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.

A long-term follow-up study of a cohort of referrals to an adult mental health clinical psychology department.

The study, using the SCL-90-R, investigated the long-term outcome of clinical psychology interventions with adults by contacting 95 clients between five and eight years after initial contact. Post-treatment improvements in global psychological well-being were generally maintained at long-term follow-up. About a quarter of clients, however, did not report any improvement in the initial problem and about a half had received help from other services since ending contact with the department. The study provides encouraging evidence of long-term benefits for many clients, but we suggest a reconsideration of the optimal provision of psychological help for people whose problems may be enduring and/or recurrent.

An ethnic comparison of eating attitudes and associated psychological problems in young British women.

OBJECTIVE: The study aimed to investigate possible differences in eating attitudes/problems and associated psychological problems in young women of differing ethnic origin. METHOD: In a city with a relatively high Asian population (with a background in the Indian subcontinent), 235 young women aged 18-27 registered with a general practice responded to a postal questionnaire. The questionnaire examined eating and weight problems (including the 26-item Eating Attitudes Test), self-esteem (measured by the Rosenberg Self-Esteem Scale), and general psychological well-being (measured by The Hospital Anxiety and Depression Scale). We also included three short vignettes designed to assess illness perception and health seeking-behavior. RESULTS: We found relatively little difference in eating attitudes and problems according to ethnicity, although self-induced vomiting for weight control was more common among Caucasian women. Neither was there any difference in self-esteem, anxiety, depression, and illness perception. DISCUSSION: The results suggest that one cannot generalize about eating problems across the Asian population and a more sophisticated approach to the examination of sociocultural factors is recommended.

Self-esteem, eating problems, and psychological well-being in a cohort of schoolgirls aged 15-16: a questionnaire and interview study.

OBJECTIVE: This study aimed to investigate the extent of eating problems and their association with self-esteem in girls aged 15-16. METHOD: Six hundred and nine schoolgirls aged 15-16 completed a questionnaire examining eating behavior, self-esteem, and general psychological well-being. A subsample of 31 girls was subsequently interviewed in terms of eating behavior and self-esteem. RESULTS: The questionnaire findings revealed that 56% of girls felt too fat and had used some form of weight control strategy. In addition, 32% scored above the Hospital Anxiety and Depression Scale (HADS) threshold for anxiety and 43% reached the Rosenberg Self-Esteem Scale criterion for low self-esteem. Interviews confirmed that those showing abnormal eating behavior in the questionnaires did indeed show greater eating pathology as well as lower self-esteem. Interviews also revealed that those with high levels of eating concern showed greater levels of global self-dissatisfaction and higher dissatisfaction with their physical appearance and family relationships. DISCUSSION: The results suggest that preventative interventions targeted at girls with low self-esteem may be appropriate.

A prospective study of self-esteem in the prediction of eating problems in adolescent schoolgirls: questionnaire findings.

A number of authors have emphasized the importance of self-esteem in the aetiology of the eating disorders anorexia nervosa and bulimia nervosa. Evidence for such theorizing, however, mainly derives from clinical observations on people being treated for eating disorders. This study is the first prospective study to investigate the role of self-esteem in aetiology prior to the onset of an eating disorder. Self-esteem was measured in 594 schoolgirls aged 11-12 using the Rosenberg Self-Esteem Scale (Rosenberg, 1965). Almost 400 of these girls were successfully followed up at age 15-16 and they completed a questionnaire examining eating and other psychological problems. Results showed that girls with low self-esteem at age 11-12 were at significantly greater risk of developing the more severe signs of eating disorders, as well as other psychological problems, by the age of 15-16. It is argued that more research is needed to replicate and extend these findings. The results also give weight to the case for examining the potential role of self-esteem enhancement in the prevention of eating disorders.

Actin, its associated proteins and metastasis.

