Showing papers in "Psychiatry MMC in 2008"

Nonresponse and Dropout Rates in Outcome Studies on PTSD: Review and Methodological Considerations

Abstract: Post-traumatic stress disorder (PTSD) represents a frequent consequence of a variety of extreme psychological stressors. Lists of empirically supported treatments for PTSD usually include cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR), but nonresponse and dropout rates in these treatments often are high. We review the treatment dropout and nonresponse rates in 55 studies of empirically supported treatments for PTSD, review the literature for predictors of dropout and nonresponse, discuss methodological inconsistencies in the literature that make comparisons across studies difficult, and outline future directions for research. Dropout rates ranged widely and may have depended, at least in part, on the nature of the study population. It was not uncommon to find nonresponse rates as high as 50%. Standard methods of reporting dropout and nonresponse rates are needed for reporting outcomes. We suggest guidelines for collecting data to help identify characteristics and predictors of dropouts and nonresponders.

The impact of perfectionistic self-presentation on the cognitive, affective, and physiological experience of a clinical interview.

Abstract: Perfectionistic self-presentation is proposed as a deleterious interpersonal style that has an influence in clinical contexts that involves promoting a public image of perfection and avoiding displays and self-disclosures of imperfections. A sample of 90 clinical patients taking part in a clinical interview were assessed in terms of their levels of perfectionistic self-presentation and trait perfectionism and their affective, cognitive, and physiological reactions. Perfectionistic self-presentation dimensions were associated with (1) greater distress before and after the interview, (2) negative expectations and greater threat prior to the interview, and (3) post-interview dissatisfaction. Analyses of physiological data found that perfectionistic self-presentation was associated with higher levels of heart rate when discussing past mistakes, and, as expected, the need to avoid disclosing imperfections predicted higher levels of and greater change in heart rate when discussing past mistakes. Analyses that controlled for trait perfectionism and emotional distress showed that the need to avoid disclosing imperfections was a unique predictor of (1) appraisals of the interviewer as threatening before the interview and as dissatisfied after the interview; (2) negative pre and post self-evaluations of performance; and (3) greater change in heart rate when discussing mistakes. Perfectionistic self-presentation is discussed as an interpersonal style that can influence therapeutic alliance and treatment success.

Posttraumatic growth in former Vietnam prisoners of war.

Abstract: This study examined posttraumatic growth in 30 male veterans captured and held as prisoners of war during the Vietnam War. Participants were assessed with structured diagnostic interviews administered by trained clinicians as well as with the Posttraumatic Growth Inventory (PTGI) and other questionnaires measuring dispositional optimism, religious coping, social supports, and purpose in life. Mean age (standard deviation-SD) of participants was 66.7 (6.0) years. Mean total PTGI score (SD) was 66.3 (17.5), indicating a moderate degree of posttraumatic growth. The most strongly endorsed items corresponded to the Appreciation of Life and Personal Strength factors. The group as a whole was optimistic and reported moderate use of positive religious coping. Posttraumatic growth did not significantly differ in repatriates with and without psychopathology, but it was significantly positively correlated with dispositional optimism. In the final regression model, length of captivity and optimism were significant predictors of posttraumatic growth. Our findings confirm that it is possible to achieve long-lasting personal growth even in the face of prolonged extreme adversity. Prospective studies are needed to further evaluate whether pre-existing traits such as optimism can predict growth after trauma.

Contributions of Psychodynamic Approaches to Treatment of PTSD and Trauma: A Review of the Empirical Treatment and Psychopathology Literature

Abstract: Reviews of currently empirically supported treatments for post-traumatic stress disorder (PTSD) show that despite their efficacy for many patients, these treatments have high nonresponse and dropout rates. This article develops arguments for the value of psychodynamic approaches for PTSD, based on a review of the empirical psychopathology and treatment literature. Psychodynamic approaches may help address crucial areas in the clinical presentation of PTSD and the sequelae of trauma that are not targeted by currently empirically supported treatments. They may be particularly helpful when treating complex PTSD. Empirical and clinical evidence suggests that psychodynamic approaches may result in improved self-esteem, increased ability to resolve reactions to trauma through improved reflective functioning, increased reliance on mature defenses with concomitant decreased reliance on immature defenses, the internalization of more secure working models of relationships, and improved social functioning. Additionally, psychodynamic psychotherapy tends to result in continued improvement after treatment ends. Additional empirical studies of psychodynamic psychotherapy for PTSD are needed, including randomized controlled outcome studies.

