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Caring for psychiatrically healthy individuals at the end of life is typically emotionally taxing and burdensome. Caring for individuals with psychiatric disorders at the end of life is often considerably [...]

As (primarily) clinicians of a certain age, when picking up copies of mainstream and premier psychiatric journals these days, we, and many of our friends and associates, have increasingly experienced [...]

For the past decade, I have taught 6-hour annual seminars on the history of psychiatry to psychiatric residents. This course was assigned to me, in part, because I have lived [...]

Terminally ill patients confront difficult end-of-life choices, which can include determining how and when they wish to hasten their death. Patients with less than six months to live, for whom [...]

A case study is presented of a 17-year old girl with a common medical problem called anorexia nervosa, which is an eating malady featured by resolute dieting and exercise, and results in persistent low weight among other characteristics. The treatment recommended consists of regular family meetings and psychotherapy to encourage healthy eating, and reducing anxiety about body weight, while education, advice and support also constitute key factors in resolving the problem.

Objective: To examine (1) the prevalence, types, and severity of child abuse and neglect (CAN) and (2) the relationship between CAN and lifetime psychiatric disorders among American Indian women using primary care services. Methods: A cross-sectional study was conducted among 234 American Indian women, age 18-45 who presented for outpatient ambulatory services at a community-based Indian Health Service Hospital in Albuquerque, New Mexico. Dependent measures included mood, substance abuse, and anxiety disorders as well as posttraumatic stress disorder (PTSD) as measured by the Composite International Diagnostic Interview. CAN was assessed using the Childhood Trauma Questionnaire. Results: Approximately three-quarters of respondents (76.5%; 95% CI = 70.4, 81.7) reported some type of childhood abuse or neglect; over 40% reported exposure to severe maltreatment. Severity of child maltreatment was associated in a close response manner with lifetime diagnosis of mental disorders. After adjusting for social and demographic correlates, severe child maltreatment was strongly associated with lifetime PTSD (prevalence ratio [PR] = 3.9; 95% CI = 1.9, 8.0); and was moderately associated with lifetime substance use disorders (PR = 2.3; 95% CI = 1.6, 3.3); mood disorders (PR = 2.1; 95% CI = 1.4, 3.2); and with two or more disorders (PR = 2.3; 95% CI = 1.6, 3.4). Conclusion: CAN was common in our sample of American Indian women in primary care and was positively associated with lifetime psychiatric disorders outcomes. Screening for CAN and psychiatric disorders would enhance the treatment of patients seeking primary care services. Primary prevention of child maltreatment might reduce the high prevalence of mental disorders among American Indian women. Keywords: American Indian; Native American; Child abuse; Mental disorders; Posttraumatic stress disorder; Substance abuse; Epidemiology; Primary care; Mood disorders; Anxiety disorders

Objectives. We examined the lifetime and the past-year prevalence and correlates of common mental disorders among American Indian and Alaska Native women who presented for primary care. Methods. We screened 489 consecutively presenting female primary care patients aged 18 through 45 years with the General Health Questionnaire, 12-item version. A sub-sample (n=234) completed the Composite International Diagnostic Interview. We examined associations between psychiatric disorders and sociodemographic variables, boarding school attendance, and psychopathology in the family of origin. Results. The study participants had high rates of alcohol use disorders, anxiety disorders, and anxiety/depression comorbidity compared with other samples of non-American Indian/Alaska Native women in primary care settings. Conclusions. There is a need for culturally appropriate mental health treatments and preventive services.

Issues are presented concerning the remembered levels of the incidence of parental intrusiveness during the adolescence of women who develop a history bulimia nervosa and those who do not.

Although histories of child sexual abuse among eating disorder patients have attracted considerable attention in the past decade, relatively little is known about parental physical abuse among these patients. We examined aspects of childhood parental physical punishment and its family environmental correlates among women with a lifetime history of bulimia nervosa (BN group; n = 80) and women with no history of eating disorder (Control group; n = 40), recruited primarily by newspaper advertisement. Women in the BN group reported significantly more physical punishment and perceived their discipline to have been more harsh and capricious than women in the Control group. Nonetheless, the groups did not differ significantly in the extent to which they believed they deserved their punishment or in their belief that they were 'physically abused.' Further, subjects often failed to assert that they had been physically abused despite meeting conservative criteria, while the reverse tendency was uncommon. Finally, increased levels of physical punishment were associated with greater global family pathology in the BN group, but not in the Control group. Our findings underscore the necessity of explicitly inquiring about physically punitive events in the histories of bulimic women, as well as beliefs regarding these events. Key Words - Bulimia nervosa, Physical abuse, Family environment.

