptoms at that time. These results support the hypothesis that elevated obsessionality is associated with more severe eating disorder symptomatology. In addition, obsessional symptoms change along with those of the eating disorder, and their persistence may be associated with a poorer outcome.

Naloxone, an opiate blocker, reduces the consumption of sweet high-fat foods in obese and lean female binge eaters.

To test the hypothesis that endogenous opiate peptides selectively influence hedonic response to sweet and high-fat foods, the opiate antagonist naloxone, opiate agonist butorphanol, and a saline placebo were administered by intravenous infusion to 16 obese and 25 normal-weight women. Twenty of the women (10 obese, 10 lean) fulfilled DSM-III-R diagnostic criteria for bulimia nervosa, as determined by psychiatric interview. During drug infusion the women tasted and rated 20 sweetened dairy products and were presented with eight snack foods of varying sugar and fat content. Naloxone suppressed hedonic responses in all subject groups and suppressed the consumption of sweet and high-fat foods in binge eaters, but not in nonbingers. Food intakes of obese women were not affected by naloxone. Butorphanol had no effect on either hedonic response or on food consumption in any group. Although opiate blockade is not a viable strategy for weight reduction in the treatment of obesity, it may be useful in the clinical management of the binge-eating disorder.

Development and initial validation of a measure of drinking urges in abstinent alcoholics.

Although drinking urges and cravings are commonly reported by alcoholics, prospective studies have found inconsistent associations between such urges and drinking relapses. Previous studies have measured drinking urges by use of single-item ratings of alcohol craving or other measures of unknown reliability and validity. To permit improved evaluation of hypotheses regarding alcohol craving, a 49-item questionnaire that reflects several urge-related domains was developed and pretested. Items assessed subjects' desire for a drink, expectations of positive effects following drinking, relief of withdrawal and negative affect following drinking, and intention to drink. Exploratory and confirmatory factor analyses of the responses of 351 abstinent, treatment-seeking alcoholics indicated that alcohol urges are best described by a single factor. Based on these analyses, an internally consistent, reliable, and psychometrically valid 8-item scale, the Alcohol Urge Questionnaire (AUQ), was developed. Data indicated that AUQ scores were strongly related to alcohol dependence severity and to cognitive preoccupation with alcohol, and that they declined with prolonged abstinence. The AUQ may be useful in alcoholism treatment research and in laboratory studies of reactivity to alcohol or other manipulations.

Effects of body image on dieting, exercise, and anabolic steroid use in adolescent males.

This cross-sectional survey study examined body image, dieting and exercise variables, and steroid use in 2,088 high-school graduates aged 18 years. In contrast to women, more men wished to gain (46%) rather than loose weight (32%). Men who wished to gain weight were more satisfied with their body shape, showed no fear of fatness, and dieted and exercised less frequently than did men who wished to lose weight. The prevalence of dieting was low (4%), even among men who wished to lose weight (9%), and physical exercise was more likely to be used for both weight loss and weight gain. Contrary to expectations, anabolic steroid use was rare (0.6%) and was not associated with a desire for weight gain. Steroid users were more likely to engage in running and swimming than football. The data did not support the notion that anabolic steroid use is widespread among high-school males.

The severity of dieting and bingeing behaviors in college women: interview validation of survey data.

A combined survey and interview study was conducted to validate a categorical Dieting and Bingeing Severity Scale (DBSS), and to estimate the prevalence of eating disorders in young women. We hypothesized that assignment to the DBSS categories would be confirmed by clinical interviews such that interview-diagnosed eating disorders would be found with increasing frequency and severity at the upper end of the DBSS. Freshmen college women (n = 1367) completed a survey instrument addressing the frequency and severity of dieting, binge-eating, and other behaviors and attitudes related to weight control. Random stratified sampling procedures were used to select a subset of women (n = 306) from each DBSS category for structured clinical interviews for DSM-III-R (SCID). Survey respondents were assigned to one of six mutually exclusive DBSS categories: non-dieters (9% of sample), casual dieters (26%), moderate dieters (23%), intense dieters (21%), dieters at-risk (19%), and probable bulimia nervosa (2%). The DBSS effectively rank-ordered subjects according to the risk of having interview-diagnosed eating disorders. Women in the three most severe DBSS categories were significantly more likely to have current subthreshold and threshold level eating disorders, in particular bulimia nervosa and eating disorder not otherwise specified (EDNOS). The estimated prevalence of current bulimia nervosa was approximately 2% by both survey and interview methods. The prevalence of current EDNOS was 13%, more than six times greater than the prevalence of bulimia nervosa. The DBSS was found to be a reliable and valid measure of dieting and bingeing severity. The survey instrument may be useful in measuring the extent of, and changes in, pathological dieting in community-based samples of young women, and in studying comorbidity of dieting and bingeing severity with other psychiatric conditions including depression and substance use. The DBSS may also be useful in identifying risk factors associated with the onset of eating disorders.

