Stephen Touyz

Measuring the Specific Psychopathology of Eating Disorder Patients

Cooper and Fairburns Eating Disorder Examination (EDE) is a semi-structured interview designed to assess the specific psychopathology of eating disorder subjects. It was employed in a study of 116 Sydney patients for 2 purposes: first, to determine its usefulness in an Australian context; and second, to compare patients with anorexia nervosa, bulimia and atypical eating disorder. The instrument appears to be quite appropriate for studies in Australia. With respect to the second aim, the results emphasize the essential similarity in psychopathology between the three diagnostic groups. The relevance of this latter finding to the categorisation of eating disorders in the DSM-IV proposals is discussed.

In the eye of the beholder: Processing body shape information in anorexic and bulimic patients

Previous body image studies have suggested that dieting-disordered patients (anorexia and bulimia nervosa) differ from normal subjects in their estimation of body size and desired body shape. It was hypothesized that overconcern with body shape in these patients would be reflected in their visual analyses of specific parts of their bodies. This hypothesis was investigated using a system that combines an infrared light source, video camera, dedicated microprocessor, and computer to monitor eye-gaze direction at 50 times per second. Fifteen dieting-disordered patients and 10 control subjects were examined in this way while simultaneously being shown a picture of themselves on a TV screen. Preliminary results suggest that the patients tend to focus on those parts of their body with which they are dissatisfied, while normal subjects scan their whole body shape. Objective assessment of areas of specific bodily concern among dieting-disordered patients, as well as the examination of voluntary and involuntary processing of self-referential stimuli, is offered by the use of such technology.

Behavioural differences between twin and non-twin female sibling pairs discordant for anorexia nervosa.

Despite the voluminous literature on anorexia nervosa, its aetiology remains an issue of speculation and debate. Family influences have long been considered important, but genetic factors only recently have attracted interest. We surveyed a consecutive sample of anorexia nervosa patients referred to our service and identified 11 patients who were members of a same-sex twin pair. To our surprise, in no instance was there evidence that the co-twin was concordant for the illness. This finding contrasts with other reports in the literature, and it aroused our interest in the effects of being a twin on susceptibility to the illness. The aim of the present study was to determine whether there were any significant differences in premorbid factors and in symptoms following the development of the illness in 11 twin anorexia nervosa females who were compared with 11 non-twin anorexic patients. The development of each patient was also contrasted with that of a sister. The development of each patient was elicited from the patients mother by means of an interview schedule that contained questions relating to parental background, birth history, infancy, and adolescent development stages, as well as daughters attitudes towards school, food, appearance, and weight-reducing behaviours, including eating, exercise, and sport. The findings suggest that there may be differences in clinical pictures presented by twin and non-twin anorexia nervosa patients that could influence response to treatment and outcome.

A study of the relation between eating disorder and death concern

The relationship between eating disorder and various components of death orientation (fear, anxiety, acceptance and concern) was examined, taking into account the level of depression in patient samples as well as elements of religiosity. The results were not able to support more than a very modest relationship between eating disorder and death orientation. Eating disorder patients could not be distinguished from other clinical controls, nor did anorexia nervosa patients differ from other eating disorder patients in this respect. Beck and Beck [20] depression scores were higher in the non eating disordered clinical sample than in the eating disorder group, and death concern was shown to be related to the severity of depression. Religiosity did not appear important when indices of religiosity were considered, but did emerge as an important factor in the “free information” provided by participants.

Ganser Syndrome in a 10 Year Old Boy - An 8 Year Follow up

A case of pseudodementia in a 10 year old boy was first reported in 1981. When reviewed 8 years after initial presentation, his symptoms were largely unchanged. the case continues to be complicated by claims for compensation and a successful appeal against the initial compensation judgment.

