Follow-up mortality study of compulsorily treated patients with anorexia nervosa.

OBJECTIVE: In a previous study we found that compulsory inpatient treatment was associated with an increase in the number of deaths over the following 5 years when compared to non-compulsory admission. This study aimed to examine the longer term mortality of patients admitted compulsorily. METHOD: The mortality outcome of patients with a compulsory admission (n = 81) and a comparison group (n = 81) of patients admitted to the specialized eating disorder unit at the Maudsley Hospital in the period 1983-95 was traced over two decades through the National Register held by the National Health Service (NHS) Central Register. RESULTS: Approximately 20 years following admission there were 27 deaths in the series. The standardized mortality rate in the compulsory treatment group no longer differed significantly from that of the non-compulsory group. The suicides were not particularly linked with compulsory admission. DISCUSSION: Although the mortality in the 5 years following a compulsory admission is higher than that seen in the non-compulsory patients, this difference is attenuated over time. The overall standardized mortality rate remains elevated.

The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors.

Here we revisit and reinterpret the original study in which the so-called 'Maudsley (London) model' of family therapy was compared with individual therapy for anorexia nervosa. Family therapy was more effective in adolescents with a short duration of illness. However, this is only part of the story. A later study describing the 5-year outcome contains important information. Those adolescents randomised to family therapy achieved a better outcome 5 years later. Moreover, the group with an onset in adolescence but who had been ill for over 3 years had a poor response to both family and individual therapy, suggesting that unless effective treatment is given within the first 3 years of illness onset, the outcome is poor. We examine other evidence supporting this conclusion and consider the developmental and neurobiological factors that can account for this.

Steroid metabolism and excretion in severe anorexia nervosa: effects of refeeding.

BACKGROUND: To our knowledge, changes in steroid metabolism in subjects with anorexia nervosa (AN) after weight gain have not been elucidated. OBJECTIVE: We characterized urinary steroid excretion and metabolism in AN patients and investigated the effects of refeeding. DESIGN: In an intervention study, we recruited 7 women with life-threatening weight loss upon admission and after a median [interquartile range (IQR)] of 95 d (88-125 d) of intensive refeeding; 15 age-matched women were recruited as control subjects. The major urinary metabolites were quantified in 24-h collections by capillary gas chromatography. A single examiner measured weights, heights, and skinfold thicknesses. RESULTS: The median (IQR) age of patients was 24 y (21-26 y), and the duration of AN was 4.0 y (3.3-8.0 y). Body mass index (BMI; in kg/m(2)) increased from 12.8 (12.7-13.1) to 18.6 (18.0-19.6) after refeeding (P < 0.0001). Steroid values [median pre-, post-refeeding (P value)] were as follows: androgen metabolites [472, 1017 µg/24 h (0.93)], cortisol metabolites [1960, 3912 µg/24 h (0.60)], and ratios of androsterone (5α)/etiocholanolone (5ß) [0.28, 0.63 (<0.001)], 5α-/5ß-tetrahydrocortisol [0.20, 0.48 (0.02)], tetrahydrocortisols/tetrahydrocortisone [0.87, 0.61 (0.09)], 20-hydroxy-/20-oxocortisol metabolites [0.29, 0.47 (0.01)], and 20α-/20ß-reduced cortisol metabolites [1.18, 1.89 (≥1.00)]. BMI change was positively correlated with 5α-/5ß-tetrahydrocortisol (r = 0.95, P < 0.001). Before refeeding, the following metabolites were lower in patients than in control subjects: androsterone, 5α-tetrahydrocortisol, α-cortolone and α-cortol, 5α-/5ß-tetrahydrocortisol, androsterone/etiocholanolone, and 20-hydroxy/20-oxocortisol (all P < 0.05). After refeeding, all steroid metabolites in patients were at concentrations that were comparable with those in control subjects. CONCLUSIONS: Significant changes in urine steroid-metabolite excretion occurred upon starvation, which were reversed upon refeeding. For cortisol, there were decreases in 5α-/5ß-tetrahydrocortisol and 20-hydroxy-/20-oxometabolites; for androgen, there was a decrease in androsterone/etiocholanolone.

A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up.

BACKGROUND: There is growing evidence that family therapy is an effective treatment for adolescent anorexia nervosa. This study aimed to ascertain the long-term impact of two forms of outpatient family intervention previously evaluated in a randomised controlled trial (RCT). METHOD: A five-year follow-up was conducted on a cohort of 40 patients who had received either 'conjoint family therapy' (CFT) or 'separated family therapy' (SFT). All patients were traced and 38 agreed to be reassessed (29 interviewed in person, 3 completed telephone interviews, 6 completed questionnaires and/or agreed for parents/GP to be interviewed). RESULTS: Overall there was little to distinguish the two treatments at 5 years, with more than 75% of subjects having no eating disorder symptoms. There were no deaths in the cohort and only 8% of those who had achieved a healthy weight by the end of treatment reported any kind of relapse. Three patients developed bulimic symptoms but only one to a degree warranting a diagnosis of bulimia nervosa. The one difference between the treatments was in patients from families with raised levels of maternal criticism. This group of patients had done less well at the end of treatment if they had been offered conjoint family meetings. At follow-up this difference was still evident, as shown in the relative lack of weight gain since the end of outpatient treatment. CONCLUSIONS: This study confirms the efficacy of family therapy for adolescent anorexia nervosa, showing that those who respond well to outpatient family intervention generally stay well. The study provides further support for avoiding the use of conjoint family meetings at least early on in treatment when raised levels of parental criticism are evident.