Stigma of depression is more severe in Chinese Americans than Caucasian Americans.

Abstract: Stigma of mental illness is a major obstacle to its diagnosis and treatment and may be worse among Asians than Caucasians. This study compared the stigma of depression in 50 Chinese Americans (CA) and 50 Caucasian Americans (WA). Subjects were asked to read 5 case vignettes in the following order: diabetes mellitus (DB), major depressive disorder (MDD), somatoform depression (SD), psychotic depression (PD), and fever of unknown origin (HA). Diagnosis of each case was not revealed. Subjects then rated their response to each case, on a Likert scale from “strongly disagree” to “strongly agree,” to 25 statements that contained 6 stigma factors: fear, shame, cognitive distortion, social consensus, discrimination, and sanction. Composite scores constructed from ratings of each factor were used to calculate the severity of stigma. Stigma of all 5 cases was worse in CA than WA. Both groups ranked DB and HA to be least and PD to be most stigmatizing. CA rated SD to be less stigmatizing than MDD but not WA. We conc...

Does psychoeducation help prevent post traumatic psychological distress

Abstract: Psychoeducation is increasingly used following trauma. The term covers the provision of information about the nature of stress, posttraumatic and other symptoms, and what to do about them. The provision of psychoeducation can also occur before possible exposure to stressful situations or, alternatively, after exposure. The intention of both is to ameliorate or mitigate the effects of exposure to extreme situations. Educational information can be imparted in a number of ways and can also form part of what has been termed psychological first aid. Despite its ubiquity, however, good evidence as to the value of psychoeducation is rare. Perhaps it could be assumed that psychoeducation, like education in general, is so obviously a "good thing" that it requires no evidence. In this paper we question the assumption, arguing that like any other intervention, psychoeducation needs to be backed up by empirical evidence. We will first present the case for and then the case against psychoeducation before reaching some conclusions and making some recommendations.

"I actually don't know who I am": the impact of bipolar disorder on the development of self.

Abstract: The majority of patients with bipolar disorder have onset prior to twenty years with early onset associated with increased impairment. Despite this, little attention has been given to the psychosocial developmental impact of this disorder. This qualitative study explored the impact of having bipolar disorder on the development of a sense of self and identity. Key findings from this qualitative study identified that for these participants, bipolar disorder had a significant impact in the area of self and identity development. Bipolar disorder created experiences of confusion, contradiction, and self doubt which made it difficult for these participants to establish continuity in their sense of self. Their lives were characterized by disruption and discontinuity and by external definitions of self based on their illness. Developing a more integrated self and identity was deemed possible through self-acceptance and incorporating different aspects of themselves. These findings would suggest that it is critical to view bipolar disorder within a psychosocial developmental framework and consider the impact on the development of self and identity. A focus on the specific areas of impact and targeting interventions that facilitate acceptance and integration thus promoting self and identity development would be recommended.

Comparison of the Conceptualization of Wisdom in Ancient Indian Literature with Modern Views: Focus on the Bhagavad Gita

Abstract: The study of wisdom has recently become a subject of growing scientific interest, although the concept of wisdom is ancient. This article focuses on conceptualization of wisdom in the Bhagavad Gita, arguably the most influential of all ancient Hindu philosophical/religious texts. Our review, using mixed qualitative/quantitative methodology with the help of Textalyser and NVivo software, found the following components to be associated with the concept of wisdom in the Gita: Knowledge of life, Emotional Regulation, Control over Desires, Decisiveness, Love of God, Duty and Work, Self–Contentedness, Compassion/Sacrifice, Insight/Humility, and Yoga (Integration of Personality). A comparison of the conceptualization of wisdom in the Gita with that in modern scientific literature shows several similarities, such as rich knowledge about life, emotional regulation, insight, and a focus on common good (compassion). Apparent differences include an emphasis on control over desires and renunciation of materialistic pl...

