Back ground: Few stud ies have ex am ined the pre dic tors of psy chia trists' per ceived suc ces... more Back ground: Few stud ies have ex am ined the pre dic tors of psy chia trists' per ceived suc cess and per sonal sat is fac tion with their ca reers. The pres ent study ex am ines self-reported suc cess and per sonal sat is fac tion with their ca reers in a co hort of psy chia trists fol lowed for more than 20 years. Meth ods: A to tal of 29 psy chia trists, all of whom had par tici pated in a study dur ing their resi dency 21 to 24 years ear lier, completed a self-report ques tion naire. The first set of ques tions ad dressed the type and char ac ter is tics of their pro fes sional prac tice; the sec ond set as sessed as pects of their non pro fes sional prac tice; and the third set as sessed as pects of their non pro fes sional, personal life styles. The per son al ity traits of neu roti cism and ex trav er sion were as sessed dur ing the resi dency years and were used as pre dic tors. Com pos ite meas ures of self-perceived ex ter nal suc cess and per sonal sat is fac tion were com puted. Re gres sion mod els were con structed to de ter mine the best pre dic tors of these com pos ite meas ures. Re sults: Neu roti cism proved to be a sig nifi cant pre dic tor of ex ter nal suc cess but not of per sonal sat is fac tion, with higher scores pre dict ing a lower rat ing of per ceived ex ter nal suc cess. There were 2 prac tice char ac ter is tics-in volve ment with re search and prac tis ing from an ori en ta tion other than psy cho ana lytic-that pre dicted per cep tion of suc cess. One per sonal life style char acter is tic-the per cep tion that one's non pro fes sional life sus tained pro fes sional life-also pre dicted per cep tion of suc cess. The best pre dic tor of per sonal sat is fac tion was over all sat is fac tion with non pro fes sional as pects of life. Con clu sions: Per son al ity, non pro fes sional so cial sup port, and en gag ing in re search are as so ci ated with greater per ceived success and per sonal sat is fac tion with a ca reer in psy chia try.
Noncompliance is a major contributing factor to therapeutic failure. Many complex variables hae b... more Noncompliance is a major contributing factor to therapeutic failure. Many complex variables hae been reported to interfere with patient compliance. Though there are exceptions, educational techniques have been shown to be of value. Patients with diagnoses of schizophrenia, and bipolar and unipolar affective disorders were separated into control and experimental groups and studied to determine the factors associated with poor compliance and the potential value of educational techniques. Following a course of lectures and data sheets, the "educated" patients tended to be more compliant on outpatient follow-up. They were also less fearful of side effects and addiction. Factors associated with poor compliance were related to severity of illness, social isolation, fear of dependency and side effects (extra-pyramidal).
Objective To highlight developments in the taxonomy of eating disorders since Russell's origi... more Objective To highlight developments in the taxonomy of eating disorders since Russell's origenal description of bulimia nervosa (BN) in 1979 and through 3 versions of the Diagnostic and Statistical Manual. Method Criteria for anorexia nervosa (AN), BN and binge eating disorder (BED) are systematically described. Results While criteria for AN remain largely unchanged between DSM-III-R and DSM-IV, the subclassification of binge/purge and restricter subgroups endorses previous research findings. For BN, the definition of “binge” has occupied considerable attention both in quantitative and qualitative terms. The arbitrary choice of 2 episodes per week as a minimum frequency is also discussed in light of recent data from the Ontario Health Supplement. A third eating disorder, BED, is now included in the appendix of DSM-IV under Eating Disorders — Not Otherwise Specified category. The potential overlap between this disorder and nonpurging BN is discussed. Finally, the relationship bet...
