Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

I have developed "tennis elbow" from lugging this book around the past four weeks, but it is worth the pain, the effort, and the aspirin. It is also worth the (relatively speaking) bargain price. Including appendixes, this book contains 894 pages of text. The entire panorama of the neural sciences is surveyed and examined, and it is comprehensive in its scope, from genomes to social behaviors. The editors explicitly state that the book is designed as "an introductory text for students of biology, behavior, and medicine," but it is hard to imagine any audience, interested in any fragment of neuroscience at any level of sophistication, that would not enjoy this book. The editors have done a masterful job of weaving together the biologic, the behavioral, and the clinical sciences into a single tapestry in which everyone from the molecular biologist to the practicing psychiatrist can find and appreciate his or

Principles of Neural Science

Emotion and Adaptation

Borderline Conditions and Pathological Narcissism

Context The place of long-term psychodynamic psychotherapy (LTPP) within psychiatry is controversial. Convincing outcome research for LTPP has been lacking. Objective To examine the effects of LTPP, especially in complex mental disorders, ie, patients with personality disorders, chronic mental disorders, multiple mental disorders, and complex depressive and anxiety disorders (ie, associated with chronic course and/or multiple mental disorders), by performing a meta-analysis. Data Sources Studies of LTPP published between January 1, 1960, and May 31, 2008, were identified by a computerized search using MEDLINE, PsyclNFO, and Current Contents, supplemented by contact with experts in the field. Study Selection Only studies that used individual psychodynamic psychotherapy lasting for at least a year, or 50 sessions; had a prospective design; and reported reliable outcome measures were included. Randomized controlled trials (RCTs) and observational studies were considered. Twenty-three studies involving a total of 1053 patients were included (11 RCTs and 12 observational studies). Data Extraction Information on study characteristics and treatment outcome was extracted by 2 independent raters. Effect sizes were calculated for overall effectiveness, target problems, general psychiatric symptoms, personality functioning, and social functioning. To examine the stability of outcome, effect sizes were calculated separately for end-of-therapy and follow-up assessment. Results According to comparative analyses of controlled trials, LTPP showed significantly higher outcomes in overall effectiveness, target problems, and personality functioning than shorter forms of psychotherapy. With regard to overall effectiveness, a between-group effect size of1.8 (95% confidence interval [Cl], 0.7-3.4) indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96% of the patients in the comparison groups (P= .002). According to subgroup analyses, LTPP yielded significant, large, and stable within-group effect sizes across various and particularly complex mental disorders (range, 0.78-1.98). Conclusions There is evidence that LTPP is an effective treatment for complex mental disorders. Further research should address the outcome of LTPP in specific mental disorders and should include cost-effectiveness analyses.

Effectiveness of Long-term Psychodynamic Psychotherapy : A Meta-analysis. Commentary

Restoration of weight and nutritional status are key elements in the treatment of anorexia nervosa (AN). This review aims to describe issues related to the caloric requirements needed to gain and maintain weight for short and long-term recovery for AN inpatients and outpatients. We reviewed the literature in PubMed pertaining to nutritional restoration in AN between 1960–2012. Based on this search, several themes emerged: 1. AN eating behavior; 2. Weight restoration in AN; 3. Role of exercise and metabolism in resistance to weight gain; 3. Medical consequences of weight restoration; 4. Rate of weight gain; 5. Weight maintenance; and 6. Nutrient intake. A fair amount is known about overall caloric requirements for weight restoration and maintenance for AN. For example, starting at 30–40 kilocalories per kilogram per day (kcal/kg/day) with increases up to 70–100 kcal/kg/day can achieve a weight gain of 1–1.5 kg/week for inpatients. However, little is known about the effects of nutritional deficits on weight gain, or how to meet nutrient requirements for restoration of nutritional status. This review seeks to draw attention to the need for the development of a foundation of basic nutritional knowledge about AN so that future treatment can be evidenced-based.

