Avoidant/restrictive food intake disorder: what do we know so far?

2019 ◽  
Vol 25 (2) ◽  
pp. 90-98 ◽  
Author(s):  
Laura Coglan ◽  
John Otasowie
Keyword(s):  
Food Intake ◽  
Psychosocial Functioning ◽  
Service Planning ◽  
Learning Objectives ◽  
List Type ◽  
Treatment Approaches ◽  
Stunted Growth ◽  
Know How ◽  
Dsm 5 ◽  
New Diagnosis

SUMMARYAvoidant/restrictive food intake disorder (ARFID) was a new diagnosis in DSM-5 and is due to be included in ICD-11. However, confidence in making the diagnosis seems to be low among clinicians. Furthermore, there is no national consensus on care pathways for ARFID and therefore patients tend to be managed across core child and adolescent mental health services, specialist eating disorder services and paediatric services. If not adequately treated, ARFID can result in stunted growth, nutritional deficiency and impaired psychosocial functioning. Research and guidelines for managing this disorder are scarce, owing to low rates of diagnosis. This article aims to improve clinician confidence in the use of ARFID as a diagnosis and explores current consensus on treatment approaches, in order to progress future service planning for this complex and diverse patient group.LEARNING OBJECTIVES•Gain an improved knowledge of the diagnostic criteria for ARFID•Know how to distinguish ARFID from other eating disorders•Understand the current consensus on treatment approaches for ARFIDDECLARATIONS OF INTERESTNone.

scholarly journals Health anxiety: detection and treatment

2018 ◽  
Vol 24 (1) ◽  
pp. 66-72 ◽  
Author(s):  
Peter Tyrer ◽  
Helen Tyrer
Keyword(s):  
Health Anxiety ◽  
Behavioural Therapy ◽  
Learning Objectives ◽  
List Type ◽  
Psychological Treatments ◽  
Cognitive Behavioural ◽  
New Diagnosis ◽  
Changing Attitudes ◽  
Term Benefit

SUMMARYHealth anxiety is an important new diagnosis that is increasing in frequency because of changing attitudes towards health, particularly excessive use of health information on the internet (cyberchondria). People with abnormal health anxiety become over-diligent monitors of their health, misinterpret most somatic sensations as evidence of disease, consult medical professionals unnecessarily and frequently, and are often over-investigated. Relatively few patients with health anxiety present to psychiatrists; most are seen in primary and secondary medical care. This paper reviews the diagnosis and presenting features of health anxiety, its identification in practice and its treatment. A range of simple psychological treatments have been shown to have long-lasting benefit for the disorder but are greatly under-used.LEARNING OBJECTIVES•To be able to identify abnormal health anxiety with the aid of probe questions•To respond to people whom you have identified with excessive health anxiety in a way that facilitates its treatment•To learn a few simple techniques derived from cognitive–behavioural therapy that can lead to long-term benefitDECLARATION OF INTERESTNone.

scholarly journals Current understanding of narcissism and narcissistic personality disorder

2018 ◽  
Vol 24 (5) ◽  
pp. 305-315 ◽  
Author(s):  
Jessica Yakeley
Keyword(s):  
Personality Disorder ◽  
Empirical Studies ◽  
Learning Objectives ◽  
Narcissistic Personality Disorder ◽  
List Type ◽  
Pathological Narcissism ◽  
Know How ◽  
Psychological Therapies ◽  
Narcissistic Personality

SUMMARYThis article reviews historical contributions to the conceptualisation of narcissism and narcissistic personality disorder (NPD), including its evolution as a clinical diagnosis within the DSM classification of mental disorders. It discusses the epidemiology and aetiology of NPD, noting that empirical studies of both are limited. The challenges of managing patients with prominent narcissistic traits are presented, and the psychological therapies specifically designed for the treatment of patients with NPD are summarised.LEARNING OBJECTIVES•Understand different models of narcissism•Understand the epidemiology, comorbidity and theories of aetiology of NPD•Know how to manage and treat patients with pathological narcissism and NPDDECLARATION OF INTERESTNone.

