Clinical effects of brimonidine ophthalmic drops ingestion in 52 dogs.

Brimonidine is an ophthalmic solution of 0.2% brimonidine tartrate used to lower intraocular pressure in human glaucoma patients. A retrospective study was conducted of brimonidine ophthalmic solution ingestion in 52 dogs reported to the ASPCA Animal Poison Control Center between January 1998 and December 2000. Eighty percent of the dogs were < 1-y of age. Approximate ingested dosages ranged from 0.18-5.55 mg/kg. Incidence of clinical signs were bradycardia (67%), depression (46%), ataxia (27%), hypotension (25%), pallor (23%), weakness (17%), change in mucous membrane color (17%), hypothermia (13%), vomiting or retching (13%.). Shock, weak pulses, and poor capillary refill time were also reported. Treatment involved early decontamination, supportive care, andyohimbine and atipamezole as specific alpha-2 antagonists that could be helpful in reversing the effects of brimonidine. Due to the possibility of severe cardiovascular effects developing, the ingestion of brimonidine ophthalmic solution in dogs should be considered dangerous.

Risk factors for anorexia nervosa: three integrated case-control comparisons.

BACKGROUND: Many risk factors have been implicated in the development of anorexia nervosa. Little is known about their relative contributions, nor in most cases is it clear whether they are specific to anorexia nervosa or risk factors for all eating disorders or for psychiatric disorder in general. METHODS: We used a case-control design involving the comparison of 67 female subjects with a history of anorexia nervosa with 204 healthy control subjects, 102 subjects with other psychiatric disorders, and 102 subjects with bulimia nervosa. A broad range of risk factors was assessed by interview. RESULTS: The subjects with anorexia nervosa and the healthy controls differed in their exposure to most of the putative risk factors. There was no greater exposure to factors that increased the likelihood of dieting, once the influence of other classes of risk factors had been taken into account. Premorbid perfectionism and negative self-evaluation were especially common and more so than among the general psychiatric controls. Parental obesity and an early menarche, together with parental psychiatric disorder, distinguished those with bulimia nervosa from those with anorexia nervosa. CONCLUSIONS: There appears to be a broad range of risk factors for anorexia nervosa and bulimia nervosa, some of which are shared with other psychiatric disorders. Factors that increase the likelihood of dieting seem to have more important influence as risk factors for bulimia nervosa than anorexia nervosa. Perfectionism and negative self-evaluation appear to be particularly common and characteristic antecedents of both eating disorders.

Risk factors for binge eating disorder: a community-based, case-control study.

BACKGROUND: Many risk factors have been implicated for eating disorders, although little is known about those for binge eating disorder. METHODS: A community-based, case-control design was used to compare 52 women with binge eating disorder, 104 without an eating disorder, 102 with other psychiatric disorders, and 102 with bulimia nervosa. RESULTS: The main risk factors identified from the comparison of subjects with binge eating disorder with healthy control subjects were certain adverse childhood experiences, parental depression, vulnerability to obesity, and repeated exposure to negative comments about shape, weight, and eating. Compared with the subjects with other psychiatric disorders, those with binge eating disorder reported more childhood obesity and more exposure to negative comments about shape, weight, and eating. Certain childhood traits and pronounced vulnerability to obesity distinguished the subjects with bulimia nervosa from those with binge eating disorder. CONCLUSIONS: Binge eating disorder appears to be associated with exposure to risk factors for psychiatric disorder and for obesity. When compared with the wide range of risk factors for bulimia nervosa, the risk factors for binge eating disorder are weaker and more circumscribed. Pre-morbid perfectionism, negative self-evaluation, and vulnerability to obesity appear especially to characterize those in whom bulimia nervosa subsequently develops.

Smoking and bulimia nervosa.

