Mitral valve prolapse in patients with anorexia nervosa and bulimia.

We studied 43 consecutive individuals with eating disorders (anorexia nervosa and/or bulimia) for the presence of mitral valve prolapse and/or cardiac arrhythmias by physical examination, M-mode and two-dimensional echocardiography, and 24-hour continuous ambulatory electrocardiographic monitoring. Ten of the 43 had findings of mitral valve prolapse on resting cardiac auscultation. Echocardiographic evaluation confirmed the diagnosis of mitral valve prolapse in these ten as well as in six other individuals, giving an overall incidence of 37% (16/43). Similar echocardiographic findings were present in only 4% (1/23) of control individuals. Cardiac arrhythmias other than benign isolated premature extrasystoles were noted in five patients with eating disorder; all five also had echocardiographic findings of mitral valve prolapse. The incidence of mitral valve prolapse appears to be increased in patients with eating disorders. In addition, the arrhythmogenic effects of mitral valve prolapse may present an additional risk factor in these patients.

Daily patterns of serotonin uptake in platelets from psychiatric patients and control volunteers.

Serotonin (5-HT) uptake into platelets from psychiatric patients and controls was measured in the morning and afternoon. Uptake varied with time of day in both groups studied, resulting in four recognizable patterns. Two patterns occurred in the majority of controls. In contrast, uptake patterns in the psychiatric patients were more variable, with each of the four patterns clearly represented. However, except for the fact that uptake was significantly decreased throughout the day in depressed patients, the patterns were not otherwise linked statistically to clinical condition. In any event, the greater variability of daily 5-HT uptake patterns in patients suggests that psychiatric disorders linked presumably to central nervous system (CNS) dysfunction are in some way reflected by labile platelet 5-HT pharmacokinetics.

The cytochrome P450 2D6 (CYP2D6) enzyme polymorphism: screening costs and influence on clinical outcomes in psychiatry.

OBJECTIVES: This study examined factors that affect cost, reliability, and the value of determining the cytochrome P450 2D6 (CYP2D6) polymorphism in clinical practice. STUDY DESIGN: The method of deoxyribonucleic acid isolation, sample preparation, oligonucleotide primers, and polymerase chain reaction procedures were scrutinized for their effect on CYP2D6 genotyping efforts. The determination of the CYP2D6 A, B, D, E, and T alleles was used to identify the deficiency in CYP2D6 expression in 161 individuals phenotyped for CYP2D6 activity with dextromethorphan. The CYP2D6 genotype was assessed in 74 outpatients who had received diagnoses of depression. Eighteen of these patients were screened because of an adverse response to a tricyclic or antidepressant known or suspected to be a CYP2D6 substrate. RESULTS: The CYP2D6 A, B, C, D, E, and T alleles could be detected in 13 hours at a cost of $84 per sample by judicious selection of conditions and procedures. The genotype provided an accurate predictor of CYP2D6 expression in all 134 subjects who expressed the enzyme and in all 27 unrelated individuals phenotyped as deficient in CYP2D6 activity. In the patient group that experienced adverse effects, 44% of all CYP2D6 gene copies contained the A, B, D, E, or T allele(s) associated with inactive CYP2D6 expression. This was more than twice the rate for the occurrence of mutant alleles in the other 56 psychiatric patients (21%) and in 80 random subjects from the general population (20%; p < 0.05). CONCLUSIONS: Screening psychiatric patients for CYP2D6 expression may distinguish metabolic-based therapeutic problems from drug sensitivity caused by other mechanisms.

Osteoporosis in women with eating disorders: comparison of physical parameters, exercise, and menstrual status with SPA and DPA evaluation.

Osteoporosis has been reported in anorexia nervosa (AN), but not in other eating disorders. Thirty-three patients, 8 AN, 17 bulimia nervosa (BN), and 8 eating disorder not otherwise specified (EDNOS), were evaluated by bone densitometry (radius, spine, femur) to determine the prevalence and distribution of osteoporosis and the role of physical parameters, exercise and estrogen. All three diagnostic subgroups had evidence of decreased bone density, worst in the EDNOS subgroup and least in the BN subgroup. The most affected site was the femur, least the spine; the radius was intermediate. Age, body surface area, age of onset, and length of illness weakly correlated with the femur and spine density in the BN and EDNOS subgroups. Exercise was related to bone density in the AN subgroup in the femur, moderate exercise having a protective effect and strenuous exercise being detrimental. No significant correlation of bone density measurements with estradiol levels and/or history of amenorrhea was identified. Eating disorder patients are at risk for osteoporosis, which has multiple contributing factors including physical parameters and exercise. Estrogen deficiency by itself may not be a major causative factor.

