ABSTRACT
BACKGROUND: It is important to determine the optimal manner of categorising eating disorder patients so as to aid in the understanding of their specific psychopathological state. METHOD: We compared subgroups of eating disorder patients divided according to different sets of factors, using a structured interview which elicits the specific psychopathological features of these illnesses. The patients, comprising 116 consecutive women admitted to two university-affiliated eating disorder clinics, were grouped according to DSM-III-R criteria, clinical presentation (purging, binge eating), nutritional status, and age. RESULT: The clearest separation of groups was afforded by the clinical dimension of purging as opposed to not purging. This was superior to DSM-III-R criteria. Other systems, such as presence of binge eating, and various levels of nutritional status and of age, were clearly inferior. CONCLUSION: The presence or absence of purging behaviour appears to offer the most heuristic means of categorising eating disorder patients with respect to their specific psychopathological state.
Subject(s)
Anorexia Nervosa/diagnosis , Bulimia/diagnosis , Psychiatric Status Rating Scales , Adolescent , Body Mass Index , Female , Humans , Middle AgedABSTRACT
The aim of the study was to present data which may be useful in deciding the type of services needed for eating disorder (ED) patients in New South Wales (NSW). The demographic and clinical characteristics of 155 patients consecutively admitted to a special ED unit at a major Sydney teaching hospital during the triennium 1989-1991 were documented and compared with relevant data from the State as a whole (709 admissions for ED to public facilities and 938 admissions for ED to private facilities during the same period). The findings are discussed in the light of information from overseas studies. Although a relatively large number of ED patients are admitted to hospitals in NSW, their short duration of stay suggests that many may receive inadequate treatment. The unit in the Department of Psychiatry at the Royal Prince Alfred Hospital (RPA), the largest public ED service in NSW, provides a special service for these patients. It is effective in bringing about nutritional restoration, with a duration of stay similar to those reported from centres overseas. Most referrals are tertiary, and there is a high prevalence of physical morbidity indicating a need for access to general medical facilities. Most serious physical complications occur in patients who can be identified by their chronicity and by the pattern of their behavioural disturbance. These various factors are considered in the formulation of recommendations for rationalizing the service.
Subject(s)
Anorexia Nervosa/therapy , Bulimia/therapy , Patient Admission/statistics & numerical data , Adolescent , Adult , Anorexia Nervosa/epidemiology , Anorexia Nervosa/psychology , Bulimia/epidemiology , Bulimia/psychology , Female , Health Status , Hospitals, Private/statistics & numerical data , Hospitals, Public/statistics & numerical data , Hospitals, Teaching/statistics & numerical data , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , New South Wales/epidemiology , Patient Care Team/statistics & numerical data , Treatment OutcomeABSTRACT
In 1991, the first Medical Psychiatric Unit (MPU) in Australia was established at the Royal Prince Alfred Hospital, Sydney. The processes involved in introducing it to the hospital staff and administration, as well as its structure and criteria for admission, are described. Its development was compared to the experiences of others in North America over the past 15 years. The functioning of the MPU over the subsequent 2 years was evaluated by assessing demographic and clinical criteria of patients admitted. Data were obtained from patient medical records and compared with similar data on patients admitted to a General Psychiatric Unit (GPU). It was found that patients of the MPU tended to be older, more often male, and suffering from organic brain syndromes and/or alcohol or drug abuse. Despite the multiplicity of diagnoses and the complexity of treatment procedures, the MPU patients' duration of stay was similar to the GPU patients'. The MPU was found to have achieved goals of clinical and cost-effectiveness. It has become an established subunit within the Department of Psychiatry.
Subject(s)
Hospital Units/organization & administration , Internal Medicine/organization & administration , Psychiatric Department, Hospital/organization & administration , Adolescent , Adult , Aged , Aged, 80 and over , Comorbidity , Female , General Surgery/organization & administration , Humans , Male , Middle Aged , New South Wales , Outcome Assessment, Health Care , Program Development , Program Evaluation , Psychiatric Department, Hospital/standards , Referral and ConsultationABSTRACT
To assess whether perceived parental care and protection varied according to age and gender of the child and whether they were associated with psychiatric diagnoses, these constructs were measured with the Parental Bonding Instrument in a cohort of non-referred adolescents (n = 762), in a clinically referred cohort (n = 1299), and in a group of adolescents from the referred cohort (n = 365) for whom DSM-III diagnoses were available. Significant differences in parental care and protection according to clinical status, age, gender and diagnosis were found. However, perceived parental affectionless control was not associated with emotional disorders in adolescents, contrary to reports in adult subjects, but with clinical status.
