Objective
To review the literature on the incidence and prevalence of eating disorders

Methods
We searched Medline using several key terms relating to epidemiology and eating disorders and we checked the reference lists of the articles that we found Special attention has been paid to methodologic problems affecting the selection of populations under study and the identification of cases

Results
An average prevalence rate for anorexia nervosa of 03% was found for young females The prevalence rates for bulimia nervosa were 1% and 01% for young women and young men, respectively The estimated prevalence of binge eating disorder is at least 1% The incidence of anorexia nervosa is 8 cases per 100,000 population per year and the incidence of bulimia nervosa is 12 cases per 100,000 population per year The incidence of anorexia nervosa increased over the past century, until the 1970s

Discussion
Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care © 2003 by Wiley Periodicals, Inc Int J Eat Disord 34: 383–396, 2003

Review of the prevalence and incidence of eating disorders

The authors explore the extent to which eating disorders, specifically anorexia nervosa (AN) and bulimia nervosa (BN), represent culture-bound syndromes and discuss implications for conceptualizing the role genes play in their etiology. The examination is divided into 3 sections: a quantitative meta-analysis of changes in incidence rates since the formal recognition of AN and BN, a qualitative summary of historical evidence of eating disorders before their formal recognition, and an evaluation of the presence of these disorders in non-Western cultures. Findings suggest that BN is a culture-bound syndrome and AN is not. Thus, heritability estimates for BN may show greater variability cross-culturally than heritability estimates for AN, and the genetic bases of these disorders may be associated with differential pathoplasticity.

https://my.ilstu.edu/%7Edfgrayb/Personal/EatingDisordersCultural.pdf

Are Eating Disorders Culture-Bound Syndromes? Implications for Conceptualizing Their Etiology

This paper reviews the incidence and prevalence studies of anorexia nervosa and bulimia nervosa. The incidence of anorexia nervosa has been estimated at 8.1 and of bulimia nervosa at 11.4 per 100,000 population per year. The registered incidence rates of anorexia nervosa have increased sharply, but it is still unclear whether the rates in the community have increased. It has been established, however, that the incidence rates of anorexia nervosa in females 15 to 24-years-old—the most vulnerable group—have increased during the past 50 years. The (point-)prevalence among young females is 0.28% for anorexia nervosa and 1% for bulimia nervosa. A model of the pathway to care is described to show the one-year prevalence rates at different levels of care. The role of social and cultural factors will be discussed.

Review of the epidemiological studies of eating disorders.

Psychotropic drugs play a major role in primary care management of mental disorders. This study expands the existing data on prescribing practices using data from a 15-center, primary care epidemiologic survey. Questions to be addressed include the following: Which clinical and nonclinical factors are related to the prescribing of psychotropic drugs by primary care physicians? How do prescribing patterns vary across primary care centers? At each center, primary care patients were screened using the General Health Questionnaire, and a stratified random sample completed a standardized diagnostic assessment. For each patient completing the diagnostic assessment, the treating primary care physician provided data on clinical diagnosis and medications prescribed. Study results indicated that 11.5% of all practice attenders, 51.7% of cases who received a diagnosis of mental disorders by a physician, and 27.6% of cases who received a diagnosis using the Composite International Diagnostic Interview were treated with psychotropic medication because of their psychologic problems. Anxiolytics, hypnotics, and antidepressants each accounted for approximately 20% of all prescriptions. Prescription rates increased with the prominence of psychologic complaints, severity of mental disorder, severity of social disability, female gender, age older than 40 years, lower education, unemployment, and marital separation. Rates and type of drugs also varied among specific mental disorders; 19.3% of patients with brief recurrent depression but 55.0% with agoraphobia got any psychotropic drug. Antidepressant drugs were prescribed in 7.7% of anxiety disorders compared with 31.9% of depressive disorders. There were large differences between international centers. When comparing client-type centers with clinic-type centers, overall prescription rates were similar (51.2 vs. 52.9%), but significant differences were observed with respect to psychotropic polypharmacy (12.6% client, 6.3% clinic), tranquilizer medication (24.2 client, 32.9% clinic), and antidepressant medication (17.3 client, 8.9% clinic). Psychotropic drugs have an important role in the treatment of mental disorders by general practitioners. Prescription is associated with a number of clinical but also nonclinical factors that must be recognized when guidelines for international use are to be published. Recognition of mental disorders and selection of specific drug classes are important areas in which medical practice needs improvement.

The prescribing of psychotropic drugs by primary care physicians : an International collaborative study

A widely acknowledged drawback of many statistical modelling techniques, commonly used in machine learning, is that the resulting model is extremely difficult to interpret. A number of new concepts and algorithms have been introduced by researchers to address this problem. They focus primarily on determining which inputs are relevant in predicting the output. This work describes a transparent, advanced non-linear modelling approach that enables the constructed predictive models to be visualised, allowing model validation and assisting in interpretation. The technique combines the representational advantage of a sparse ANOVA decomposition, with the good generalisation ability of a kernel machine. It achieves this by employing two forms of regularisation: a 1-norm based structural regulariser to enforce transparency, and a 2-norm based regulariser to control smoothness. The resulting model structure can be visualised showing the overall effects of different inputs, their interactions, and the strength of the interactions. The robustness of the technique is illustrated using a range of both artifical and “real world” datasets. The performance is compared to other modelling techniques, and it is shown to exhibit competitive generalisation performance together with improved interpretability.

/pdf/structural-modelling-with-sparse-kernels-1f9hiemha3.pdf

Structural Modelling with Sparse Kernels

The general belief that anorexia nervosa is rare among non-whites should be cautiously accepted based on some very recent reports of the occurrence of the disorder in individuals of African descent. Two young Nigerians who presented classical features of anorexia nervosa are reported. In Case I, anorexia now regarded to be of low diagnostic value was absent, but in both cases identified antecedent psychosexual conflicts are explainable by well-known psychodynamic hypotheses. The relatively low prevalence of the disorder that has been observed might be due to: the protective influence of the Nigerian extended kinship system, the customary passion for plumpness as an attribute of physical attractiveness, carbohydrate diet "resistance" and the non-inclusion of cases in hospital records because of consultation with unorthodox healers. The general trend of increasing prevalence calls for more diagnostic vigilance, particularly among doctors serving populations with Third World background.

Anorexia nervosa in two Nigerians.

– – A study of prescribing practice in three psychiatric institutions in Nigeria revealed high frequency of polypharmacy, liberal routine use of antiparkinsonian agents and daily multiple administration of drugs. In the treatment of depression and schizophrenia older and better known oral neuroleptics were preferred to newer ones, but there was apparent tendency for depressives to be under-treated and long-acting depot preparations were seldom administered to schizophrenics. Several aspects of drug use were similar to those observed elsewhere, particularly in the Anglo-American practice – an observation presumed explicable in terms of common psychiatry training background. The need for clinicians to comply with accept-able pharmacokinetic principles of drug treatment is stressed.

O. O. Famuyiwa

Papers

Anorexia nervosa in two Nigerians.

Psychotropic drug prescription in Nigeria