The intellectual functioning of eating disorder patients.

This study investigated the intellectual functioning of a large group of eating disorder patients to examine two previously reported findings: (1) this population exhibits above-average general intellectual skills; and (2) a specific pattern of strength in verbal abilities. Standard intellectual testing of 100 consecutive inpatient females with eating disorder diagnoses was performed. Results indicate intellectual performance conforming to a normal distribution with no specific pattern of strengths or weaknesses.

Sequential quantitative EEG analysis in acute lymphocytic leukemia of children.

Potential brain toxicity is a major concern in the treatment of acute lymphocytic leukemia with cranial irradiation or intrathecal methotrexate. We used quantitative EEG analysis based on the Fourier transform to study 13 children at the time of diagnosis, after induction, and following consolidation which included extended intrathecal chemotherapy. None had detectable CNS infiltration by leukemia. Nonetheless, initial EEG frequencies were markedly depressed compared to expected values for age (p less than .001), and improved dramatically after induction (p less than .001). Following consolidation, EEG frequencies remained significantly lower than predicted from a control population (p less than .05). Quantitative EEG is a sensitive procedure that appears useful in assessing subtle neurologic effects of acute leukemia and its treatment.

Protective action guide for radioactive material transportation accidents.

This paper briefly describes a report which has been developed to enable protective action guidance to be determined for transportation accidents involving radioactive material. The protective action guide uses data from on-scene observations as input to a series of simple flow charts leading to protective action recommendations. Where the necessary data is unavailable or unknown, the guide uses the assumptions and results found in the authors' worst case hazards analysis report.

Hazards assessment of worst case transportation accidents involving typical radioactive material shipments.

This paper reports the results of a study performed for the Oregon Department of Energy. The objectives of the study were to characterize the range of radioactive material shipments through the state and to determine the worst radiological hazards which might arise if these shipments were involved in transportation accidents. The direct and indirect radiological hazards were analyzed for worst case accidents involving a total of 10 typical shipments. The direct hazard primarily involved the gamma radiation from the material, while the indirect hazard considered the airborne release hazards of inhalation/ingestion, cloudshine and groundshine. The general and specific assumptions used in the study are given, and the results are tabulated, giving doses and dose rates as a function of distance. The data from the study are being incorporated into a protective action guide for use by state and local emergency responders. This guide bases the protective actions on the available, observable data and on flow charts which use the worst-case assumptions for unknown data.

Risks of radioactive material transportation accidents in Oregon.

As a continuation of previous research on worst case transportation accidents involving radioactive material (Dodd and Humphries 1988a), and protective action guidance for radioactive material transportation accidents (Dodd and Humphries 1988b), this paper describes the risks from such accidents in Oregon. Radioactive material transportation risks are defined in terms of accident consequences multiplied by the accident probabilities and are expressed as latent cancer fatalities (LCFs). For each of 17 different shipment types, five dose contributions are summed and multiplied by the population density and accident probability. The five dose contributors considered are: inhalation, resuspension, cloudshine, groundshine and direct exposure. The variables over which each of these dose contributors are integrated include seven accident severity categories, three population density zones, five regions of the state, as well as many isopleth areas and radionuclides. Allowance is also made for the possible distribution of meteorological conditions in each area. The dose to the public, emergency responders, pedestrians and personnel in other traffic are all considered. It is concluded that the current level of risk is 1.2 X 10(-5) latent cancer fatalities per year in Oregon. This is equivalent to one LCF every 83,000 y. This compares to 1.2 non-radiological fatalities associated from the same shipments.

Nutrition Behaviors of University Majorettes.

In brief: The eating behaviors of a group of university majorettes and the effects of nutrition counseling on the majorettes were examined. At the start of the football season, 11 varsity majorettes received nutrition counseling and were interviewed to obtain 24-hour diet reports and information about their eating behaviors and weight-control practices. The interviews were repeated eight weeks later. The women all had distorted body images. Despite the counseling, the subjects ate poorly and used other unsound weight-loss practices in an effort to meet arbitrary target weights set by a faculty advisor. The health implications of these practices are discussed and remedial actions are suggested.

Bulimia: the binge eating syndrome.

Bulimia occurs in roughly half of obese and anorexic patients. A recent study found 19% of female and 5% of male college students to be bulimic. Binge eating usually comes to the physician's attention from problems associated with purging measures--diuretics, laxatives, or self-induced postprandial vomiting--used by one out of ten bulimic patients. Continuous vomiting causes parotid enlargement, sore throat, spontaneous regurgitation, and severe electrolyte imbalance. We report a case illustrating the bulimic's distorted body image, review alternative treatment methods, and suggest needed areas of research, particularly those elucidating the relationship between bulimia and affective disorders.