Deprescribing antipsychotics: a guide for clinicians

2018 ◽  
Vol 24 (5) ◽  
pp. 295-302 ◽  
Author(s):  
Swapnil Gupta ◽  
John Daniel Cahill ◽  
Rebecca Miller
Keyword(s):  
Learning Objectives ◽  
List Type ◽  
Benefit Analysis ◽  
Antipsychotic Medications ◽  
Know How ◽  
Risks And Benefits ◽  
Key Points ◽  
Key Steps ◽  
Risk Benefit Analysis

SUMMARYPolypharmacy and the risks of long term use of antipsychotic medications point toward the need for identifying practices for deprescribing in psychiatry. The following article gives a brief overview of key points around deprescribing antipsychotic medications in psychiatry, including identifying risks and benefits, considerations around timing, and steps involved.LEARNING OBJECTIVES•Be able to define the concept of deprescribing as it relates to antipsychotic medications•Know how to perform a risk–benefit analysis for a patient on antipsychotic medication•Be able to identify the key steps involved in deprescribing antipsychotic medicationsDECLARATION OF INTERESTNone.

scholarly journals Paraphilias and paraphilic disorders: diagnosis, assessment and management

2014 ◽  
Vol 20 (3) ◽  
pp. 202-213 ◽  
Author(s):  
Jessica Yakeley ◽  
Heather Wood
Keyword(s):  
Diagnostic Category ◽  
Specific Treatment ◽  
List Type ◽  
Type Number ◽  
Sexual Offences ◽  
Paraphilic Disorder ◽  
Know How ◽  
Dsm 5 ◽  
Treatment Services ◽  
Paraphilic Disorders

SummaryWe outline the difficulties in classifying paraphilias as mental disorder and summarise the changes to this diagnostic category in DSM-5. We review the research on the epidemiology and aetiology of paraphilias, and provide guidance on assessment and referral options for general psychiatrists when they encounter patients who may meet diagnostic criteria for a paraphilic disorder. Empirical evidence for effective treatments for paraphilias is limited, and specific treatment services are scarce, particularly for individuals presenting with legal paraphilias or those who are committing paraphilic sexual offences but who have not been convicted.LEARNING OBJECTIVESBe able to diagnose a paraphilic disorder according to DSM-5 criteria.Understand the epidemiology, comorbidity and theories of aetiology of paraphilic disorders.Know how to assess the need for disclosure if the patient presents with illegal paraphilias.

scholarly journals Hoarding revisited: there is light at the end of the living room

2018 ◽  
Vol 25 (1) ◽  
pp. 26-36 ◽  
Author(s):  
Alberto Pertusa ◽  
Romina Lopez Gaston ◽  
Abid Choudry
Keyword(s):  
Treatment Options ◽  
Learning Objectives ◽  
Living Room ◽  
List Type ◽  
Potential Treatment ◽  
Pharmacological Interventions ◽  
Hoarding Disorder ◽  
Dsm 5 ◽  
Ethical And Legal Considerations ◽  
The Difference

SUMMARYSince 2013, hoarding disorder has been recognised as a standalone diagnosis in the DSM, affecting an estimated 2–6% of the general population. This article outlines the arguments for and against this separate classification and considers the differentiation of hoarding disorder from normative collecting. It then discusses aetiology, assessment, course and treatment (both psychological and pharmacological interventions). It concludes with a discussion of ethical and legal considerations, in particular the fact that the inclusion of hoarding disorder as a distinct diagnosis in DSM-5 confers specific protections for people with the disorder under the Equality Act 2010.LEARNING OBJECTIVES•Be able to define the criteria of hoarding disorder•Be able to recognise the difference between hoarding and collecting•Understand potential treatment options for patients with hoarding disorderDECLARATION OF INTERESTNone.

INTERACTIONS OF OESTRONE AND TESTOSTERONE ON MAMMARY GLANDS OF MALE RABBITS

1961 ◽  
Vol 36 (1) ◽  
pp. 141-156 ◽  
Author(s):  
B. Bengtsson ◽  
A. Norgren
Keyword(s):  
Mammary Gland ◽  
Testosterone Propionate ◽  
Mammary Glands ◽  
List Type ◽  
Stunted Growth ◽  
Abnormal Growth ◽  
Growth Reaction ◽  
Extensive Growth ◽  
Higher Doses

ABSTRACT The effect of testosterone and oestrone on the mammary glands of castrated male rabbits was studied. Testosterone propionate was used in daily doses from 0.5 to 80 mg. The doses of oestrone ranged from 0.05 to 25 μg per day. Mammary glands were examined after 14, 28 or 56 days of injections. 1) Testosterone in doses below 20 mg failed to affect the mammary glands. With 40 or 80 mg a distinct, though abnormal growth reaction was consistently obtained. 2) Oestrone in doses lower than 0.5 μg did not stimulate mammary growth. With 0.5 μg and higher doses extensive growth of the mammary glands occurred. Stunted growth and secretion were found in the mammary glands of rabbits injected with 12.5 or 25 μg oestrone. 3) Testosterone in doses of 1 or 5 to 10 mg depressed or abolished the response of the mammary glands to 0.5 μg oestrone. When testosterone, in doses ineffective when given alone, was added to at least 3.125 μg oestrone, the mammary glands developed alveoli. The abnormalities produced by the highest doses of oestrone studied were exaggerated by the addition of testosterone. 4) The observations indicate a complicated interplay between the actions of testosterone and oestrone on the mammary gland of the rabbit. The interactions between testosterone and oestrone are presumably different from those observed between progesterone and oestrone.