Acute disaster exposure and mental health complaints of Norwegian tsunami survivors six months post disaster

Abstract: The objective was to investigate the relationship between possible disaster stressors and subsequent health problems among tourists experiencing the 2004 South-East Asia tsunami. A cross-sectional study was performed as a postal survey concerning the experiences of the disaster exposure in retrospect and the presence of psychological symptoms (GHQ-28) in Norwegian tsunami victims 6 months post disaster. The strongest predictors of health complaints were danger of death, witness impressions, and bereavements. Aggravated outcomes were also seen in those who helped others in the acute phase or had sole responsibility for children when the tsunami struck. Having a family member or close friend who was injured was reversely associated with health problems. Women reported more psychological distress than men, but the difference disappeared with increasing degree of danger exposure. Dose-response relationships to psychological distress were found for single exposure factors as well as for the cumulative effects of being exposed to several exposure variables.

Eleven deaths of Mr. K.: contributing factors to suicide in narcissistic personalities.

Abstract: The objective of this paper is to discuss and illuminate the problem of abrupt suicide in relatively well-functioning individuals without a major DSM-IV mental illness. A case of a man diagnosed with narcissistic personality, who first allegedly staged a suicide attempt and later, without overt warning, killed himself in the context of financial losses and divorce, will be discussed. The paper addresses how and why a life event can generate an internal subjective experience that evokes a sudden deadly self-attack. Discussion of eleven explanatory hypotheses serves to further the understanding of these seemingly inexplicable events. We conclude that additional studies are necessary, especially of the interconnected interaction between life event, psychological functioning, and neurobiological correlates to expand understanding and develop proactive treatment strategies.

The syndrome of Capgras.

Abstract: The delusional belief that a close relative has been replaced by a look-alike impostor was named the Capgras delusion in honor of Joseph Capgras, who described the first case. Capgras's original patient, Mme M., had a complex mental illness with various symptoms in addition to the delusion of substitution. The focus in the literature has always been on her eponymous delusion, ignoring the rest of her condition. However, studying the substitution delusion in isolation from the rest of her illness has led to inadequate conclusions. It is necessary to understand the delusion within the broad context of her illness. Toward that goal, her mental illness is described here in detail. A particular pattern of delusions and illness is identified. This same pattern is noted in other cases of Capgras in the literature. Three new cases are reported here, each with the same overall pattern of illness that Mme M. had. This pattern is labeled the Syndrome of Capgras. A hypothesis is offered to explain the Capgras delusion within the context of this illness.

Internalized Representations of Early Interpersonal Experience and Adult Relationships: A Test of Copy Process Theory in Clinical and Non–Clinical Settings

Abstract: Studies connecting childhood experience and adult psychopathology often focus on consequences of abuse and neglect. Copy process theory (Benjamin, 2003) states that constructive as well as destructive experiences shape adult behavior with surprising interpersonal specificity. Childhood perceptions and social learning are encoded in memory and then "copied" in 3 basic ways in subsequent relationships: Identification (behaving as he or she behaved), Recapitulation (behaving as one behaved when with him or her), and Introjection (treating oneself as he or she was treated). The first step in evaluating copy process theory is to verify that the predicted correspondence between adult relational patterns and internal representation of early experience can be observed in different adult samples. Remembered interpersonal patterns from childhood and perceptions of adult relational patterns were measured using the Structural Analysis of Social Behavior (SASB). Strong evidence was found for each copy process in a sample of psychiatric inpatients (N = 161) and a college sample (N = 133). Positive and negative behaviors were copied in both. Evidence suggests that gender, patient status, and rated state may influence whether, and in which forms, copying occurs.