Intravenous morphine self-administration by rats with low versus high saccharin preferences.

An experiment was performed to determine the relationship between saccharin preference and the self-administration of morphine via the oral and intravenous routes. On the basis of voluntary intake of a saccharin solution by male rats, low and high preference groups were formed. Rats selected for high saccharin preference self-administered more morphine intravenously than rats selected for low preference. The two groups did not differ in oral morphine intake. The positive relationship between the intake of saccharin and intravenous morphine self-administration may be due to their mediation by a common mechanism. Measures of taste sensitivity or preference may be useful in identifying individuals at risk for drug abuse.

Weight-loss strategies of young adults: exercise versus dieting.

This cross-sectional survey study examined weight control practices of 2,092 male and 1,748 female feshman students aged 18 years. For women, the desire for weight loss was observed at all levels of body weight. Most women (79%) wished to weigh less than their current weight, and 23% were following a restricted-calorie diet. In contrast, more men wished to gain (46%) rather than lose weight (32%), and only 3% were dieting at the time of the study. A comparison of weight control practices of men and women who wished to lose weight showed that women restricted calories far more frequently than did men. In contrast, although men were more likely to use exercise for weight control than were women, the differences between the sexes were small. A combined analysis of dieting and exercise behaviors showed that while men relied almost exclusively on intensive exercise as opposed to dieting, women employed exercise as well as dieting for the purpose of weight control.

Eating pathology and DSM-III-R bulimia nervosa: a continuum of behavior.

This longitudinal survey study of 557 college women used the new Eating Pathology Scale to classify respondents as nondieters, casual dieters, intensive dieters, dieters at risk, and bulimic. Shifts in the severity of dieting behavior over a 6-month period occurred primarily between adjacent scale categories. While new cases of bulimia were drawn from intensive dieters and dieters at risk, those women who no longer met DSM-III-R criteria for bulimia nervosa continued to engage in bulimic behavior.

Body weight and dieting in adolescence: impact of socioeconomic status.

This cross-sectional survey study examined dieting and exercise variables as a function of parental education in 2,174 male and 1,804 female college-bound high school graduates aged 18 years. Parental education is an index of socioeconomic status (SES). Higher SES was associated with lower current and desired body weight in both women and men. The prevalence of dieting, binging, and vigorous exercise for weight control increased with SES for women but not for men. These data confirm the inverse relationship between body weight, dieting, and social class, previously demonstrated with American adults.

Findings from the Seasonal Pattern Assessment Questionnaire in patients with eating disorders and control subjects: effects of diagnosis and location.

We previously reported a high degree of seasonality as measured by the Seasonal Pattern Assessment Questionnaire (SPAQ) in 41 patients with eating disorders (ED) compared with control subjects and patients with five other affective spectrum disorders. To clarify the relationship of the specific ED diagnosis and latitude to seasonal variation in a larger sample, we administered the SPAQ to 159 women with ED as defined by DSM-III-R. Subtype diagnoses were as follows: bulimia nervosa (BN), n = 109; anorexia nervosa (AN), n = 30; BN+AN, n = 20. Patients were studied at three locations: National Institute of Mental Health (NIMH), n = 46; Medical University of South Carolina (MUSC), n = 53; University of Michigan (UM), n = 60. The control group comprised 50 female normal volunteers studied at NIMH. There was a statistically significant difference in Global Seasonality Scale (GSS) scores among the four diagnostic groups, and all ED subtypes had significantly higher GSS scores than control subjects after post hoc Bonferroni t tests. Higher GSS scores were also found in patients with BN+AN compared with patients with BN or AN alone. The patterns of change were similar to those observed in winter seasonal affective disorder (SAD). Thirteen percent of the total sample of ED patients met SPAQ criteria for winter SAD, with 2.5% each for summer SAD and subsyndromal SAD. UM BN patients (latitude 42 degrees N) had higher GSS scores and a higher prevalence of winter SAD than MUSC BN patients (latitude 33 degrees N), but this difference was not statistically significant. These data support the hypothesis that ED and SAD may involve similar pathophysiological mechanisms, possibly related to serotonin dysregulation.

Ethanol reinforcement and its relationship to saccharin preference in Wistar rats.

