A comparative study of South Asian and non-Asian referrals to an eating disorders service in Leicester, UK.

Literature on eating disorders (EDs) among South Asian people in Britain is limited. In an extension of an earlier study, referrals to the Leicester Adult Eating Disorders Service were examined between 1991 and 2005. All South-Asians presenting to the service were compared on age, gender and diagnosis with non-Asians. Female Asian patients diagnosed as bulimia nervosa and ED not otherwise specified were compared on a larger number of variables with the same number of non-Asian patients matched for diagnosis. As there were only six Asian patients with anorexia nervosa they were excluded from this comparison. Only 4.5% of female patients were Asian, as opposed to 13.8% of the local young female population in the most recent UK census. Overall, Asian women were significantly younger than the non-Asians but did not differ significantly with regard to clinical features or treatment variables. Asians are under-represented amongst women presenting to the service. The explanation for this remains uncertain. Overall, Asian sufferers who reach secondary specialist services closely resemble non-Asian patients.

Simple graphical methods of displaying multiple clinical results.

A common challenge in clinical research trials is for applied statistics to manage, analyse, summarize and report an enormous amount of data. Nowadays, due to advances in medical technology, situations frequently arise where it is difficult to display and interpret results. Consequently, a creative approach is required to summarize the main outcomes of the statistical analyses in a form which is easy to grasp, to interpret and possibly to remember. In this paper a number of clinical case studies are provided. Firstly, a topographical map of the brain summarizing P-values obtained from comparisons across different EEG sites; secondly, a bulls eye plot, showing the agreement between observers in different regions of the heart; thirdly, a pictorial table reporting inter- and intra-rater reliability scores of a speech assessment; fourthly a star-plot to deal with numerous questionnaire results and finally a correlogram to illustrate significant correlation values between two diagnostic tools. The intention of this paper is to encourage the effort of visual representations of multiple statistical outcomes. Such representations do not only embellish the report, but aid interpretation by conveying a specific statistical meaning.

Biomagnetic characterization of spatiotemporal parameters of the gastric slow wave.

Certain gastric disorders affect spatiotemporal parameters of the gastric slow wave. Whereas the electrogastrogram (EGG) evaluates electric potentials to determine primarily temporal parameters, fundamental physical limitations imposed by the volume conduction properties of the abdomen suggest the evaluation of gastric magnetic fields. We used a multichannel superconducting quantum interference device magnetometer to study the magnetogastrogram (MGG) in 20 normal human subjects before and after a test meal. We computed the frequency and amplitude parameters of the gastric slow wave from MGG. We identified normal gastric slow wave activity with a frequency of 2.6 +/- 0.5 cycles per minute (cpm) preprandial and 2.8 +/- 0.3 cpm postprandial. In addition to frequency and amplitude, the use of surface current density mapping applied to the multichannel MGG allowed us to visualize the propagating slow wave and compute its propagation velocity (6.6 +/- 1.0 mm s(-1) preprandial and 7.4 +/- 0.4 mm s(-1) postprandial). Whereas MGG and EGG signals exhibited strong correlation, there was very little correlation between the MGG and manometry. The MGG not only records frequency dynamics of the gastric slow wave, but also characterizes gastric propagation. The MGG primarily reflects the underlying gastric electrical activity, but not its mechanical activity.

No evidence that panic attacks are associated with the white coat effect in hypertension.

The authors aimed to determine whether hypertensive patients with panic attacks or panic disorder have a larger white coat effect (difference between clinic blood pressure measured under standard conditions and mean daytime ambulatory blood pressure) than hypertensive patients without panic attacks. White coat effect was compared in a hospital hypertension clinic between 24 patients with panic attacks in the previous 6 months (12 with panic disorder) and 23 hypertensive controls. There were no significant differences between cases and controls in clinic blood pressure, mean daytime ambulatory blood pressure, or white coat effect (18/3 vs. 19/6 mm Hg; difference for systolic, -1.9 mm Hg; 95% confidence interval, -15.8 to +12.0; difference for diastolic, -3.0 mm Hg; 95% confidence interval, -10.2 to +4.3). Comparing only patients with panic disorder with controls, there were again no significant differences in clinic blood pressure, mean daytime ambulatory blood pressure, or white coat effect. This study provides no evidence for an exaggerated white coat effect in hypertensive patients who have experienced panic attacks or panic disorder. However, only larger studies could exclude differences in white coat effect <12/4 mm Hg, or an exaggerated white coat effect in a minority of patients with panic attacks.

Childhood trauma has dose-effect relationship with dropping out from psychotherapeutic treatment for bulimia nervosa: a replication.

