Sleep disorders. Consider nocturnal paroxysmal dystonia.
Explore the source record for details and available documents.
Dystonia↗
Biomedical subjects
A H Crisp
Publications and source records attributed to A H Crisp.
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↗
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↗
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↗
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↗
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↗
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↗
The clinical features of late onset anorexia nervosa.
This study examines clinical features of late onset anorexia nervosa. This involved the scrutiny of a large database of patients with anorexia nervosa comprising data gathered at standardized initial assessments over the period 1960-1990. Patients with a late onset were compared to other selected patient samples. The population comprised 12 patients with a first onset of anorexia nervosa at or after the age of 30, 415 patients with an onset after 15 but before 20 and 9 patients with an onset after 15 but before 20 and matched for age at presentation with the late onset group. Features studied included age at menarche, age at onset of anorexia nervosa, age at presentation, duration of illness, weight at presentation, lowest adult weight, highest weight, weight at onset of illness, marital status and parity. Patients with an onset of anorexia nervosa after the age 30 comprised 2% of the total female patient sample. Though such patients were rare, their clinical features were very similar to those of typical patients with adolescent onset. Notably, young and late onset patients had similar durations of illness prior to presentation, and similar proportions had bulimia and defensive vomiting. Feared sexuality, no longer necessary for childbearing, emerged as being of apparent aetiological significance in the late onset group, with the disorder embodying its rejection, as often also seems to be the case with earlier onset. The late onset cases were hard to diagnose and had a poor outcome. The study underlines the importance of considering the diagnosis of anorexia nervosa in older patients, even if there is no earlier history of anorexia nervosa. Such patients are likely to find it easier to conceal the psychological origins of their problem behind the possibility of a primary physical illness, or behind psychiatric diagnoses such as depression, the treatment of which may not threaten their avoidance of normal body weight.
Adult↗
Patients' illness models in chronic pelvic pain.
A modification of Kleinman's approach to eliciting concepts that patients have about their illnesses was applied to 64 patients with chronic pelvic pain. The women involved did not have clear schemata about causes of the process, and displayed flexibility in the concepts they did have. A significant proportion had clear ideas about what they did not want in terms of treatment. Worries focussed on interminability and effects on sex and work. It appears that offering a simple explanatory model such as that based on venous congestion fulfils some of the treatment needs in this group. Kleinman's approach could be more widely employed.
Attitude to Health↗
A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa.
Ninety patients with severe anorexia nervosa fulfilling DSM-III-R criteria were assessed in depth in terms of their family developmental psychopathology and then randomly allocated to either one of three treatment groups or to no treatment. In three treatment regimes, a behavioural approach to diet and weight gain was coupled with individual and family psychotherapy directed at the adolescent maturational problems. All three treatment regimes were highly significantly effective at one year in terms of weight gain, return of menstruation, and aspects of social and sexual adjustment. Body weights above those at pubertal onset were achieved for the group mean maximum and one-year follow-up weights for all three treatment groups but not the control group.
Adolescent↗
Sleepwalking, night terrors, and consciousness.
OBJECTIVE: To determine some personality and psychoneurotic characteristics of adults who have the sleepwalking-night terrors syndrome. DESIGN: Prospective assessment of two groups of consecutive patients with a firm diagnosis of either of two specific sleep disorders as established clinically and by polysomnography. SETTING: Outpatient sleep disorders clinic and sleep laboratory in a tertiary referral centre. PATIENTS: 12 Patients referred consecutively to the clinic in whom a diagnosis of sleepwalking (six) or night terrors (six) was confirmed. MAIN OUTCOME MEASURES: Psychological characteristics as measured at the time of clinical assessment by means of the Eysenck personality questionnaire, the hostility and direction of hostility questionnaire, and the Crown-Crisp experiential index. RESULTS: Both groups scored exceptionally highly on the hysteria scale of the Crown-Crisp experiential index and the night terrors group also scored highly on the anxiety scale. The patients with sleepwalking also scored highly on a measure of externally directed hostility. CONCLUSIONS: The physiological and psychological features identified in these patients, possibly reflecting different expressions of a constitutional cerebral characteristic, may be explored in terms of hysterical dissociation. The findings contribute to the debate concerning the nature of sleepwalking, in particular with and without the forensic aspects.
Adult↗
A comparison between women seeking self-help and psychiatric treatment in anorexia nervosa and bulimia.
