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Serotonin activity in anorexia nervosa after long-term weight restoration: response to D-fenfluramine challenge

Published online by Cambridge University Press:  09 July 2009

A-M. O'Dwyer ,
J. V. Lucey  and
G. F. M. Russell
A-M. O'Dwyer*
Affiliation:
Department of Psychiatry, Institute of Psychiatry, London
J. V. Lucey
Affiliation:
Department of Psychiatry, Institute of Psychiatry, London
G. F. M. Russell
Affiliation:
Department of Psychiatry, Institute of Psychiatry, London
*
1Address for correspondence: Dr Anne-Mane O'Dwyer, Institute of Psychiatry, De Crespigny Park, London SE5 8AF.
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Synopsis

Abnormalities in central serotonin function have been implicated in the pathogenesis of anorexia nervosa. It is difficult, however, to separate neuroendocrine abnormalities induced by weight loss and malnutrition from those related primarily to the disorder itself. To minimize these influences, this study assessed long-term weight restored anorexics. A correlation between persistent eating-related psychopathology, co-morbid illness and serotonin dysfunction was sought. Nine female weight-restored out-patients who had previously fulfilled DSM-III-R criteria for anorexia nervosa and nine healthy controls participated. Following baseline estimation, prolactin and cortisol responses to 30 mg p.o. of D-fenfluramine were measured over a 5 h period. Eating related psychopathology was assessed using the Eating Disorders Inventory and Eating Attitudes Test. Depressive and obsessional symptoms were measured using the Beck Depressive and Maudsley Obsessive–Compulsive Inventories respectively. The Tridimensional Personality Questionnaire assessed impulsivity. The weight-restored anorexic group exhibited persistent eating-related psychopathology and significant co-morbid symptomatology. There was no difference between long-term weight restored anorexics and controls in their endocrine response to D-fenfluramine. Long-term weight-recovered anorexic subjects continued to exhibit behavioural and attitudinal disturbances characteristic of anorexia nervosa. The results suggest that abnormalities in 5HT activity do not contribute significantly to trait status in anorexia nervosa.

Type
Original Articles
Information
Psychological Medicine , Volume 26 , Issue 2 , March 1996 , pp. 353 - 359
Copyright
Copyright © Cambridge University Press 1996

