Psychotherapy and bulimia nervosa. Longer-term effects of interpersonal psychotherapy, behavior therapy, and cognitive behavior therapy.

OBJECTIVE: To determine whether cognitive behavior therapy (CBT) for bulimia nervosa has a specific therapeutic effect and determine whether a simplified behavioral treatment (BT) of CBT is as effective as the full treatment. DESIGN: Randomized controlled trial involving three psychological treatments. Two planned comparisons, CBT with interpersonal psychotherapy (IPT), and CBT with BT. Closed 12-month follow-up period. Independent assessors. SETTING: Secondary referral center. PATIENTS: Seventy-five consecutively referred patients with bulimia nervosa. Patients with concurrent anorexia nervosa were excluded. INTERVENTIONS: Cognitive behavior therapy, IPT, BT conducted on an individual outpatient basis. There were nineteen sessions over 18 weeks. Six experienced therapists administered all three treatments. There was no concurrent treatment. MAIN OUTCOME MEASURE: Frequency of binge eating and purging. RESULTS: High rate (48%) of attrition and withdrawal among the patients who received BT. Over follow-up, few patients undergoing BT met criteria for a good outcome (cessation of all forms of binge eating and purging). Patients in the CBT and IPT treatments made equivalent, substantial, and lasting changes across all areas of symptoms, although there were clear temporal differences in the pattern of response, with IPT taking longer to achieve its effects. CONCLUSIONS: Bulimia nervosa may be treated successfully without focusing directly on the patient's eating habits and attitudes to shape and weight. Cognitive behavior therapy and IPT achieved equivalent effects through the operation of apparently different mediating mechanisms. A further comparison of CBT and IPT is warranted. The behavioral version of CBT was markedly less effective than the full treatment.

Three psychological treatments for bulimia nervosa. A comparative trial.

The specificity and magnitude of the effects of cognitive behavior therapy in the treatment of bulimia nervosa were evaluated. Seventy-five patients who met strict diagnostic criteria were treated with either cognitive behavior therapy, a simplified behavioral version of this treatment, or interpersonal psychotherapy. Assessment was by interview and self-report questionnaire, and many aspects of functioning were evaluated. All three treatments resulted in an improvement in the measures of the psychopathology. Cognitive behavior therapy was more effective than interpersonal psychotherapy in modifying the disturbed attitudes to shape and weight, extreme attempts to diet, and self-induced vomiting. Cognitive behavior therapy was more effective than behavior therapy in modifying the disturbed attitudes to shape and weight and extreme dieting, but it was equivalent in other respects. The findings suggest that cognitive behavior therapy, when applied to patients with bulimia nervosa, operates through mechanisms specific to this treatment and is more effective than both interpersonal psychotherapy and a simplified behavioral version of cognitive behavior therapy.

Changes in eating in dementia.

Changes in eating and weight are not uncommon in dementia although they have yet to be systematically studied. These changes are of clinical importance since they can seriously affect patients' physical health and they are often a major problem for carers. These changes are also of theoretical interest since certain abnormalities may be a direct expression of specific brain pathology. Studying these changes in eating and weight may therefore further our understanding of certain of the pathological processes underlying dementia and suggest new approaches to the management of these problems.

Predictors of 12-month outcome in bulimia nervosa and the influence of attitudes to shape and weight.

Seventy-five patients with bulimia nervosa were treated with 1 of 3 short-term psychological treatments and were then entered into a closed 1-year period of follow-up. Pretreatment predictors of 3 measures of outcome were sought. Only 2 variables were significantly associated with outcome: attitudes toward shape and weight, and self-esteem. The nature of the relation between attitudinal disturbance and outcome was complex and unexpected. The data set was also used to test the major prediction of the cognitive view of bulimia nervosa, namely that among patients who have responded to treatment, the residual level of attitudinal disturbance will predict subsequent outcome. This prediction was confirmed.

Changes during treatment for bulimia nervosa: a comparison of three psychological treatments.

Seventy-five patients with bulimia nervosa were treated with cognitive behaviour therapy, behaviour therapy or interpersonal psychotherapy. The changes that occurred during treatment were assessed in a subsample of 38 patients. There was an immediate decrease in the frequency of binge-eating and purging (self-induced vomiting or laxative misuse). This continued for 4 wk in interpersonal psychotherapy and for 8 wk in the other two treatment conditions. There were no clear differences between the three treatments in the time course of their effects on a global measure of eating behaviour and attitudes or on measures of depression and self-esteem. The findings suggest that certain shared 'non-specific' properties of psychological treatments can have a substantial early effect on the eating behaviour of patients with bulimia nervosa. Indeed, patients with bulimia nervosa may be particularly likely to show non-specific treatment effects. Cognitive behaviour therapy and behaviour therapy appear to have an immediate influence on eating behaviour over and above these non-specific effects. The study gave no clues as to the mechanism of action of interpersonal psychotherapy.