A study of bulimia nervosa (BN) patients reveals that childhood abuse, especially psychological abuse, increases the chances of permanent comorbid Axis I disorders and personality pathology among BN patients. While psychological abuse is related to personality disorder, physical abuse is not related to personality disorder. Eating disordered patients with a history of child abuse and comorbid psychopathological patients may need special treatments.

BIOLOGICAL and developmental vulnerabilities, maladaptive learning experiences, and pathological family patterns may all contribute to the appearance and persistence of eating disorder (Bruch 1973, Crisp 1980, Garfinkel and Garner 1982). Psychosocial treatment approaches are currently the most important and effective intervention methods for anorexia nervosa (American Psychiatric Association 1993, Garner 1985) and are at least equivalent to medication approaches for bulimia nervosa as well.

A case study of a 31-year-old single woman, who was underweight and complained of restrictive eating, nausea, and occasional vomiting after meals, is described. She was diagnosed with celiac disease after an initial diagnosis of atypical eating disorder, thus was suggested the implementation of gluten-free diets for relief.

A study was conducted to examine the effects of eating disorders in young women. Findings reveal the diagnostic awareness regarding eating disorders in patients of young women.

The medication, treatment and outcomes in a young female patient who after suffering from anorexia nervosa (AN) and later on developed Raynaud's phenomenon is presented. A combination of nutritional rehabilitation, group and individual therapy and counseling was used to enhance the patient's weight, attitudes and eating disorder-related behavior.

A study reports wide weight fluctuations during a week of early refeeding for two patients with anorexia nervosa and discusses possible mechanisms. Laboratory tests were within normal limits for both patients except for leukopenia in one patient.

More research is needed to identify the cause of night-eating syndrome and an appropriate treatment. People with NES wake several times during the night and usually eat then. Many are obese and attribute their weight problem to NES. Many people with NES eat half of their daily calories between 8 p.m. and 6 a.m. In one study, 70% were taking an antidepressant or antipsychotic drug. This indicates that a psychologic disorder may cause NES. Many patients also have an eating disorder during the day. A 1999 study found disordered biological rhythms in a group of NES patients.

Pediatricians are in a unique position to identify children at risk for mental illness. Children of parents who are divorced, depressed or previously hospitalized with mental illness are at a particularly high risk. The attitudes of 316 pediatric practitioners towards their role in preventing mental illness among children were evaluated. The reliability of measuring attitudes and barriers to implementing prevention programs were assessed among pediatricians practicing at one medical school. Although most pediatricians considered it appropriate, effective and ethical to be involved in the prevention of mental illness in children, they thought that ethical guidelines concerning mental illness prevention were inadequate. The prevention of mental illness was inhibited by financial, educational and time constraints. Preventive health practices were related to their own personal beliefs regarding how people become and stay healthy. It is suggested that more information and improvement in prevention skills are needed to implement mental health-oriented practices. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Seven hundred sixteen female UCLA students-drawn from Primary Care Clinic, Women's Health Clinic, sorority, athletic team, dance major, and undergraduate psychology class populations-completed questionnaires regarding eating disorders symptoms and attitudes compatible with the diagnostic criteria published by the American Psychiatric Association in the Diagnostic and Statistical Manual, (3rd ed., DSM-III), the Eating Disorders Inventory and related information. The purpose of the study was to determine the prevalence of eating disorders and eating disorder-related symptoms in particular subgroups for targeting intervention and prevention programs. Although between 7.5% and 46% of subgroup populations reported the presence of individual eating disorder-related symptoms, the prevalence of active eating disorders for the group as a whole at the time of the survey was 2.1 %, with the prevalence of disorders at any ti me during life 4.8%, using DSM-III diagnosis. The Eating Disorders Inventory scores for the group as a whole were comparable with norms reported by other researchers in the literature. Primary Care Clinic attenders and dance majors reported the highest rates of symptoms and disorders, while athletes reported the lowest rates. J Am Diet Assoc 89:45-53, 1989., Although a large number of studies have attempted to determine the prevalence of anorexia nervosa and bulimia in university populations, wide disparity exists among the reported findings. Most of the [...]

Research investigating the efficacy of the use of electronic mailing in treating anorexia nervosa is presented. Particular attention is given to the frequency of electronic communications and to the improvements registered by the patients as a result .

Issues are presented concerning the influence of parental factors in the incidence of bulimia nervosa among women. The value of the Parental Intrusiveness Rating Scale in the study of bulimia is discussed.

Aspects of suffering from bulimia nervosa (BN) may make it hard for bulimic women to sustain a network of family and friends that offers support at deeper levels, particularly emotionally. It is also possible that problems with maintaining meaningful relationships make these women vulnerable to developing an eating disorder. Relationships with relatives are potentially the most problematic social relationships for women with BN, particularly during the recovery phase. Many bulimic women feel isolated from their family, unless they have revealed their condition and have received a positive response.