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Biomedical subjects

A H Crisp

Publications and source records attributed to A H Crisp.

At least 19 recordsLinked to original sources
PubMed1997

Sociopsychological factors in women with chronic pelvic pain with and without pelvic venous congestion.

Social and psychological factors have long been proposed as being of importance in a sizeable subgroup of women complaining of unexplained chronic pelvic pain (CPP). The aim of this study was to examine this in two subgroups of CPP patients, thereby eliminating pain alone as the determining variable. Consecutive attenders at a clinic for CPP were assessed on a range of somatic, historical, social, and psychological variables using detailed interviews and questionnaires. They were subsequently allocated to one of two groups, based on the presence or absence of pelvic venous congestion (PVC). Significant associations emerged between some social arrangements, paternal parenting, and patterns of hostility in the group with pelvic venous congestion. The groups also differed in patterns of family illness, and the congested group tended to report more childhood sexual abuse (CSA). Clear case definition in CPP is important. In the subgroup with pelvic venous congestion early social experience may play an important role. Father-daughter relationships may be particularly relevant. Hostility patterns may influence the development of the condition. CSA does not appear to play a specific role in all unexplained CPP cases, but may have relevance for the subgroup with pelvic venous congestion.

Adolescent↗
PubMed1997

Sociopsychological factors in chronic pelvic pain: a review.

Chronic pelvic pain is a common gynecological problem. There has long been an assumption that social and psychological factors play a part in its genesis in a significant subgroup, but their precise role remains unclear. More recently, childhood sexual abuse has been implicated as a specific risk factor. For this review, PSYCHLIT and MEDLINE searches for relevant publications were supplemented by tracing back through the latter's related reference lists. One hundred thirty-one references directly concerning pelvic pain were identified with varying emphasis on social and psychological aspects. A further 449 references were in related fields. Forty-three were considered to be helpful in directly exploring the link between chronic pelvic pain and sociopsychological factors and 22 of these reported specific studies directly relevant. In common with other research into chronic pain conditions, it appears unhelpful to separate this type of pain into "psychogenic" and "organic" categories. Clear case definition is essential. The specificity of childhood sexual abuse as a risk factor is unclear. It may be helpful to consider clearly defined subgroups with the condition in future studies. An example of such a subgroup with pelvic venous congestion is discussed.

Adult↗
PubMed1996

Interviewing for sexual abuse: reliability and effect of interviewer gender.

An interview to detect histories of sexual abuse was administered to consecutive attenders at a gynecology clinic on two occasions, on one occasion by a male interviewer and on the other by a female interviewer. Fifty-six subjects were assessed, and at least partial agreement was found in 70% between the two interviews. Approximately one-third of incidents were reported at only one of the interviews, with gender of interviewer making little apparent difference to this. Contrary to expectation, subjects appeared more forthcoming at the first interview. Reasons for this are discussed. Interviews for sexual abuse must be carried out in an appropriate context, and simple routine screening questions may not be appropriate. Selection of interviewers on the basis of gender alone may not be helpful.

Adolescent↗
PubMed1996

The sleepwalking/night terrors syndrome in adults.

A third of a million adults in the UK sleepwalk while a million suffer from night terrors. In both conditions the individual is unaware of the fullness of their surroundings and is totally focussed in their concern or activity. Doctors are only likely to become involved if the individual comes to harm or seeks help or if other people are inconvenienced or threatened. The constitutional basis of the disorder is beyond doubt, although the actual expression may be related to stressful life-events resulting from an individual's personality, relationships and circumstances. Treatment may include the provision of a secure environment, counselling, and the use of benzodiazepines and serotonin re-uptake inhibitors.

Adult↗
PubMed1995

The incidence and prevalence of anorexia nervosa in three suburban health districts in south west London, U.K.