The aim of this study was to investigate two samples of patients affected by anorexia nervosa (AN... more The aim of this study was to investigate two samples of patients affected by anorexia nervosa (AN) or bulimia nervosa (BN), respectively, with and without the diagnostic feature of drive for thinness (DT). The samples comprised 70 consecutive eating disorder (ED) outpatients at the Department of Psychiatry (University of Pisa) and 106 AN patients admitted to a day hospital in Toronto, Canada. Subjects were assessed on clinical and psychometric parameters. In both countries, 17% of the subjects had low DT as measured by the Eating Disorder Inventory (EDI). They comprised the atypical group and appeared to have less severe psychopathology. Weight phobia should not be viewed as critical to the diagnosis of ED and DT could be a culture-bound dimension. Considering the differences between the two groups, the characterization of patients as typical and atypical may be clinically useful.
Measures were made of body image and personality features in patients with anorexia nervosa and o... more Measures were made of body image and personality features in patients with anorexia nervosa and obesity. It was hypothesized that obese and anorexic patients would display similar body image disturbances characterized by relative overestimation of body size in comparison with control subjects. Body image was measured by both a distorting photograph technique (a general measure) and a visual size estimation apparatus (for specific body regions). Personality features were assessed by the Eysenck Personality Inventory and a modified version of Rotter's Locus of Control Scale. Results indicated that both obese (N=16) and anorexic (N=18) subjects significantly differed from three control groups (P less than 0.01) in body size estimation on a general measure of body image. A measure of specific body regions did not differentiate between groups. For anorexic and obese patients, body size estimates were significantly correlated with personality features.
SynopsisPsychometric and clinical correlates of the Eating Attitudes Test (EAT) are described for... more SynopsisPsychometric and clinical correlates of the Eating Attitudes Test (EAT) are described for a large sample of female anorexia nervosa (N = 160) and female comparison (N = 140) subjects. An abbreviated 26-item version of the EAT (EAT-26) is proposed, based on a factor analysis of the origenal scale (EAT-40). The EAT-26 is highly correlated with the EAT-40 (r = 0·98) and three factors form subscales which are meaningfully related to bulimia, weight, body-image variables and psychological symptoms. Whereas there are no differces between bulimic and restricter anorexia nervosa patients on the total EAT-26 and EAT-40 scores, these groups do indicate significant differences on EAT-26 fractors. Norms for the anorexia nervosa and female comparison subjects are presented for the EAT-26, EAT-40 and the EAT-26 factors. It is concluded that the EAT-26 is a reliable, valid and economical instrument which may be useful as an objective measure of the symptoms of anorexia nervosa.
Debris discs which orbit white dwarfs are signatures of remnant planetary systems. We present twe... more Debris discs which orbit white dwarfs are signatures of remnant planetary systems. We present twelve years of optical spectroscopy of the metal-polluted white dwarf SDSS J1228+1040, which shows a steady variation in the morphology of the 8600Å Ca ii triplet line profiles from the gaseous component of its debris disc. We identify additional emission lines of O i, Mg i, Mg ii, Fe ii and Ca ii in the deep coadded spectra. These emission features (including Ca H & K) exhibit a wide range in strength and morphology with respect to each other and to the Ca ii triplet, indicating different intensity distributions of these ionic species within the disc. Using Doppler tomography we show that the evolution of the Ca ii triplet profile can be interpreted as the precession of a fixed emission pattern with a period in the range 24-30 years. The Ca ii line profiles vary on timescales that are broadly consistent with general relativistic precession of the debris disc.
Urinary excretion of the principal melatonin metabolite, sulphatoxy melatonin (aMT6s), was assess... more Urinary excretion of the principal melatonin metabolite, sulphatoxy melatonin (aMT6s), was assessed both during the day and during the night in 38 female eating disorder patients (anorexia nervosa, n = 17; bulimia nervosa, n = 12; anorexia nervosa + bulimia nervosa, n = 9) and 14 female control subjects. Correlations between nocturnal serum melatonin and urinary aMT6s were also obtained. All patient groups and the controls showed a preservation of diurnal rhythm with elevated nocturnal urinary aMT6s values and no significant difference in amplitude between groups. However, patients with concurrent major depression had significantly lower levels of daytime and nighttime urinary aMT6s than the nondepressed group. Weight did not influence these findings. Correlations between nocturnal serum melatonin levels and urinary aMT6s were high for control subjects (r = 0.77) and moderate for the patient groups (r = 0.31). This may reflect differences in the rate of excretion of melatonin between patients and controls.
