A Review of: “The Prevention of Eating Problems and Eating Disorders: Theory,Research, and Practice”

Abstract

This study examines one possible source of social pressure regarding body shape and weight, and relationships with family, friends, and acquaintances, It compares the reported existence and influence of such pressure in a group of eating disorder patients and a community sample. Female subjects as a whole were significantly more likely than males to report that other persons influenced their body shape- and weight-related attitudes and behaviors, and it appears that females are much more likely than males to receive negative criticism of their bodies. It is suggested that research on the role of personal relationships in both the prevention and treatment of eating disorders may be worthwhile.     

Research Classic: “Some Myths of Psychotherapy Research and the Search for A Paradigm”: Revisited

The article considered and refuted three myths prevalent within the psychotherapy literature of the time: the patient and therapist uniformity assumptions; the assumption of spontaneous remission of psychoneurotic disorders (as promulgated by Eysenck, 1952); and the belief that theoretical formulations of the time provided adequate paradigms for guiding psychotherapy research. The author proposed a new research paradigm (advocating increased use of ANOVA factorial designs) that requires specification of patient change variables (dependent variables), and of relevant patient, therapist, and intervention dimensions (independent variables), so that the field can begin to assess the central theoretical and research question: Which therapist behaviors are more effective with which type of patients?     

Base Rates of “10 to 11” Clocks in Alzheimer's and Parkinson's Disease

We extended the work of Rouleau et al. (I. Rouleau, D. P. Salmon, N. Butters, C. Kennedy, & K. McGuire, Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease. Brain and Cognition, 18, 1992, 70–87) and Ryan et al. (J. J. Ryan, S. J. Lopez, & S. W. Sumerall, Base rate of “10 to 11” clocks among patients referred for neuropsychological evaluation. Perceptual and Motor Skills, 81, 1995, 1138) by providing base rates for “10 to 11” clocks in samples of healthy elderly (n = 168), Alzheimer's disease (AD; n = 81), and Parkinson's disease (PD; n = 105). Groups were comparable in age and education. Stimulus bound clocks occurred in 3.0% of controls, 30.9% of AD, 5.7% of PD, and 10.2% of the combined sample. The 10.2% base rate is consistent with Ryan et al. for a mixed sample and Rouleau et al. for healthy elderly and patients with AD or Huntington's disease.     

“The Apartment is for You,It’s Not for Anyone Else”: Managing Social Recovery and Risk on the Frontlines of Single-Adult Supportive Housing

This multi-method qualitative study examines frontline provider perspectives on consumer social relationships and barriers to social recovery in supportive housing programs for adults with serious mental illness. Thematic analyses show that guest and occupancy policies that enforce the “single” nature of single-adult supportive housing challenge consumer rights to self-determination in the realm of social recovery. Findings also highlight the ways in which providers act to reinforce and subvert these policies while mitigating risk in this service setting. Recommendations for enhancing the recovery orientation of supportive housing and implications for the design of the homeless service system are discussed.     

Commentary on “A roadmap for the prevention of dementia II. Leon Thal Symposium 2008.” Centers of excellence in Alzheimer's disease: It is time to better integrate patient care and clinical research to improve the prevention and treatment of Alzheimer's disease

Despite enormous worldwide public and private interest in improving the prevention and treatment of Alzheimer's disease (AD), we have not made as much of an impact as we would like, and the number of affected individuals continues to grow. Even more alarmingly, whereas global efforts to identify AD cases and to develop new treatments are increasing, patient-care options are disappearing, so that even if a highly efficacious therapy or prevention approach arose, it would not be used effectively. As a first step toward organizing a better way forward, we should establish AD centers of excellence that mandate both patient care and research in the same setting. These centers would benefit from changes in public health policies related to chronic-disease surveillance, Center for Medicare and Medicaid Services funding for the care of chronic diseases, institutional review boards, good clinical practice guidelines, National Institutes of Health regulations for the use of research funds, Food and Drug Administration guidelines for the approval of AD drugs, and Department of Commerce regulations related to patent protection of AD diagnostic aids and treatments. This new form of AD centers of excellence would also provide direct care to many patients and their families, model care for communities and medical trainees, enhance the voluntary recruitment of AD patients to clinical trials, and improve our understanding of AD and its management.     