The Mental Health Consequences of Disaster-Related Loss : Findings from Primary Care One Year After the 9/11 Terrorist Attacks

Abstract: This study examines the long-term psychiatric consequences, pain interference in daily activities, work loss, and functional impairment associated with 9/11-related loss among low-income, minority primary care patients in New York City. A systematic sample of 929 adult patients completed a survey that included a sociodemographic questionnaire, the PTSD Checklist, the PRIME-MD Patient Health Questionnaire, and the Medical Outcomes Study Short Form-12 (SF-12). Approximately one-quarter of the sample reported knowing someone who was killed in the attacks of 9/11, and these patients were sociodemographically similar to the rest of the sample. Compared to patients who had not experienced 9/11-related loss, patients who experienced loss were roughly twice as likely (OR = 1.97, 95%; CI = 1.40, 2.77) to screen positive for at least one mental disorder, including major depressive disorder (MDD; 29.2%), generalized anxiety disorder (GAD; 19.4%), and posttraumatic stress disorder (PTSD; 17.1%). After controlling for pre-9/11 trauma, 9/11-related loss was significantly related to extreme pain interference, work loss, and functional impairment. The results suggest that disaster-related mental health care in this clinical population should emphasize evidence-based treatments for mood and anxiety disorders.

Genotype–environment correlations: implications for determining the relationship between environmental exposures and psychiatric illness

Abstract: Psychosocial risk factors for psychiatric illness are moderately heritable. This has two implications: first, that individuals actively shape their environments through heritable behaviour; second, that the relationship between environmental exposure and psychopathology may be confounded by genotype. We define three types of genotype–environment correlation (passive, evocative, and active), describe the evidence from quantitative and molecular genetic studies for their existence, and discuss the implications of genotype–environment correlations for the prevention and treatment of psychiatric disorder. Research designs are needed that can test which exposures have truly causal effects on mental illness and which are confounded by genotype, so that clinicians can make informed decisions about when modifying exposures will be likely to result in reductions in mental illness. By considering bi-directional and reciprocal relations between risk exposures and patients’ behaviour, clinicians may develop a fuller picture of the causes of disorder and develop more effective treatment methods.

Ethnic/Racial diversity and posttraumatic distress in the acute care medical setting.

Abstract: Recent commentary has advocated for epidemiological investigation as a foundational science for understanding disparities in the delivery of mental health care and for the development of early trauma-focused interventions. Few acute care investigations have examined the diversity of ethnic/racial heritages or compared variations in early posttraumatic distress in representative samples of injured trauma survivors. Hospitalized injury survivors at two United States level I trauma centers were randomly approached in order to document linguistic and ethnic/racial diversity. Approximately 12% of patients approached were non-English speaking with 16 languages represented. English speaking, inpatients were screened for posttraumatic stress disorder, peritraumatic dissociative, and depressive symptoms. For 269 English speaking study participants, ethnic/racial group status was clearly categorized into one group for 72%, two groups for 25%, and three groups for 3% of participants. Regression analyses that adjusted for relevant clinical and demographic characteristics revealed that relative to whites, patients from American Indian, African American, Hispanic, and Asian heritages demonstrated significant elevations in one or more posttraumatic symptom clusters. A remarkable diversity of heritages was identified, and posttraumatic distress was elevated in ethnic/racial minority patients. Policy-relevant clinical investigations that combine evidence-based treatments, bilingual/bicultural care-management strategies, and support for trauma center organizational capacity building may be required in order to enhance the quality of mental health care for diverse injured trauma survivors.