The 2014 Ranzcp Clinical Practice Guideline Project and Cpg for Eating Disorders

Background: Natural disasters affect the health and wellbeing of adults throughout the world. There is some debate in the literature as to whether older persons have increased risk of mental health outcomes after exposure to natural disasters when compared to younger adults. To date, no systematic review has evaluated this. Objectives: We aimed to synthesise the available evidence on the impact of natural disasters on the mental health and psychological distress experienced by older adults. Methods: A meta-analysis was conducted on papers identified through a systematic review. The primary outcomes measured were post-traumatic stress disorder (PTSD), depression, anxiety disorders, and adjustment disorder. Findings: We identified six papers with sufficient data for a random effects meta-analysis. Older adults were 2.11 times more likely to experience PTSD symptoms when exposed to natural disasters when compared to younger adults. Conclusions: Recent decades have seen a global rise in the numbers of older adults affected by natural disasters, implying that an increasing number of the older adults will find themselves “in harm’s way” amid community disruption and distress. Mental health service providers need to be prepared to meet the mental health needs of older persons, and be particularly vigilant after natural disasters to ensure, in particular, early detection and management of PTSD.Abstract of a poster presentation at the RANZCP 2015 Congress, Brisbane, Australia, 3-7 May 2015. Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Dawes, K., Lethbridge, A. & Pai, N. (2015). Does clinical placement location affect medical student exam performance in psychiatry?. Australian and New Zealand Journal of Psychiatry, 49 (Suppl. 1), 107-108. This journal article is available at Research Online: http://ro.uow.edu.au/smhpapers/2780 Poster Presentations RANZCP 2015 CONGRESs, Brisbane Convention and Exhibition Centre, 3–7 May 2015 Does Clinical Placement Location Affect Medical Student Exam Performance in Psychiatry? K Dawes, A Lethbridge, N Pai University of Wollongong, Wollongong, Australia Background: One of the many challenges in managing student clinical placements is trying to ensure equity of opportunity and experience in regards to meeting the curriculum objectives. Students often complain that they have been disadvantaged by their clinical placement due to variations in patient population and acuity, the availability of consultants, registrars and other health care staff to guide learning, and the presence of other students from all disciplines who compete for opportunities. Objectives: To identify if there is a relationship between psychiatry placement location in the Illawarra Shoalhaven Local Health District (ISLHD) and end of year psychiatry exam results for medical students from the University of Wollongong. Methods: We compared psychiatry oral and written exam results for six cohorts of students, from 2009 to 2014, across four different placement locations in the ISLHD (N = 450) using one-way multivariate analysis of variance. Findings: The multivariate effect of placement location was not significant (Pillai’s Trace = .013, F(6,892) = .994, p = .428). Univariate ANOVAs on the individual outcome variables were also non-significant (written exam scores, F(3, 446) = 1.373, p = .250; oral exam scores F(3,446) = .789, p = .501). Conclusions: Maintaining the quality and consistency of clinical placements will always be a challenge due to limited and varied opportunities, student numbers, and the dynamic nature of both the workforce and the patient populations. However, based on our findings, within our region there is no difference in placement location in regards to end of year psychiatry exam results.Background Australia and New Zealand both have mandated systems for routine outcome measurement within public mental health services. A comprehensive 2014 review of the Australian system highlighted both support for routine outcome measurement and a need to spread good practice in the use of the mandated measures in practice. At the same time, the mandated measures are under evaluation in Australia for inclusion within activity based funding processes. The RANZCP has completed two online modules to assist trainees in improving their knowledge and skills in this important area of practice.

