Pierre Leichner

An epidemiologic study of maladaptive eating attitudes in a Canadian school age population

Although cases of anorexia nervosa and bulimia are being seen increasingly by health care professionals, little data is available on the prevalence of these disorders in the general population of school age children. Using a validated eating attitude test (EAT), a total of 5150 students, aged 12–20, from public schools and one university in the Province of Manitoba were surveyed. Overall, 5% of males and 22% of females scored 30 or above on the scale, suggesting significant concerns and attitudes regarding eating. These concerns were somewhat higher in urban versus rural settings and seemed to increase between the ages of 12 and 13 and remain high thereafter. Many of the students who scored high on the EAT were overweight, suggesting that these attitudes or concerns are not specific to anorexia nervosa and/or bulimia.

Defense styles and parental bonding in eating‐disordered women

Fifty-eight women with anorexia or bulimia nervosa were compared with 24 normal women on measures of defense style and parental bonding. Results indicated that all eating-disorder subtypes exhibit more primitive defenses and fewer mature ones than controls. Eating-disorder patients uniformly recalled less paternal empathy than controls. Thus, difficulties involving object representations of fathers may be a theme common to eating disorders. No major differences were identified among eating-disorder subtypes, suggesting that these disorders share substantial psychodynamic features. Patterns of parental bonding were associated with defense styles in a manner consistent with theories that link defense style development to early object relationships.

Senior residents in psychiatry: Views on training in developmental disabilities

Objectives: To determine the proportion of senior residents who believed their education in the field of developmental disabilities was adequate and to collect suggestions for improvements. Method: We distributed a self-administered questionnaire to senior residents prior to an annual voluntary preparatory exam. Their views on training in developmental disabilities and ideas about improving curricula were solicited in detail, and their feedback results were analyzed. Results: Of the 89 senior residents who attended the exam, 60 (67.4%) completed the survey. This represents 29% of the national complement. Most (85%) of the one-half who reported receiving undergraduate training in developmental disabilities felt the quantity was inadequate. Almost 90% of those who did not receive training felt they should have. Of respondents, 85% received residency training in dual diagnosis, but most (59%) felt more curriculum time was needed. Conclusions: Senior residents also desire curricular enhancements that experts in developmental disabilities have long recommended.

A Method of Teaching and Evaluating Psychiatric Case Formulation

Formulation is a poorly defined, core clinical skill in psychiatry. The authors present a method of teaching and evaluating biopsychosocial formulation of cases and introduce a reliable formulation marking scheme for scoring the comprehensiveness of a formulation. This method has been well received by four successive groups of residents, does not involve excessive reading or esoteric terminology, can be used within the time constraints of clinical practice, is flexible, and can be used for any psychiatric patient.

Geriatric psychiatry training in Canada: current teaching facilities and resources

A survey of Canadian psychiatry residency programs requested information on training activities in geriatric psychiatry. Fourteen out of sixteen programs responded. On average ten hours of didactic instruction were provided per year over the four years of the residency program. Only one program had no facility that provided a rotation in geriatric psychiatry. The majority of programs have policies that encourage exposure of trainees to the care of the elderly. There is a concentration of teachers of this sub-specialty in a minority of centres. These findings are discussed in the light of current and future needs in the care of the elderly. Recommendations for meeting these are proposed.

The interaction of sex-role identity and ideology conflicts with depression in women and men

SummaryThis study explored sex-role conflict, sex-role ideology, and sex-role satisfaction in clinically depressed hospitalized women and men at a time when they were depressed and six months later to see whether improvements in their depression were associated with changes in the various scores. The results indicated that sex-role conflict as measured by the Bern Sex Role Inventory was not confined to the depressed group but was experienced by all subjects. Women scored as less traditional than men on the sex-role ideology scale although there were no significant differences between the depressed and control groups. There was some evidence that depression seemed related to a decrease in sex-role satisfaction. Resolution of depression was not correlated with changes in sex-role conflict.

Severe paternal sexual abuse in early childhood and systematic aggression against the family and the institution

This report examines incest and its sequela in individuals suffering from severe chronic mental illness. Descriptive data drawn from 11 cases paints a clinical picture characterized by severe chronic psychotic symptoms and aggressive behaviour that are often precipitated by the familys rejection. In all patients, the incest for occurred over a long period of time, was violent, and was perpetrated by the male parental figure. Health care professionals need to increase their knowledge of and skills in the identification and treatment of sexual abuse.

Residents performance on the Mental Status Examination

Twenty-six residents watched a videotape of the mental status examination of a psychotic patient, then wrote their assessment of the patients mental status. The residents’ reports were independently graded by the authors. The residents’ marks were compared to performance on departmental oral examinations. Results showed that global or qualitative assessment of mental status performance was reliable. Excellent inter-rater reliability was achieved when the assessment criteria for sub-items of the mental status were well defined.

The clinical oral examination in psychiatry: association between subscoring and global marks

Fifteen academic psychiatrists rated a videotaped clinical oral examination done in the Royal College format. In addition to assigning an overall mark, the raters completed a detailed scoring form. The ratings of the case presentation and discussion accounted for most of the variance in the overall mark. The rating of the interview difficulty and establishment of rapport were weaker predictors. Implication of these findings for the trainees and the examiners are discussed.

Book Review: Eating Behavior in Eating DisordersEating Behavior in Eating Disorders. Edited by WalshB. Timothy, M.D. Washington DC: American Psychiatric Press, Inc., 232 pp.,

especially in light of the clinical efficacy of the new 5HT 1A receptor drugs, which possess anxiolytic properties, The last five chapters deal mostly with methodological aspects. Perhaps they should have constituted the first section of the book. In any case, they are certainly pertinent and should insure that the clinician-reader is aware of possible pitfalls in this field. In Chapter 21, Kraemer and McKiney discuss animal models used in psychiatric research. This excellent chapter clearly outlines the necessity for adequate models for the development of new drugs for treating mental disorders. The chapter also clearly outlines the need for further research in this area, since, for example, tests used to detect the anxiolytic properties of benzodiazepines might not be adequate for other classes of anxiolytic substances. Antelman then discusses the concept of time-dependent sensitization (Chapter 22) and its relevance to drug regimens. This is a challenging concept worthy of further investigation. In Chapter 23, Young and Penney review the field of quantitative receptor autoradiography. It is evident that the use of this method could contribute a great deal to our current knowledge of discrete receptor alterations in various psychiatric disorders. Leysen and Janssen (Chapter 24) summarize concepts related to the study of receptors using binding assays and the absolute necessity of using the most selective and specific ligand available in order to adequately characterize a given receptor class. This aspect is often forgotten, giving rise to potentially artefactual data. The last chapter (Chapter 25, by Davis and Niznik) deals with the use of monoclonal antibodies for the purification of receptors. This is an interesting approach, although recent data have failed to confirm its general usefulness. Instead, most scientists are now using cDNA cloning approaches, with great success. In conclusion, this is a useful book which is a useful addition to any collection on the neurosciences and their relevance to mental illness.