OBJECTIVE: The primary goal of this study was to replicate the finding that experiences of childhood trauma have a dose-effect relationship with dropping out from psychotherapeutic treatment for bulimia nervosa. It also aimed to replicate logistic regression findings that parental break-up predicts dropping out. METHOD: The cohort consisted of 114 women consecutively presenting to an outpatient eating disorders clinic with bulimia nervosa or atypical bulimia nervosa. Data were gathered using a retrospective, case-note approach and were analysed using logistic regression (LR). A correlation technique was employed to assess the presence of a dose-effect relationship between experiences of trauma in childhood and dropping out. LR models were double cross-validated between this and an earlier cohort. RESULTS: The dose-effect relationship between experiences of childhood trauma and dropping out was confirmed. Witnessing parental break-up in childhood again predicted dropping out of treatment in adulthood. Cross-validation of LR equations was unsuccessful. DISCUSSION: These results strongly suggest that experiences of childhood trauma have a dose-effect relationship with dropping out. Parental break-up is a stable predictor of dropping out. It is possible that these experiences influence attachment style, particularly the ability to make and maintain a trusting relationship with a psychotherapist. Clinical implications are discussed.

Do broken relationships in childhood relate to bulimic women breaking off psychotherapy in adulthood?

OBJECTIVE/METHOD: The case notes of 111 women presenting consecutively to an outpatient eating disorders clinic with bulimia nervosa or atypical bulimia nervosa were reviewed for pretreatment factors that predicted dropout in a retrospective study. Dropping out was conceptualized as not just a patient characteristic but as a transaction between patient and therapist. Factors believed to influence this transaction included experiences of childhood trauma, severity of eating disorder characteristics and comorbid psychiatric symptoms, demographic characteristics, waiting times for assessment and therapy, distance traveled to the clinic, previous experience of psychiatric treatment, and Eating Disorder Inventory (EDI) and Rosenberg Self-Esteem questionnaire results. RESULTS: Witnessing parental breakup, being younger, being employed outside the home, and having previous experience of psychiatric treatment predicted dropping out in logistic regression models. Experiences of childhood trauma had a dose-effect relationship with dropping out. Having lower overall severity of eating disorder characteristics may also relate to dropping out. DISCUSSION: An impaired ability to trust resulting from disturbed attachments may link childhood trauma and dropping out.

Prevalence of thiamin deficiency in anorexia nervosa.

OBJECTIVE: Deficiency of thiamin (vitamin B1) causes a range of neuropsychiatric symptoms that resemble those reported in patients with anorexia nervosa (AN) but the prevalence of thiamin deficiency in AN has not been reliably established. This study was designed to investigate the prevalence of thiamin deficiency in AN. METHOD: Thirty-seven patients attending a specialist eating disorders unit and meeting all or some of the DSM-IV criteria for AN were compared with 50 blood donor controls. All subjects underwent measurement of erythrocyte transketolase activation following the addition of thiamin pyrophosphate, the standard biochemical test for thiamin deficiency. Deficiency was defined as a result more than 2 SD above the mean of the control population. RESULTS: Fourteen patients (38%) had results in the deficient range; 7 (19%) met the most stringent published criterion for deficiency. Deficiency was not related to duration of eating restraint, frequency of vomiting, or alcohol consumption. DISCUSSION: Thiamin deficiency may account for some of the neuropsychiatric symptoms of AN and routine screening or supplementation may be indicated.

The childhood and family background of women with clinical eating disorders: a comparison with women with major depression and women without psychiatric disorder.

BACKGROUND: Childhood antecedents are often put forward as being of possible aetiological significance for both anorexia nervosa and bulimia nervosa. METHOD: Comparisons were made of groups of women with eating disorders with groups of women with major depression or without current psychiatric disorder, using the Childhood Experience of Care and Abuse interview (CECA). RESULTS: Women with bulimia nervosa (or mixed bulimia and anorexia nervosa) tended to report more troubled childhood experiences than did women from the non-morbid comparison group. In this respect, they resembled those with major depression. In contrast, those with anorexia nervosa resembled the non-morbid women rather than the other psychiatric groups. CONCLUSIONS: Adversity in childhood as measured by the CECA may play a part in the causation of bulimia nervosa but not of anorexia nervosa. It remains possible that more specific or subtle family influences may be relevant.

The prevalence and correlates of binge eating in a British community sample of women with a history of obesity.

OBJECTIVE: To estimate the frequency of binge eating and binge eating disorder and their correlates in a sample of women with a history of obesity. METHOD: A group of women who had been found in a previous community study to have a body mass index > or = 30 were studied using self-report measures (n = 74) and interview (n = 62). RESULTS: One subject met criteria for binge eating disorder, while 24% reported binging. Subjects who reported binging were significantly more likely to have a past history of depressive illness. DISCUSSION: Prevalence of binge eating, binge eating disorder, and psychopathology was broadly in keeping with that found in North America. In addition, there were nonsignificant trends towards a positive family history of obesity, of childhood obesity, of early onset of dieting, of excessive concern about weight and shape, and a recent history of weight reduction. Further study is required to elucidate the causes of binge eating in the obese.

Anorexia nervosa and bulimia nervosa: sibling sex ratio and birth rank--a catchment area study.

OBJECTIVES: These were to determine (1) whether there is a birth rank effect in eating disorders, and (2) whether all-female sibships are overrepresented in the families of those with eating disorders. METHOD: The study sample consisted of 293 female patients referred from a defined catchment area, the County of Leicester, United Kingdom, to an eating disorders clinic. Diagnoses were made using DSM-III and DSM-III-R. To discern birth rank effect, this core sample was expanded to one of 673 by adding published data sets to our own. RESULTS: No evidence for either effect was found. DISCUSSION: Biases which may have obscured genuine effects are discussed. A comment is made on the implication for family theories of causation of these negative findings.