Neurologic complications of anorexia nervosa.

The records of 100 patients with anorexia nervosa were reviewed. Neurologic complications were present in 47 patients. Neuromuscular abnormalities were most common and were present in 45% of patients. Generalized muscle weakness was detected in 43% of patients and peripheral neuropathies in 13%. Less common neurologic complications included headaches (6%), seizures (5%), syncope in the absence of orthostatic hypotension (4%), diplopia (4%), and movement disorders (2%). Neurologic problems due to chronic deficiency diseases were rare; only one patient had symptoms directly attributable to a vitamin B12 deficiency and none had evidence of Wernicke's encephalopathy. In most patients, the neurologic complications were reversed completely after correction of nutritional deficiencies and fluid and electrolyte imbalances.

Anorexia nervosa.

Anorexia nervosa typically occurs in a "model child" of a family that values achievement, appearance and nonconflictual interactions. Three diagnostic criteria are weight loss of at least 25 percent of ideal body weight, physiologic changes (including amenorrhea) and a distorted body image in which the patient, even when cachectic, insists she is fat. Therapy must involve the entire family, focusing not on pounds gained but on learning to handle conflict.

Neuropsychological test performance of bulimic patients.

Thirty subjects with DSM-III diagnoses of bulimia were compared to 30 matched controls on the Luria-Nebraska Neuropsychological Battery. The bulimics showed poorer performance on tasks associated with functioning of the right frontal cortical area, primarily tasks involving speed of drawing geometric figures. The similarities of the findings to previous findings with anorexic samples and patients with affective disorders are discussed.

Dietary induced anorexia: a review of involvement of the histaminergic system.

This review examines possible relationships between anorexia, dietary intake and central nervous system histaminergic activity. The hypothesis being reviewed is that one component of normal or pathophysiological neuroregulation of food intake involves histaminergic activity in the central nervous system, as influenced by concentrations and bioperiodicities of histamine and/or histamine receptors. Changes in concentrations of receptors are gender specific. Low protein quality or quantity diets elevate both central histamine and histamine receptors (H1) in rats while significantly decreasing their food intake. When injected with histaminergic antagonists, rats fed low protein diets increase food intake and have improved efficiency of weight gain. This review supports a dual hypotheses: central histaminergic activity is involved in the regulation of food intake, but food intake patterns (including dietary composition or energy content) can modify central histaminergic activity. This review also suggests that modified histamine and/or H1 receptor concentrations are potential mechanisms for elevated central histaminergic activity in food intake-related pathophysiological states. Thus, dietary interventions (clinically- or self-imposed) which modify food intake or diet composition have the potential of affecting the histaminergic system. Also, drugs with antihistaminergic properties have the potential of affecting food intake/weight gain patterns by interfering with normal neurochemical signals.

Gastrointestinal and nutritional aspects of eating disorders.

Anorexia nervosa (AN) and bulimia nervosa (BN) are potentially fatal eating disorders which primarily affect adolescent females. Differentiating eating disorders from primary gastrointestinal (GI) disease may be difficult. GI disorders are common in eating disorder patients, symptomatic complaints being seen in over half. Moreover, many GI diseases sometimes resemble eating disorders. Inflammatory bowel disease, acid peptic diseases, and intestinal motility disorders such as achalasia may mimic eating disorders. However, it is usually possible to distinguish these by applying the diagnostic criteria for eating disorders and by obtaining common biochemical tests. The primary features of AN are profound weight loss due to self starvation and body image distortion; BN is characterized by binge eating and self purging of ingested food by vomiting or laxative abuse. GI complications in eating disorders are common. Recurrent emesis in BN is associated with dental abnormalities, parotid enlargement, and electrolyte disturbances including metabolic alkalosis. Hyperamylasemia of salivary origin is regularly seen, but may lead do an erroneous diagnosis of pancreatitis. Despite the weight loss often seen in eating disorders, serum albumin, cholesterol, and carotene are usually normal. However, serum levels of trace metals such as zinc and copper often are depressed, and hypophosphatemia can occur during refeeding. Patients with eating disorders frequently have gastric emptying abnormalities, causing bloating, postprandial fullness, and vomiting. This usually improves with refeeding, but sometimes treatment with pro-motility agents such as metoclopromide is necessary. Knowledge of the GI manifestations of eating disorders, and a high index of suspicion for one condition masquerading as the other, are required for the correct diagnosis and management of these patients.