The molecular pathology of Alzheimer’s disease

Abstract: Alzheimer’s disease (AD) is the most common cause of dementia in elderly people, and the fourth most common cause of death in developed nations. Clinically, the disease is characterized by the deterioration of a patient’s cognitive and functional abilities, which may be accompanied by varying degrees of psychiatric and behavioural symptoms. The clinical decline is associated with a significant loss of neurons and synapses and ensuing neurochemical changes within the brain of an affected individual. In addition, two further microscopic pathologies are observed within the brain tissue: extracellular neuritic plaques and intracellular neurofibrillary tangles (NFTs). Both of these distinctive neuropathologies, regarded as hallmarks of the disease, are the result of abnormal aggregation of proteinaceous material. Neuritic plaques are largely formed from the aggregation of the 4 kDa β-amyloid peptide, which is released into the extracellular space following the metabolic breakdown of the larger amyloid precursor protein (APP). NFTs, which develop within neurons, are aggregates principally composed of the cytoskeletal protein tau and may be initiated by aberrant phosphorylation of tau. The prevailing view within the field is that mismetabolism of APP and abnormal production, aggregation and deposition of Aβ are central to the pathogenesis of AD, and that the Aβ pathology somehow leads to the tau/NFT pathology and the subsequent neuronal damage observed. In this article we review our current understanding of these molecular events and highlight how this knowledge is directing approaches to develop AD-modifying therapies.

Distinguishing distress and psychopathology among survivors of the Oakland/Berkeley firestorm.

Abstract: Disaster mental health research has historically focused on assessment of psychopathology, using measures of psychiatric symptoms and disorders. The Oakland/Berkeley firestorm provided an opportunity to explore resilience among highly exposed survivors through consideration of psychiatric variables in the context of personality. The Diagnostic Interview Schedule/Disaster Supplement was administered to 62 firestorm survivors at approximately 4, 16, and 39 months and the Temperament and Character Inventory administered at 16 months postdisaster. Few individuals had postdisaster psychopathology (16% with any diagnosis, 5%with PTSD). There was considerable evidence of distress, however, indicated by an abundance of reported posttraumatic symptoms, functional impairments, and endorsement of emotional upset, all of which decreased substantially over time. Group C (avoidance/numbing) posttraumatic symptoms were relatively uncommon and were specifically associated with elevated Self-Transcendence. Groups...

Insight, Stigma, and Post–Diagnosis Identities in Schizophrenia

Abstract: This paper examines insight into mental illness, particularly as it applies to people diagnosed with schizophrenia. The paper argues that insight should be reconceptualized as a component of post-diagnosis identities that are defined in relation to other social identities, and under conditions of stigma against mental illness. The proposed conceptualization suggests there are at least four possibilities for post-diagnosis identities in schizophrenia: engulfed, resistant, detached, and empowered. Revising the insight concept to integrate the influence of social context and the potential for multiple post-diagnosis identities could be the basis for therapeutic dialogues with individuals about the implications that diagnosis has for their lives.

The protective effect of religiosity under terrorism

Abstract: Religious observance has a protective effect on the mental health of individuals facing adverse events. Its role under terrorism has been less investigated. Gaza and West Bank settlers, both secular and those keeping different degrees of observance, have faced terrorism in recent years. We investigated their PERI-Demoralization mean scores following terrorist attacks controlling for confounding variables. The results showed that the higher the religiosity the lower the demoralization mean score. This protective effect lessened when there was dissonance between the degree of religiosity of the respondent and the religious observance of the settlement of residence. Language: en

Services for people with personality disorder

Abstract: After years of relative neglect, increased efforts are being made to improve services for people with personality disorder (PD). Mental health services can play an important part in supporting people with PD and facilitating access to psychological therapies and dedicated PD services. Although further evidence is required to determine the most effective and cost-effective ways of helping people with PD, there is a broad consensus about general principles for working with people with PD that can help to ensure that best use is made of the resources that are currently available. PD services need to be consistent and reliable, to promote self-efficacy, and to ensure that services users are actively involved in their treatment. Realistic expectations are needed regarding what contact with services can help someone achieve and to help people identify short- and long-term goals. Clear communication between all those involved in providing services for people with PD is important, as are opportunities for reflective practice.