Aggressive behaviour in elderly psychiatric inpatients.

We describe the types of aggressive behaviour and determine their prevalence in a sample of hospitalized elderly psychiatric patients. Data were obtained by nurse ratings of aggressive behaviour using the recently developed Rating Scale for Aggressive Behaviour in the Elderly; 90 patients were rated over a 3-d period. Nearly half the sample were at least mildly aggressive; the frequencies of some specific types of aggressive behaviour were high. In contrast, the frequency of injuries and the use of restraints and medication for aggressive behaviour were low. Some correlates of the aggressive behaviour were also analysed.

A rating scale for aggressive behaviour in the elderly--the RAGE.

A 21-item rating scale for measuring aggressive behaviour in psychogeriatric in-patients is described. This scale is designed to be completed by ward staff. It should prove valuable in treatment studies and in studies which aim to investigate the correlates of aggressive behaviour. Studies using the scale demonstrate that when used in conjunction with a ward check list the scale has high reliability and validity.

The visuotectal projection following translocation of grafts within an optic tectum in the goldfish.

Rectangular grafts were translocated between the rostral and caudal tectum in adult goldfish. In some animals the optic nerve was also cut. After periods ranging from 161 to 378 days the retinotectal projections were mapped. The results showed that translocation of tectal grafts is followed by translocation of the corresponding part of the visuotectal map. In many cases the visual field positions projecting to points in the region between the grafts were abnormal and in some cases intercalated field positions were found across the borders between grafted and normal tissue. The results are taken as strong evidence for the existence of affinity labels on the tectum and their importance in the restoration of the retinotectal projection.

The prevalence of immediate positive skin tests in Nepalese children.

Two hundred and ninety-three normal schoolchildren between 5 and 15 years old living in the hills of Eastern Nepal were tested by the skin prick method for sensitivity to six allergens: Dermatophagoides pteronyssinus, Aspergillus fumigatus. Cladosporium herbarum, Penicillium notatum, mixed pollens and mixed threshings. These children were also questioned and examined for symptoms and signs relating to allergic disease. Of the children, 20% were skin-prick positive to at least one of the allergens, and 20% had symptoms of allergic disease, but there was no relationship between the symptoms and the prick test results. No relationship was found between the prick test results and any of the following: the length of time a child was breast-fed; the age of the child and his month of birth. Of the boys, 19% admitted to smoking cigarettes, as did 11% of the girls.

Exercise-induced asthma in Nepalese children.

Three hundred and one children between 5 and 15 years old in the hills of east Nepal were studied to determine the prevalence and the main causes of asthma and atopy. Asthma was diagnosed on the basis of history, clinical examination and the results of a 6-min exercise test (step test). Asthma was diagnosed in six children, none of whom was skin prick test positive. We present here normal values of baseline peak expiratory flow rate (PEFR), and the exercise-induced changes in PEFR in normals, asthmatics, other wheezy children and others with atopic histories. The results of the skin prick tests are presented with the atopic histories in another paper.

Eating habits in dementia. A descriptive study.

The eating habits of 33 patients with dementia were studied. They were assessed by semistructured interview with a relative who was able to act as an informant for the whole period of the dementia. Changes in eating were found to be common and included both increased and decreased food intake, altered food choice, the consumption of inedible substances and disturbances in the process of eating. The clinical significance of these changes and some likely underlying mechanisms are discussed.

Emotionalism following brain damage: a complex phenomenon.

Emotionalism is a common and distressing consequence of many forms of brain damage. There is uncertainty about its classification, aetiology and treatment. A commonly used typology is difficult to apply in practice as illustrated by three clinical examples. We describe the various components of emotionalism and highlight their range and variability. In future research each component should be examined in detail using a standardized form of assessment.

Recommended minimum data to be collected in research studies on Alzheimer's disease. The MRC (UK) Alzheimer's Disease Workshop Steering Committee.

In order to be able to compare the results of research work carried out in different centres on Alzheimer's disease and dementia, it is necessary for there to be standardised assessment methods. The Medical Research Council organised a workshop in order to see whether workers in Britain in the field of dementia research could agree on such standardised assessment methods. The workshop agreed guidelines for the minimum data which should be collected, in clinical and pathological studies, on patients with presumed Alzheimer's disease and dementia. These recommendations are compared with other approaches based on research diagnostic criteria.