Self-regulatory disturbances in eating disorders

The hypothesis that eating-disordered patients utilize their bodies as transitional objects is examined, but the evidence does not support this proposition. Instead, these patients reveal a deficit in transitional object relatedness. It is found that these patients have severe deficits in self-organization and self-regulation. Much of the symptomology such as starvation, hinging, vomiting, and hyperactivity is better understood as desperate measures to drown out states of overstimulation and/or fragmentation.     

Measuring functional ability in chronic arthritis. a critical review

Functional assessment instruments used in rheumatology are critically evaluated against five basic criteria: whether they allow for quantification, whether they have been tested for reliability, validity, and precision, and whether the data collection procedures are specified. No one instrument completely fulfills all criteria. Few adequately address the issues of measurement reliability and validity; none have sufficient measurement precision to detect subtle but clinically significant changes in function. Issues to be addressed in future research are discussed.     

The assessment of need for mental health services

BACKGROUND: The field of psychiatric epidemiology has yielded several large and important studies of the prevalence of psychiatric disorders. These surveys have been enhanced by the inclusion of methodologies that reflect the needs for care of the population in question. Clinical studies of psychiatric disorders and unmet needs have focussed on identifying needs and correlating them with service evaluation and satisfaction measures. The association between prevalence, service use and unmet need requires review in order to establish whether there are trends and consistent findings. METHOD: Peer-reviewed studies involving the assessment of need up to the present were included. These were of two broad groups: population-based studies and clinical studies. Studies based on outcome measures, review articles, and child psychiatry, old age, and intellectual disability samples were excluded. We conducted a search of MEDLINE and PSYCHINFO using the key words, "mental health needs","assessment of need", and "needs assessment". In addition, we hand-searched key journals and sought personal communication with researchers in the field. RESULTS: A total of 14 population studies and 19 clinical studies were retrieved. The percentage of the general population who reported at least one need for care ranged from 9.5% to 13.8%. The numbers of needs in psychiatric patients ranged from 3.3 to 8.6. Correlates of unmet need include: unemployment, single status, low quality of life and high disability scores, and the presence of certain psychiatric diagnoses, such as affective psychosis and personality disorders. Higher rates of met need and service satisfaction are correlated with a longer duration of service contact. CONCLUSION: The assessment of need to date has been established either by service use data to make inferences about unmet need, by asking limited guided questions about needs, or by using established needs assessment instruments. The high prevalence of psychiatric disorders and the weak correlation between disorder and unmet need require a combined approach towards service development.     

Factors that affect the uptake of ammonia by the brain: the blood-brain pH gradient

The brain uptake index (BUI) for [¹³N]ammonia was measured in 7 areas of the rat brain at 8 different pH values ranging from 6.58 to 7.73. When the regional BUI was plotted as a function of the pH of the test bolus, a significant linear correlation was found for each region (P < 0.001). The highest slope was observed in the thalamus-basal ganglia complex (0.392 ± 0.018) (S.D.), and the lowest in the ventral pons (0.143 ± 0.011). These studies indicate that the brain-blood pH gradient plays a major role in determining the forward flux of ammonia from the blood into the brain in the physiological pH range. Regional differences in the slope may be due to metabolic factors. This pH effect may be important in clinical conditions characterized by hyperammonemia such as hepatic encephalopathy, and in the interpretation of [¹³N]ammonia emission tomographic images of the brain.