/pdf/nutritional-rehabilitation-in-anorexia-nervosa-review-of-the-4zdgf43774.pdf

Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment

This paper aimed to investigate cognitive rigidity and decision making impairments in patients diagnosed with Anorexia Nervosa Restrictive type (AN-R), assessing also verbal components. Thirty patients with AN-R were compared with thirty age-matched healthy controls (HC). All participants completed a comprehensive neuropsychological battery comprised of the Trail Making Test, Wisconsin Card Sorting Test, Hayling Sentence Completion Task, and the Iowa Gambling Task. The Beck Depression Inventory was administered to evaluate depressive symptomatology. The influence of both illness duration and neuropsychological variables was considered. Body Mass Index (BMI), years of education, and depression severity were considered as covariates in statistical analyses. The AN-R group showed poorer performance on all neuropsychological tests. There was a positive correlation between illness duration and the Hayling Sentence Completion Task Net score, and number of completion answers in part B. There was a partial effect of years of education and BMI on neuropsychological test performance. Response inhibition processes and verbal fluency impairment were not associated with BMI and years of education, but were associated with depression severity. These data provide evidence that patients with AN-R have cognitive rigidity in both verbal and non-verbal domains. The role of the impairment on verbal domains should be considered in treatment. Further research is warranted to better understand the relationship between illness state and cognitive rigidity and impaired decision-making.

https://link.springer.com/content/pdf/10.1186%2F1471-244X-11-162.pdf

Cognitive flexibility in verbal and nonverbal domains and decision making in anorexia nervosa patients: A pilot study

The aim of this study is assessing interactions between attachment style and personality in predicting body dissatisfaction (BD). A total of 586 outpatients with eating disorders (EDs) were recruited: 101 with anorexia nervosa, restricting type; 52 with anorexia nervosa, binge-eating/purging type; 184 with bulimia nervosa, purging type; and 249 with an eating disorder not otherwise specified. Participants completed Temperament and Character Inventory, Body Shape Questionnaire, Beck Depression Inventory, and Attachment Style Questionnaire. An insecure attachment was found in all EDs, as well as in eating disorder not otherwise specified. In all diagnostic groups, need for approval, as measured by the Attachment Style Questionnaire and depressive symptomatology, was found to be the best predictor of BD. Personality traits are weaker predictors of BD. This study supports the hypothesis that attachment insecurity is directly correlated with BD, core element in predicting and perpetuating EDs, independently of personality. Implications for treatment are discussed.

Attachment insecurity, personality, and body dissatisfaction in eating disorders.

Family therapy approaches have generated impressive empirical evidence in the treatment of adolescent eating disorders (EDs). However, the paucity of specialist treatment providers limits treatment uptake; therefore, our group developed the intensive family therapy (IFT)-a 5-day treatment based on the principles of family-based therapy for EDs. We retrospectively examined the long-term efficacy of IFT in both single-family (S-IFT) and multi-family (M-IFT) settings evaluating 74 eating disordered adolescents who underwent IFT at the University of California, San Diego, between 2006 and 2013. Full remission was defined as normal weight (≥ 95% of expected for sex, age, and height), Eating Disorder Examination Questionnaire (EDE-Q) global score within 1 SD of norms, and absence of binge-purging behaviours. Partial remission was defined as weight ≥ 85% of expected or ≥ 95% but with elevated EDE-Q global score and presence of binge-purging symptoms (<1/week). Over a mean follow-up period of 30 months, 87.8% of participants achieved either full (60.8%) or partial remission (27%), while 12.2% reported a poor outcome, with both S-IFT and M-IFT showing comparable outcomes. Short-term, intensive treatments may be cost-effective and clinically useful where access to regular specialist treatment is limited.

/pdf/short-term-intensive-family-therapy-for-adolescent-eating-25b750xe5m.pdf

Short-Term Intensive Family Therapy for Adolescent Eating Disorders: 30-Month Outcome†

We investigated whether cognitive remediation therapy (CRT) is effective in improving cognitive flexibility in anorexia nervosa (AN). Twenty AN outpatients were consecutively recruited at the Eating Disorders Center of the Turin University. All participants completed 10 sessions of CRT. Neuropsychological performances improved with CRT. Data showed also a significant improvement of impulse regulation and interoceptive awareness (subscales of the Eating Disorders Inventory-2). CRT was also associated with improvement of reflexive skills and awareness. These preliminary findings are promising, but further work is necessary to find ways of enhancing the effects of this treatment.

Enrica Marzola

Papers

Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment

Cognitive flexibility in verbal and nonverbal domains and decision making in anorexia nervosa patients: A pilot study

Attachment insecurity, personality, and body dissatisfaction in eating disorders.

Short-Term Intensive Family Therapy for Adolescent Eating Disorders: 30-Month Outcome†

Effectiveness of cognitive remediation therapy (CRT) in anorexia nervosa: A case series