Very brief psychological interventions with university students.

Annual college mental health service statistics reveal that 50% to 60% of all students served are seen for very brief psychological interventions--5 or fewer sessions. A substantial portion of the students benefit from these very brief contacts. The authors review the selection criteria for student and therapist that make very brief intervention possible. The student must be motivated for and seek a brief encounter and must enter the therapeutic relationship with the capacity for trust already in place and the professional qualifications of the therapist already established. The problem presented should be sufficiently clear and manageable to be resolved, or to begin being resolved, in a few sessions. Finally, the student must have the capacity for rapid insight and learning. The therapist brings to the relationship a belief in the value of very limited sessions, the capacity to develop a positive relationship quickly, and the ability to determine when it is appropriate to work in such a short time frame and to use the time most effectively. Four ways that students may benefit from very brief psychological interventions include (1) psychodynamic therapy, (2) crisis intervention, (3) mental health consultation, and (4) managed referral. Case illustrations and clinical methods are presented.

Pituitary abnormalities in eating disorders: further evidence from MRI studies.

1. The frequent occurrence of hypothalamo-pituitary dysfunction in patients with eating disorders as well as prior reports that nutritional and endocrine status influence pituitary morphology, led us to hypothesize that pituitary size and shape may be altered in patients with eating disorders. 2. Magnetic resonance imaging (MRI) does not use ionizing radiation and is currently one of the most feasible modalities available to study the pituitary gland in vivo. Using MRI, we have previously reported in a preliminary study that female patients with eating disorders had significantly smaller pituitary glands than controls. In addition MRI excluded any pituitary mass lesions. 3. In this report, we confirm our previous MRI findings and provide further evidence of pituitary abnormalities in an expanded sample of eating disorder patients. Preliminary data on pituitary volume estimates from MRI scans are provided for a subset of patients and controls.

Individual patterns of immediate skin reactivity to mold extracts.

One hundred atopic patients were skin tested intradermally over a 2-year period with 30 different mold extracts. Subjects were monitored for immediate reactions. Data suggest that to evaluate mold sensitivity in atopic patients one must use multiple mold extracts.

Psychotherapy and career counseling: toward an integration for use with college students.

The authors suggest that psychotherapy and career counseling with college students can be identified as potentially concurrent and interactive processes. They seek to increase awareness of this connection and underscore the value of its application when it is appropriate to do so. Selecting a career is a crucial developmental task for young adults and is, to varying degrees, an integral part of their psychosocial adjustment. The literature is reviewed from five perspectives: the psychodynamic model of career counseling; case examples; integration of career counseling and psychotherapy; a review of the developmental theories of Erikson, Farnsworth, Chickering, and Medalie; and empirical justification. The authors discuss the rationale for merging student psychotherapy and career counseling and offer case examples.

A brain magnetic resonance imaging study of pituitary gland morphology in anorexia nervosa and bulimia.

Magnetic resonance imaging (MRI) of the brain was used to examine the morphology and dimensions of the pituitary gland in 18 patients with eating disorders (8 anorectics and 10 bulimics), in comparison with 13 healthy volunteers. None of the 18 patients with anorexia or bulimia had any radiological evidence suggestive of pituitary macroadenoma, cyst, or empty sella. Measurements revealed that the anorectics and bulimics had smaller pituitary gland cross-sectional areas (p less than 0.05) and smaller pituitary gland heights, compared with healthy controls. These preliminary findings in anorectics and bulimics are suggestive of pituitary atrophy secondary to nutritional or endocrine alterations, rather than a primary pituitary pathology.

Abnormalities in the response of plasma arginine vasopressin during hypertonic saline infusion in patients with eating disorders.

We examined the response of plasma arginine vasopressin (pAVP) to intravenous 5% hypertonic saline in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Patients did not differ from controls in their subjective response for the onset of thirst; however, only 5 patients (3 AN and 2 BN) showed pAVP levels that were within the normal range (0.5-11.0 pg/ml) for this test. With the exception of two eating disorder (ED) patients, all others showed some nonlinear irregularities in the pattern of their secretion of pAVP in response to the hypertonic saline infusion. Seven of the ED patients showed an irregular abnormally high pAVP secretion, and three patients showed abnormally low pAVP responses. Both of these pAVP secretion abnormalities occurred in underweight and weight-recovered AN patients, as well as in BN patients. The cause and pathophysiological consequences of these abnormalities remain unresolved.

Cerebral atrophy in bulimia.

