B. Timothy Walsh

Treating and preventing adolescent mental health disorders: What We Know and What We Don't Know. A Research Agenda for Improving the Mental Health of Our Youth

ajp.psychiatryonline.org In any case, as I read chapter after chapter I began to discover a different perspective about this book. While there is no longer a need to prove that homosexuality is not a mental disorder or that Dr. Spitzer’s study of 2001 lacked scientific rigor, this compendium of papers/chapters permitted the review of this historical series of events together rather than separately. This historical and comprehensive approach has some value when seen in this context. However, for the reader who might want to examine both sides of this issue for the purpose of deciding who was right or who was wrong on this topic, reading this book will serve no purpose whatsoever, since that type of decision has no validity in the 21st century. In terms of the book itself, it has 37 chapters, divided into four sections. The first section lays out an introduction to the topic of this book and the book itself. The second section focuses on the concept of “changing sexual orientation.” The third section is comprised of a series of commentaries about Dr. Spitzer’s controversial study of the early 2000s and his response to them. Both sides attempt to explain how right or wrong Dr. Spitzer’s study was. The fourth section includes commentaries on the Spitzer study as well as an interview with Dr. Spitzer conducted by Dr. Jack Drescher. In summary, despite its shortcomings, this compendium of previously published papers offers a unique opportunity to review and understand the historical perspective of “homosexuality” as perceived by the profession and society at large during the last several decades. From this viewpoint, I strongly recommend this book to those interested in this historical perspective.

Food choice and diet variety in weight-restored patients with anorexia nervosa.

Anorexia nervosa is a serious psychiatric illness associated with substantial morbidity and mortality. Weight-restored females with anorexia nervosa with limited diet variety, assessed by a diet variety score, have been reported to have poor outcomes. Using the same patient cohort, the objective of the current study was to provide a detailed description of the types of foods from which patients restrict variety in their diets. Forty-one weight-restored patients, hospitalized between June 2000 and July 2005, who completed a 4-day food record before discharge were followed for up to 1 year. Patient outcomes were categorized as a success (n=29) or failure (n=12) using Morgan-Russell criteria. Although the total number of foods selected did not differ between the success and failure groups (73±14 vs 74±13, respectively; P=0.741), a significant difference in the total number of different foods was observed: the failure group selected fewer and the success group selected more (43±9 vs 51±7; P=0.005). Outcomes groups also differed significantly in the variety of foods selected from 5 of 17 food groups. Results suggest that a diet limited in total variety and specifically limited in variety from five food groups may be associated with relapse in patients with anorexia nervosa.

Accuracy of self-reported energy intake in weight-restored patients with anorexia nervosa compared with obese and normal weight individuals.

OBJECTIVEnTo compare self-reported and measured energy intake in weight-restored patients with anorexia nervosa (AN), weight-stable obese individuals (OB), and normal weight controls (NC).nnnMETHODnForty participants (18 AN, 10 OB, and 12 NC) in a laboratory meal study simultaneously completed a prospective food record.nnnRESULTSnAN patients significantly (p = .018) over-reported energy intake (16%, 50 kcal) and Bland-Altman (B-A) analysis indicated bias toward over-reporting at increasing levels of intake. OB participants significantly (p = .016) under-reported intake (19%, 160 kcal) and B-A analysis indicated bias toward under-reporting at increasing levels of intake. In NC participants, NS (p = .752) difference between reported and measured intake was found and B-A analysis indicated good agreement between methods at all intake levels.nnnDISCUSSIONnSelf-reported intake should be cautiously interpreted in AN and OB. Future studies are warranted to determine if over-reporting is related to poor outcome and relapse in AN, or under-reporting interferes with weight loss efforts in OB.

Dietary energy density and diet variety as risk factors for relapse in anorexia nervosa: a replication.

OBJECTIVEnTo replicate our previous findings of an association between energy density and diet variety in recently weight-restored patients with anorexia nervosa (AN) and clinical outcome in the year following treatment.nnnMETHODnNineteen hospitalized, weight-restored women with AN completed a food record, from which a diet energy density score (DEDS) and a diet variety score (DVS) were calculated. After hospital discharge, patients were contacted regularly; at the end of one year, clinical outcome was determined using modified Morgan-Russell criteria. As in our previous study, outcome was dichotomized into full, good, or fair and poor groups.nnnRESULTSnData from 16 subjects were available. The DEDS was significantly lower (p < .05) in the poor outcome group (0.7 ± 1) compared with the full, good, or fair outcome group (0.9 ± 1). Although the DVS was also lower in the poor outcome group (13.9 ± 2) compared with the full, good or fair outcome group (15.7 ± 1.8), this difference was not statistically significant.nnnDISCUSSIONnIn recently weight-restored patients with AN, a lower DEDS, but not DVS, is associated with poor clinical outcome after inpatient treatment. This finding may be important in the assessment of risk for relapse in patients with AN.

Can the reinforcing value of food be measured in bulimia nervosa

Binge eating is a core clinical feature of bulimia nervosa (BN). Enhanced reinforcing value of food may play a role in this behavioral disturbance, but a systematic behavioral assessment of objective measures of the rewarding value of binge eating is lacking. The purpose of this study was to quantify the reinforcing value of food in BN patients as compared with normal controls. A progressive ratio (PR) computerized work task was completed under binge and non-binge instruction. The task consisted of 12 trials. The first trial required 50 keyboard taps to earn one portion of yogurt shake, and subsequent trials required progressive work increments of 200 taps for each additional portion. Completion of all 12 trials required 13,800 taps to earn 2100ml of shake. The breakpoint, defined as the largest ratio completed before a participant stopped working, was the measure of reinforcing efficacy. Ten patients and 10 controls completed the experiment. Under binge instruction, patients completed more trials and taps, and had a higher breakpoint than controls. The non-binge instruction yielded opposite findings; compared to controls, patients completed fewer trials and taps, and had a lower breakpoint. These results support the feasibility and potential utility of a PR task to quantify the reinforcing value of food in patients with BN.