Cerebellum: from Development to Disease—the 8th International Symposium of the Society for Research on the Cerebellum and Ataxias

In recent years, there has been tremendous growth in research on cerebellar motor and non-motor functions. Cerebellum is particularly involved in the spectrum of neurodevelopmental diseases. The 8th International Symposium of the Society for Research on the Cerebellum and Ataxia (SRCA) was held in Winnipeg, Manitoba, (Canada) on May 24–26, 2017. The main theme of the 8th International Symposium was “Development of the Cerebellum and Neurodevelopmental Disorders.” Advances in genetics, epigenetic, cerebellar neurogenesis, axonogenesis and gliogenesis, cerebellar developmental disorders including autism spectrum disorders (ASD), neuroimaging, cerebellar ataxias, medulloblastoma, and clinical investigation of cerebellar diseases were presented. The goal of this symposium was to provide a platform to discuss cutting-edge knowledge while allowing researchers and trainees the opportunity to share and discuss their front-line research and ideas with others in the field, make connections, and strengthen international collaborations. The Ferdinando Rossi lecture was delivered by Dr. Richard Hawkes on the topic of patterning of the cerebellar cortex. This symposium emphasized the major importance of the involvement of the cerebellum in neurodevelopmental diseases from the clinical, radiological, biological, and genetic standpoint.     

“Excessive Thinking” as Explanatory Model for Schizophrenia: Impacts on Stigma and “Moral” Status in Mainland China

Although psychiatric stigma in China is particularly pervasive and damaging, rates of high expressed emotion (“EE” or family members'' emotional attitudes that predict relapse) are generally lower than rates found in Western countries. In light of this seemingly incongruous juxtaposition and because Chinese comprise approximately one-fifth of the world''s mentally ill, we examine how one of the most widely held causal beliefs of schizophrenia—excessive thinking (xiang tai duo)—may powerfully shape how those exhibiting psychotic symptoms pass from “normal” status to stigmatized “other.” Using a framework by which stigma threatens an actor''s capacity to participate in core everyday engagements, we examine how expressions of excessive thinking intersect with psychotic symptoms and how this idiom reduces stigma by preserving essential moral standing. Four focus groups with family members (n = 34 total) of schizophrenia outpatients, who had participated in psychoeducation, were conducted in Beijing. Open coding was conducted by 2 bilingual coders achieving high interrater agreement. Common expressions of excessive thinking—taking things too hard that is perceived as a causal factor and unwarranted suspicion that is used to benignly interpret paranoid symptoms encapsulated disruptive behaviors that closely overlapped with psychotic symptoms. Because excessive thinking is understood to occur universally, this idiom encourages socially accommodating behavior that signifies acceptance of these individuals as full-status community members. In contrast, due to beliefs implying moral contamination, those labeled mentally ill are threatened with both subtle and outright social exclusion. We discuss implications of this idiom for EE and the detection of schizophrenia “prodrome” in China.     

“A Dignified and Caring Mother:” 1 An Examination of Munchausen Syndrome by Proxy Case Law∗

Beginning with 1990, this article identifies and comments on fifteen years of legal case law across the five national common law jurisdictions of Australia, Canada, New Zealand, the United Kingdom and the United States, addressing legal responses to Munchausen Syndrome by Proxy (MSBP). MSBP is a syndrome in which perpetrators either harm a child in their care or achieve harm through their insistence on medical tests and treatments for non-existent, fabricated or exaggerated conditions. Abuse may go on for some time, and sometimes this abuse results in the child's death. The discussion situates this body of reported cases, identified through keyword searches in the LexisNexis databases, within current academic and professional literatures. Primarily, this review finds that the open-textured attributes of syndrome evidence, coupled with the idealisation of mothering and the concomitant social revulsion and retributive impulse towards “bad mothers”, invites professionals to infuse alleged cases of MSBP with morality, gender attributions, and social judgements. While identifying and preventing child abuse is an important goal, the questions of conscious knowledge and volition in a psychiatrically disordered perpetrator and the nexus of professional expertise in attributing liability and assigning punishment and treatment options deserve a more nuanced consideration.     

“They Thought It Was an Obsession”: Trajectories and Perspectives of Autistic Transgender and Gender-Diverse Adolescents

Despite research exploring autism in gender-diverse adolescents, no studies have elicited these individuals’ perspectives. In-depth interviews with 22 well-characterized autistic gender-diverse adolescents revealed critical themes, including: recollections of pre-pubertal gender nonconformity; vivid experiences of gender dysphoria; a fear of social gender expression due to perceived animosity toward transgender people; and specific challenges that result from the interplay of gender diversity and neurodiversity. During the ~?22 month study social gender affirmation increased in six participants and gender dysphoria attenuated in four participants. Given the ethical imperative to understand and prioritize the voiced perspectives and needs of autistic gender minority adolescents as well as the discovery of shared themes and experiences in this population, results should inform clinical research approaches and priorities.     

“I Just Have to Stick with It and It’ll Work”: Experiences of Adolescents and Young Adults with Mental Health Concerns

Mental health issues are common among adolescents and young adults but service utilization in this group is low. This study aimed to better understand the experiences of older adolescents and young adults who were experiencing symptoms of depression or anxiety, including the factors that affected their decision to seek treatment and their feelings about their experience of mental health issues. We conducted semi-structured interviews with 37 older adolescents and young adults. Participants tended to have a sophisticated understanding of the causes of mental disorders, but to have been unsure about whether their own experiences of depression or anxiety were the result of a mental disorder, or just “normal” experiences. They reported concerns about taking medication and about keeping information about their condition private. They also felt that it was important to them to be active participants in their own care.     