Thirty new members of a branch of Anorexic Aid were interviewed to determine their characteristics and compared with women seeking psychiatric treatment for anorexia nervosa and normal-weight bulimia. It was expected that the two samples would be similar and that the women in the self-help group would have also had professional treatment. Over half (53 per cent, 16) of the Anorexic Aid sample were anorectic, 40 per cent (12) were normal-weight bulimics and 7 per cent (2) could not be classified and were excluded. Demographic characteristics were similar, with both samples being mainly British, single and from social classes I-III, but the Anorexic Aid sample was significantly older. Clinical features were also similar, although there was a trend towards the Anorexic Aid anorectics being less severely ill at presentation. Nearly 90 per cent (25) of the Anorexic Aid sample had had professional treatment. The hypotheses are partially confirmed. Reasons for the differences in age and severity are discussed.
Adult↗
Medical training in the European Community.
The free movement of doctors within the European Community demands harmonization of standards of medical practice and carries major implications of an undergraduate and postgraduate educational kind. These have begun to be addressed by the first three Medical Directives and also by a series of reports produced by the Advisory Committee on Medical Training to the European Community. This Committee was established in 1975 in order to provide informed agreed advice to the Commission. Many tasks remain to be tackled. A system of mutual inspection of the examination processes and standards in Member States should be established. Control must be exercised over the numbers of doctors produced since educational resources, including numbers of patients available for study, are limited. Thus, excellent standards of medical practice can only be developed and maintained if the primacy of clinical skills derived from the study of patients is recognized as essential in this respect. In some Member States at the present time there are many unemployed and therefore presumably deskilled doctors.
Credentialing↗
Anorexia nervosa in an 80-year-old woman.
A woman aged 80 years had suffered with anorexia nervosa in adolescence and the condition was rekindled after 50 years of remission. The remission was seen in the light of affective disorder and a chronic grief reaction.
Aged↗
Cerebral hemisphere function and migraine.
An hypothesis that migraine is the experience of a protective vascular response to cerebral information overload has been explored to a limited extent by examining the association between laterality of the attack and verbal and spatial performances under standard symptom-free conditions. The study was restricted to individuals with unilateral symptoms always presenting on the same side. It emerged that those with classical migraine do not always have prodromata referable to the same side as the pain. Indeed, in the present study, prodromata were almost exclusively referable to the left (dominant) cerebral hemisphere. A subgroup of those with speech disturbances as a feature of the prodromal symptoms was also found to have relatively impaired language abilities on routine testing. It is this finding that lends some support to the hypothesis. The findings also invite the refining proposition that information overload, as defined in the hypothesis, is almost always borne by the dominant (verbal) hemisphere in our species. Such overload might concurrently or sequentially also overtax a suggested limited right hemisphere language capacity, in terms of the hypothesis, accounting for the right-sided pain sometimes presenting in these cases. Otherwise, pain appears to be predominantly left-sided or midline. Perhaps the frequency of this particular syndrome is an indictment of the limitations of language as a basis for communication, as well as reflecting the possibility that most of our stressful transactions and their cerebral processing use a verbal substrate. The results also reveal the need for agreement on rules for classification of laterality in migraine.
Adolescent↗
Adoption and identity: a case of anorexia nervosa.
Anorexia nervosa, as a retreat from and subsequent avoidance of intolerable maturational turmoil, can provide a vivid insight, especially as body weight is restored to normal within treatment, into the sexual and identity conflicts that have previously characterized the adolescence of the individual. When the adolescent has been adopted into the family then the challenge of developing biological (genetic) identity is especially great to the individual and his adoptive parents. A rare case of anorexia nervosa in a male adoptee is presented against this background. Our patient's dependent and smothering bond with his adoptive mother, which was loving but highly conditional, left him with no room for negotiation when it was threatened by his emerging sexual and other impulsivity and new assertiveness. Understanding and treatment of such cases can also help to shed light on the particular challenges that face many adoptive parents when their adopted children experience the thrust of puberty and enter adolescence.
Adoption↗
Communication in medical practice across ethnic boundaries.
The communication skills basic to good medical practice are, for many of us, unnatural. The authors attempt to address aspects of the matter with particular reference to communication across ethnic boundaries.
Communication↗
The relevance of anatomy and morbid anatomy for medical practice and hence for postgraduate and continuing medical education of doctors.
A case is presented for the durability of anatomy including dissection of the cadaver and of morbid anatomy as elements in medical education and practice. It is these subjects, as consistently relevant over the centuries for medical practice as are communication skills, that are our hallmark as doctors. It is submitted that we should take stock very carefully of their relevance to us before it is too late easily to redress the balance, given the major trends of the last two decades.
Anatomy↗