Dialectical behaviour therapy

Abstract: Dialectical Behaviour therapy (DBT) was originally developed for the treatment of women diagnosed with borderline personality disorder (BPD) in the community. Since then DBT has been modified and evaluated for use with comorbid disorders, across the lifespan and across a range of clinical settings. The DBT model assumes that individuals with BPD lack key interpersonal, self-regulation, and distress tolerance skills, and that personal and environmental factors may frequently block and/or inhibit the use of behavioural skills or reinforce maladaptive actions. DBT is based on an assumption of a pervasive skills deficit; thus the therapy is designed to facilitate the learning of new skills, the embedding of these skills into the individual’s repertoire, and the generalization of these skills across contexts. DBT incorporates a range of change-enhancing strategies interwoven with acceptance-focused strategies. DBT was developed from the cognitive–behavioural model of treatment, and thus shares many of its key components. DBT incorporates the principles of dialectics, mindfulness, and validation with cognitive–behavioural principles and techniques.

Functional neuroanatomy of psychopathy

Abstract: Psychopathy has been characterized as a psychiatric disorder consisting of emotional deficits (shallow affect, remorselessness, and lack of shame), antisocial behaviour (impulsivity, irresponsibility, and poor behaviour controls), and interpersonal features (conning/manipulative, superficial charm, and pathological lying). In this article, structural and functional imaging findings on psychopathy are reviewed and several hypotheses are provided with regard to the neural bases of psychopathy. It is proposed that the emotional deficits are associated with impairments in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), amygdala–hippocampus complex, and the insula, whereas antisocial behaviour may be linked to deficits in the OFC, ACC, dorsolateral prefrontal cortex, and superior temporal gyrus. On the other hand, differences in the white matter of the OFC, ACC, and ventrolateral prefrontal cortex may contribute to the pathological lying behaviour often seen in psychopathic individuals. A discussion is also presented on the topic of successful vs unsuccessful psychopaths, suggesting the absence of brain abnormalities, particularly in the prefrontal cortex and the hippocampus, in successful psychopaths, and how these findings have furthered our knowledge of the neuropathology underlying psychopathy.

Evidence Based Psychosocial Practices and Recovery from Schizophrenia

Abstract: Pessimistic views about the course and outcome of schizophrenia have been replaced by a more hopeful perspective that emphasizes on providing opportunities for recovery. Recovery, from a provider perspective, means that priority is placed on providing access to treatments and community services that have been proven effective in both decreasing symptoms and assisting individuals to lead maximally productive and personally meaningful lives. In 2004, the Schizophrenia Patient Outcomes Research Team (PORT) published a consensus list of evidence-based practices (EBPs) that includes six psychosocial treatments. These psychosocial interventions in combination with access to pharmacotherapy are important components of comprehensive treatment programs for the seriously mentally ill. This paper summarizes and updates the research basis for the PORT psychosocial EBPs and discusses several additional issues and research topics to be considered in the future.

Alexithymia and therapist reactions to the patient: expression of positive emotion as a mediator.

Abstract: This study examined patient's expression of emotion as a mediator of the relationship between patient alexithymia and therapist reactions to the patient. We analyzed data from 107 psychiatric outpatients who participated in a randomized controlled trial of two forms of group therapy for complicated grief. Patient alexithymia was assessed using the Toronto Alexithymia Scale–20. Patient's expression of emotion was assessed via sociometric ratings provided by other group members. Therapist reactions to the patient were assessed via therapist's ratings of each member in the group. Patient's expression of positive emotion met all the requirements for being considered a mediator. The findings indicated that the higher the level of alexithymia (specifically, greater difficulty communicating feelings and greater tendency to engage in externally oriented thinking), the less expression of positive emotion by the patient, and the more negative the therapist's reactions to the patient. The mediation provided by expre...