Imaging Usual Addictions: Tobacco, Canabis and Alcohol

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
C. Leroy ◽  
S. Chanraud ◽  
E. Artiges ◽  
C. Martelli ◽  
A. Cachia ◽  
...  
Keyword(s):  
White Matter ◽  
Psychosocial Functioning ◽  
Grey Matter ◽  
Diffusion Imaging ◽  
Temporal Cortex ◽  
List Type ◽  
Dopamine Level ◽  
Type Number ◽  
Positron Emission ◽  
Brain Microstructure

Background:Brain models of drug addiction are being tackled in humans, using PET and MRI.Results:1.Whereas tobacco and cannabis do not interact directly with dopamine sites, positron emission tomography detected lower availability in sites regulating the catecholamines homeostasis, notably in dopamine transporter sites in striatal and in extrastriatal regions. This further supports repeated and long term substance use progress towards an adaptative diminished basal dopamine level that would contribute to the switch to an addicted brain.2.Alcohol: abnormalities in brain macro- and micro- structure were searched in detoxified alcohol-dependents with preserved psychosocial functioning:-Brain function (fMRI): fronto-cerebellar overactivation detected during an auditory language task in alcohol-dependents may reflect the compensatory effort required for patients to maintain the same level of performance as controls.-Brain macrostructure (MRI). Widespread lower white matter volumes, and lower grey matter volumes in the frontal lobe, insula, hippocampus, thalami and cerebellum, were detected. Poorer neuropsychological performance correlated with smaller grey matter volumes in these regions and with lower white matter volume in the brainstem.-Brain microstructure (DTI): tractography of white matter fiber bundles revealed that brainstem bundles alteration may contribute to cognitive flexibility impairment. Regression analyses showed memory scores were related to brain microstructure in parahippocampal areas, frontal cortex, and left temporal cortex. This suggest diffusion imaging (DTI) is a useful probe to early alcohol-induced brain alterations.Conclusion:While indices of dopamine down-regulation are consistency detected in several drug addictions, even “socially-adapted” alcohol dependence may induce change in brain structure.Psychol Med. 1998 28:1039-48.Neuropsychopharmacology. 2007 32:429-38.IEEE Trans Med Imaging. 2007 26:553-65J Nucl Med. 2007 48:538-46.Neuropsychopharmacology (Chanraud S et al., 2008 Jul 9. [Epub ahead of print]).J Clin Psychopharmacol (Leroy C et al, in press).

scholarly journals Metabolic syndrome in psychiatry: advances in understanding and management

2014 ◽  
Vol 20 (2) ◽  
pp. 101-112 ◽  
Author(s):  
Cyrus S. H. Ho ◽  
Melvyn W. B. Zhang ◽  
Anselm Mak ◽  
Roger C. M. Ho
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Psychiatric Disorders ◽  
Psychiatric Patients ◽  
Learning Objectives ◽  
List Type ◽  
Type Number ◽  
Unhealthy Lifestyle ◽  
Definition Of ◽  
The Relationship

SummaryMetabolic syndrome comprises a number of cardiovascular risk factors that increase morbidity and mortality. The increase in incidence of the syndrome among psychiatric patients has been unanimously demonstrated in recent studies and it has become one of the greatest challenges in psychiatric practice. Besides the use of psychotropic drugs, factors such as genetic polymorphisms, inflammation, endocrinopathies and unhealthy lifestyle contribute to the association between metabolic syndrome and a number of psychiatric disorders. In this article, we review the current diagnostic criteria for metabolic syndrome and propose clinically useful guidelines for psychiatrists to identify and monitor patients who may have the syndrome. We also outline the relationship between metabolic syndrome and individual psychiatric disorders, and discuss advances in pharmacological treatment for the syndrome, such as metformin.LEARNING OBJECTIVES•Be familiar with the definition of metabolic syndrome and its parameters of measurement.•Appreciate how individual psychiatric disorders contribute to metabolic syndrome and vice versa.•Develop a framework for the prevention, screening and management of metabolic syndrome in psychiatric patients.

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