Geodesic photogrammetry for localizing sensor positions in dense-array EEG.

OBJECTIVE: An important goal for functional brain studies using EEG technology is to estimate the location of brain sources that produce the scalp-recorded signals. The accuracy of source estimates is dependent upon many variables, one of which is the accurate description of the scalp positions of the EEG sensors. The objective of the present research was to develop a photogrammatic method for sensor localization that is fast, accurate, and easy to use. METHODS: With the novel photogrammetric method, multiple cameras were arranged in a geodesic array, and images of the sensors on the subject's head were acquired allowing for the reconstruction of the 3D sensor positions. RESULTS: Data from the photogrammetric method were compared with data acquired with the conventional electromagnetic method. The accuracy of the photogrammatic method, quantified as RMS of the measured positions and the actual known positions, was similar (mean error = 1.27 mm) to the electromagnetic method (mean error = 1.02 mm), and both approximated the localization error of the calibration object (mean error = 0.56 mm). CONCLUSIONS: Accurate determination of 3D sensor positions can be accomplished with minimal demands on the time of the subject and the experimenter using the photogrammetric method.

The effects of estrogen, its antagonist ICI 182, 780, and interferon-tau on the expression of estrogen receptors and integrin alphaV beta 3 on cycle day 16 in bovine endometrium.

We have shown previously that downregulation of intercaruncular stromal integrin alphavbeta3 in bovine endometrium on day 16 of the estrous cycle coincided with the antibody recognition of estrogen receptors (ER) in the luminal epithelium. In pregnancy, these changes were not observed. Our hypothesis was that on day 16 of the estrous cycle, estrogen from the dominant follicle causes a reduction in integrin alphavbeta3 and affects ERalpha in the luminal epithelium. The pregnancy recognition protein, interferon-tau (IFN-tau), may prevent downregulation of integrin alphavbeta3 and suppress ERalpha expression in the luminal epithelium. On days 14 to 16, heifers received uterine infusions of the anti-estrogen ICI 182, 780, estradiol 17beta, IFN-tau or the saline control. On day 16, reproductive tracts were collected for analysis of integrin alphavbeta3 and ERalpha. Estrogen receptor alpha immunoreactivity was largely restricted to the luminal epithelium in control animals. Using anti-ERalpha recognizing the amino terminus, estrogen-treated animals showed reactivity in the stroma, shallow and deep glands and myometrium as is typical of estrus, whereas ICI 182, 870 treated heifers showed little or no reactivity. In contrast, carboxyl terminus-directed antibodies showed a widespread distribution of ERalpha with reactivity detected in the uterine epithelium, stroma and myometrium of both estrogen and ICI 182, 780 treated animals. Heifers treated with IFN-tau had low ERalpha reactivity overall. Control and IFN-tau treated heifers had lower intercaruncular stromal expression of integrin alphavbeta3 in comparison to estrogen and ICI 182, 780 treatments. Overall, the results suggest that on day 16 of the estrous cycle, estrogen effects on integrin alphavbeta3 are indirect and do not directly involve ERalpha in the luminal epithelium. During pregnancy, interferon-tau may block ERalpha in the luminal epithelium but likely does not rescue integrin alphavbeta3 expression.

Evaluation of Four Analytical Methods to Detect Weevils in Wheat: Granary Weevil, Sitophilus granarius (L.), in Soft White Wheat.

Soft white wheat was infested with adult granary weevils under controlled conditions at 3 levels of infestation, and samples were removed for testing 6 times over a total of 48 d. Three analytical methods available for use in FDA laboratories were compared along with a simple counting of the visually-detectable, insect-damaged kernels in a 100-g sample. The objective of the study was to determine how the analytical results compared with one another and with the levels of infestation. Data confirmed that the more rapid visual exam of wheat is not reliable for indicating the hidden, internally-developing weevils. Analysts should be aware of the possibility that wheat inspected visually could be passable with respect to insect-damaged kernels, but still may produce violative flour due to high insect fragment counts when processed. More research is needed to correlate insect infestation in wheat with insect fragment counts in flour. The two methods which could be used to estimate potential flour contamination caused by weevils are the x-ray exam and the cracking and flotation method, since both of these reveal the stages of weevil development inside the kernels. Tables present the results of the analyses and relate them to the number and sex of the founding adults in each level of infestation.