23 years of experience

Accepting new patients
Hebrew Rehabilitation Center for the Aged
1200 Centre St
Roslindale, MA 02131
Locations and availability (3)

Education ?

Medical School Score Rankings
Pennsylvania State University (1987)
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

American Board of Psychiatry and Neurology

Affiliations ?

Dr. Metzger is affiliated with 6 hospitals.

Hospital Affilations



  • New England Baptist Hospital
    125 Parker Hill Ave, Boston, MA 02120
    • Currently 2 of 4 crosses
  • Beth Israel Deaconess Hospital - Needham Campus, Inc.L CORP
  • Hebrew Rehabilitation Center for the Aged
    1200 Centre St, Roslindale, MA 02131
  • Faulkner Hospital
  • Beth Israel Deaconess Medical Center
  • Beth Israel Deaconess Medical Center - West Campus
    1 Deaconess Rd, Boston, MA 02215
  • Publications & Research

    Dr. Metzger has contributed to 17 publications.
    Title State Self-esteem Ratings in Women with Bulimia Nervosa and Bulimia Nervosa in Remission.
    Date August 2008
    Journal The International Journal of Eating Disorders

    OBJECTIVE: Bulimia nervosa (BN) is associated with low self-esteem. This study was designed to assess whether low self-esteem persists in nondepressed individuals who have recovered from BN (BN-R). METHOD: Study groups included BN (n = 22), BN-R (n = 20), and healthy controls (n = 42). Participants were medication-free, and none met criteria for current major depression. Assessment instruments included the State Self-Esteem Scale (SSES), a self-rating scale designed to measure state-related changes in self-esteem. RESULTS: Consistent with previous reports, SSES scores for BN were lower than for controls (p < .001). For BN-R, SSES scores were higher than for BN (p < .001), but lower than for controls (p < .025). For BN-R, scores on the SSES Appearance subscale were inversely correlated with ratings of dietary restraint (p < .005). CONCLUSION: This study provides new evidence for persistent low self-esteem following recovery from BN. Follow-up studies are needed to assess whether low self-esteem contributes to recurrent dieting and risk for relapse.

    Title Obsessive-compulsive Characteristics in Women Who Have Recovered from Bulimia Nervosa.
    Date July 2007
    Journal The International Journal of Eating Disorders

    OBJECTIVE: The goal of this study was to follow up on reports that obsessive-compulsive characteristics, which are commonly elevated in bulimia nervosa (BN), may also be elevated in individuals who have recovered from BN (BN-R). METHOD: Self-ratings on the Maudsley Obsessional-Compulsive Inventory (MOCI), the Restraint Scale (a measure of dieting behavior related to weight concerns), and questionnaires reflecting eating disorder-related symptoms were evaluated for women who met criteria for BN (n = 25) or BN-R (n = 21) and were free of obsessive-compulsive disorder, and for healthy female controls (n = 28). RESULTS: MOCI scores for the BN-R group (5.5 +/- 5.4) were similar to those for the BN group (5.4 +/- 4.4) and were significantly elevated (p < 0.05, p < 0.02, respectively) in comparison to controls (2.5 +/- 1.9). Of note, MOCI scores for the BN-R group were significantly correlated with scores on the Restraint Scale (r = 0.60, p < 0.02). CONCLUSION: Further studies are needed to assess the relationship between elevated obsessive-compulsive characteristics and eating patterns in individuals recovered from BN.

    Title Ethics Corner: Cases from the Hebrew Rehabilitation Center for Aged--problematic Proxies.
    Date January 2004
    Journal Journal of the American Medical Directors Association
    Title Ethics Corner: Cases from the Hebrew Rehabilitation Center for Aged--sex in the Facility.
    Date November 2003
    Journal Journal of the American Medical Directors Association
    Title Ethics Corner: Cases from the Hebrew Rehabilitation Center for Aged--restraint Complaint.
    Date October 2003
    Journal Journal of the American Medical Directors Association
    Title Ethics Corner: Cases from the Hebrew Rehabilitation Center for Aged.
    Date October 2003
    Journal Journal of the American Medical Directors Association
    Title Ethics Corner: Cases from the Hebrew Rehabilitation Center for Aged-friends.
    Date July 2003
    Journal Journal of the American Medical Directors Association
    Title Ethics Corner: Cases from the Hebrew Rehabilitation Center for Aged-truth or Consequences.
    Date July 2003
    Journal Journal of the American Medical Directors Association
    Title Laboratory Screening for Electrolyte Abnormalities and Anemia in Bulimia Nervosa: a Controlled Study.
    Date January 2002
    Journal The International Journal of Eating Disorders

