Sarah Welch

Life events and the onset of bulimia nervosa: a controlled study.

BACKGROUND Life events may play a role in precipitating the onset of bulimia nervosa. This study aimed to determine the rates of occurrence of certain life events during the year before onset of disordered eating in women with bulimia nervosa, and to compare them with the rates among age-matched normal controls. METHODS The subjects were 102 women with bulimia nervosa and 204 women without an eating disorder, all recruited from the same community sample of young adult women. Interview measures were used for diagnosis and for assessment of life events. RESULTS The bulimia nervosa cases reported more life events during the year before onset of disordered eating than were reported by controls of the same age. Events involving disruption of family or social relationships, or a threat to physical safety, were especially common among the bulimia nervosa cases. CONCLUSIONS These findings suggest that certain life events may play a role in precipitating the onset of bulimia nervosa. The study was retrospective in design. Prospective studies of the role of life events would be valuable, but difficult to perform.

Childhood sexual and physical abuse as risk factors for the development of bulimia nervosa: a community-based case control study.

OBJECTIVE There were two aims: First, to determine whether sexual or physical abuse in childhood or adolescence increases the risk of developing bulimia nervosa, and second, to see whether any increase in risk is specific to bulimia nervosa rather than being common to psychiatric disorders in general. METHOD A case control design with individual matching was used. There were two related case control comparisons based on community samples. One hundred and two young adult women with bulimia nervosa were compared with 204 control subjects without an eating disorder, and with 102 control subjects with other psychiatric disorders, all recruited from the same community source. An investigator-based interview was used to assess sexual and physical abuse. RESULTS Sexual abuse involving physical contact was reported by 35% of the cases of bulimia nervosa. It was more common among this group than among the normal controls. Physical abuse was also reported by a minority of the cases of bulimia nervosa, and was more common among this group than among the normal controls. However, there were no significant differences between the cases of bulimia nervosa and the controls with general psychiatric disorder, except in the category of repeated severe sexual abuse: this was more common among the cases of bulimia nervosa although present only in small numbers within these two groups. CONCLUSIONS The findings indicate that sexual and physical abuse are both risk factors for the development of bulimia nervosa. However, they are not present in the majority of cases. This indicates that other risk factors must operate in these cases. Sexual and physical abuse do not appear to be risk factors specific to bulimia nervosa; rather, they appear to be risk factors for psychiatric disorder in general in young adult women.

The classification of recurrent overeating: The “binge eating disorder” proposal

It has been suggested that a new diagnostic category be added to the section on eating disorders in DSM-IV. This new diagnosis has been termed binge eating disorder. In this article we argue that for two main reasons it would be a mistake to include binge eating disorder in DSM-IV: first, too little is known about binge eating and other related forms of recurrent overeating to justify its inclusion in DSM-IV; and second, its inclusion would be a source of diagnostic confusion. We argue that it is premature to crystallize this specific subgroup from amongst those who recurrently overeat and that to do so would impede the acquisition of knowledge rather than enhance it. We advocate a research strategy that involves studying broad samples of those with recurrent overeating rather than narrow ones.

Smoking and bulimia nervosa

OBJECTIVE Little is known about the long-term physical consequences of bulimia nervosa. Some physical morbidity may result from high rates of cigarette smoking. The aim of the present study was to test three hypotheses regarding smoking among women with bulimia nervosa. METHOD The subjects were 102 women with DSM-IV bulimia nervosa, 204 matched normal controls, and 102 matched controls with affective or anxiety disorders. All three groups were recruited from the same community sample. Interview measures were used for diagnosis and for information on smoking. RESULTS A higher proportion of the bulimia nervosa cases were smokers than of either comparison group. Of those smokers who had achieved a period of abstinence, bulimia nervosa cases were more likely than normal control subjects to have resumed smoking, and more likely to attribute their resumption to concern about their weight. DISCUSSION Smoking-related morbidity should be assessed in long-term follow-up studies of bulimia nervosa.

Quality of life after TIA and stroke Ten-year results of the Oxford Vascular Study

Objective: To evaluate the 5-year impact of stroke and TIA on utility and quality-adjusted survival. Methods: TIA and stroke patients from a UK population-based study (Oxford Vascular Study) were recruited from 2002 to 2007, and followed up until 2012. Quality of life was assessed over 5 years using the EQ-5D (EuroQol-5 Dimensions), with responses converted into utilities ranging from −0.59 (worse than death) to 1 (perfect health), using UK population valuations. Utilities for stroke and TIA patients were compared with those in matched controls obtained from the 2006 Health Survey for England. Five-year quality-adjusted life years were estimated by combining utility and survival information. Results: Four hundred forty TIA and 748 stroke patients were ascertained and included. Utility remained constant at approximately 0.78 over the 5 years after TIA. Utility improved from 0.64 one month after stroke to 0.70 at 6 months (p = 0.006), remaining at approximately 0.70 thereafter. Matched controls had considerably higher utility levels than stroke/TIA patients (0.85, p < 0.001). Event severity and recurrent stroke were significant predictors of decreased long-term utility. Five-year quality-adjusted life expectancy was 3.32 (95% confidence interval: 3.22–3.48) quality-adjusted life years after TIA and 2.21 (2.15–2.37) after stroke, varying considerably by severity (minor: 2.94; moderate: 1.65; and severe: 0.70). Conclusion: Quality-adjusted survival is low over the 5 years after stroke and TIA, with severity and recurrent stroke being major predictors. There remains considerable scope for improvements in acute treatment and secondary prevention to improve the quality of life after TIA and stroke.

