Prediction of outcome in anorexia nervosa from neuropsychological status

To evaluate the possibility that subtle brain dysfunction may exist in anorexia nervosa and indicate a poor prognosis, 20 anorexia nervosa patients received neuropsychological assessments covering a broad array of cognitive performances. The patients were examined at admission and again at the end of an inhospital treatment program when they were at normal weight for their age and height. Pretreatment performance on the assessment battery was not associated with outcome 1 year after discharge. However, posttreatment performance and significantly associated with outcome. A majority (71%) of patients with two or more cognitive deficits showed an unfavorable outcome (i.e., did not maintain their weight). In contrast, a majority (85%) of patients with less than two cognitive defects had a favorable outcome (i.e., maintained or increased their weight). The findings suggest that the hypothesis of a central nervous system disorder limiting the capacity for anorectics to recover deserves further exploration.

d-Amphetamine and punished responding: the role of catecholamines and anorexia

Rats were trained to press a lever for food on a schedule in which components of variable interval reinforcement (V12') alternated with conflict components in which every response resulted in food delivery and footshock. Low doses of d-amphetamine selectively suppressed responding in the conflict component in a dose-dependent manner, whereas prefeeding suppressed responding in both components. Pretreatment with noradrenergic blocking agents (propranolol, phentolamine and phenoxybenzamine) did not diminish the suppressant effect of d-amphetamine, but this effect was reduced by pretreatment with alpha-methyl-para-tyrosine methylester and dopamine blockers (spiroperidol, haloperidol and clozapine) indicating that d-amphetamine was exerting its selective suppressant effect via the release of dopamine. It is suggested that the effects of low doses d-amphetamine on behaviour in conflict situations may provide a useful model for investigating the mode of action of neuroleptic drugs.

Psychological aspects of anorexia: areas for study

Anorexia and weight loss are frequently the first manifestations of cancer. Although psychological reasons are frequently included as a partial explanation for loss of appetite and weight in the cancer patient, there have been no systematic studies which establish the nature of this relationship. It is proposed that anorexia and cachexia are at times somatic consequences of the cancer patient's beliefs and attitudes about their disease and its treatments. The inability to overcome a sense of hopelessness leads to an adaptive biological reaction called conservation-withdrawal. The effects of the reaction of disengagement and inactivity in relation to the external world which includes external nutriment may be constructive or destructive depending on when it is experienced and the length of time the reaction continues. How this reaction is initiated and mediated biologically and how it may be related to and can be reversed by a shift in motivation are questions of great importance.