In this short article we have overviewed the effect of transformation on AAPs. We have not dealt with molecules indirectly associated with actin which are modified by transformation, such as the catenins, cadherins, vinculin, and integrins [Tsukita et al., 1993], although their relationship with and importance to the transformed phenotype cannot be overemphasised. Similarly, alterations in polyphosphoinositide metabolism that occur in transformed cells may also promote or induce alterations in the microfilament cytoskeleton via interactions with proteins such as gelsolin, alpha-actinin, and MARCKS [Bretscher, 1993]. At present, there are no clear-cut rules regarding the effect that oncogenesis has on AAPs, since the expression level of one oncogenically modified AAP can vary from one tumour to another, even within the same type of tumour [Yamamoto et al., 1993]. This apparent inconsistency may well be because we are "playing with an incomplete pack of cards" [Pollard, 1993], or it may reflect this highly complex control mechanism in which any perturbation of the normal expression levels of actin/AAPs unbalances the delicate equilibrium which controls normal cell behaviour [Bray and Vasiliev, 1989]. For example, it is possible that oncogenically induced alterations to actin isoform expression [Lin et al., 1985] exert a downstream effect on actin-associated protein expression. Oncogenically induced actin based cell movements may be activated by alterations to either a single AAP or a synergistic functional unit of these molecules [Shapland et al., 1993; Vandekerckhove et al., 1990].(ABSTRACT TRUNCATED AT 250 WORDS)

Self-esteem in girls aged 11-12: baseline findings from a planned prospective study of vulnerability to eating disorders.

The paper reports on the first stage of a planned prospective study of self-esteem and risk for eating disorders in 594 schoolgirls aged 11-12. Subjects completed a short questionnaire which incorporated the Rosenberg Self-Esteem Scale and a few "problem" questions, including one on fatness concern. Low self-esteem was associated with increased fatness concern, but also with problems in general. The girls will be followed up in detail at age 15-16, with a view to clarifying whether low self-esteem is predictive of clinically significant eating disorders.

Rigidity of construing of self and significant others and psychological disorder.

This study was designed to test the hypothesis that more rigid construing of self and others is more common in non-psychotic psychological disorder than in the general population. Thirty-one adult referrals to either a psychiatric day hospital or a clinical psychology service were compared with 31 matched normal controls using a repertory grid. There was no support for the hypothesis, but there was evidence of greater negativity of self-construing in the client group. The implications of these findings for clinical practice are discussed.

The clinical psychologist in general practice: a six-year study of consulting patterns for psychosocial problems.

Three quarters of the patients in a group practice referred to a clinical psychologist during a three-year period showed marked reductions in the consulting and psychotropic drug prescription rates in the six months after treatment compared with the six months leading up to treatment. However, the rates for the whole practice revealed a general falling trend over the period of study. Furthermore, examination of the records of all patients with at least one psychosocial problem over a six-year period during which they were registered with the practice has shown that encounters for psychosocial problems tended to be concentrated in a relatively short period - the ;worst year' - rather than being evenly distributed over the whole six years. It is concluded that the natural history of most psychological disorders is one of crisis and remission and that no benefit has been demonstrated from individual therapy by clinical psychologists.

Personal construct theory and psychological well-being.

The concept of 'psychological well-being' (as opposed to 'psychological disorder') is considered from the standpoint of George Kelly's personal construct theory (Kelly, 1955). It is argued that the origin of psychological disorder lies in a difficulty in 'person construing', with particular reference to 'self-construing'. For some (like schizophrenics) this may be a relatively permanent state of affairs, whereas for others it may reflect a temporary crisis or transition. It seems that the ability to maintain a relatively stable, yet flexible, self-construction may be crucial. Social relationships, however, although potentially validating, also carry the risk of invalidating our self-construction. An individual's particular response to 'invalidation' may be substantially determined by commonality of construing in his particular context, e.g. an adolescent female may turn to slimming whereas a young male may turn to alcohol. Although the theory has proved to be most useful at an explanatory level, it has been applied therapeutically only to a limited extent. It is argued that psychologists may make a greater contribution to the enhancement of psychological well-being by applying constructive alternativism within a learning or educational context rather than the clinical setting.

Porcine thyroid cytosolic, latent, alkaline, ribonuclease: does an acidification step during purification alter the enzyme's properties?

