Cross-cultural patterns in eating disorders: a review.

Eating disorders were previously thought to be isolated to achievement-oriented, upper and middle class individuals in Western countries. It now appears that these disorders may be increasing in other sectors of society and in a number of diverse cultural settings. We review the studies that comprise the relevant cross-cultural research literature on eating disorders. We also discuss the changing cultural factors that may be contributing to the apparent increase in these disorders around the world and directions for future research on such factors.

Influence of race on diagnosis in adolescent psychiatric inpatients.

OBJECTIVE: To examine racial differences in 352 psychiatric inpatients, aged 12 to 18 years, at a state hospital facility that accepted admissions from throughout South Carolina. These were all the adolescent admissions during an entire calendar year (1988). There were 101 African-American and 251 white subjects. METHOD: The data were abstracted from patients' hospital medical records and nursing incident reports. DSM-III-R discharge diagnoses were assigned to five non-mutually exclusive groupings (organic/psychotic, mood/anxiety, disruptive, personality, substance abuse). Racial differences were analyzed using chi 2, logistic regression, and T statistics. RESULTS: African-Americans were more likely to be involuntarily committed at the time of admission (p = .010). Organic/psychotic diagnoses were much more frequent in African-Americans (odds ratio = 3.15, p < .003). Whites (p = .0347) were almost two times more likely to receive mood/anxiety diagnoses even when controlling for gender, type of admission, and comorbid diagnoses. Substance abuse was more often diagnosed in whites (odds ratio = 5.46, p < .0001). CONCLUSIONS: This study identifies significant racial differences in the discharge diagnoses of psychiatrically hospitalized adolescents. African-Americans have fewer mood/anxiety and substance abuse diagnoses but significantly more organic/psychotic diagnoses. Some of these differences may reflect ethnocentric clinician bias in the diagnostic assessment of youth from differing cultural/racial backgrounds.

The development of psychiatric symptomatology in patients with cystic fibrosis.

Psychiatric symptomatology was compared in 61 cystic fibrosis patients, ages 8 to 15 years, and 36 cystic fibrosis patients, ages 16 to 40 years. When the prevalence of psychiatric symptomatology was compared in the two groups, a developmental pattern emerged: Symptoms of depression and anxiety were more frequent in the older group, while symptoms associated with eating disorders were more frequent in the younger group. Although duration of illness was longer and severity of illness was greater in the older group, these factors were largely unrelated to psychiatric symptomatology in either group. It is hypothesized that younger patients may express psychological distress through less direct means than older patients.

A multimodal approach to functional dysphagia.

Functional dysphagia in children has historically been treated using a cognitive behavioral approach. The case of a 7-year-old boy treated using a successful multimodal approach, including behavioral, family, and play therapy with alprazolam augmentation, is reported. The patient showed minimal response to early interventions but rapidly improved with the prescription of alprazolam before meals.

Assessment of risk of eating disorders among adolescents in Appalachia.

OBJECTIVE: Students from 5 public schools in east Tennessee in grades 6 through 10 were assessed for their risk of eating disorder. METHOD: The Eating Attitudes Test (EAT40), a self-administered questionnaire, was given anonymously to 1,302 male and female adolescents. RESULTS: The results showed that 19.8% of females and 3.7% of males scored above 29, indicating high risk for development of an eating disorder. There was also a trend toward increased prevalence of risk in areas that are more rural. CONCLUSIONS: These findings suggest that the risk for eating disorders may be greater in rural areas than has previously been believed. This has implications for understanding the etiology of these diseases as well as demonstrating the need for more research in these often underserved areas.

Race and gender differences in the treatment of psychiatric disorders in young adolescents.