Childhood sexual experiences with adults: adult male psychiatric patients and general practice attenders.

BACKGROUND: Sexual abuse of male children is now believed to be common, and there may be links to adult psychiatric disorders. METHOD: Recollections of sexual experiences with adults in childhood were studied systematically in 115 men attending general practice surgeries and 100 male psychiatric patients. RESULTS: The latter reported more frequent and more serious events before the age of 13 than the general practice attenders. No significant difference was detected for events between the ages of 13 and 15. CONCLUSIONS: Childhood sexual abuse before the age of 13 may be associated with later psychiatric disorders, although the nature of the association remains uncertain. The possible significance of such experiences should be considered when assessing men with mental disorders.

Attention deficit disorder in children: three clinical variants.

A clinic-referred population of 116 children with attentional problems was classified by DSM-III [attention deficit disorder (ADD)] with respect to inattention, impulsivity, and hyperactivity. The sample proved to subdivide into three groups: inattentive, impulsive, and hyperactive (HII), n = 60; inattentive and impulsive (II), n = 26; and inattentive (I), n = 30. The distinction between II and I resolves the confounding of impulsivity and inattention in previous studies of children who have ADD but are not hyperactive. The three groups were found to be similar in mean age, gender ratio, prevalence, and pattern of associated learning disabilities, family history of psychopathology, and probability of favorable response to methylphenidate. Group I differed from Groups HII and II in the frequency of externalizing relative to internalizing comorbid psychopathology. A group that is hyperactive and impulsive but not inattentive was not found. The preponderance of similarities in associated characteristics suggests that the three groups are differing clinical presentations of an ADD spectrum.

Weight concern should not be a necessary criterion for the eating disorders: a polemic.

Problems associated with the inclusion of weight concern as a necessary and defining criterion for the diagnosis of the eating disorders are reviewed. It is proposed that the substitution of the criterion of eating restraint that is overinvested by the subject might have advantages for both clinical classification and for research.

Childhood sexual experiences with adults. A comparison of reports by women psychiatric patients and general-practice attenders.

Reports of childhood sexual experiences with adults were collected from 120 women attending general-practice surgeries and 115 women psychiatric patients. The method of study, research team and county of residence were the same for the two groups. The psychiatric patients tended to report rates of events higher than the general-practice attenders by a factor of 2-3. The results suggest an association between such experiences and later psychiatric patienthood and are compatible with a causal role for them in some cases.

Who benefits from electroconvulsive therapy? Combined results of the Leicester and Northwick Park trials.

This paper describes the results obtained by combining data from the Northwick Park and Leicester randomised controlled trials of ECT. Patients who suffered from depression in which retardation and delusions were features and who received real ECT had a significantly improved outcome at the end of four weeks of treatment (as measured by improvement in the HRSD) in comparison with those who received simulated ECT. However, this treatment effect was not detectable at six-month follow-up. Patients who were neither retarded nor deluded did not benefit significantly from real as opposed to simulated ECT.

Childhood sexual experiences with adults reported by female psychiatric patients.

A group of 115 female psychiatric in-patients and out-patients were studied, using a self-report questionnaire followed by interview, for evidence of childhood sexual activity with adults. About half of the sample reported some childhood sexual experience, ranging from full sexual intercourse to sexual suggestions. Future research should study the possible role of such experience in the genesis of subsequent psychiatric disorder.

Changes in beta-1,3-Glucan Synthase Activity in Developing Lima Bean Plants.

A plasma membrane-enriched fraction was isolated from various tissues of developing lima bean seedlings, Phaseolus lunatus var Cangreen, to study beta-1,3-glucan synthase activity changes. All tissues contained an active beta-glucan synthase, including the cotyledons that will be senescent in mature lima bean plants. Young primary leaves exhibited a very active beta-glucan synthase; but this activity dropped markedly, about fivefold, as the leaves gained weight and became photosynthetic. Some tissues, such as the hypocotyl and young stem, exhibited an increase in beta-glucan synthase activity as the tissues were growing and a decrease as the growth rate slowed. Roots exhibited a high activity early in development that only decreased slightly, about 30%, as root growth increased. Surprisingly the senescent cotyledons contained an activity equivalent to some other tissues that was maintained over our measurement time of 21 days. Perhaps this callose synthesis activity is related to translocation processes as the cotyledons transfer their reserves to the growing seedling. We concluded that beta-glucan synthase was not a good indicator of sink strength in these lima bean tissues. The plasma membrane fractions also were tested for other enzymes that might be present because an electron microscope study revealed a low contamination by other types of membranes. The membrane fractions had low but detectable activities of sucrose synthase, UDPglucose pyrophosphorylase, UDPase, alkaline invertase, and a general phosphatase; but these enzymes exhibited no consistent pattern(s) of activity change with plant development.