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References

REFERENCES

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Psychiatric Disorders (3rd edn, revised) (DSM-III-R). APA: Washington, DC.Google Scholar
Beck, A. T. (1978). Depression Inventory. Centre for Cognitive Therapy: Philadelphia.Google Scholar
Blundell, J. E. (1984). Serotonin and appetite. Neuropharmacology 23, 1537–1551.CrossRefGoogle ScholarPubMed
Brewerton, T. D., Brandt, H. A. & Lesem, M. D. (1990). Serotonin in eating disorders. In Serotonin in Major Psychiatric Disorders (ed. Coccaro, E. F. and Murphy, D. L.), pp. 155–184. American Psychiatric Press: Washington, DC.Google Scholar
Brown, G. L., Goodwin, F. K., Ballenger, J. C., Gayer, P. F. & Major, L. F. (1979). Aggression in humans correlates with CSF amine metabolites. Psychiatry Research 1, 131–139.CrossRefGoogle Scholar
Casper, R. C. (1990). Personality features of women with good outcome from restricting anorexia nervosa. Psychosomatic Medicine 52, 156–170.CrossRefGoogle ScholarPubMed
Cloninger, C. R. (1987). A systematic method for clinical description and classification of personality variants: a proposal. Archives of General Psychiatry 44, 573–588.CrossRefGoogle ScholarPubMed
Garattini, S., Mennini, T. & Samnain, R. (1987). From fenfluramine racemate to D-fenfluramine: specificity and potency of the effects on the serotoninergic system and food intake. Annals of New York Academy of Science 499, 156–166.CrossRefGoogle ScholarPubMed
Garfinkel, P. E., Brown, G. M., Stanser, H. C. & Moldofsky, H. (1975). Hypothalamic–pituitary function in anorexia nervosa. Archives of General Psychiatry 32, 739–744.CrossRefGoogle ScholarPubMed
Garner, D. L. & Garfinkel, P. E. (1979). The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychological Medicine 9, 273–279.CrossRefGoogle ScholarPubMed
Garner, D. M., Olmstead, M. P. & Polivy, J. (1983). Development and validation of a multidimensional eating disorders inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders 2, 15–35.3.0.CO;2-6>CrossRefGoogle Scholar
Gold, P. W., Gwittsman, H. E., Aveignie, P. C., Nieman, L. K., Galluci, W. T., Kaye, W. H., Jimerson, D., Ebert, M., Rittmaster, R., Loriaux, D. L. & Chrousos, G. P. (1986). Abnormal hypothalamic–pituitary–adrenal function in anorexia nervosa: pathophysiologic mechanisms in underweight and weight corrected patients. New England Journal of Medicine 314, 1335–1342.CrossRefGoogle ScholarPubMed
Goodwin, G. M., Fairburn, C. G. & Cowen, P. J. (1987). The effects of dieting and weight loss on neuroendocrine responses to tryptophan, clonidine, and apomorphine in volunteers. Archives of General Psychiatry 44, 952–957.CrossRefGoogle ScholarPubMed
Goodwin, G. M., Shapiro, M., Bennie, J., Dick, H., Carroll, S. & Fink, G. (1989). The neuroendocrine response and psychological effects of infusion of L-tryptophan in anorexia nervosa. Psychological Medicine 19, 857–864.CrossRefGoogle ScholarPubMed
Hamik, A. & Peroutak, S. (1989). 1-M-Chloro-phenylpiperazine (mCPP) interactions with neurotransmitter receptors in the human brain. Biological Psychiatry 25, 569–575.CrossRefGoogle ScholarPubMed
Hodgson, R. J. & Rachman, S. (1977). Obsessional–compulsive complaints. Behaviour Research and Therapy 15, 389–395.CrossRefGoogle ScholarPubMed
Jimerson, D. C., Lesem, M. D., Kaye, W. H., Hegg, A. P. & Brewerton, T. D. (1990). Eating disorders and depression: is there a serotonin connection? Biological Psychiatry 28, 443–454.CrossRefGoogle Scholar
Jolley, M. E., Stroupe, S. D., Schwenzer, K. S., Wang, C. J., Lu-Stess, M., Hill, H. D., Popelka, S. R., Holen, J. T. & Kelso, D. M. (1981). Fluorescence polarisation immunoassay – an automated system. Clinical Chemistry 27, 1575–1579.CrossRefGoogle ScholarPubMed
Kay, W. H. & Weltzin, T. E. (1991). Serotonin activity in anorexia and bulimia nervosa: relationship to the modulation of feeding and mood. Journal of Clinical Psychiatry 52, (suppl.), 41–48.Google Scholar
Kaye, W. H., Ebert, M. J., Raleigh, M. & Lake, R. (1984). Abnormalities in CNS monoamine metabolism in anorexia nervosa. Archives of General Psychiatry 41, 350–355.CrossRefGoogle ScholarPubMed