OBJECTIVE: Most children and adolescents with mental illness remain untreated. Evidence suggests that race is a factor in the referral of children for treatment. This study examines race and gender differences in treatment of adolescent psychiatric disorders. METHOD: During a two-stage, school-based, epidemiological study of depression, data were collected on 478 adolescents. Instruments included the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Children's Global Assessment Scale. RESULTS: Twenty-two percent of the sample had contact with professionals during the prior year, including 56% of adolescents with a psychiatric diagnosis. Significant odds ratios (ORs) were found between all diagnoses and treatment. Trends for undertreatment of females and African-Americans were evident in univariable and multivariable models. The OR (0.34) for African-American females was significant in the multivariable model. African-Americans were significantly more likely to receive only one or two treatment contacts. CONCLUSION: Data suggest race and gender differences in the treatment of adolescent psychiatric disorders. Possible explanations include referral bias, low cultural competence of mental health professionals, and cultural differences in the expression and tolerance of symptoms and help-seeking behaviors. Further study of factors influencing treatment decisions is needed.

A binational school survey of depressive symptoms, drug use, and suicidal ideation.

New findings are presented from a survey of depressive symptoms, illicit drug use, and suicidality among 4,157 adolescents attending school in six border cities in Texas and neighboring Tamaulipas, Mexico. Among the Texas youth, 48.08% scored above 16 on the Center for Epidemiologic Studies' Depression Scale (CES-D); 21% reported illicit drug use in the past month; and 23.43% said they had thought about killing themselves during the past week. Rates were lower among the Mexican youth: 39.41% had high CES-D scores; 4.95% reported drug use and 11.57% reported current suicidal ideation. Multivariate models are presented to show the linkage between psychological distress, drug use, and suicidality in this sample of border youth.

The role of a research seminar for child psychiatry residents.

A major problem confronting the field of child and adolescent psychiatry is the development of teaching strategies to stimulate research activities and an appreciation of research. A teaching approach is described which emphasizes major research concepts using a programmed instruction method and illustrating these concepts with clinical cases. Fourteen child psychiatry residents participated in the seminar during a 3-year period. Overall, trainees' evaluation of the seminar was positive, and they demonstrated a high level of understanding across major research topics. In addition, the seminar may have contributed to an increased preference for academic careers by graduating residents.

Sertraline treatment of mood disorder associated with prednisone: a case report.

The use of corticosteroids, particularly high-potency steroids, for the treatment of various inflammatory conditions has been frequently associated with mood disturbance and psychosis. We report on a 12-year-old white boy treated with high doses of prednisone chronically for 7 years who presented with severe depression, irritability, violence, and psychosis. Sertraline was used to treat depressive as well as psychotic symptoms without the use of antipsychotics. This successful treatment of steroid-induced mood disorder and psychosis with a serotonin reuptake inhibitor is consistent with the literature describing a decrease in central and peripheral serotonin secretion due to steroids, as well as a possible relationship between mood and psychotic symptoms and low cerebrospinal fluid serotonin levels.

Psychopharmacological management of migraine in children and adolescents.

ABSTRACT Migraine is one of the most common causes of pain and headache seen in the offices of pediatricians and child neurologists. In addition to standard antimigraine treatments (ergots, cyproheptadine), several types of psychotropic medication have been used in the treatment of migraine, primarily prophylactically, with varying degrees of success. Although there is some evidence of their efficacy in treating migraine in adults, there are relatively few studies of their efficacy or safety with children. The authors review the literature on childhood migraine, its relationship to mood and anxiety disorders, modern pathophysiological theories, and current treatment approaches. Despite the widespread use of propranolol, further studies are needed before beta blockers can be considered an effective prophylactic agent in childhood migraine. Antidepressants seem promising in adolescents and children, but more controlled studies are needed to determine their long-term efficacy in children and adolescents. Antidepressant agents with mixed serotonin and norepinephrine action (e.g., amitriptyline) seem more effective than the more selective agents in adults, but it generally remains to be seen whether antimigraine medications that are effective in adults will be equally useful in children and adolescents. Studies on mood and anxiety disorders in children and adolescents might be usefully extended to evaluate migraine headaches.

Culture and eating disorders: a historical and cross-cultural review.

