Weight gain, thermic effect of glucose and resting metabolic rate during recovery from anorexia nervosa.

Rate of weight gain, together with metabolic rate before and after a glucose meal, were studied in a group of 15 female anorexia nervosa patients as their weight was being restored to normal levels. The previously obese anoretic patients gained weight more rapidly, on the same food intake, than those who were of normal weight before their illness began. The increase in metabolic rate (as treatment progressed) was less in the previously obese patients, who also showed a tendency for the metabolic rate to increase less after a glucose meal than the patients with no history of obesity. The thermic effect of glucose was greater in patients with anorexia nervosa than in a comparable control group of six female students.

Drug-induced weight gain.

Untoward long term morbidity and mortality and excess non-compliance with treatment may result from the weight gain induced by some drugs used for the treatment of severe psychological disorder. Whilst some weight gain during the recovery from psychological disorder is to be expected, excess weight gain, over and above the patients normal weight, is not necessary to good outcome and can be avoided. Patients vulnerable to excess weight gain can often be identified prior to beginning treatment.

Psychobiological aspects of asthma and the consequent research implications.

Recent research suggests that anxiety disorders are more common in asthmatic patients than in the population as a whole. There are a variety of biologic, psychologic, and social factors that suggest that the disorder of asthma may in itself be anxiogenic and that simply having asthma may give patients an increased vulnerability toward the development of anxiety disorders. These issues are reviewed and emphasis is placed on the need for further research into the apparent biologic areas of overlap between psychiatric disorders and asthma. It is hypothesized that a "lactate challenge test" may be used in asthmatics to see if they are predisposed to panic and suggested that a therapeutic trial of tricyclic antidepressants in anxious asthmatics is indicated. Research into the psychobiologic aspects of asthma is likely to clarify the role of "emotional" factors in asthma and may well have significant implications for the management of this disorder.

Psychological predictors of disease course in rheumatoid arthritis.

A three year prospective study of 30 patients with established rheumatoid arthritis demonstrated that symptoms of depression and anxiety predicted a good outcome whilst externalized hostility predicted a poorer outcome. A multiple regression analysis further showed that patients who denied the emotional significance of their illness faired worse. Psychological variables accounted for 32% of the variance of outcome.

Telepsychiatry in South Australia.

Telemedicine has evolved to become an integral part of the South Australian Rural and Remote Mental Health Service. The resulting telemedicine service is one of only a few telepsychiatry services around the world that is firmly embedded in normal clinical practice and can be regarded as sustainable. The telepsychiatry service has been operational in Adelaide since January 1994 and more than 2000 clinical consultations have been performed since that time. In contrast to other telepsychiatry systems internationally, more than 80% of the usage of the South Australian system has been for clinical purposes. The benefits and limitations of telepsychiatry are reviewed, as are factors that have affected the success of the project.

Telepsychiatry: 'tele' yes, but what about the 'psychiatry'?

To investigate what is lost or gained in a psychiatric evaluation when it takes place via telepsychiatry we compared the interrater reliability between two psychiatrists interviewing 63 subjects in an observer/interviewer split configuration in telepsychiatry and same-room settings. The measures used were the BPRS and interviewer ratings from a semi-structured interview. Patients also rated their experience. There were some clear differences between the telepsychiatry and same-room evaluations. Despite these variations, diagnoses were as reliably made by telepsychiatry. Patient acceptance of telepsychiatry was high.

Psychiatric disturbance and decision-making.

The relationship between psychiatric disorder (as measured by severity of psychoneurotic status and depression) and decision-making behaviour was examined in a sample of 39 hospitalised patients. Measures based on the conflict theory of decision-making of Janis and Mann (1977) and the expectancy-value theory of decision-making of Edwards (1961) were administered. Patients who scored highest on measures of psychoneurotic disorder--the Middlesex Hospital Questionnaire and the Beck Depression Inventory--were least confident about their decision-making. They also reported a high use of maladaptive decision-making coping patterns, in particular decision avoidance. Slightly over one-half of the patients demonstrated an ability to make rational decisions, while the remainder made either irrational decisions or avoided making any decision at all. Observation in the test session revealed that patients were strikingly slow in answering the questionnaires and often attempted to make no response. The importance of this area of research for patient assessment and treatment is discussed.