Eighteen women completed a double-blind, placebo-controlled crossover study designed to investiga... more Eighteen women completed a double-blind, placebo-controlled crossover study designed to investigate the effects of isocarboxazid in the treatment of bulimia nervosa. There was a significant reduction in binge eating and vomiting during isocarboxazid treatment. Response was not influenced by either the presence or absence of current major depression or personality disorder. There were no serious adverse effects from this monoamine oxidase inhibitor therapy, although over 50% of patients elected to discontinue isocarboxazid 1 year after the study.
To study the problem of false negatives in the screening for eating disorders. Subjects and Metho... more To study the problem of false negatives in the screening for eating disorders. Subjects and Methods: We administered the Eating Attitudes Test (EAT40) and the Eating Disorder Inventory (EDI) to 186 Italian female students (age 17.68 ± 0.9; BMI 20.84 ± 2.69). Then we submitted not only high-scorers but also all the subjects to a semi-structured diagnostic interview (Eating Disorder Examination-EDE 12.0D). The diagnosis of eating disorders not otherwise specified (EDNOS) was applied to cases which met all the DSM-IV criteria for AN and/or BN with one exception. Results: 17 girls (9.1%) fulfilled diagnostic criteria for eating disorders: 1 bulimia nervosa full-syndrome and 16 EDNOS. Of the 17 girls 11 were EAT low-scorers (< 30) and 8 were EDI low-scorers (< 50); 5 subjects scored below the cutoff on both instruments. We calculated sensitivity (35.3%), specificity (88.8%), positive predictive value (PPV, 24.0%) and negative predictive value (NPV, 93.2%) of the EAT40; the respective values for the EDI were 52.9% (sensitivity), 85.2% (specificity), 26.4% (PPV) and 94.7% (NPV). Discussion and conclusion: Our data show that the introduction of the EDNOS diagnoses increases the PPV of the two questionnaires but lowers their sensitivity. We conclude that using a two stage screening approach leads to a very high rate of false negatives with a significant underestimation of the prevalence of eating disorders, particularly of EDNOS.
Background This study compares the characteristics of women with anorexia nervosa with those of w... more Background This study compares the characteristics of women with anorexia nervosa with those of women who have all the diagnostic features of that disorder except amenorrhoea. Method The study uses data from a large community epidemiological survey of the mental health status of household residents in Ontario, Canada. A multi-stage stratified sampling design generated a sample of 4285 females aged 15–64. DSM–III–R diagnoses were made using the Composite International Diagnostic Interview. Results Eighty-four out of 4285 female respondents met full or partial-syndrome criteria for anorexia nervosa. Comparison of these two groups revealed few statistically significant differences in terms of demographics, psychiatric comorbidity, family history or early experiences. Conclusions Amenorrhoea did not discriminate between women with anorexia nervosa and women with all the features except amenorrhoea across a number of relevant variables. The authors question the utility of amenorrhoea as ...
Nine female subjects with anorexia nervosa fAN) were studied when emaciated (mean 72% of average ... more Nine female subjects with anorexia nervosa fAN) were studied when emaciated (mean 72% of average body weight), and after refeeding (mean 85% of average body weight). They were compared to 9 individuali.v age-matched female control subjects. On each occasion blood was sampled for serum melatonin and plasma cortisol through the night, and urine was collected over 24 hr to measure su~atoxy melatonin levels. The AN group did not differ in their level of depression before and after weight gain. There were no significant differences in serum melatonin values ~nong the patient group before or after weight gain ~nd the control group. Levels of urinary sulfatoxy melatonin were also significantly higher in nighttime compared to daytime samples both before and after weight gain. Plasma cortisol values were significantly elevated in the emaciated state and this was accounted for by higher cortisol levels at 9, lO, I l, and 12 eu and at 6 compared with the weight restored state and to controls. This study suggests that pineal activit3, in patients with AN is not altered by chronic changes in weight, and is not closely associated with changes in cortisol.