Cultural beliefs and attitudes have been identified as significant contributing factors in the development of eating disorders. Rates of these disorders appear to vary among different racial/ethnic and national groups, and they also change across time as cultures evolve. Eating disorders are, in fact, more prevalent within various cultural groups than previously recognized, both within American ethnic minorities and those in other countries. This review examines evidence for the role of culture as an etiological factor for the development of eating disorders. Historical and cross-cultural experiences suggest that cultural change itself may be associated with increased vulnerability to eating disorders, especially when values about physical aesthetics are involved. Such change may occur across time within a given society, or on an individual level, as when an immigrant moves into a new culture. Further research into the cultural factors that promote the development of eating disorders is much needed. Understanding how cultural forces contribute to the development of disorders is needed so that preventive interventions can be created.

Naltrexone treatment of dementia with severe self-injurious behaviors: a single case study.

The results of studies of the opiate antagonist Naltrexone (NLTX) in the treatment of self-injurious behavior (SIB) in various psychiatric populations have been equivocal. The majority of studies has relied on small samples, many of which lacked scientific rigor and none of which occurred in a nursing facility. The present study investigates the use of NLTX on a patient with severe SIB who resides in a nursing facility. The patient is a 38-year-old male with a history of heavy drug and alcohol abuse. He has been in either a state hospital or nursing facility since age 21. The patient overdosed on alcohol and drugs in 1990, which led to a prolonged coma with organic brain damage.

Fluvoxamine treatment of a child with severe PDD: a single case study.

Recent reports suggest that selective serotonin reuptake inhibitors (SSRIs) are useful in the treatment of individuals with autism and other pervasive developmental disorders. We report on a single case study of the use of fluvoxamine with a 7-year-old Caucasian girl with severe pervasive developmental disorder. Our findings indicate that fluvoxamine was significantly effective in reducing stereotypical, repetitive behaviors, anxiety, and aggression and in improving prelinguistic and social behaviors. Our results indicate that the use of the SSRIs as a platform for the long-term habilitation of these children should be considered, but further studies are required to establish the efficiency of fluvoxamine for the treatment of children with autism.

Body-image distortion among male and female college and high school students, and eating-disordered patients.

For 179 male and female college and high school students, and 26 female eating-disordered patients body-image distortion was measured using a computer-based image-analysis of redrawn images of standardized human figures. Statistical analysis indicated that body-image distortion was the same for all groups. Body-image distortion was significantly and negatively related to weight:height ratio as a function of a simple polynomial. These results suggest this evaluation of distortion of body-image yields a quantitative measure reliably related to weight status but also suggests the technique, and possibly measurement of body-image distortion in general, may not be a valid discriminator between eating-disordered and normal persons.

Clinical correlates of body-size distortion.

Body-size distortion has been considered a central symptom of eating disorders. We studied 35 female eating-disordered patients and 85 controls using a computer-based body-size estimation technique. We have found almost identical linear relationships between body-size distortion and weight:height ratios in both groups. In the clinical group, distortion scores were not correlated with scores on the Eating Attitudes Test or Beck Depression Inventory but were negatively correlated with body dissatisfaction as measured on the Eating Disorder Inventory. These results raise further questions about the role of body-size distortion both as a diagnostic criterion and as a complicating phenomenon in eating disorders.

Body-image distortion among male and female American and Costa Rican students and female Japanese students.

395 American male and female high school and college students, 286 Costa Rican male and female high school students, and 127 Japanese female college students were tested for body-image distortion using a computer-based body-image distortion task. A reliable negative relationship between stature and body-image distortion was observed. No reliable differences in body-image distortion were observed between different sex or cultural groups.

Community-based systems of care for children's mental health services.

Community-based mental health systems of care for children, adolescents, and their families involve innovative approaches to improve access, utilization, financing, clinical efficacy, and cost-effectiveness of mental health services provided to children and adolescents within the context of their home communities. This model offers numerous advantages as rising needs for mental health services in an increasingly diverse population of children and families are recognized, while public and private resources are increasingly stressed. This report reviews the history of the development of this model, its basic principles, its emerging research literature, and its application within a managed care context.