    OBJECTIVE: Abnormal eating patterns and recurrent purging behaviors can result in significant medical complications. The purpose of this study was to assess the frequency of abnormalities in clinical laboratory tests in patients with bulimia nervosa who reported being otherwise in good health. METHODS: Subjects included nonhospitalized women (N = 74) who met criteria for bulimia nervosa outlined in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders. They also reported use of self-induced vomiting and/or laxatives as compensatory behaviors (purging subtype). The control group (N = 110) included female volunteers with no history of a psychiatric disorder. All subjects reported being in good medical health, were medication free, and were in a normal weight range. Blood samples were analyzed in the hospital clinical laboratory. RESULTS: Compared with controls, patients showed more frequent occurrence of low values for serum potassium (6.8% vs. 0.9%; p <.05) and chloride (8.1% vs. 0.9%; p <.02). Electrolyte abnormalities occurred most often in patients with frequent bulimic episodes. Study groups did not differ significantly in frequency of abnormal hemoglobin concentrations. DISCUSSION: These results help to clarify the expected frequency of electrolyte abnormalities in individuals with bulimia nervosa who report otherwise good medical health. The substantial frequency of hypokalemia and hypochloremia underscores the importance of an appropriate medical assessment for individuals with this disorder.

    Title Decreased Serum Leptin in Bulimia Nervosa.
    Date February 2001
    Journal The Journal of Clinical Endocrinology and Metabolism

    The eating disorder bulimia nervosa has been associated with impaired satiety, decreased resting metabolic rate, and abnormal neuroendocrine regulation. Preclinical studies suggest that such alterations could be associated with impaired leptin function. Thus, the goal of this study was to assess whether leptin function is decreased in bulimia nervosa. Serum leptin levels measured in women with bulimia nervosa (n = 18) and in women who had maintained stable recovery from bulimia nervosa (n = 15) were compared with values in healthy female controls (n = 20). Subjects were studied during the follicular phase of their menstrual cycle after an overnight fast and bed rest. Baseline serum samples were analyzed for leptin concentration by RIA. Subject groups were matched for age and body weight. Analysis of covariance, adjusting for percent body fat, demonstrated abnormally low serum leptin levels in the bulimia nervosa group (P: = 0.02), with a trend toward an inverse correlation between frequency of binge episodes and serum leptin concentration (P: < 0.1). Additionally, the remitted patient group demonstrated abnormally low leptin values (P: = 0.01). These results are consistent with the hypothesis that decreased leptin function may be associated with alterations in eating patterns, metabolic rate, and neuroendocrine regulation in bulimia nervosa.

    Title Serotonin Function Following Remission from Bulimia Nervosa.
    Date March 2000
    Journal Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology

    Abnormal serotonergic regulation in bulimia nervosa is thought to contribute to recurrent binge eating, depressed mood, and impulsivity. To follow-up on previous studies showing decreased neuroendocrine responses in symptomatic patients, this study assessed serotonin-mediated prolactin responses in individuals who had remitted from bulimia nervosa. Subjects included 21 women with a history of bulimia nervosa and 21 healthy female controls, as well as an additional comparison group of 19 women with current bulimia nervosa. Placebo-controlled neuroendocrine response studies utilized a single oral dose (60 mg) of the indirect serotonin agonist d,l-fenfluramine. For the bulimia nervosa remitted group, the fenfluramine-stimulated elevation in serum prolactin concentration was not significantly different from the response in healthy controls, but was significantly larger than the response in patients with current bulimia nervosa (p < .01). These findings suggest that diminished serotonergic neuroendocrine responsiveness in bulimia nervosa reflects a state-related abnormality. The results are discussed in relationship to recent reports indicating that some alterations in central nervous system serotonin regulation may persist in symptomatically recovered individuals.

    Title Salivary Gland Enlargement and Elevated Serum Amylase in Bulimia Nervosa.
    Date August 1999
    Journal Biological Psychiatry

    BACKGROUND: Clinical reports have described salivary gland enlargement in bulimia nervosa, particularly in patients with elevated serum amylase concentration. The goal of the current study was to provide a controlled comparison of salivary gland size in patients with bulimia nervosa and healthy volunteers. METHODS: Subjects included 17 women with bulimia nervosa and 21 healthy female control subjects. Dimensions of the parotid and submandibular salivary glands were estimated by ultrasonography. Blood samples for amylase measurement were obtained after overnight fast. RESULTS: Parotid gland size was enlarged 36% in patients with bulimia nervosa in comparison to control subjects (p < .01). For the patient group, salivary gland size was significantly correlated with frequency of bulimic symptoms and with serum amylase concentration. CONCLUSIONS: These results provide new quantitative data demonstrating increased salivary gland size in bulimia nervosa. Further studies are needed to evaluate factors responsible for salivary gland enlargement and hyperamylasemia in this disorder.