Heroin overdose among a treatment sample of injecting drug misusers: accident or suicidal behaviour?

Overdose is a common cause of premature death in opiate misusers. Substance misuse is known to increase the risk of completed suicide. The relationship between ‘non-intentional overdoses’ and ‘intentional overdoses’ or suicides is unclear. In order to investigate this relationship a semi-structured interview investigating the history of heroin overdose and suicidal thoughts and behaviour was undertaken with 48 injecting drug misusers attending a South London community-based treatment centre. Fifty-four percent had previously overdosed on heroin, and 35% had made a suicide attempt. A history of suicide attempts and history of heroin overdose were significantly associated. However, heroin overdose as a means of attempting suicide was uncommon, with the majority reporting overdose by use of other drugs. It is concluded that heroin overdose and history of suicide attempts were both common. Although heroin overdose was seldom chosen as a suicide method, the findings suggest that the risks of non-intentional he...

Zyban for smoking cessation in a general practice setting: the response to an invitation to make a quit attempt.

The objective of this study was to assess the feasibility and success of Zyban as part of a moderately supported smoking cessation programme within UK general practice. Treatment was offered to 479 moderately dependent smokers (smoking 15 or more cigarettes per day) who had never used Zyban, and who had taken part in a previous NRT trial (the PATCH study). Main outcome measures were point prevalence and continuous abstinence from smoking at 6 and at 12 months. Two hundred and forty were excluded because of medical reasons or prescribing contraindication. Of the remainder (n  = 239) only 54 (23%) made an active quit attempt. Thirty percent (16/54) were abstinent at six months, and 22% (12/54) at 12 months (biochemically validated point prevalence rates). Age, socio‐economic status, nicotine dependence, and genetic profile appeared to have little impact on success rates, but male quit‐attempters were significantly more successful than female (40% vs. 10% at 12 months, p  < 0.05). In conclusion, a real‐world smoking cessation programme using Zyban with moderate support within a general practice setting may achieve satisfactory quit rates without widening existing disparities in cessation.

Changes in cigarette smoking among alcohol and drug misusers during inpatient detoxification

Smoking prevalence and changes during inpatient detoxification were examined among 135 admissions to an inpatient alcohol and drug detoxification unit, of whom 83 (61.5%) were re‐interviewed one week later. Ninety‐two per cent of the initial sample were currently smokers; 87% of alcohol misusers, 97% of drug misusers and 100% of drug/alcohol misusers. Smokers consumed a daily mean of 27 cigarettes before admission. Those classified as heavy smokers (smoking 40 or more cigarettes prior to admission) decreased their smoking levels by an average of 10.5 cigarettes during detoxification. Light smokers (1–19 cigarettes per day) increased by a daily average of 8.6 cigarettes and intermediate smokers (20–39 cigarettes) by 4.9 cigarettes. The findings suggest a dose‐dependent relationship between cigarette smoking and inpatient detoxification that requires further study. Over three‐quarters of the sample expressed a desire to change their smoking behaviour, many of whom felt they would like help to tackle this change. Given the high smoking prevalence and reported interest in smoking cessation/reduction, there is an opportunity to address the smoking behaviour of drug and alcohol misusers entering inpatient care, whether during or after their detoxification.

External data required timely response by the Trial Steering-Data Monitoring Committee for the NALoxone InVEstigation (N-ALIVE) pilot trial

The prison-based N-ALIVE pilot trial had undertaken to notify the Research Ethics Committee and participants if we had reason to believe that the N-ALIVE pilot trial would not proceed to the main trial. In this paper, we describe how external data for the third year of before/after evaluation from Scotlands National Naloxone Programme, a related public health policy, were anticipated by eliciting prior opinion about the Scottish results in the month prior to their release as official statistics. We summarise how deliberations by the N-ALIVE Trial Steering-Data Monitoring Committee (TS-DMC) on N-ALIVEs own interim data, together with those on naloxone-on-release (NOR) from Scotland, led to the decision to cease randomization in the N-ALIVE pilot trial and recommend to local Principal Investigators that NOR be offered to already-randomized prisoners who had not yet been released.