OBJECTIVE: Little is known about the long-term physical consequences of bulimia nervosa. Some physical morbidity may result from high rates of cigarette smoking. The aim of the present study was to test three hypotheses regarding smoking among women with bulimia nervosa. METHOD: The subjects were 102 women with DSM-IV bulimia nervosa, 204 matched normal controls, and 102 matched controls with affective or anxiety disorders. All three groups were recruited from the same community sample. Interview measures were used for diagnosis and for information on smoking. RESULTS: A higher proportion of the bulimia nervosa cases were smokers than of either comparison group. Of those smokers who had achieved a period of abstinence, bulimia nervosa cases were more likely than normal control subjects to have resumed smoking, and more likely to attribute their resumption to concern about their weight. DISCUSSION: Smoking-related morbidity should be assessed in long-term follow-up studies of bulimia nervosa.

Risk factors for bulimia nervosa. A community-based case-control study.

BACKGROUND: Many apparently disparate risk factors have been implicated as causes of eating disorders. This study was designed to test the hypothesis that 2 broad classes of risk factors exist for bulimia nervosa: those that increase the risk for development of a psychiatric disorder in general and those that increase the risk of dieting. It was predicted that the latter are especially common among persons with bulimia nervosa. METHODS: A case-control design was used involving 2 integrated comparisons. First, 102 subjects with bulimia nervosa were compared with 204 healthy control subjects without an eating disorder. Second, the same 102 subjects with bulimia nervosa were compared with 102 subjects with other psychiatric disorders. To reduce sampling bias, the subjects were recruited directly from the community. A broad range of putative risk factors was assessed. RESULTS: The subjects with bulimia nervosa and the healthy control subjects differed in their rates of exposure to most of the putative risk factors. Far fewer differences were evident between the subjects with bulimia nervosa and the control subjects with other psychiatric disorders, although exposure to factors that were likely to increase the risk of dieting and to negative self-evaluation and certain parental problems (including alcohol use disorder) were substantially more common among those with bulimia nervosa. CONCLUSIONS: The findings support the hypothesis that bulimia nervosa is the result of exposure to general risk factors for psychiatric disorder and risk factors for dieting. An unexpected finding was the particularly high rates of premorbid negative self-evaluation and certain parental problems among those with bulimia nervosa.

Life events and the onset of bulimia nervosa: a controlled study.

BACKGROUND: Life events may play a role in precipitating the onset of bulimia nervosa. This study aimed to determine the rates of occurrence of certain life events during the year before onset of disordered eating in women with bulimia nervosa, and to compare them with the rates among age-matched normal controls. METHODS: The subjects were 102 women with bulimia nervosa and 204 women without an eating disorder, all recruited from the same community sample of young adult women. Interview measures were used for diagnosis and for assessment of life events. RESULTS: The bulimia nervosa cases reported more life events during the year before onset of disordered eating than were reported by controls of the same age. Events involving disruption of family or social relationships, or a threat to physical safety, were especially common among the bulimia nervosa cases. CONCLUSIONS: These findings suggest that certain life events may play a role in precipitating the onset of bulimia nervosa. The study was retrospective in design. Prospective studies of the role of life events would be valuable, but difficult to perform.

Impulsivity or comorbidity in bulimia nervosa. A controlled study of deliberate self-harm and alcohol and drug misuse in a community sample.

BACKGROUND: Studies showing high rates of alcohol and drug misuse and deliberate self-harm in bulimia nervosa have led some authors to call for a distinct diagnostic subgroup, sometimes termed "multi-impulsive bulimia". However, these studies have been uncontrolled and of clinic samples and may be subject to sampling bias. METHOD: One hundred and two women with DSM-III-R bulimia nervosa were compared with 204 normal controls and 102 controls with other psychiatric disorders, all recruited from the same community sample. Interview measures were used for diagnosis and for the assessment of alcohol and drug misuse and deliberate self-harm. RESULTS: Bulimia nervosa cases did not differ from either of the control groups in terms of current alcohol consumption. Bulimia nervosa cases used more illicit drugs than either control group, but loss of control over drug use was very uncommon. Bulimia nervosa cases had a higher rate of deliberate self-harm than the controls. Only six (6%) bulimia nervosa cases had two or more of these behaviours concurrently. CONCLUSION: Sampling bias is present in clinic-based studies of comorbidity in bulimia nervosa. Those with comorbid substance misuse and deliberate self-harm are probably heterogeneous in character, and their classification as a subgroup would therefore be premature.

