Dexamethasone suppression test and plasma dexamethasone levels in bulimia.

A 1-mg dexamethasone suppression test (DST) was carried out in 66 women with bulimia and in 26 age- and sex-matched controls. Blood samples were obtained at 4 PM on the day following dexamethasone ingestion, and levels of cortisol and of dexamethasone in the plasma were measured. Thirty-two percent of the patients vs only 7% of the controls had plasma cortisol levels of 140 nmol/L (5 micrograms/dL) or greater following the DST (a positive DST). The plasma levels of dexamethasone varied substantially, and there was a significant inverse relationship between the plasma level of cortisol and that of dexamethasone. Patients with positive DST results had lower levels of plasma dexamethasone than did those with negative DST results, and the mean plasma level of dexamethasone was lower in the bulimic group than in the control group. These results suggest that factors other than a disturbance of hypothalamic-pituitary-adrenal activity may contribute to positive DST results in bulimia.

The dexamethasone suppression test in bulimia.

Nineteen (35%) of 55 women with bulimia failed to exhibit cortisol suppression after dexamethasone administration. Although there was no statistically significant difference between suppressors and nonsuppressors on any clinical variable, there was a higher frequency of major depression among nonsuppressors.

Attention-deficit hyperactivity disorder and comorbid psychosis: a review and two clinical presentations.

BACKGROUND: A review of literature relating attention-deficit hyperactivity disorder (ADHD) to adult-onset psychosis suggests that cases of comorbid ADHD and atypical neuroleptic-refractory psychosis may respond to psychostimulants. METHOD: Two patients are described who presented to the authors for clinical care. Data were gathered by reviewing hospital charts from previous admissions and by conducting serial mental status examinations over many weeks. Subjects chosen for presentation herein met DSM-III-R criteria for ADHD and atypical psychosis characterized by delusions or hallucinations. RESULTS: After each subject had suffered multiple neuroleptic-refractory psychotic episodes, both had been treated by adding psychostimulants to ongoing neuroleptic therapy. The patients were then observed by the authors to be free of psychosis for many weeks, both while taking neuroleptics and psychostimulants concurrently, as well as while taking only psychostimulants after neuroleptics had been withdrawn. CONCLUSION: When integrated with reports of five similar cases and a review of the literature, the above results suggest that further attention be given to the evaluation, treatment, and eventual classification of a potentially distinct patient group with ADHD and atypical psychotic episodes.

Lactate infusions in patients with bulimia.

We performed lactate infusions in 18 bulimic patients and 11 normal controls. On the basis of blind ratings, bulimic patients appeared to react to the infusion with greater anxiety than controls. The frequency of lactate-induced panic, per se, was lower in bulimic patients than rates reported for panic disorder patients. However, it would be premature to conclude that bulimia is not a heterogeneous syndrome which includes a group of patients who panic with lactate.