"I have to fight for them to investigate things": a qualitative exploration of physical and mental healthcare for women diagnosed with mental illness.

Introduction: Women play a significant role in the management of their own healthcare and that of others, however women diagnosed with mental illness and physical health concerns experience significant health inequalities as compared to people living without mental health concerns. Methods: In this paper, we reflect on the experiences of 20 cis women diagnosed with mental and physical health concerns who agreed to be a part of this research. This qualitative study is part of the larger Healthtalk Australia research project which was not gender specific. Female participants shared many experiences of mental and physical healthcare in interviews with researchers that pointed to the need for a gendered approach to addressing health inequalities. Consequently, we iteratively consolidated transcripts of interviews with participants into thematic categories facilitated by NVIVO 12. Results: We identified two broad themes and a set of subthemes: in the doctor's office - experience of labelling; negotiating medications; and interactions with physical and mental health, and outside the doctor's office - responses to trauma, financial concerns, and reliance on participant's internal resources to get healthcare needs met. Discussion: We conclude that participants in this study undertook significant work to manage their own healthcare needs, despite being challenged by clinicians and systems that failed to see them as whole people with expertise regarding their own health.

"You Can't Be Too Skinny. You Can't Be Too Fat. I Don't Know What You Are Supposed To Be.": A qualitative focus group study exploring body image experiences of South Asian women in the UK.

British South Asian women may experience unique appearance pressures associated with their intersecting (racialised and gendered) identities; yet qualitative investigations of intersectional understandings of their body image are scarce. The aim of this study was to explore sociocultural factors influencing British South Asian women's body image using an intersectional framework. Seven focus groups were conducted with 22 women of South Asian heritage living in the UK between the age of 18 and 48 years old who were comfortable speaking in English. Data were analysed using reflexive thematic analysis. We generated four themes (1) navigating (often marriage-related) appearance pressures from South Asian elders and aunties (2) negotiating cultural and societal standards across different aspects of one's identity (3) representation of South Asian women in the wider context and (4) forms of healing from the pressures imposed on South Asian women. The findings have important implications for the body image experiences of South Asian women by acknowledging the need for tailored and nuanced responses to their complex needs in the sociocultural, political and relational context such as family, peers, education, health, media and the wider consumer landscape.

Novel ketamine and zinc treatment for anorexia nervosa and the potential beneficial interactions with the gut microbiome.

Anorexia nervosa (AN) is a severe illness with diverse aetiological and maintaining contributors including neurobiological, metabolic, psychological, and social determining factors. In addition to nutritional recovery, multiple psychological and pharmacological therapies and brain-based stimulations have been explored; however, existing treatments have limited efficacy. This paper outlines a neurobiological model of glutamatergic and γ-aminobutyric acid (GABA)-ergic dysfunction, exacerbated by chronic gut microbiome dysbiosis and zinc depletion at a brain and gut level. The gut microbiome is established early in development, and early exposure to stress and adversity contribute to gut microbial disturbance in AN, early dysregulation to glutamatergic and GABAergic networks, interoceptive impairment, and inhibited caloric harvest from food (e.g., zinc malabsorption, competition for zinc ions between gut bacteria and host). Zinc is a key part of glutamatergic and GABAergic networks, and also affects leptin and gut microbial function; systems dysregulated in AN. Low doses of ketamine in conjunction with zinc, could provide an efficacious combination to act on NMDA receptors and normalise glutamatergic, GABAergic and gut function in AN.

A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope.

The ethical approach to treatment non-response and treatment refusal in severe-enduring anorexia nervosa (SE-AN) is the source of significant ethical debate, particularly given the risk of death by suicide or medical complications. A recent article proposed criteria to define when anorexia nervosa (AN) can be diagnosed as 'terminal' in order to facilitate euthanasia or physician-assisted suicide (EAS), otherwise known as medical assistance in dying, for individuals who wish to be relieved of suffering and accept treatment as 'futile'. This author utilises their personal lived experience to reflect on the issues raised, including: treatment refusal, iatrogenic harm, suicidality and desire to end suffering, impact of diagnosis/prognosis, schemas, alexithymia, countertransference, ambivalence, and holding on to hope. Within debates as critical as the bioethics of involuntary treatment, end-of-life and EAS in eating disorders, it is crucial that the literature includes multiple cases and perspectives of individuals with SE-AN that represent a wide range of experiences and explores the complexity of enduring AN illness, complex beliefs, communication patterns and relational dynamics that occur in SE-AN.