OBJECTIVE: To determine incidence and prevalence of anorexia nervosa in a defined geographical area of south west London, UK, total population 519,900. METHOD: Hospital and community health workers in the defined area were contacted initially by letter asking them to identify all cases (new or existing) of anorexia nervosa known to them in the period July 1991-June 1992, using DSM-III-R criteria. A semistructured interview was conducted with the respondents to confirm the diagnosis. The large database record of the senior authors' specialist anorexia nervosa service, including inpatient and outpatient service records, was concurrently screened for cases living in the defined area. RESULTS: The prevalence of anorexia nervosa was found by this method to be 20.2 cases per 100,000 population (0.02% total population). Prevalence in females aged 15-29 years was 115.4 cases per 100,000 (0.1% of young females). Similarly, the annual incidence of anorexia nervosa was found to be 2.7 cases per 100,000 total population. In females aged 15-29 years the incidence was 19.2 cases per 100,000. DISCUSSION: Such prevalence and incidence figures are probably significant underestimates since the disorder can often defy detection or correct diagnosis and, with our own methodology, some identified cases may not have been reported to the study. However, these results can be used as a start for resource planning and service development.

Adolescent↗
PubMed1995

Anorexia nervosa in 'non-white' populations.

BACKGROUND: Comparisons were made between two groups of anorectic patients, 'non-white' and 'white', on a variety of clinical and social characteristics. METHOD: The study is based on a 34-year long database (1960-93) associated with a national tertiary referral centre. Thirty-six non-white patients meeting DSM-III-R criteria for anorexia nervosa (AN) and five with 'partial syndrome' are compared with a white group comprising 944 patients with full syndrome. RESULTS: The main finding is clinical similarity between the two groups, extending to social class and pathological patterns of family relationship. The non-whites are shorter in stature (P = 0.004) and report earlier menarche (P = 0.004); they are younger at presentation (P < 0.001), somewhat less emaciated, and practice veganism slightly more commonly; they less often acknowledge sensitivity to 'fatness' (P < 0.003). This sensitivity was exposed later whenever treatment involved substantial weight gain. The proportion of non-white cases accepted for assessment has not changed in respect of year of onset (around 6%) for the last 20 years, or year of presentation (around 6-7%) over the last 15 years. There was a tendency for non-white patients to be referred earlier in their illness. CONCLUSIONS: The clinical and background profiles of non-white and white anorectics are generally similar. The numbers arising and presenting have not changed recently. Non-white patients apparently have as ready access as white patients to assessment and treatment by us.

Adolescent↗
PubMed1994

Outcome of outpatient psychotherapy in a random allocation treatment study of anorexia nervosa.

Ninety subjects with DSM-III-R anorexia nervosa were randomly allocated to four treatment options, one inpatient, two outpatient, and one comprising an assessment interview only. Twenty were thus offered a package of outpatient individual and family psychotherapy. At 2-year follow-up, 12 of the 20 were classed as well, or very nearly well, according to operationally defined criteria. Statistically significant improvements over time were obtained for weight, mean body mass index (BMI), and also for psychological, sexual, and socioeconomic adjustments. Weight and BMI changes were significantly better than for the assessment only group, some of whom had received extensive treatment elsewhere. The style of the outpatient therapy and compliance with it are described in some detail and prognostic indicators for the treated and untreated groups presented. Lower weights at presentation and vomiting were associated with poorer outcome, although age and length of history were not.

Adaptation, Psychological↗
PubMed1994

Anorexia nervosa: change over time in age of onset, presentation and duration of illness.

The question as to whether anorexia nervosa as an illness has transformed itself was partially addressed in an investigation into the possible change over time in age of onset, age of presentation and the derived variable, delay between onset and presentation. These three variables were examined in 827 patients diagnosed as suffering with anorexia nervosa, who had attended the Eating Disorders Unit at the Middlesex and St George's Hospitals from 1960 to 1990. This analysis revealed a stable age of onset but a lengthening in duration of illness and associated increase of age at presentation. However, investigation of data obtained from two other tertiary referral centres revealed stability of all three variables over time. The overall conclusion was that there has been no change in the age of onset of anorexia nervosa during the past 30 years. The increasing delay in presentation to the eating disorders clinic is most likely attributable to a change in the practice of patient referrals to a national tertiary referral centre.

Adolescent↗
PubMed1993

Sexual abuse as a factor in anorexia nervosa: evidence from two separate case series.