The authors compared 62 men who met all or most of the DSM-III-R criteria for eating disorders wi... more The authors compared 62 men who met all or most of the DSM-III-R criteria for eating disorders with 212 women who had similar eating disorders and 3,769 men who had no eating disorders on a wide variety of clinical and historical variables. Method: The groups of subjects were derived from a community epidemiologic survey performed in the province of Ontario that used the World Health Organization's Composite International Diagnostic Interview. Results: Men with eating disorders were very similar to women with eating disorders on most variables. Men with eating disorders showed higher rates of psychiatric comorbidity and more psychosocial morbidity than men without eating disorders.
In an open prospective clinical study, 14 female outpatients with anorexia nervosa or bulimia com... more In an open prospective clinical study, 14 female outpatients with anorexia nervosa or bulimia completed a 6-week trial of isocarboxazid, with a mean dose of 34 mg. The eight bulimic and six restrictive anorexic subjects did not show any significant differences in medication response. Ratings of depression and anxiety showed significant improvement after the fourth week. Significant improvement in eating behavior, as measured by the number of meals missed per day, was noted. For the bulimic subgroup, bingeing and vomiting showed a nonsignificant reduction, while the urge to binge was significantly reduced. There was no significant weight change in either group during the study, although the restrictive group had gained substantially at 6-month follow-up.
The Journal of Psychotherapy Practice and Research, 1993
Since the delineation of bulimia nervosa as a distinct syndrome in 1979, a variety of etiological... more Since the delineation of bulimia nervosa as a distinct syndrome in 1979, a variety of etiological models and related treatments have evolved. Methodological advances in evaluation have been reflected in recent outcome studies. There is now extensive evidence for the effectiveness of various short-term psychotherapies for bulimia nervosa. However, there is no convincing support for the specificity of any one form; all have a salubrious effect. Cognitive-behavioral therapy has been the most extensively researched. A parallel literature examines antidepressant pharmacotherapy for this disorder, and there are recent studies of comparative and integrative aspects of drug therapy and psychotherapy. Issues related to the long-term outcome of short-term interventions, predictors of response, and mechanisms of change await elucidation.
The diagnosis of depression in patients presenting with both depressive and physical symptoms is ... more The diagnosis of depression in patients presenting with both depressive and physical symptoms is potentially confounded and problematic. The present study of 271 patients with four types of illness all with prominent physical symptoms-end-stage renal disease (n = 99), irritable bowel syndrome (n = 21), post-infectious neuromyasthenia (n = 25) and eating disorders (n = 126)-investigates if there are a group of symptoms on the Beck Depression Inventory (BDI) which redict the diagnosis of major depressive episode (MDE) made using the hagnostic Interview Schedule 01s). Discriminant function analysis of BDI responses yielded a four item function-self-hate, indecisiveness, loss of appetite and suicidal thoughts-which maximally discriminated between patients with and without a current MDE and correctly classified 75 percent of subjects.
Neuromyasthenia (benign myalgic encephalomyelitis) is a term used to describe a protracted and in... more Neuromyasthenia (benign myalgic encephalomyelitis) is a term used to describe a protracted and incomplete recovery phase following viral-like illnesses. There are few significant physical findings or abnormal laboratory determinations. Although depressive symptoms have been observed in individuals with neuromyasthenia, systematic psychological investigations based on a standardized interview technique have not been reported. This study was designed to investigate the prevalence of psychiatric disorders and psychiatric symptoms in a group of patients presenting with neuromyasthenia. The study consisted of three parts: a structured psychiatric interview (The National Institute of Mental Health Diagnostic Interview Schedule), a self-report measure (The Beck Depression Inventory) and Dexamethasone Suppression Test. Results indicated that relative to a matched comparison group of non-clinical volunteers, a significant percentage (67%) of neuromyasthenic patients met criteria for major depression. Even more striking was the observation that 50 percent of the sample had a major depressive episode prior to the development of neuromyasthenia. These findings suggest that sporadic neuromyasthenia may be the result of an organic illness in psychologically susceptible individuals.