A framework for conceptualising early intervention for eating disorders.

OBJECTIVE: This paper outlines the evidence base for early intervention for eating disorders; provides a global overview of how early intervention for eating disorders is provided in different regions and settings; and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders. METHOD AND RESULTS: Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence-based approaches to early intervention for eating disorders and progress is being made in scaling these. CONCLUSIONS: We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics.

The neural correlates of socio-cognitive factors and eating disorders in young people: A systematic review.

BACKGROUND: Although the primary aetiology of Eating Disorders (ED) remains unknown, research suggests a complex interplay of biological, psychological, and cultural/environmental factors. This paper aims to systematically review the literature on neuroimaging studies that measure socio-cognitive factors, in the context of body dissatisfaction and EDs in young people. Specifically, our aim was to identify patterns in the findings linked to social media-type behaviours. METHODS: The review was conducted in accordance with PRISMA guidelines using PubMed, Scopus, and Web of Science databases. 799 papers were identified in the database search and 38 studies were selected based on exclusion and inclusion criteria. Selected studies were assessed using the National Institute of Health study quality assessment tool. RESULTS: Findings point to state-related impairments in inhibitory control and salient emotional processing. Anorexia Nervosa(AN) showed impaired set-shifting abilities, working memory and decision making, while altered activation in attention networks and associated difficulties with conflict resolution were seen for Bulimia Nervosa(BN) and Other Specified Feeding and Eating Disorders(OSFED). AN and BN also demonstrated altered sensitivity to food-related stimuli in striatal regions, suggesting aberrant top-down emotional-cognitive control. ED participants also show deficits in body representation, impaired control over social behaviours and altered integration of visual and body perception. DISCUSSION: These findings support the notion that socio-cognitive dysfunctions in ED are underpinned by a distributed network of structural and functional brain changes which influence the way young people with ED interact with and respond to social media, and ultimately places at them at increased risk for body image disturbances. This Review was registered with the PROSPERO International Register of Systematic Reviews, Registration number CRD42021270696.

Valuing the voice of lived experience of eating disorders in the research process: Benefits and considerations.

Although the inclusion of individuals with lived experience is encouraged within the research process, there remains inconsistent direct involvement in many mental health fields. Within the eating disorders field specifically, there is a very strong and increasing presence of lived experience advocacy. However, due to a number of potential challenges, research undertaken in consultation or in collaboration with individuals with lived experience of an eating disorder is scarce. This paper describes the significant benefits of the inclusion of individuals with lived experience in research. The specific challenges and barriers faced in eating disorders research are also outlined. It is concluded that in addition to existing guidelines on working with lived experience collaborators in mental health research, more specific procedures are required when working with those with eating disorders.

A critical review of research into mental health consumers' perspectives on their physical health: Is there an absence of consumers in the design, conduct, analysis and reporting of this research?

We conducted a critical review, using systematic methods, of the literature examining mental health consumer perspectives on their physical and mental health in academic research published between 2005 and 2021. This review examined the inclusion, extent, type and centrality of consumer perspectives regarding their mental and physical health. The search produced 1,865 papers from which 116 met the inclusion criteria. Studies predominantly focused on consumers' individual experiences of their physical and mental health, including but not limited to their understandings and experiences of medication and associated risk factors. They also captured some social aspects of mental health consumers' physical health, including factors that impacted individual agency, stigma, and social and interpersonal factors. Structural factors affecting physical and mental health, such as accessibility of services and financial constraints, were also identified. The review revealed that in comparison to clinician perspectives, the direct representation of consumer perspectives was lacking. Similarly, while clinician and carer perspectives on structural factors were investigated, the consumer perspective in this area was missing. The review also found few genuine codesigned or coproduced research studies. To better identify and respond to the health needs as prioritized by consumers, this paper argues it is imperative that future studies prioritize codesigned and coproduced research. It is argued that a focus on "services as provided" rather than "services as received" has contributed to a lack of progress in addressing the life expectancy gap for consumers. It is recommended that journals, ethics committees and research policy organizations develop guidelines and standards to inform best practice in research on consumer perspectives and experience and to support the implementation of codesigned and/or coproduced approaches in future research. Respecting and including consumers as equal partners in the research process will lead to more meaningful insights to inform policy and practice and reduce the life expectancy gap for people living with mental health concerns.