Evidence of a link between reported sexual abuse and specific eating behaviours was considered in 100 anorexic women. The women were assessed as part of case series from two separate clinics. There was a strong association between reported unwanted sexual experiences and purging behaviours (vomiting and/or abusing laxatives). Anorexics who did not purge had lower reported rates of abuse. The pattern and prevalence rate of reported abuse were similar in the two clinics, suggesting that the association was not a product of a specific method of eliciting disclosure. Implications for treatment and possible causal mechanisms behind this relationship are discussed.

Adolescent↗
PubMed1993

Post-traumatic anorexia nervosa--a case study.

The nature of the relationship between accidental trauma and psychopathology may not always be clear. Cases of post-traumatic anorexia nervosa have been described but without detailed attention to pre-existing psychopathological processes. This may give rise to spurious conclusions about direction of casualty. We describe a male patient who developed anorexia nervosa on two occasions, both episodes occurring during the convalescent period following traumatic accidents several years apart. The intervening period was characterized by strict self-regulation and conflict avoidance, typical of anorexia nervosa but with the body maintained at only a moderately low weight. We suggest that accidents can arise at times of crisis in such ongoing attempts at intense self-regulation. They may then reflect the escape from control of impulsivity and also provide an ultimate means of avoidance of further guilt-laden behaviour. They can be understood in the light of pre-existing psychopathology. The difficulties in early recognition and diagnosis of anorexia nervosa, especially in the male and in the absence of extreme weight loss are also discussed.

Adult↗
PubMed1993

Relationship between smoking, weight and attitudes to weight in adolescent schoolgirls.

A total of 1,932 schoolgirls aged 11-18 from seven schools in the South London area were surveyed using questionnaires which addressed eating patterns, body weight history, attitudes to body weight and shape, menstrual history and current smoking behaviour. They were also weighed and their height was measured. Twelve per cent of the girls were regular smokers and 10% smoked seven or more cigarettes over a 4 day period. Amongst girls aged 14 and over, 15% smoked regularly and a further 9% occasionally. A significant relationship was found between smoking and weight. Smokers were more likely to be moderately overweight in relation to their peers and to have been worried about their weight at some stage. There were differences between girls in state schools and those in independent schools with regard to smoking behaviour and weight. The findings have implications for anti-smoking strategies and health education generally.

Adolescent↗
PubMed1993

Psychosocial aspects of chronic pelvic pain, with special reference to sexual abuse. A study of 164 women.

Patients with chronic pelvic pain attending a tertiary referral centre show certain social, developmental and psychological characteristics. Specifically, they appear to have fewer children and to report more paternal overprotection, and a trend towards low maternal care compared to normals. They also show more depression, free-floating anxiety and somatic anxiety than such populations. The levels are similar to those found in other outpatient populations presenting with migraine or irritable bowel syndrome. Hostility levels are greater than those in normal subjects. Overall the present patient population reports the same degree of childhood sexual abuse as do many other female clinic and community sample populations. Sexual abuse is unlikely to be a specific aetiological factor in the development of chronic pelvic pain though it may yet be found to be important in subsets of the population.

Adolescent↗
PubMed1992

Long-term mortality in anorexia nervosa. A 20-year follow-up of the St George's and Aberdeen cohorts.

Two cohorts of anorexia nervosa patients were followed up for a mean of 20 years. All except 4% of each cohort was traced. The crude mortalities were: St George's, 4%; Aberdeen, 13%. The SMRs were: St George's, 136; Aberdeen, 471. If the untraced were assumed to be dead, crude mortalities were 7.6% and 15.9% respectively, and SMRs were 276 and 592 respectively. Causes of death were complications of the illness and suicide. Medical treatment may reduce early mortality, while comprehensive medical and psychotherapeutic treatment may reduce late mortality.

Adolescent↗
PubMed1991

Premenarcheal anorexia nervosa.

The notions of 'early-onset' and 'prepubertal' anorexia nervosa are reviewed, with particular reference to the role of the pubertal process within the condition. A database of 650 female cases is utilized to identify a small sub-group (n = 30) who developed the condition before the menarche. Many clinical, familial, social and precipitating factors distinguish this group from post-pubertal cases as a whole, and a sub-group of post-menarcheal cases (n = 42) matched for age. An explanation for previous inconsistent findings in 'early-onset' and 'prepubertal' anorexia nervosa is advanced.

Adolescent↗