Subject(s)
Mental Disorders/diagnosis , Object Attachment , Parent-Child Relations , Psychology, Adolescent , Adolescent , Age Factors , Australia/epidemiology , Child , Cohort Studies , Female , Humans , Male , Mental Disorders/epidemiology , Mental Disorders/psychology , Parenting/psychology , Psychometrics , Referral and Consultation , Sex FactorsABSTRACT
The demographic and clinical features of 12 male patients with anorexia nervosa were investigated by means of a retrospective analysis of their medical records. The clinical characteristics of the male patients were found to be remarkably similar to those reported for female patients and our findings concur with previously published literature. There appears however to be a greater tendency to exercise excessively. The importance of recognising anorexia nervosa in males is emphasized.
Subject(s)
Anorexia Nervosa/diagnosis , Adolescent , Adult , Anorexia Nervosa/psychology , Anorexia Nervosa/therapy , Body Mass Index , Body Weight , Child , Feeding Behavior/psychology , Humans , Length of Stay , Male , Personality Assessment , Psychiatric Status Rating Scales , Retrospective StudiesABSTRACT
Cooper and Fairburn's Eating Disorder Examination (EDE) is a semi-structured interview designed to assess the specific psychopathology of eating disorder subjects. It was employed in a study of 116 Sydney patients for 2 purposes: first, to determine its usefulness in an Australian context; and second, to compare patients with anorexia nervosa, bulimia and atypical eating disorder. The instrument appears to be quite appropriate for studies in Australia. With respect to the second aim, the results emphasize the essential similarity in psychopathology between the three diagnostic groups. The relevance of this latter finding to the categorisation of eating disorders in the DSM-IV proposals is discussed.
Subject(s)
Anorexia Nervosa/psychology , Bulimia/psychology , Feeding and Eating Disorders/psychology , Personality Assessment/statistics & numerical data , Adult , Anorexia Nervosa/diagnosis , Body Image , Body Weight , Bulimia/diagnosis , Feeding Behavior/psychology , Feeding and Eating Disorders/diagnosis , Female , Humans , Patient Admission , Psychometrics , Reproducibility of ResultsABSTRACT
OBJECTIVE: To determine the rate of development of AIDS, and the demographic and clinical cofactors for development of AIDS in a group of 117 people with transfusion-acquired HIV infection, who were infected between 1980 and 1985 in New South Wales, Australia. RESULTS: By December 1991, 67 (57%, 95% CI 48-66%) of the study subjects had developed AIDS. The estimated median time to development of AIDS was 7.2 years from the date of infection. There was no significant difference in median age at infection or sex between individuals who did and did not develop AIDS. The median time to development of AIDS was shorter in older individuals (median time to AIDS for age groups 13-39, 40-59 and > 59 was 7.8, 7.1 and 5.4 years, respectively; P = 0.20). A significantly greater proportion of individuals who had never received treatment with zidovudine developed AIDS compared with individuals who had (P = 0.04). But in a statistical analysis which took account of the changing availability of zidovudine over time, there was no significant association between the development of AIDS and treatment with zidovudine (P = 0.44). CONCLUSION: Consistent with other studies, age appeared to increase the rate of progression to AIDS, although not significantly so in this study.
Subject(s)
Acquired Immunodeficiency Syndrome/diagnosis , HIV Infections/etiology , Transfusion Reaction , Adolescent , Adult , Age Factors , Demography , Female , HIV Infections/drug therapy , Humans , Male , Middle Aged , New South Wales/epidemiology , Time Factors , Zidovudine/therapeutic useABSTRACT
This study is concerned with the service provided to adolescent patients with eating disorders admitted to a private hospital. The patients' parents were asked to evaluate the service. Parental satisfaction was assessed by means of a questionnaire devised for this purpose and comments were elicited as to how the service could be improved. Parents of a consecutive series of 56 patients were asked to complete the questionnaire 6 months after admission; 82% (N = 46) responded. Most parents were pleased with the service provided but nevertheless many made some criticisms (35%) or suggestions for improvement (37%). The parental responses were discussed with the staff involved in treatment, resulting in changes to the service.
Subject(s)
Anorexia Nervosa/therapy , Bulimia/therapy , Consumer Behavior , Hospitalization , Parents/psychology , Adolescent , Anorexia Nervosa/psychology , Bulimia/psychology , Family Therapy , Female , Follow-Up Studies , Hospitals, Private , Hospitals, Psychiatric , Humans , Treatment OutcomeABSTRACT
The Parental Bonding Instrument (PBI) was administered to 54 adolescent patients with anorexia nervosa. Scores were compared with those of matched groups of normal and of nonanorectic adolescents referred for assessment to an adolescent psychiatric unit. Significant differences between the 3 groups were demonstrated with respect to care and protection dimensions. Overall scores of subjects in the anorectic group resembled those of normals rather than those of referred patients. Anorexia nervosa patients described their fathers and mothers as being more caring and their mothers as being less overprotective than did psychiatrically referred peers. The study raised questions concerning the use of the PBI in adolescents, in particular those with anorexia nervosa, and the role of the family in the aetiogenesis of this condition.