Childhood sexual and physical abuse as risk factors for the development of bulimia nervosa: a community-based case control study.

OBJECTIVE: There were two aims: First, to determine whether sexual or physical abuse in childhood or adolescence increases the risk of developing bulimia nervosa, and second, to see whether any increase in risk is specific to bulimia nervosa rather than being common to psychiatric disorders in general. METHOD: A case control design with individual matching was used. There were two related case control comparisons based on community samples. One hundred and two young adult women with bulimia nervosa were compared with 204 control subjects without an eating disorder, and with 102 control subjects with other psychiatric disorders, all recruited from the same community source. An investigator-based interview was used to assess sexual and physical abuse. RESULTS: Sexual abuse involving physical contact was reported by 35% of the cases of bulimia nervosa. It was more common among this group than among the normal controls. Physical abuse was also reported by a minority of the cases of bulimia nervosa, and was more common among this group than among the normal controls. However, there were no significant differences between the cases of bulimia nervosa and the controls with general psychiatric disorder, except in the category of repeated severe sexual abuse: this was more common among the cases of bulimia nervosa although present only in small numbers within these two groups. CONCLUSIONS: The findings indicate that sexual and physical abuse are both risk factors for the development of bulimia nervosa. However, they are not present in the majority of cases. This indicates that other risk factors must operate in these cases. Sexual and physical abuse do not appear to be risk factors specific to bulimia nervosa; rather, they appear to be risk factors for psychiatric disorder in general in young adult women.

Bias and bulimia nervosa: how typical are clinic cases?

OBJECTIVE: Since patients being treated for bulimia nervosa constitute only a minority of persons with the disorder, the cases seen in clinics may be subject to sampling bias. The aim of this study was to investigate sampling bias as it affects secondary referrals for bulimia nervosa. METHOD: The personal and family characteristics of a consecutive series of 60 women with secondary referrals for bulimia nervosa (clinic subjects) were compare with those of 83 subjects with bulimia who were recruited directly from the community. Most of the data were collected by interview. RESULTS: The demographic characteristics of the two groups were similar. The clinic subjects had a more severe eating disorder and much greater impairment of social functioning. There was no difference between the groups in duration of the eating disorder or level of general psychiatric disturbance. The community subjects were heavier and had stronger family histories of obesity. CONCLUSIONS: There is sampling bias among secondary referrals for bulimia nervosa. The relative absence of persons prone to obesity among secondary subjects is important, since there is evidence that vulnerability to obesity is a poor prognostic feature as well as being a risk factor for the development of bulimia nervosa. The greater social impairment among the clinic subjects is suggestive of greater personality disturbance in this group. Caution is warranted when generalizing from clinic cases to the disorder as a whole.

A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments.

BACKGROUND: Little is known about the longer-term outcome of bulimia nervosa and the distal effects of treatment. METHODS: Prospective follow-up of subjects from two randomized controlled trials, involving a comparison of cognitive behavior therapy, behavior therapy, and focal interpersonal therapy. RESULTS: Ninety percent (89/99) underwent reassessment by interview (mean [+/- SD] length of follow-up, 5.8 +/- 2.0 years). Almost half (46%) had a DSM-IV eating disorder; 19%, bulimia nervosa; 3%, anorexia nervosa; and 24%, eating disorder not otherwise specified. There was a low rate of other psychiatric disorders. Premorbid and paternal obesity predicted a poor outcome. While the three treatments did not differ with respect to the proportion of subjects with anorexia nervosa or bulimia nervosa at follow-up, they did differ once all forms of DSM-IV eating disorder were considered together. Those who had received cognitive behavior therapy or focal interpersonal therapy were doing markedly better than those who had received behavior therapy. CONCLUSIONS: The longer-term outcome of bulimia nervosa depends on the nature of the treatment received. Patients who receive a treatment such as behavior therapy, which only has a short-lived effect, tend to do badly, whereas those who receive treatments such as cognitive behavior therapy or focal interpersonal therapy have a better prognosis.