The effect of an acidic step in the purification of porcine thyroid, latent, alkaline ribonuclease was studied using highly purified acid-treated and non-acid-treated enzymes. The enzymes differed by affinity and CM-cellulose chromatography, specific activity, in distribution among multiple forms, in response to some mono- and divalent salts, in degree of inhibition by p-chloromercuriphenylsulfonate and ribonuclease inhibitor, in activity toward poly (U). The acid-treated enzyme was very heterogeneous as shown by chromatography on affinity and ion-exchange columns and electrophoresis. The enzymes had similar molecular weights, pH optima, ionic strength effects, general specificity and products.

Subclinical anorexia nervosa.

The Eating Attitudes Test (Garner & Garfinkel, 1979) was administered to 578 students (446 females and 132 males) at a College of Technology and to 14 "control" subjects fulfilling strict diagnostic criteria for anorexia nervosa. Although no male students scored highly, a total of 28 female students (6.3% of the female student sample) scored in the "anorexic" range. These "high scorers", together with a random control group of 28 "non-high scorers", were subsequently interviewed. Interview revealed that the symptoms of anorexia nervosa were common in the high scoring group but virtually absent in the student control group. It is concluded that a substantial proportion of post-pubertal females (approximately 5%) develop a subclinical form of anorexia nervosa. The implications of these findings are discussed in relation to the aetiology, prevention and treatment of disturbances in eating behaviour.

Compulsory admissions in a London borough: I. Social and clinical features and a follow-up.

This study examines the role that clinical and social factors play in compulsory admissions to hospital in a London borough. 150 patients compulsorily admitted under a section of the Mental Health Act 1959 were compared with 100 informally admitted patients. Significant differences in social-demographic and clinical characteristics are described as well as differences in outcome on follow-up. A long-term unwillingness on the part of the compulsory patients to engage in follow-up services was evident. These differences still held when the compulsory patients were compared with a group of informal patients matched for age, sex and diagnosis. Patients referred by the police and admitted under Section 136 of the Mental Health Act showed those features associated with compulsory admission in general to the most severe degree.

Comparison of single-dose trimethoprim with a five-day course for the treatment of urinary tract infections in the elderly.

Ninety-six elderly patients (mean age 80 years) with acute urinary infections were treated in a single-blind trial, with either one 200 mg dose of trimethoprim or 200 mg b.d. for five days. After one week the initial pathogen was eliminated in 67% of patients who had received the single dose and in 94% who received the drug for five days. These differences were highly significant (P less than 0.01). After two weeks, the patients who had received trimethoprim for five days were significantly freer from infection than those who had received the single dose. The level of acquired resistance following trimethoprim was small. The single dose of trimethoprim was associated with less suppression of the faecal Enterobacteriaceae and the selection of less resistance in these organisms than the five-day course. Interrupted antibiotic courses may not be particularly prone to select resistance. Trimethoprim was well tolerated in the great majority of patients; only three patients suffered possible side-effects.

A reappraisal of body perception disturbance in anorexia nervosa.

Previous research has suggested that patients suffering from anorexia nervosa tend to overestimate their body size, whereas normal females tend to be very accurate in this respect. This paper presents the results of further investigations of body perception amongst anorexic and normal females. The results, in contrast to earlier findings, indicate no such difference between groups. Detailed analysis of the data, however, points to the likelihood of certain differences between the present group of anorexic patients and previous groups. Moreover, it seems that body perception disturbance is not a consistent feature of anorexia nervosa and is only present amongst some patients at certain stages during their illness. On subdividing the anorexic group it was demonstrated that patients who vomit tend to overestimate their size more than do non-vomiters. It also seems likely that normal females are far from homogeneous in terms of body perception. In line with previous findings, a direct relationship was found between marked overestimation of body size and an early relapse. Evidence is also discussed which suggests that body perception disturbance is not specific to anorexia nervosa and may reflect an abnormal sensitivity about body size associated with such factors as the anticipation of an undesired change in weight, extreme concern about slimness and anxiety about putting on weight.