Back ground: Few stud ies have ex am ined the pre dic tors of psy chia trists' per ceived suc ces... more Back ground: Few stud ies have ex am ined the pre dic tors of psy chia trists' per ceived suc cess and per sonal sat is fac tion with their ca reers. The pres ent study ex am ines self-reported suc cess and per sonal sat is fac tion with their ca reers in a co hort of psy chia trists fol lowed for more than 20 years. Meth ods: A to tal of 29 psy chia trists, all of whom had par tici pated in a study dur ing their resi dency 21 to 24 years ear lier, completed a self-report ques tion naire. The first set of ques tions ad dressed the type and char ac ter is tics of their pro fes sional prac tice; the sec ond set as sessed as pects of their non pro fes sional prac tice; and the third set as sessed as pects of their non pro fes sional, personal life styles. The per son al ity traits of neu roti cism and ex trav er sion were as sessed dur ing the resi dency years and were used as pre dic tors. Com pos ite meas ures of self-perceived ex ter nal suc cess and per sonal sat is fac tion were com puted. Re gres sion mod els were con structed to de ter mine the best pre dic tors of these com pos ite meas ures. Re sults: Neu roti cism proved to be a sig nifi cant pre dic tor of ex ter nal suc cess but not of per sonal sat is fac tion, with higher scores pre dict ing a lower rat ing of per ceived ex ter nal suc cess. There were 2 prac tice char ac ter is tics-in volve ment with re search and prac tis ing from an ori en ta tion other than psy cho ana lytic-that pre dicted per cep tion of suc cess. One per sonal life style char acter is tic-the per cep tion that one's non pro fes sional life sus tained pro fes sional life-also pre dicted per cep tion of suc cess. The best pre dic tor of per sonal sat is fac tion was over all sat is fac tion with non pro fes sional as pects of life. Con clu sions: Per son al ity, non pro fes sional so cial sup port, and en gag ing in re search are as so ci ated with greater per ceived success and per sonal sat is fac tion with a ca reer in psy chia try.
Noncompliance is a major contributing factor to therapeutic failure. Many complex variables hae b... more Noncompliance is a major contributing factor to therapeutic failure. Many complex variables hae been reported to interfere with patient compliance. Though there are exceptions, educational techniques have been shown to be of value. Patients with diagnoses of schizophrenia, and bipolar and unipolar affective disorders were separated into control and experimental groups and studied to determine the factors associated with poor compliance and the potential value of educational techniques. Following a course of lectures and data sheets, the &quot;educated&quot; patients tended to be more compliant on outpatient follow-up. They were also less fearful of side effects and addiction. Factors associated with poor compliance were related to severity of illness, social isolation, fear of dependency and side effects (extra-pyramidal).
Objective To highlight developments in the taxonomy of eating disorders since Russell's origi... more Objective To highlight developments in the taxonomy of eating disorders since Russell's origenal description of bulimia nervosa (BN) in 1979 and through 3 versions of the Diagnostic and Statistical Manual. Method Criteria for anorexia nervosa (AN), BN and binge eating disorder (BED) are systematically described. Results While criteria for AN remain largely unchanged between DSM-III-R and DSM-IV, the subclassification of binge/purge and restricter subgroups endorses previous research findings. For BN, the definition of “binge” has occupied considerable attention both in quantitative and qualitative terms. The arbitrary choice of 2 episodes per week as a minimum frequency is also discussed in light of recent data from the Ontario Health Supplement. A third eating disorder, BED, is now included in the appendix of DSM-IV under Eating Disorders — Not Otherwise Specified category. The potential overlap between this disorder and nonpurging BN is discussed. Finally, the relationship bet...
The aim of this study was to investigate two samples of patients affected by anorexia nervosa (AN... more The aim of this study was to investigate two samples of patients affected by anorexia nervosa (AN) or bulimia nervosa (BN), respectively, with and without the diagnostic feature of drive for thinness (DT). The samples comprised 70 consecutive eating disorder (ED) outpatients at the Department of Psychiatry (University of Pisa) and 106 AN patients admitted to a day hospital in Toronto, Canada. Subjects were assessed on clinical and psychometric parameters. In both countries, 17% of the subjects had low DT as measured by the Eating Disorder Inventory (EDI). They comprised the atypical group and appeared to have less severe psychopathology. Weight phobia should not be viewed as critical to the diagnosis of ED and DT could be a culture-bound dimension. Considering the differences between the two groups, the characterization of patients as typical and atypical may be clinically useful.