The extent of cerebral atrophy in 8 consecutively chosen unmedicated bulimics and 8 normal controls was determined by magnetic resonance imaging. There was no history of anorexia nervosa or alcoholism in either group. Measures obtained included the ratio of cerebral to cranial area at the midsagittal section, as well as maximum ventricle/brain ratio in the axial plane. Sagittal cerebral/cranial ratio was significantly less in the bulimic group than in controls [0.82 +/- 0.04 (SD) versus 0.90 +/- 0.03, Z = -2.74, p = 0.006, two-tailed Mann-Whitney U-test], whereas ventricle/brain ratio was not significantly different between groups. Implications for the occurrence of cortical atrophy in normal-weight bulimics, as well as for the relative absence of ventricular enlargement in these patients, are discussed.

Multidisciplinary training in the College Mental Health Service.

A one-year training program for advanced psychiatry, psychology, and clinical social work students interested in college mental health is built into the framework of Duke University's Counseling and Psychological Services. The program's multidisciplinary team format allows the trainees to interact with senior staff from the three fields while retaining their professional identities through close supervision by staff within their chosen specialty. The authors review the advantages of and problems with interdisciplinary training as reported in the literature, describe the operation of the program and the response of students, faculty, and trainees, and offer recommendations for making such a program work smoothly.

The significance of the spores of the Basidiomycetes (mushrooms and their allies) in bronchial asthma and allergic rhinitis.

The role of Basidiospores in the allergic diathesis is poorly understood. Dialyzed extracts of Agaricus campestris, Coprinus micaceus, Fuligo septica, Lycoperdon perlatum, Scleroderma lycoperdoides, Ustilago maydis, and sooty mold were prepared from fresh spores. The study group consisted of 100 patients with asthma and 100 patients with allergic rhinitis. These 200 patients had symptoms occurring during October and November. All were intradermally skin tested with the seven extracts at concentrations of 1 microgram/mL or 10 micrograms/mL. No scratch or pressure puncture tests were performed. Skin tests were recorded at 15 minutes (pos = 5-mm wheal with 10-mm erythema or greater) and at six or 24 hours (pos = 6 mm or greater of induration and erythema). A total of 436 immediate reactions were observed in the asthmatic group (4.4/patient) compared with 129 in the rhinitic group (1.3/patient). The late phase reactions were just the opposite. The asthmatic group had 66 late phase reactions or 0.7/patient compared with 382 or 3.8/patient in the rhinitic group. This study demonstrates that patients with bronchial asthma have a higher incidence of immediate skin sensitivity by intradermal testing, whereas patients with allergic rhinitis have late phase sensitivity to these fungal spores. This study was performed in the eastern United States only; therefore, the clinical significance of the results will become more apparent once this study is repeated in other parts of the country by other investigators.

Anorexia nervosa. Current perspectives in research.

This article is a thorough update of drug treatment studies and basic research. In their presentation of drug interventions, the authors discuss the efficacy of such psychotropic medications as neuroleptics, tricyclic antidepressants, lithium carbonate, cyproheptadine, and delta 9-tetrahydrocannabinol. An overview of new research perspectives on two new anorectogenic substances--AP, isolated from the urine of "hypothalamic" anorectics, and satietin, purified from normal serum--is presented.

A caerulein-sensitive potentiation of the behavioral effects of apomorphine by dibutyryl-cAMP.

The dopaminergic behavioral effects of apomorphine in rats were evaluated using a rating scale. Caerulein, a decapeptide physiologically similar to cholecystokinin, enhanced at lower doses and inhibited at higher doses the behaviors induced by apomorphine. Dibutyryl-cAMP, but not dibutyryl-cGMP, potentiated apomorphine behaviors. This potentiation was inhibited by a high dose of caerulein. These data provide evidence for an opposing effect of cAMP and caerulein or cholecystokinin in modulating dopaminergic systems.

Psychotropic drugs promoting weight gain: health risks and treatment implications.

The use of psychotropic medication is often associated with weight gain. We provide documentation for this effect and review the mechanisms possibly responsible for it in the case of neuroleptic agents, lithium carbonate, monoamine oxidase inhibitors, and amitriptyline. We also enumerate the undesirable medical consequences of obesity. Failure to take medication because it promotes weight gain is a serious impediment to successful treatment. Strategies that may promote drug compliance and prevent or reduce weight gain are discussed.

Anorexia nervosa in treated gonadal dysgenesis: case report and review.

The 12th reported case of anorexia nervosa in association with the 45,XO genotype and Turner's phenotype is presented. This patient received hormonal treatment but had a poor psychological outcome. Reasons for a possible increased coincidence of the two disorders, and the relationships among hormonal treatment, onset of puberty, and development of anorexia nervosa, are discussed in light of this and previous cases.