Sexual abuse and bulimia nervosa: three integrated case control comparisons.

OBJECTIVE: This study had three aims: to determine whether sexual abuse increases the risk of developing bulimia nervosa, to see whether any increase in risk is specific to bulimia nervosa, and to determine whether patients referred for treatment of bulimia nervosa differ from a community group of subjects with bulimia nervosa with respect to their exposure to sexual abuse. METHOD: A case control design with individual matching was used. There were three related case control comparisons. Fifty community-based subjects with bulimia nervosa were compared with 100 community-based comparison subjects without an eating disorder, 50 community-based comparison subjects with other psychiatric disorders, and 50 patients (secondary referrals) with bulimia nervosa. An investigator-based interview was used to assess sexual abuse. RESULTS: Sexual abuse involving physical contact was reported by a minority of the community-based subjects with bulimia nervosa. It was more common among this group than among the normal comparison subjects. There was no difference between the community-based subjects with bulimia nervosa and either the subjects with general psychiatric disorders or the patients with bulimia nervosa. CONCLUSIONS: While the findings indicate that sexual abuse is a risk factor for the development of bulimia nervosa, it does not appear to be specific to bulimia nervosa nor is it relevant to most cases. Sexual abuse appears to be a risk factor for psychiatric disorder in general (including bulimia nervosa) among young adult women. There was no evidence that secondary referrals of bulimia nervosa are biased with respect to sexual abuse.

The classification of recurrent overeating: the "binge eating disorder" proposal.

It has been suggested that a new diagnostic category be added to the section on eating disorders in DSM-IV. This new diagnosis has been termed binge eating disorder. In this article we argue that for two main reasons it would be a mistake to include binge eating disorder in DSM-IV: first, too little is known about binge eating and other related forms of recurrent overeating to justify its inclusion in DSM-IV; and second, its inclusion would be a source of diagnostic confusion. We argue that it is premature to crystallize this specific subgroup from amongst those who recurrently overeat and that to do so would impede the acquisition of knowledge rather than enhance it. We advocate a research strategy that involves studying broad samples of those with recurrent overeating rather than narrow ones.

Myoid cell differentiation in true thymic hyperplasia and lymphoid hyperplasia.

Four cases of thymic hyperplasia (TH) and/or lymphoid hyperplasia (LH) were investigated immunohistochemically for evidence of myoid cell (MC) and epithelial cell (EC) differentiation using antibodies to myoglobin, desmin, and cytokeratin. Although MCs were identified in all the cases, the most impressive perifollicular proliferation of ECs and MCs was seen in the hyperthyroid patient with TH/LH, suggesting that these cells have a role in immune function. The unusual combination of LH and TH in this patient demonstrates that exceptional cases can show overlapping features of what are otherwise considered to be separate thymic lesions. The observations that MCs occur in close proximity to ECs and ECs are depleted along with MCs in myasthenia gravis provide strong evidence supporting closely related histogeneses for ECs and MCs within the thymus.

Differences among subfractions of H1 histone in retention of linear and superhelical DNA on filters.

Four kinds of rabbit thymus H1 histone differ among themselves in their ability to retain DNA on nitrocellulose filters. This is true for linear, or superhelical DNA, but the order of effectiveness of the different H1 histones depends on the physical conformation of the DNA. For linear DNA the binding efficiencies of the H1 histones are: RTL2 = RTL3 greater than RTL4 greater than RTL1. This order of effectiveness parallels the effectiveness of the H1 histones previously found for the condensation of linear DNA as observed by circular dichroism and viscosity. The binding efficiencies of the various histones toward superhelical DNA were: RTL4 greater than RTL3 greater than RTL1 greater than RTL2. The variation in amino acid sequence between different rabbit thymus H1 histones might thus introduce structural variations in nucleohistone fibers and perhaps in chromatin.