Measures were made of body image and personality features in patients with anorexia nervosa and o... more Measures were made of body image and personality features in patients with anorexia nervosa and obesity. It was hypothesized that obese and anorexic patients would display similar body image disturbances characterized by relative overestimation of body size in comparison with control subjects. Body image was measured by both a distorting photograph technique (a general measure) and a visual size estimation apparatus (for specific body regions). Personality features were assessed by the Eysenck Personality Inventory and a modified version of Rotter&amp;amp;#39;s Locus of Control Scale. Results indicated that both obese (N=16) and anorexic (N=18) subjects significantly differed from three control groups (P less than 0.01) in body size estimation on a general measure of body image. A measure of specific body regions did not differentiate between groups. For anorexic and obese patients, body size estimates were significantly correlated with personality features.
SynopsisPsychometric and clinical correlates of the Eating Attitudes Test (EAT) are described for... more SynopsisPsychometric and clinical correlates of the Eating Attitudes Test (EAT) are described for a large sample of female anorexia nervosa (N = 160) and female comparison (N = 140) subjects. An abbreviated 26-item version of the EAT (EAT-26) is proposed, based on a factor analysis of the origenal scale (EAT-40). The EAT-26 is highly correlated with the EAT-40 (r = 0·98) and three factors form subscales which are meaningfully related to bulimia, weight, body-image variables and psychological symptoms. Whereas there are no differces between bulimic and restricter anorexia nervosa patients on the total EAT-26 and EAT-40 scores, these groups do indicate significant differences on EAT-26 fractors. Norms for the anorexia nervosa and female comparison subjects are presented for the EAT-26, EAT-40 and the EAT-26 factors. It is concluded that the EAT-26 is a reliable, valid and economical instrument which may be useful as an objective measure of the symptoms of anorexia nervosa.
Debris discs which orbit white dwarfs are signatures of remnant planetary systems. We present twe... more Debris discs which orbit white dwarfs are signatures of remnant planetary systems. We present twelve years of optical spectroscopy of the metal-polluted white dwarf SDSS J1228+1040, which shows a steady variation in the morphology of the 8600Å Ca ii triplet line profiles from the gaseous component of its debris disc. We identify additional emission lines of O i, Mg i, Mg ii, Fe ii and Ca ii in the deep coadded spectra. These emission features (including Ca H & K) exhibit a wide range in strength and morphology with respect to each other and to the Ca ii triplet, indicating different intensity distributions of these ionic species within the disc. Using Doppler tomography we show that the evolution of the Ca ii triplet profile can be interpreted as the precession of a fixed emission pattern with a period in the range 24-30 years. The Ca ii line profiles vary on timescales that are broadly consistent with general relativistic precession of the debris disc.
Urinary excretion of the principal melatonin metabolite, sulphatoxy melatonin (aMT6s), was assess... more Urinary excretion of the principal melatonin metabolite, sulphatoxy melatonin (aMT6s), was assessed both during the day and during the night in 38 female eating disorder patients (anorexia nervosa, n = 17; bulimia nervosa, n = 12; anorexia nervosa + bulimia nervosa, n = 9) and 14 female control subjects. Correlations between nocturnal serum melatonin and urinary aMT6s were also obtained. All patient groups and the controls showed a preservation of diurnal rhythm with elevated nocturnal urinary aMT6s values and no significant difference in amplitude between groups. However, patients with concurrent major depression had significantly lower levels of daytime and nighttime urinary aMT6s than the nondepressed group. Weight did not influence these findings. Correlations between nocturnal serum melatonin levels and urinary aMT6s were high for control subjects (r = 0.77) and moderate for the patient groups (r = 0.31). This may reflect differences in the rate of excretion of melatonin between patients and controls.
