The genetic epidemiology of bulimia nervosa

Article Abstract:

Bulimia nervosa is characterized by recurrent episodes of binge eating, a feeling of lack of control over eating behavior, regular self-induced vomiting or the use of laxatives to rid the body of food, and persistent concern with body shape or size. Under current standard diagnostic criteria, the incidence of bulimia is thought to be about 2.6 percent, affecting mostly young women. Studies using other diagnostic criteria have estimated a similar prevalence. The disorder is often seen as 'spectrum of pathology' as opposed to a discrete disorder. Those affected often display some but not all the requisite behaviors, or display them to a degree insufficient for formal bulimia diagnosis. It is not clear whether or not bulimia runs in families. In the present study, 2,163 female twins were assessed for bulimia and bulimia-like behaviors. The subjects were asked about their childhood environment, playmates, dress, and whether they attended the same classes as their twin. Personality was assessed as well, as was self-esteem, attributional style (the degree of control one believes one has over life events), and maternal and paternal care, and overprotectiveness. Genetic information on each pair was available as well. When bulimia was narrowly defined, using strict inclusion criteria, the lifetime prevalence was 2.8 percent and the lifetime risk was 4.2 percent. When inclusion criteria were relaxed to incorporate those displaying bulimia-like behavior, the lifetime prevalence was 5.7 percent and lifetime risk was 8.0 percent. Some risk factors that emerged were being born later than 1960; low scores on paternal care; a history of weight changes, dieting, or frequent exercise; low self-esteem; and an external locus of control (life events are not under one's control.) Bulimia was often seen in subjects who were also suffering from anorexia, alcoholism, panic disorder and other anxiety disorders, and depression. When bulimia was defined narrowly, the changes of both twins having bulimia were 22.9 percent for the identical twins and 8.7 percent for the non-identical twins. There appeared to be a 55 percent chance of inheriting the disorder. A number of risk factors for bulimia were identified which seemed to pertain to both the narrowly defined and the bulimia-like syndromes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Demographic aspects, Eating disorders, Genetic aspects, Bulimia

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Long-term care of an individual with schizophrenia: pharmacologic, psychological, and social factors

Article Abstract:

The psychiatric treatment of a schizophrenic patient is describe to demonstrate the long-term managed care of the mental illness. The case involves R whose family has no history of psychotic illness. Interventions were conducted at the level of pharmacology, social factors, psychological concerns and spiritual issues. The range of concerns was dealt with in a pragmatic manner. The psychiatrist adopted the dual roles of physician expert and advisor-colleague.

Care and treatment, Practice, Schizophrenia, Psychiatry, Schizophrenics

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A Hanukkah card

Article Abstract:

A case study of a young woman suffering from severe paranoia and psychotic symptoms is presented. The improvements she experiences as a result of the long-term care from her doctor illustrate the importance of personal care in psychiatric practice.

United States, Case studies, Personal narratives, Paranoid disorders, Psychoses, Paranoia, Paranoid personality disorder, Psychotic disorders

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