Psychoactive substance use disorder in relatives of patients with anorexia nervosa.

We assessed the lifetime prevalence and morbid risk of psychoactive substance use disorder (SUD; alcoholism and drug use disorder) in the first- and second-degree relatives, excluding children, of 34 female patients with anorexia nervosa (AN) and 34 age- and sex-matched controls who had no history of an eating disorder. Diagnoses of relatives were made blind to probands' diagnoses. The prevalence of SUD was 9% in both anorectic and control relatives, and the figures for morbid risk were 14% and 15%, respectively; these differences were nonsignificant. These results suggest that adolescent and adult women with AN do not possess many of the familial factors that predispose to the development of psychoactive SUD.

How are depression and bulimia related?

The idea that bulimia may be related to affective illness was encouraged by early reports of a high prevalence of clinical depression in bulimic patients as well as a high lifetime prevalence of depression in the families of these patients. More recent evidence suggests, however, that bulimia and major depression are distinct entities. The authors review clinical data, family studies, pharmacotherapy, and the neurobiology of bulimia and discuss the nature of the relationship between depression and bulimia.

Pituitary response to TRH in bulimia.

The response to thyrotropin-releasing hormone (TRH) of thyroid-stimulating hormone (TSH), growth hormone (GH), and prolactin (PRL) was examined in nine normal weight female bulimics without endogenous depression and eight female controls. Four bulimics had delayed peak TSH response, but none demonstrated a blunted TSH response, unlike that which has been reported in endogenous depression. Bulimics had elevated mean +/- SD serum GH levels (controls 1.6 +/- 1.4 ng/ml, bulimics 5.6 +/- 3.9) and an inappropriate GH release following TRH. Their mean +/- SD serum PRL (3.1 +/- 1.7 ng/ml) was lower than that of controls (4.7 +/- 1.3); however, the PRL response to TRH was significantly greater in bulimics than in controls. These data show that neuroendocrine abnormalities exist in normal weight bulimic women without endogenous depression and provide further evidence for a neuroendocrine component to this illness.

REM and delta sleep in anorexia nervosa and bulimia.

Several recent investigations have suggested that neurobiological similarities may exist between patients with eating disorders and those with depression. We performed polysomnograms for two consecutive nights on nine bulimic and six anorectic patients who had no concomitant diagnosis of endogenous depression. The rapid eye movement (REM) latency, REM density, and delta sleep of these subjects on night 2 were compared to those of 10 healthy controls of similar ages. Contrary to reports of shortened REM latency and increased REM density in depressed patients, we did not find significant REM differences between eating disorder patients without endogenous depression and healthy control subjects. Low weight anorectics did appear to have less delta sleep than did controls. These findings do not support the contention that eating disorders are variants of affective disorders.

Affective disorder in the families of women with normal weight bulimia.

The authors determined the lifetime prevalence of affective disorder in the first- and second-degree relatives, excluding children, of 27 bulimic women who had never had anorexia nervosa and 27 women with no history of an eating disorder. Family diagnoses were made blind to the proband's diagnosis. The prevalence of affective disorder was 9% in the relatives of the bulimic probands and 10% in the relatives of the control probands, a nonsignificant difference. These findings are in contrast to reports of an increased prevalence of affective disorder in the relatives of patients with anorexia nervosa.

Group therapy for bulimia.

Thirty women meeting DSM-III criteria for bulimia were seen weekly in a group setting using behavioral techniques and insight-oriented discussion. Pre- and post-measures using the EAT, Marlowe Crowne Social Desirability Scale, Rotter Locus of Control, and SCL-90-R self-rating scales were performed on 11 group completers. Two comparison groups consisted of bulimic women who received either no treatment or individual psychotherapy. The differences on the parameters measured in comparing group therapy, individual therapy, and no treatment subject groups would suggest that a group therapy approach holds promise for an otherwise poor prognosis disorder and that the changes are measureable.

Insomniac children.

In this preliminary investigation sixteen latency-age children were compared with matched good sleep children from child psychiatric and general pediatric clinic populations. Parent and child reports support the existence of chronic childhood insomnia, occurring at a greater frequency in an emotionally disturbed population. Although parent-child agreement on insomnia symptoms tends to be high, there was poor agreement on other sleep-related symptoms.

The psychiatric abortion consultation.

The role of the psychiatric consultant has changed with the recent liberal "on demand" abortion legislation. This paper emphasizes factors relevant to the psychiatric consultant in the evaluation of the adolescent patient, the retarded patient and the patient with psychiatric illness. In addition, a survey of the literature is made to identify the patient who is at high risk of developing postabortion psychiatric complications. The authors conclude that postabortion complications are infrequent and that there are no absolute psychiatric contraindications to elective abortion.

Father-son incest: underreported psychiatric problem?

Six families are described in which 10 sons were involved incestuously with a natural father (N=4) or step-father (N=2). Father-son incest as a part of the spectrum of child abuse appears to be a more frequent clinical entity than was thought previously.