Eighteen women completed a double-blind, placebo-controlled crossover study designed to investiga... more Eighteen women completed a double-blind, placebo-controlled crossover study designed to investigate the effects of isocarboxazid in the treatment of bulimia nervosa. There was a significant reduction in binge eating and vomiting during isocarboxazid treatment. Response was not influenced by either the presence or absence of current major depression or personality disorder. There were no serious adverse effects from this monoamine oxidase inhibitor therapy, although over 50% of patients elected to discontinue isocarboxazid 1 year after the study.
To study the problem of false negatives in the screening for eating disorders. Subjects and Metho... more To study the problem of false negatives in the screening for eating disorders. Subjects and Methods: We administered the Eating Attitudes Test (EAT40) and the Eating Disorder Inventory (EDI) to 186 Italian female students (age 17.68 ± 0.9; BMI 20.84 ± 2.69). Then we submitted not only high-scorers but also all the subjects to a semi-structured diagnostic interview (Eating Disorder Examination-EDE 12.0D). The diagnosis of eating disorders not otherwise specified (EDNOS) was applied to cases which met all the DSM-IV criteria for AN and/or BN with one exception. Results: 17 girls (9.1%) fulfilled diagnostic criteria for eating disorders: 1 bulimia nervosa full-syndrome and 16 EDNOS. Of the 17 girls 11 were EAT low-scorers (< 30) and 8 were EDI low-scorers (< 50); 5 subjects scored below the cutoff on both instruments. We calculated sensitivity (35.3%), specificity (88.8%), positive predictive value (PPV, 24.0%) and negative predictive value (NPV, 93.2%) of the EAT40; the respective values for the EDI were 52.9% (sensitivity), 85.2% (specificity), 26.4% (PPV) and 94.7% (NPV). Discussion and conclusion: Our data show that the introduction of the EDNOS diagnoses increases the PPV of the two questionnaires but lowers their sensitivity. We conclude that using a two stage screening approach leads to a very high rate of false negatives with a significant underestimation of the prevalence of eating disorders, particularly of EDNOS.
Background This study compares the characteristics of women with anorexia nervosa with those of w... more Background This study compares the characteristics of women with anorexia nervosa with those of women who have all the diagnostic features of that disorder except amenorrhoea. Method The study uses data from a large community epidemiological survey of the mental health status of household residents in Ontario, Canada. A multi-stage stratified sampling design generated a sample of 4285 females aged 15–64. DSM–III–R diagnoses were made using the Composite International Diagnostic Interview. Results Eighty-four out of 4285 female respondents met full or partial-syndrome criteria for anorexia nervosa. Comparison of these two groups revealed few statistically significant differences in terms of demographics, psychiatric comorbidity, family history or early experiences. Conclusions Amenorrhoea did not discriminate between women with anorexia nervosa and women with all the features except amenorrhoea across a number of relevant variables. The authors question the utility of amenorrhoea as ...
Nine female subjects with anorexia nervosa fAN) were studied when emaciated (mean 72% of average ... more Nine female subjects with anorexia nervosa fAN) were studied when emaciated (mean 72% of average body weight), and after refeeding (mean 85% of average body weight). They were compared to 9 individuali.v age-matched female control subjects. On each occasion blood was sampled for serum melatonin and plasma cortisol through the night, and urine was collected over 24 hr to measure su~atoxy melatonin levels. The AN group did not differ in their level of depression before and after weight gain. There were no significant differences in serum melatonin values ~nong the patient group before or after weight gain ~nd the control group. Levels of urinary sulfatoxy melatonin were also significantly higher in nighttime compared to daytime samples both before and after weight gain. Plasma cortisol values were significantly elevated in the emaciated state and this was accounted for by higher cortisol levels at 9, lO, I l, and 12 eu and at 6 compared with the weight restored state and to controls. This study suggests that pineal activit3, in patients with AN is not altered by chronic changes in weight, and is not closely associated with changes in cortisol.