The “Patient Presentation:” The Evolutions of a Practice,of Its Objectives,and of Its Effects on Training

ObjectivesThrough a review of the history of patient presentations and changes to this system, we will try to situate its function and challenges, particularly with regard to its effects on the training of professionals. The articulation of these effects with the necessary ethical questions raised by this practice will be highlighted.MethodThe review of the French-language literature on the practice of patient presentations makes it possible to note its permanence since the origins of psychiatry, its multiple challenges, the risks it has encountered over the course of its history, and the consequent changes that have resulted from it. A personal experience of patient presentations at the Centre Hospitalier Sainte-Anne over more than twenty years allows us to emphasize the essential elements of this exercise.ResultsPracticed mainly in recent years by psychoanalysts, the system of patient presentations has been considerably modified by taking into account the registers of language, speech, and the transference. The control or supervisory dimension also becomes a central function of this practice. This subversion makes it possible to significantly advance the controversies that run through its history. It also highlights its instructive effects, which, far from being limited to a pedagogical demonstration to inexperienced practitioners, involve practitioners in a place that allows them to question their position as well as their action, in their daily practice.DiscussionThe diversity of patient presentation systems, the variety of circumstances that led to their implementation in hospital services, the variable place they occupy in the organization of care, and the unequal interest that they can arouse on the part of healthcare teams justify identifying the essential benchmarks that make this practice so specific. The articulation of the three distinct places of the patient, the examiner, and the public – through the distinct knowledge attributed to each of these places – makes it possible to propose a reading of the structure of these presentations to examine their effects on the training of practitioners, as well as on clinical research.ConclusionIf clinical practice is developed and transmitted “at the patient's bedside” and in the dialogue between practitioners, then the presentation of the patient is one of the key places where clinical practice is developed. The ethical questions it raises thus constitute an opportunity for a renewal of the psychiatric clinic and its practice.     

The MOPEAD project: Advancing patient engagement for the detection of “hidden” undiagnosed cases of Alzheimer's disease in the community

In most, if not all health systems, dementia is underdiagnosed, and when diagnosis occurs, it is typically at a relatively late stage in the disease process despite mounting evidence showing that a timely diagnosis would result in numerous benefits for patients, families, and society. Moving toward earlier diagnoses in Alzheimer's disease (AD) requires a conscientious and collective effort to implement a global strategy addressing the multiple causes hindering patient engagement at different levels of society. This article describes the design of the Models of Patient Engagement for Alzheimer's Disease project, an ongoing EU-funded public-private multinational initiative that will compare four innovative patient engagement strategies across five European countries regarding their ability to identify individuals with prodromal AD and mild AD dementia, which are “hidden” in their communities and traditionally not found in the typical memory clinic setting. The strategies include an online AD citizen science platform, an open house initiative at the memory clinics, and patient engagement at primary care and diabetologist clinics.     

“The Castle of Remembrance”: New insights from a cognitive training programme for autobiographical memory in Alzheimer's disease

Autobiographical memory deficits are prominent from the early stages of Alzheimer's disease (AD) and result in a loss of personal identity. Nevertheless, standardised methods of autobiographical memory stimulation for the neuropsychological rehabilitation of patients with AD remain underdeveloped. Our aim was to evaluate the impact of a new cognitive training programme for autobiographical memory (REMau) on both the episodic and semantic components of autobiographical memory performance across lifetime periods, as well as on mood. Pre/post evaluations were conducted on two groups of patients with early to moderate AD, assigned to one of two different training activities: either the REMau or a cognitive training programme focused on collective semantic memory. Statistical comparisons showed significant improvement of episodic and semantic autobiographical memory performance in the REMau group, which was more pronounced for the semantic component, as well as improved mood. By contrast, deleterious pre/post differences were observed in the other group. Most interestingly, this study showed that the REMau programme boosted autobiographical memory from the reminiscence bump period, which is considered crucial for the construction and maintenance of personal identity. We discuss the theoretical and practical implications of these results for the reduction of autobiographical memory deficits in AD.     

“Parents for Parents”: A Self-Help Project for and by Parents of Eating Disorder Patients

The project “Parents for Parents” was set up for and by parents of patients with eating disorders. The primary goal of the project was to train these parents to become “field experts” who can support other parents in similar situations. The volunteering parents were carefully selected and received an intensive training program including knowledge of eating disorders, educational themes, guidance of groups, and counseling techniques. Nine parents have completed the whole training and are now working independently as field experts on a voluntary basis. They run discussion groups, answer telephone calls, and give lectures at schools. There are intervisions on a regular basis to follow up the work of the field experts and adjust it if necessary. This article gives an overview of the different steps in this project with a first evaluation.