Rosalind Ramsay

Attachment research in eating disorders.

AIM In a recent review, disturbances in attachment have been linked with eating disorder symptomatology. However, because of the limitations of study design, few inferences could be drawn about these processes in the aetiology and maintenance of eating disorder. Since that review, there has been further development in the instruments used and the publication of several further studies of attachment processes in eating disorders. We reviewed the field, expecting that greater clarity may have emerged in the 3 years since the previous review. METHOD A review of the literature was carried out, using the computer search PsychLIT, Medline, Embase and The Cochrane Library. RESULTS There have been more studies published in this area in the last 3 years than in the entire period up until then. These can broadly be divided into those carried out in clinical and non-clinical populations, with greater weight ascribed to the former. The vast majority of studies found that attachment processes, by whatever method measured, are abnormal in eating disordered populations. Attachment style (dismissing versus preoccupied) may be linked with eating disorder diagnostic subgroup. CONCLUSIONS Insecure attachment is common in eating disordered populations, with implications for therapy. Further work with refined instruments may clarify whether or not there is a specific association between attachment style and eating disorder subgroup. However, such an association is likely to be complicated and it may be more fruitful to study specific aspects of attachment, rather than global attachment style, in relation to eating disorder behaviour. The transgenerational transmission of attachment is a fruitful area for further investigation in eating disordered populations.

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.

Use of aspirin to facilitate vomiting in a young woman with bulimia nervosa: A case report

A 25-year-old female patient with a 9-year history of bulimia nervosa gave a 2-year history of regularly ingesting up to 24 x 300 mg aspirin tablets to facilitate vomiting after a binge. Awareness of this dangerous practice is important when asking for an eating disorder history. Assessing for the possible physical sequelae of aspirin misuse and educating the patient about the risks would be an important part of the overall treatment.

Recent Advances: Psychiatry

Psychiatric illness stands out as having a rich multifactorial aetiology. This makes it unreasonable to expect massive advances because of the complexity of studies needed to understand it. Acknowledging the multifactorial nature of psychiatric illness, over the past year researchers have tried to consolidate information about different disorders—for example, by studying environmental aspects of the more biological conditions and biological aspects of the traditionally more environmental disorders—and in drawing up treatment protocols. Schizophrenia There have been some promising developments in the treatment of schizophrenia, with both pharmacological and psychological interventions. It is now recognised that the atypical neuroleptic drug clozapine is effective in 30-60% of patients with schizophrenia who do not respond to conventional neuroleptics.1 2 As up to 2% of patients treated with clozapine develop agranulocytosis, obligatory blood monitoring has been introduced, which can be a considerable obstacle to compliance for many chronically psychotic patients. The introduction of clozapine in Britain in 1990 was followed by the release of another atypical neuroleptic, risperidone, in 1993. The clinical effects of these drugs have stimulated investigations into the neurochemistry of schizophrenia and are leading to the formulation and testing of different hypotheses to explain the disorders complex phenomenology. Conventional neuroleptics are presumed to exert their effect through blockade of dopamine D2 receptors. Clozapine has a more complex pharmacology, with a lower occupancy of D2 receptors and higher occupancy of D1 receptors than conventional neuroleptics,3 4 in addition to potent blockade of 5HT2 receptors. The finding that clozapine also selectively binds to the D4 receptor led to speculation about the role of this receptor in the aetiology of schizophrenia. There is, however, no difference between patients who respond to clozapine and those who do not respond in the distribution of alleles for the D4 gene,5 which suggests that clozapines …

Dr Stephen McGowan

Stephen William McGowan, who died unexpectedly aged 45, was a consultant psychiatrist remembered by colleagues as a doctor willing to ‘go the extra mile’ in his job at the South London and Maudsley NHS Foundation Trust. He was dedicated to his work. A former trainee described how he ‘embodied

The Three Christs of Ypsilanti

The Three Christs of Ypsilanti By Milton Rokeach. NYRB Classics. 2011. £10.99 (pb). 325pp. ISBN: 9781590173848 This book, originally published in 1964, has recently been re-released. The author, Milton Rokeach, a social psychologist, describes his work investigating the nature of belief and

Narrative Psychiatry: How Stories Can Shape Clinical Practice

Narrative Psychiatry: How Stories Can Shape Clinical Practice By Bradley Lewis. The Johns Hopkins University Press. 2011. US

Ageing and Older Adult Mental Health: Issues and Implications for Practice

50.00 (hb). 240pp. ISBN: 9780801899027 The project of narrative medicine is to emphasise subjectivity and the particular in the consideration of a patient’s condition.

Flexible training: a view from the South East

Ageing and Older Adult Mental Health: Issues and Implications for Practice Edited by Patrick Ryan, Barry J. Coughlan. Routledge. 2011. £21.99 (pb). 296pp. ISBN: 9780415582902 This is a most unusual and curious book. It took me quite a while to work out its frame of reference, relax and start to

Prevention in Psychiatry

The number of women consultants is still relatively small less than one in five at the end of 1994 but growing. Forty-six per cent of new consultant appointments in 1993/4 were women, and the National Health Service has set targets for further increases in the number of women consultants by the end of the decade. One of the ways of encouraging women to stay in hospital specialities has been the development of flexible training, allowing trainees at the old registrar and senior registrar grades to train part-time, between five and nine sessions per week, with appropriate on-call experience. Flexible traA®nA©es can face a number of difficulties in attempting to train part-time, in gaining similar expA©rience to full-timers. Last autumn the South East Thames Associate Postgraduate Deans Office organised a seminar