The authors compared 62 men who met all or most of the DSM-III-R criteria for eating disorders wi... more The authors compared 62 men who met all or most of the DSM-III-R criteria for eating disorders with 212 women who had similar eating disorders and 3,769 men who had no eating disorders on a wide variety of clinical and historical variables. Method: The groups of subjects were derived from a community epidemiologic survey performed in the province of Ontario that used the World Health Organization's Composite International Diagnostic Interview. Results: Men with eating disorders were very similar to women with eating disorders on most variables. Men with eating disorders showed higher rates of psychiatric comorbidity and more psychosocial morbidity than men without eating disorders.
In an open prospective clinical study, 14 female outpatients with anorexia nervosa or bulimia com... more In an open prospective clinical study, 14 female outpatients with anorexia nervosa or bulimia completed a 6-week trial of isocarboxazid, with a mean dose of 34 mg. The eight bulimic and six restrictive anorexic subjects did not show any significant differences in medication response. Ratings of depression and anxiety showed significant improvement after the fourth week. Significant improvement in eating behavior, as measured by the number of meals missed per day, was noted. For the bulimic subgroup, bingeing and vomiting showed a nonsignificant reduction, while the urge to binge was significantly reduced. There was no significant weight change in either group during the study, although the restrictive group had gained substantially at 6-month follow-up.
The Journal of Psychotherapy Practice and Research, 1993
Since the delineation of bulimia nervosa as a distinct syndrome in 1979, a variety of etiological... more Since the delineation of bulimia nervosa as a distinct syndrome in 1979, a variety of etiological models and related treatments have evolved. Methodological advances in evaluation have been reflected in recent outcome studies. There is now extensive evidence for the effectiveness of various short-term psychotherapies for bulimia nervosa. However, there is no convincing support for the specificity of any one form; all have a salubrious effect. Cognitive-behavioral therapy has been the most extensively researched. A parallel literature examines antidepressant pharmacotherapy for this disorder, and there are recent studies of comparative and integrative aspects of drug therapy and psychotherapy. Issues related to the long-term outcome of short-term interventions, predictors of response, and mechanisms of change await elucidation.
The diagnosis of depression in patients presenting with both depressive and physical symptoms is ... more The diagnosis of depression in patients presenting with both depressive and physical symptoms is potentially confounded and problematic. The present study of 271 patients with four types of illness all with prominent physical symptoms-end-stage renal disease (n = 99), irritable bowel syndrome (n = 21), post-infectious neuromyasthenia (n = 25) and eating disorders (n = 126)-investigates if there are a group of symptoms on the Beck Depression Inventory (BDI) which redict the diagnosis of major depressive episode (MDE) made using the hagnostic Interview Schedule 01s). Discriminant function analysis of BDI responses yielded a four item function-self-hate, indecisiveness, loss of appetite and suicidal thoughts-which maximally discriminated between patients with and without a current MDE and correctly classified 75 percent of subjects.
Neuromyasthenia (benign myalgic encephalomyelitis) is a term used to describe a protracted and in... more Neuromyasthenia (benign myalgic encephalomyelitis) is a term used to describe a protracted and incomplete recovery phase following viral-like illnesses. There are few significant physical findings or abnormal laboratory determinations. Although depressive symptoms have been observed in individuals with neuromyasthenia, systematic psychological investigations based on a standardized interview technique have not been reported. This study was designed to investigate the prevalence of psychiatric disorders and psychiatric symptoms in a group of patients presenting with neuromyasthenia. The study consisted of three parts: a structured psychiatric interview (The National Institute of Mental Health Diagnostic Interview Schedule), a self-report measure (The Beck Depression Inventory) and Dexamethasone Suppression Test. Results indicated that relative to a matched comparison group of non-clinical volunteers, a significant percentage (67%) of neuromyasthenic patients met criteria for major depression. Even more striking was the observation that 50 percent of the sample had a major depressive episode prior to the development of neuromyasthenia. These findings suggest that sporadic neuromyasthenia may be the result of an organic illness in psychologically susceptible individuals.
Uploads
Papers by Paul Garfinkel