Eating Disorders Bench to Bedside: New Findings and Novel Directions

Background: Natural disasters affect the health and wellbeing of adults throughout the world. There is some debate in the literature as to whether older persons have increased risk of mental health outcomes after exposure to natural disasters when compared to younger adults. To date, no systematic review has evaluated this. Objectives: We aimed to synthesise the available evidence on the impact of natural disasters on the mental health and psychological distress experienced by older adults. Methods: A meta-analysis was conducted on papers identified through a systematic review. The primary outcomes measured were post-traumatic stress disorder (PTSD), depression, anxiety disorders, and adjustment disorder. Findings: We identified six papers with sufficient data for a random effects meta-analysis. Older adults were 2.11 times more likely to experience PTSD symptoms when exposed to natural disasters when compared to younger adults. Conclusions: Recent decades have seen a global rise in the numbers of older adults affected by natural disasters, implying that an increasing number of the older adults will find themselves “in harm’s way” amid community disruption and distress. Mental health service providers need to be prepared to meet the mental health needs of older persons, and be particularly vigilant after natural disasters to ensure, in particular, early detection and management of PTSD.Abstract of a poster presentation at the RANZCP 2015 Congress, Brisbane, Australia, 3-7 May 2015. Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Dawes, K., Lethbridge, A. & Pai, N. (2015). Does clinical placement location affect medical student exam performance in psychiatry?. Australian and New Zealand Journal of Psychiatry, 49 (Suppl. 1), 107-108. This journal article is available at Research Online: http://ro.uow.edu.au/smhpapers/2780 Poster Presentations RANZCP 2015 CONGRESs, Brisbane Convention and Exhibition Centre, 3–7 May 2015 Does Clinical Placement Location Affect Medical Student Exam Performance in Psychiatry? K Dawes, A Lethbridge, N Pai University of Wollongong, Wollongong, Australia Background: One of the many challenges in managing student clinical placements is trying to ensure equity of opportunity and experience in regards to meeting the curriculum objectives. Students often complain that they have been disadvantaged by their clinical placement due to variations in patient population and acuity, the availability of consultants, registrars and other health care staff to guide learning, and the presence of other students from all disciplines who compete for opportunities. Objectives: To identify if there is a relationship between psychiatry placement location in the Illawarra Shoalhaven Local Health District (ISLHD) and end of year psychiatry exam results for medical students from the University of Wollongong. Methods: We compared psychiatry oral and written exam results for six cohorts of students, from 2009 to 2014, across four different placement locations in the ISLHD (N = 450) using one-way multivariate analysis of variance. Findings: The multivariate effect of placement location was not significant (Pillai’s Trace = .013, F(6,892) = .994, p = .428). Univariate ANOVAs on the individual outcome variables were also non-significant (written exam scores, F(3, 446) = 1.373, p = .250; oral exam scores F(3,446) = .789, p = .501). Conclusions: Maintaining the quality and consistency of clinical placements will always be a challenge due to limited and varied opportunities, student numbers, and the dynamic nature of both the workforce and the patient populations. However, based on our findings, within our region there is no difference in placement location in regards to end of year psychiatry exam results.Background Australia and New Zealand both have mandated systems for routine outcome measurement within public mental health services. A comprehensive 2014 review of the Australian system highlighted both support for routine outcome measurement and a need to spread good practice in the use of the mandated measures in practice. At the same time, the mandated measures are under evaluation in Australia for inclusion within activity based funding processes. The RANZCP has completed two online modules to assist trainees in improving their knowledge and skills in this important area of practice.

Medical Management of Eating Disorders: List of contributors

Part I. The Medical Perspective: 1. Definitions and epidemiology 2. The behavioural disorders 3. History, examination and investigations 4. Medical manifestations by system 5. The clinicians response to common physical complaints Part II. Treatment: 6. Principles of treatment 7. Medical and nutritional therapy Part III. Special Issues: 8. Specific patient populations 9. Prepubertal child and the younger adolescent Part IV. The Psychiatric and Psychological Perspective: 10. Physical disease and mental illness: pathology and psychopathology 11. Psychopathology and the mental status examination 12. Psychopathology and phenomenology 13. Specific psychological therapies Part V. Areas of Special Interest: 14. The role of the general practitioner 15. Nursing patients with anorexia nervosa 16. The role of the dietitian 17. Information for family and friends Bibliography Index.

Medical Management of Eating Disorders: THE MEDICAL PERSPECTIVE

Part I. The Medical Perspective: 1. Definitions and epidemiology 2. The behavioural disorders 3. History, examination and investigations 4. Medical manifestations by system 5. The clinicians response to common physical complaints Part II. Treatment: 6. Principles of treatment 7. Medical and nutritional therapy Part III. Special Issues: 8. Specific patient populations 9. Prepubertal child and the younger adolescent Part IV. The Psychiatric and Psychological Perspective: 10. Physical disease and mental illness: pathology and psychopathology 11. Psychopathology and the mental status examination 12. Psychopathology and phenomenology 13. Specific psychological therapies Part V. Areas of Special Interest: 14. The role of the general practitioner 15. Nursing patients with anorexia nervosa 16. The role of the dietitian 17. Information for family and friends Bibliography Index.

Medical Management of Eating Disorders: Index

Part I. The Medical Perspective: 1. Definitions and epidemiology 2. The behavioural disorders 3. History, examination and investigations 4. Medical manifestations by system 5. The clinicians response to common physical complaints Part II. Treatment: 6. Principles of treatment 7. Medical and nutritional therapy Part III. Special Issues: 8. Specific patient populations 9. Prepubertal child and the younger adolescent Part IV. The Psychiatric and Psychological Perspective: 10. Physical disease and mental illness: pathology and psychopathology 11. Psychopathology and the mental status examination 12. Psychopathology and phenomenology 13. Specific psychological therapies Part V. Areas of Special Interest: 14. The role of the general practitioner 15. Nursing patients with anorexia nervosa 16. The role of the dietitian 17. Information for family and friends Bibliography Index.