    Title The Effects of Dieting on Plasma Tryptophan Concentration and Food Intake in Healthy Women.
    Date June 1997
    Journal Physiology & Behavior

    Although many people diet, relatively few dieters are successful in maintaining weight loss. The extent to which dieting behavior might dampen satiety responses normally mediated by the neurotransmitter serotonin remains uncertain. This study tested the hypothesis that dieting behavior decreases the availability of plasma tryptophan (TRP) and the ratio of TRP to other branched-chain amino acids (BCAA) that compete for entry into the central nervous system (CNS). This effect could diminish the CNS concentration of TRP, the amino acid precursor for serotonin synthesis, thus interfering with serotonin-mediated influences on food intake. Using a fixed-order design, 15 healthy, normal-weight women were studied longitudinally during an ad lib dietary intake phase and subsequent reduced-calorie diet phase. Physiological and behavioral measures were collected at baseline, at the end of the ad lib-intake phase, and at the end of the 4-week study diet phase. Food intake was measured by a single-item test meal. Plasma TRP and TRP: sigma BCAA significantly decreased following the study diet compared to baseline (p < 0.05). Change in TRP and TRP: sigma BCAA significantly correlated with decrease in body weight (p < 0.01). No significant relationship was observed between postdiet change in TRP or TRP: sigma BCAA ratio and postdiet change in test meal food intake, with covariation for weight loss. The observed decreases in plasma TRP and TRP: sigma BCAA extend previous reports suggesting that dieting behavior may diminish central serotonin function through a reduction in precursor availability.

    Title Decreased Serotonin Function in Bulimia Nervosa.
    Date June 1997
    Journal Archives of General Psychiatry

    BACKGROUND: Evidence that serotonin-active antidepressant medications decrease binge eating in patients with bulimia nervosa has fueled interest in the hypothesis that abnormal serotonergic neurotransmitter function contributes to symptoms of the disorder. To evaluate this hypothesis, we employed pharmacological challenge testing to compare serotonin function in patients with bulimia nervosa and healthy controls. METHODS: Neuroendocrine response patterns were compared for 15 nonhospitalized, medication-free, normal-weight women with bulimia nervosa and 14 age-matched healthy female controls. Behavioral assessment included ratings of eating disorder symptoms, depression, and anxiety. Serotonergic response patterns were assessed by measuring the increase in serum prolactin concentration during 5 hours following single-dose, oral administration of 60 mg of d,l-fenfluramine hydrochloride (Pondimin). RESULTS: For patients with bulimia nervosa, the fenfluramine-stimulated increase in serum prolactin concentration was significantly less than for controls. Within the patient group, the frequency of binge eating episodes during the 4 weeks prior to the study exhibited a significant inverse correlation with serotonin-stimulated prolactin secretion. CONCLUSION: Our study provides new evidence that impaired central nervous system serotonergic responsiveness may contribute to the onset or maintenance of abnormal eating patterns in patients with bulimia nervosa.

    Title Medications in the Treatment of Eating Disorders.
    Date March 1997
    Journal The Psychiatric Clinics of North America

    Effective planning for medication treatment in patients with bulimia nervosa and anorexia nervosa is based on a comprehensive clinical assessment, including a careful review of comorbid psychiatric disorders and response to treatments for previous episodes of the disorder. Although most patients with bulimia nervosa are offered a trial of psychotherapy, significant results of controlled trials have contributed to an increased role for medications in the treatment of patients with this disorder. Pharmacologic treatment of anorexia nervosa has similarities to that of treatment-resistant depression, with the clinician turning to open trials and clinical reports for clues to rational management. As described in this article, considerations of potential side effects and medical complications are likely to play an important role in guiding the choice of medication used for treatment of patients with eating disorders.

    Title Comparison of the Effects of Amino Acid Mixture and Placebo on Plasma Tryptophan to Large Neutral Amino Acid Ratio.
    Date October 1996
    Journal Life Sciences

    To assess the possible role of altered central serotonin function in psychiatric disorders, investigators have utilized pharmacological challenge testing with an amino acid mixture to decrease blood tryptophan concentration and, indirectly, brain serotonin levels. The aim of this pilot study was to assess the effectiveness of a modified amino mixture, administered in capsule form, in decreasing plasma tryptophan levels. Studies were conducted in six healthy, medication-free female volunteers. Following double-blind, randomized, cross-over design, subjects received on separate days capsules containing a tryptophan-free amino acid mixture (31.5 grams) or lactose placebo. Over the six hours following amino acid administration, plasma tryptophan concentrations decreased to 21% of baseline values, while the tryptophan/large neutral amino acid ratio decreased to 6% of baseline. Subjects reported minimal symptoms of nausea or other side effects following amino acid administration. The results suggest that the modified amino acid mixture may be useful in assessing behavioral responses to acute tryptophan depletion challenge testing.

    Title Development of a Unidimensional Composite Measure of Neuropsychological Functioning in Older Cardiac Surgery Patients with Good Measurement Precision.
    Journal Journal of Clinical and Experimental Neuropsychology

    The objective of this analysis was to develop a measure of neuropsychological performance for cardiac surgery and to assess its psychometric properties. Older patients (n = 210) underwent a neuropsychological battery using nine assessments. The number of factors was identified with variable reduction methods. Factor analysis methods based on item response theory were used to evaluate the measure. Modified parallel analysis supported a single factor, and the battery formed an internally consistent set (coefficient alpha = .82). The developed measure provided a reliable, continuous measure (reliability > .90) across a broad range of performance (-1.5 SDs to +1.0 SDs) with minimal ceiling and floor effects.

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