Adolescent substance misuse

Abstract: Substance misuse is common in adolescence. Young people with substance misuse have comorbid mental health problems and multiple psychosocial difficulties, including family conflict, interpersonal difficulties, academic failure, and offending behaviour. Adult definitions of substance misuse are often inadequate and restrictive. Developmental and systemic perspectives are essential in the assessment and treatment of young people with drug- and alcohol-related problems. There is a robust body of evidence, mainly from the USA, to indicate that integrated multimodal treatment programmes produce significant improvement across a number of domains. Clinical experience suggests that practitioners from a wide variety of backgrounds could offer safe and effective treatment. Clinicians working in child and adolescent mental health services and paediatrics have a key role to play in the assessment and treatment of young people with substance misuse and comorbid mental health problems. Early identification and treatment could alter the developmental trajectory of young people at high risk of developing substance misuse and prevent potentially serious complications.

Comorbidity of personality disorders and mental illnesses

Abstract: Mental illness and personality disorder often occur in the same person. Although concern has been expressed that this may be due to overlapping diagnostic criteria, many different studies have confirmed this finding. Various models have been proposed to explain the association, and it is likely that different models will be relevant to different associations. Associations between specific personality disorders and categories of mental illness include those between Cluster A personality disorders and schizophrenia, Cluster B personality disorders and substance misuse and post-traumatic stress disorder, and Cluster C personality disorders and depression, eating disorders and a number of neurotic disorders.

Cognitive–behavioural therapy for personality disorders

Abstract: Cognitive–behavioural therapy (CBT) has been adapted to treat individuals with personality disorder. The model is biosocial, recognizing that the origins of personality problems are likely to lie in inherent temperament, the internal working model of relationships, self-identity, self-worth, and the emotional availability of the infant’s caregivers. To date, there are six randomized controlled trials that suggest that CBT is an effective treatment for patients with borderline and avoidant personality disorder, although some trials have shown more evidence of improvement than others. The therapy is structured, based on an individual formulation of the patient’s problems, and uses methods that take into account problems arising in the therapeutic relationship. Although more sessions are needed to change long-standing behavioural patterns and associated core beliefs in individuals with personality disorder, important changes, such as a reduction in self-harm and modification of beliefs, can take place within months rather than years.

Eating disorders and diabetes

Abstract: Diabetes mellitus is characterized by chronic hyperglycaemia and its incidence is rising rapidly in parallel with the obesity epidemic. Disordered eating, especially sub-threshold eating disorders, is a common psychological problem in both type 1 and type 2 diabetes, and Is associated with poor diabetes control, complications, and an increased mortality rate. Assessment requires a consideration of the risk factors for eating disorders and for poor diabetes control, and should include the inappropriate use of insulin (omission or reduced doses) as a means of purging in type 1 diabetes and avoid becoming overweight in type 2 diabetes. Eating problems tend to co-exist with other psychological difficulties, especially depression, which should be actively treated. There have been insufficient studies to establish an evidence base for a psychotherapeutic approach to managing eating problems in patients with diabetes, but generic psychological models from eating disorders could be adapted to address diabetes-related coping problems, such as fear of needles or of hypoglycaemia.

Management of eating disorders in children and adolescents

Abstract: This review summarizes current recommendations for the psychological and pharmacological management of early-onset eating disorders in childhood and adolescence. It describes the differences in assessment and management compared with managing adults with eating disorders, discusses specific issues regarding consent to treatment in children, and highlights the important principles of treatment in both the inpatient and outpatient setting.

Eating disorders and pregnancy

Abstract: Eating disorders affect women of childbearing age. The literature on the effects of a maternal eating disorder on pregnancy and pregnancy outcomes, and the effects of pregnancy on eating disorders, is limited. However, most studies seem to suggest that eating disorder symptomatology decreases during pregnancy with a recrudescence postpartum. Eating disorders also have potentially negative effects on pregnancy outcomes, as most of the literature suggests. The literature on the course of eating disorders on pregnancy and on pregnancy outcomes in women with eating disorders is reviewed.