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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
PubMed2001

Is there a dissociative process in sleepwalking and night terrors?

The enduring and contentious hypothesis that sleepwalking and night terrors are symptomatic of a protective dissociative mechanism is examined. This is mobilised when intolerable impulses, feelings and memories escape, within sleep, the diminished control of mental defence mechanisms. They then erupt but in a limited motoric or affective form with restricted awareness and subsequent amnesia for the event. It has also been suggested that such processes are more likely when the patient has a history of major psychological trauma. In a group of 22 adult patients, referred to a tertiary sleep disorders service with possible sleepwalking/night terrors, diagnosis was confirmed both clinically and polysomnographically, and only six patients had a history of such trauma. More commonly these described sleepwalking/night terrors are associated with vivid dream-like experiences or behaviour related to flight from attack. Two such cases, suggestive of a dissociative process, are described in more detail. The results of this study are presented largely on account of the negative findings. Scores on the dissociation questionnaire (DIS-Q) were normal, although generally higher in the small "trauma" subgroup. These were similar to scores characterising individuals with post-traumatic stress disorder. This "trauma" group also scored particularly highly on the anxiety, phobic, and depression scales of the Crown-Crisp experiential index. In contrast the "no trauma" group scored more specifically highly on the anxiety scale, along with major trends to high depression and hysteria scale scores. Two cases are presented which illustrate exceptional occurrence of later onset of sleepwalking/night terrors with accompanying post-traumatic symptoms during wakefulness. It is concluded that a history of major psychological trauma exists in only a minority of adult patients presenting with sleepwalking/night terror syndrome. In this subgroup trauma appears to dictate the subsequent content of the attacks. However, the symptoms express themselves within the form of the sleepwalking/night terror syndrome rather than as rapid eye movement sleep related nightmares. The main group of subjects with the syndrome and with no history of major psychological trauma show no clinical or DIS-Q evidence of dissociation during wakefulness. The proposition that, within the character structure of this group, the mechanism still operates but exclusively within sleep remains a possibility.

Adult↗
PubMed2000

Use of leucotomy for intractable anorexia nervosa: a long-term follow-up study.

OBJECTIVE: We studied the long-term outcomes of intractable anorexia nervosa treated with leukotomy and specialized psychotherapy over 20 years ago. METHOD: All traceable subjects were interviewed using the Eating Disorders Examination (EDE) and the Structured Clinical Interview for DSM-III-R (SCID). They also completed questionnaires. Detailed histories were taken. RESULTS: Four of five female subjects were traced. Their cases had been severe, with failure of previous intensive psychotherapy and now with high risk of death from terminal inanition. One patient had committed suicide, whereas the others enjoyed a reasonable quality of life. Persistent core psychopathology was evident, but patients had not succumbed to weight loss. All suffered depression and anxiety-related disorders, but endorsed their treatment, which had allowed sustained weight gain by release of appetitive behavior, provision of a license to change, and alleviation of phobic anxiety, allowing psychotherapeutic engagement. DISCUSSION: We argue that these outcomes are relatively favorable and would not have been possible without this latter engagement in specialist psychotherapy to address burgeoning panic at unavoidable weight gain.

Adult↗
PubMed2000

Stigmatisation of people with mental illnesses.

BACKGROUND: Recognition of the additional social handicaps and distress that people with mental illnesses experience as a result of prejudice. AIMS: To determine opinions of the British adult population concerning those with mental illnesses as baseline data for a campaign to combat stigmatization. METHOD: Survey of adults (n = 1737 interviewed; 65% response) regarding seven types of common mental disorders. Responses evaluated concerned eight specified perceptions. RESULTS: Respondents commonly perceived people with schizophrenia, alcoholism and drug addiction as unpredictable and dangerous. The two latter conditions were also viewed as self-inflicted. People with any of the seven disorders were perceived as hard to talk with. Opinions about effects of treatment and prognosis suggested reasonable knowledge. About half the respondents reported knowing someone with a mental illness. CONCLUSIONS: Negative opinions indiscriminately overemphasize social handicaps that can accompany mental disorders. They contribute to social isolation, distress and difficulties in employment faced by sufferers. A campaign against stigma should take account of the differences in opinions about the seven disorders studied.

Adolescent↗
PubMed1998

Smoking and pursuit of thinness in schoolgirls in London and Ottawa.

It has been proposed that teenage girls often smoke cigarettes to protect themselves from the impulse to binge eat, with its feared weight-gain consequences, particularly when other measures such as greater dietary restraint have failed. The present study looked at the relationship between body mass index and standardised questionnaire responses concerning smoking, alcohol consumption, moods, weight changes, attitudes to body weight and shape, dietary patterns and menstruation in 1936 British (London) and 832 Canadian (Ottawa) schoolgirls. Data analysis revealed links between cigarette smoking and body weight/shape concerns, and awareness by subjects of these links; there was also a tendency for smokers in these two populations to be overweight but not grossly obese. Smoking was also related at all ages to being postmenarchal. The London population in particular revealed an association between smoking and a weight loss of 7 kg or more at some stage since puberty. Smoking was also linked, in a minority, with regular vomiting undertaken as a further defence against weight gain when overeating had occurred. These associations existed alongside the major and predictable association found between alcohol consumption and smoking. Similarities between the British and Canadian schoolgirls were striking in respect of rank order of reasons given for smoking and consequences of giving it up. Since smoking amongst older women is reportedly associated with below-average body weight it may indeed be effective in helping to curb weight gain. Our study provided little evidence of association between smoking and generalised anxiety or social anxiety (in either population), or depression (in the British cohort). We suggest that any preventive psychological approach to teenage female smoking should include attention to weight gain anxiety and consequent pursuit of thinness.

Adolescent↗
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↗