Forty rats were given a choice between 0.1% sodium saccharin and water. Based on their intakes, three groups of six rats representing high, intermediate, and low saccharin preferences were selected. These rats were reduced to 80% of their free-feeding weights. Ethanol was established as a reinforcer by use of a food-induced drinking procedure. Between-group differences were assessed based on response rates across acquisition sessions (0, 1, 2, 4, 5.7, 8%, w/v), a fixed-ratio series (1, 2, 4, 8, 1), and a concentration series (8, 5.7, 4, 2, 2, 4, 5.7, 8, 11.3, 16, 22.6, 32, 8%, w/v). In 29 of 32 conditions which were analyzed, the mean number of responses for ethanol was higher for the high saccharin preference group than for the low, and in 25 of 32 conditions, the intermediate group fell between the high and the low. However, there was considerable variability within groups across all conditions, such that mean between-group differences were not significant. This variability may be reduced by considering diet preferences in addition to saccharin preference. Nonetheless, these results offer limited support for the increasing body of evidence indicating a relationship between the factors mediating ethanol self-administration and those involving ingestion of palatable foods and fluids.

The effects of continuous morphine infusion on diet selection and body weight.

The administration of morphine causes a short-term increase in food intake, and repeated administration of morphine has been shown to cause progressively larger increases in intake and/or the relative intake of dietary fat. In this experiment, we measured the effects of continuous morphine infusions on diet choice and total intake. Male rats were given ad lib access to two diets: a high-carbohydrate diet (80% carbohydrate, 20% protein) and a high-fat diet (80% fat, 20% protein). Diet intakes were measured daily for 21 days. Via the implantation of osmotic minipumps, one group received continuous infusions of morphine sulfate (approx. 2.8 mg/kg/h) for days 1-7 and of saline for days 8-14. A second group was infused with saline for days 1-7 and with morphine for days 8-14. A third group received sham surgery but no minipumps. Total caloric intake was significantly decreased on the final 6 days of morphine infusions. The percentage of total caloric intake consumed from the high-fat diet was significantly increased for the first 2-3 days of morphine treatment; this effect was due to an initial reduction in carbohydrate intake and an increase in fat intake. Over the course of the infusion period, fat intake gradually decreased and carbohydrate intake increased. The effects of morphine when infused on days 1-7 were similar to those observed when the drug was infused during days 8-14.(ABSTRACT TRUNCATED AT 250 WORDS)

Relation of dissociative phenomena to levels of cerebrospinal fluid monoamine metabolites and beta-endorphin in patients with eating disorders: a pilot study.

Dissociation is made manifest by a failure to integrate thoughts, feelings, memories, and actions into a unified sense of consciousness. Although dissociation is presumed to be a special state of consciousness manifested by state-dependent memory and physiology, the psychobiology of dissociation is poorly understood. In this study, we examined cerebrospinal fluid levels of the major monoamine metabolites and beta-endorphin in patients with eating disorders (11 with anorexia nervosa, 16 with bulimia nervosa), while they were acutely ill. Dissociative capacity was measured using the Dissociative Experiences Scale (DES). We provide evidence that neurochemical changes in dopaminergic, serotonergic, and opioid systems may be associated with the clinical expression of dissociation in patients with eating disorders during the acute phase of their illness. These preliminary results are compatible with previous studies of neurochemical disturbances in the eating disorders and suggest that future work in dissociation should specifically include examination of these neurobiologic systems.

Morphine-induced feeding: a comparison of the Lewis and Fischer 344 inbred rat strains.

Rats of the Lewis inbred strain have been shown to self-administer more morphine than rats of the inbred Fischer 344 (F344) strain. Because morphine reward and opioid-induced feeding may involve a common mechanism, we measured whether these strains also differ in their feeding response to morphine. In Experiment 1, rats were maintained on powdered rat chow and given SC injections of morphine sulfate (1, 3, and 10 mg/kg) and saline; all rats were tested with all doses. Food intake was measured 2, 4, and 6 h after injection. In Experiment 2, rats were given a choice of two diets: a fat/protein diet and a carbohydrate/protein diet. Feeding responses to morphine were measured in a manner identical to that in Experiment 1. In both experiments, the feeding response to morphine was greater in Lewis rats than in F344 rats. To determine whether these responses might be explained by differences in the levels of morphine achieved in the blood or brain, rats of each strain were given SC injections of morphine sulfate (3 mg/kg) and sacrificed either 30 min or 3 h after injection. Serum and brain morphine levels were determined by radioimmunoassay. Lewis rats had significantly less brain morphine than F344 rats at 30 min; they did not differ in morphine content at 3 h. Serum levels were similar at 30 min; at 3 h, F344 rats had slightly lower levels than Lewis rats. Thus, differences in tissue levels cannot readily explain the differences in feeding responses to morphine.(ABSTRACT TRUNCATED AT 250 WORDS)