Kaye, W. H., Gwirtsman, J. E., George, D. T., Jimerson, D. C. & Ebert, M. H. (1988). CSF-5HIAA concentrations in anorexia nervosa: reduced values in underweight subjects normalize after weight gain. Biological Psychiatry 23, 102–105.CrossRefGoogle Scholar
Kaye, W. H., Gwirtsman, H. E., George, D. T. & Ebert, M. H. (1991). Altered serotonin activity in anorexia nervosa after long-term weight restoration: docs elevated CSF-5HIAA correlate with rigid and obsessive behavior? Archives of General Psychiatry 48, 556–562.CrossRefGoogle Scholar
Liebowitz, S. F., Weiss, G. F. & Shorposner, G. (1988). Hypothalamic serotonin: pharmacological biochemical and behavioural analyses of its feeding suppressive action. Clinical Neuropharmacology 11 (suppl. 1), 51–71.Google Scholar
Linnoila, M., Virkkunen, M., Scheinin, M., Nuutial, A., Rimon, R. & Goodwin, F. K. (1983). Low CSF-5HIAA concentration differentiates impulsive from non-impulsive violent behaviour. Life Science 33, 2609–2614.CrossRefGoogle Scholar
Lucey, J. V., O'Keane, V., Butcher, G., Clare, A. W. & Dinan, T. G. (1992). Cortisol and prolactin responses to D-fenfluramine in normothymic obsessive–compulsive disorder – a comparison with depressed and healthy controls. British Journal of Psychiatry 161, 517–521.CrossRefGoogle ScholarPubMed
McBride, P. A., George, M. A., Khait, V. D., Sunday, S. R. & Halmi, K. A. (1991). Serotonergic responsivity in eating disorders. Psychopharmacology Bulletin 27, 365–372.Google ScholarPubMed
Metropolitan Life Insurance Company (1964). Chart of Desirable Weights for Men and Women. MLIC: New York.Google Scholar
Morgan, H. G. & Russell, G. F. M. (1975). Value of family background and clinical features as predictors of long term outcome in anorexia nervosa: 4 year follow-up study of 41 patients. Psychological Medicine 5, 355–371.CrossRefGoogle ScholarPubMed
Murphy, D. L., Campbell, I. C. & Costa, J. L. (1978). The brain serotonergic system in the affective disorders. Progress in Neuro-psychopharmacology and Biological Psychiatry 2, 5–31.CrossRefGoogle ScholarPubMed
O'Keane, V. & Dinan, T. G. (1991). Prolactin and cortisol responses to D-fenfluramine in major depression: evidence for diminished responsivity of central serotonergic function. American Journal of Psychiatry 148, 1009–1015.Google ScholarPubMed
O'Keane, V., O'Hanlon, M., Webb, M.Webb, M. & Dinan, T. G. (1991). D-Fenfluramine/prolactin responses throughout the menstrual cycle: evidence for an oestrogen-induced alteration. Clinical Endocrinology 34, 289–292.CrossRefGoogle ScholarPubMed
Ratnasuriya, R. H., Eisler, I., Szmukler, G. I. & Russell, G. F. M. (1991). Anorexia nervosa: outcome and prognostic factors after 20 years. British Journal of Psychiatry 158, 495–502.CrossRefGoogle ScholarPubMed
Rattle, S. J., Purnell, D. R., Williams, P., Siddle, K. & Forrest, G. C. (1984). New separation method for monoclonal immuno-radiometric assays and its application to assays for thyrotropin and human gonadotropin. Clinical Chemistry 30, 1457–1462.CrossRefGoogle Scholar
Rothenberg, A. (1990). Adolescence and eating disorder: the obsessive–compulsive syndrome. Psychiatric Clinics of North America 13, 469–488.CrossRefGoogle ScholarPubMed
Rowland, N. E. & Carlton, J. (1986). Neurobiology of an anorectic drug: fenfluramine. Progress in Neurobiology 27, 13–62.CrossRefGoogle ScholarPubMed
Russell, G. F. M. (1970). Anorexia nervosa: its identity as an illness and its treatment. In Modern Trends in Psychological Medicine, vol. 2 (ed. Price, J. H.), pp. 131–164. Butterworth: London.Google Scholar
Statistical Graphics Corporation: Statgraphics V-2.7. (1987). Statistical Graphics Corporation: New York.Google Scholar
van Praag, H. M., Lemus, C. & Kahn, R. (1986). The pitfalls of serotonin precursors as challengers in hormonal probes of central serotonin activity. Psychopharmacology Bulletin 22, 565–570.Google ScholarPubMed
Windauer, U., Lennerts, W., Talbot, P., Touyz, S. W. & Beumont, P. J. V. (1993). How well are ‘cured’ Anorexia Nervosa Patients? An investigation of 16 weight recovered anorexic patients. British Journal of Psychiatry 163, 195–200.CrossRefGoogle ScholarPubMed
Young, M.J., Bresnitz, E. A. & Strom, B. L. (1983). Sample size nomograms for interpreting negative clinical studies. Annals of Internal Medicine 99, 248–251.CrossRefGoogle ScholarPubMed