Locus of control in obesity: predictors of success in a jaw-wiring programme.

One hundred and thirty-three obese women were administered a modified version of the Reid-Ware Locus of Control questionnaire prior to jaw wiring. The factorial structure of the questionnaire was examined, and found to be primarily a unidimensional measure of internal and external locus of control, with two subscales. Total score had greatest predictive validity in terms of the four criteria of success of weight loss while wired, percentage weight loss of wiring weight, weight gain over six months, and compliance with the treatment régime. Twenty items of the scale predicted success on one or more of these criteria of success, and are presented as an abbreviated locus of control scale with a higher degree of validity than the original scale.

How common is anorexia nervosa? A prevalence study.

During 1972-74 nine populations of schoolgirls were surveyed in respect of the occurrence of anorexia nervosa. As well as the current school year, previous years (going back variously 3-6 years) were also carefully studied within seven of the schools. Anorexia nervosa was only identified as present or having been present if the diagnosis was unequivocal: for instance, seemingly evident and severe cases which could not be traced were excluded. The condition in severe form was found to be relatively common in the independent sector of education, probably implying a social class factor. In all such schools, the prevalence was one severe case in approximately every 200 girls. In those aged 16 and over it amounted to one severe case in about every 100 girls. Overall, these schools encountered one 'new' severe case in every 250 pupils aged 16 years and over. The condition is likely to be even more common than this study allows because of the stringent limits set here on inclusion of cases and the age-bands studied. It is concluded that severe anorexia nervosa is a common condition and is probably getting more common.

A factor analytic study of clinical competence in undergraduate psychiatry.

This study used factor analysis to define the components of clinical competence of medical students during their undergraduate psychiatric training. Four factors were defined; factor 1 related to cognitive and psychological problem-solving; factor 2 tapped the interpersonal and observational skills students showed with patients; factor 3 was characterized by knowledge in the examination setting, and factor 4 related to students' capacity to demonstrate their ability in an interpersonal setting. These are similar to the component skills of clinical competence demonstrated by students in other areas of the medical curriculum. They also correspond to the skills which Walton (1986) has suggested should be focused upon in undergraduate psychiatric education.

The relationship of panic-fear to anxiety and tension in jaw wiring for obesity.

Sixty patients being jaw-wired for massive obesity were administered the MMPI Panic-Fear scale as well as self- and clinician's ratings of pre- and post-wiring tension and anxiety. Results confirmed the hypotheses that the scale would correlate significantly with patients' subjective feelings of tension and anxiety regarding the procedure, and that defaulters who were unwired or who unwired themselves had higher scale scores. The findings suggest that panic-fear is involved in defaulting from jaw wiring, and that panic-fear may have some utility in determining risk factors in jaw wiring as a treatment for massive obesity.

Problems of subject inclusion in psychiatric research: observations from research with psychiatric inpatients.

In a recent study of psychiatric disturbance and decision making behaviour, it was observed that a significant number of psychiatric inpatients experienced difficulties in addressing themselves to the experimental tasks at hand. Despite the large number of studies that have used psychiatric inpatients as subjects, little, if any mention has been made of these difficulties. The following report describes the difficulties that have been observed in the above research project, and examines their possible implications for clinical assessment, research, and for clinical investigations and evaluation of treatment regimes (e.g. effectiveness of particular drug therapies), which use psychiatric inpatient populations as subject sources.

Early childhood development: a comparative study of beliefs held by adolescents, medical students and mothers.

This study examined beliefs about the normal development of preschool children held by adolescents, medical students and mothers. A consistent pattern was identified, with adolescents estimating that young children can do the least, medical students' estimations lying between those of adolescents and mothers, and mothers estimating that the children can do the most. In addition, medical students were found to change their beliefs during the time that they participated in their paediatric teaching programme. It is suggested that paediatricians and other child health professionals take into account the varying beliefs held by different groups in the community when providing advice or teaching about early child development.