Subject(s)
Anorexia Nervosa/therapy , Bulimia/therapy , Adolescent , Adult , Anorexia Nervosa/mortality , Australia , Female , Humans , Predictive Value of Tests , Prospective Studies , Treatment OutcomeABSTRACT
Bulimia nervosa and related syndromes are common, and occur in up to 5% of women who attend general practitioners. Young women in First World countries, particularly those who "diet", are at increased risk. Behaviours, such as binge eating and induced vomiting, are typically kept well hidden. Only a minority of those with these disorders present for treatment. General practitioners play a key role in primary and secondary prevention. Effective treatments include psychotherapies that focus on the patient's attitudes and relationships, not just the binge eating behaviour. About 50% of patients make a complete recovery, but the long term outcome is unknown.
Subject(s)
Bulimia/diagnosis , Patient Care Team , Bulimia/psychology , Bulimia/therapy , Diet, Reducing/psychology , Family Practice , Female , Humans , Psychiatric Status Rating Scales , Syndrome , Treatment OutcomeABSTRACT
Anorexia nervosa is a serious psychiatric illness with a high morbidity and a significant lifetime mortality. Recurring themes in such patients centre on issues of self-worth and control. Treatment is difficult and prolonged, and may require hospitalisation. Therapy focuses on altering the misperceptions that patients have of themselves, both psychologically and physically. A multi-disciplinary team based in a specialised unit provides the treatment of choice, but if this is not available, a consistent, supportive relationship with an individual therapist familiar with the condition will be beneficial. Successful outcome should be based not simply on body weight but also on the resolution of anorexic thinking.
Subject(s)
Anorexia Nervosa , Anorexia Nervosa/diagnosis , Anorexia Nervosa/psychology , Anorexia Nervosa/therapy , Body Weight , Diagnosis, Differential , Family Practice , Humans , Physician's Role , Risk Factors , ThinkingSubject(s)
Family , Mental Disorders/diagnosis , Psychological Tests , Aged , Female , Humans , Male , Mental Disorders/psychology , Middle Aged , PsychometricsABSTRACT
A series of 100 consecutive admissions to a psychogeriatric unit in a large public psychiatric hospital is described. Fifty-four of these were readmissions. Most of the patients presented with moderate to severe acute psychiatric disorders, and many of these were admitted under detention orders. Their disorders were often readily treatable and most patients returned to their local communities in less than three weeks. Unexpectedly, only one-third of patients had a primary diagnosis of organic cerebral disorder, and few had received a diagnosis from the referring doctor. The principal reason for the referral of patients was that they were obviously severely disturbed and disturbing within their community. Patients who do not cause a disturbance may thus be underdiagnosed and their treatment unnecessarily compromised. The traditional system of health care seems to be working well and in the interests of these psychogeriatric patients and there is no evidence that radical changes are needed.
Subject(s)
Hospitals, Psychiatric/statistics & numerical data , Mental Disorders/diagnosis , Aged , Australia , Female , Hospital Bed Capacity, 500 and over , Humans , Length of Stay , Male , Middle Aged , Mood Disorders/diagnosis , Neurocognitive Disorders/diagnosis , Paranoid Disorders/diagnosis , Referral and ConsultationABSTRACT
Patients receiving artificial nutritional support are subject to ongoing psychological stress. They are often physically ill, are required to follow a rigid dietary regime and, by necessity, are involved in an ongoing relationship with members of the treating team. This paper presents examples of the clinical problems and discusses the role of the psychiatrist as a member of the multidisciplinary team.
Subject(s)
Enteral Nutrition/psychology , Parenteral Nutrition/psychology , Adult , Antidepressive Agents/therapeutic use , Australia , Depression/drug therapy , Depression/etiology , Enteral Nutrition/adverse effects , Family , Female , Home Nursing , Humans , Middle Aged , Parenteral Nutrition/adverse effects , Patient Care Team , Psychiatry , Stress, Psychological/etiologyABSTRACT
Psychologic problems associated with the short bowel syndrome have received limited recognition. The literature has previously considered these problems as due to the underlying condition or its treatment. We present a case illustrating these as well as addressing the problem of compliance to treatment that has been previously neglected. The occurrence of metabolic acidosis in this patient whenever there was not strict dietary adherence to diet provide a ready marker to her noncompliance.
