Weight Loss After Weight-Loss Surgery: The Mediating Role of Dichotomous Thinking.

PURPOSE: Overly rigid forms of dietary restraint are associated with poorer weight loss outcomes. Dichotomous ("all or nothing") thinking has been shown to mediate this relationship in non-clinical participants, but this finding has yet to be replicated in clinical samples of individuals who have had weight-loss surgery. MATERIALS AND METHODS: A cross-sectional design was used, adopting quantitative questionnaires with 129 individuals who had previously underwent bariatric surgery at least 12 months prior to participation. Bootstrapped mediation analysis was used to establish the mediating role of dichotomous thinking. RESULTS: Eating-specific dichotomous thinking was shown to fully mediate the relationship between dietary restraint and post-surgical weight loss. In contrast, no mediation effect was found for generalised dichotomous thinking. CONCLUSION: Dichotomous thinking specifically about food/eating may play a central role in weight loss maintenance after weight-loss surgery. Pre-surgical assessment of dichotomous thinking, and provision of psychological therapy to think more flexibly about food, is suggested.

Ageism in first episode psychosis.

OBJECTIVE: To consider the characteristics of first episode psychosis in older adults in a county in North East England. METHOD/DESIGN: The present study used a naturalistic design to compare individuals aged 65 years and over with those under 65, with a first episode psychosis. Data were collected on demographics, diagnosis at presentation and hospital admissions in the first year. RESULTS: Almost a quarter of all patients were aged 65 years or older. The older group were admitted later on after presentation, but with longer average hospital stays (p < 0.01), compared to the younger group, with no difference in the use of the Mental Health Act. Late onset schizophrenia (40-59 years) and very late onset schizophrenia-like psychosis (60 + years) formed a considerable proportion of patients. CONCLUSIONS: There is a substantial proportion of older people with first episode psychosis, with a significant use of hospital bed days. There are large gaps in services for this group who often do not have the same access to those offered to younger people, e.g. Assertive Outreach or crisis teams, access to Clozapine and CBT. Ageism exists in all forms; the elderly are doubly disadvantaged in view of their age and mental illness.In view of the Age Discrimination Act (2006) the elderly functionally ill group of patients should be entitled to the same level of care and equal access to services as younger people. More attention and interventions need to be focused on this overlooked group.