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Biomedical subjects

D I Ben-Tovim

Publications and source records attributed to D I Ben-Tovim.

At least 19 recordsLinked to original sources
PubMed2001

Outcome in patients with eating disorders: a 5-year study.

BACKGROUND: Eating disorders are disabling, unpredictable, and difficult to treat. We did a prospective 5-year investigation of a representative sample of patients with eating disorders. Our aim was to identify predictors of outcome and to assess effects of available treatments. METHODS: We prospectively investigated 95 patients with anorexia nervosa, 88 with bulimia nervosa, and 37 with eating disorders not otherwise specified (EDNOS), who sought treatment in Adelaide, South Australia. We divided patients into those who had, and had not, received treatment in specialist units and reached a safe body weight. Individuals were then further classified dependent on intensity of any treatment received. We assessed clinical symptoms, body-related attitudes, and psychosocial function. FINDINGS: 216 (98%) patients were available for follow-up after 5 years. Three patients with anorexia nervosa and two with EDNOS died. 65 (74%) bulimic, 29 (78%) EDNOS, and 53 (56%) anorexic patients had no diagnosable eating disorder. A small proportion of patients in every group had poor Morgan-Russell-Hayward scores at outcome. Final outcome was predicted by extent and intensity, but not duration, of initial symptoms in patients with anorexia nervosa, and by initial body-related attitudes and impaired psychosocial functioning in bulimia patients. We were unable to predict EDNOS outcome. Treatment did not affect outcome for any group. INTERPRETATION: Deaths in the study confirm the serious nature of eating disorders. However, our results suggest that the efficacy of existing interventions is questionable.

Adolescent↗
PubMed2001

Does the body image exist in three dimensions? The study of visual mental representation of a body and a nonbody object.

Do the mental images of 3-dimensional objects recreate the depth characteristics of the original objects? This investigation of the characteristics of mental images utilized a novel boundary-detection task that required participants to relate a pair of crosses to the boundary of an image mentally projected onto a computer screen. 48 female participants with body attitudes within expected normal range were asked to image their own body and a familiar object from the front and the side. When the visual mental image was derived purely from long-term memory, accuracy was better than chance for the front (64%) and side (63%) of the body and also for the front (55%) and side (68%) of the familiar nonbody object. This suggests that mental images containing depth and spatial information may be generated from information held in long-term memory. Pictorial exposure to views of the front or side of the objects was used to investigate the representations from which this 3-dimensional shape and size information is derived. The results are discussed in terms of three possible representational formats and argue that a front-view 2 1/2-dimensional representation mediates the transfer of information from long-term memory when depth information about the body is required.

Adolescent↗
PubMed2000

[Personal behavior and mental state in anorexia nervosa].

Personality of the patients with anorexia nervosa is characterised by high neurotization and anxiety that resulted in diffuse anxiety in stress situation. Personal peculiarities included also high total hostility and intrapunitivity, inclination to obsessive-phobic and dysthymic reactions and tendency to somatization of anxiety. Such peculiarities promoted the choice of intrapunitivity type of reaction in situation of frustration. Its manifestation increases with an increase in the disease duration. The range of psychotic disorders in anorexia nervosa is restricted to anxious-depressive, obsessive and asthenic sphere.

Adult↗
PubMed1998

Eating disorders revisited. II: Bulimia nervosa and related syndromes.

Bulimia nervosa and related syndromes are common, and occur in up to 5% of women who attend general practitioners. Young women in First World countries, particularly those who "diet", are at increased risk. Behaviours, such as binge eating and induced vomiting, are typically kept well hidden. Only a minority of those with these disorders present for treatment. General practitioners play a key role in primary and secondary prevention. Effective treatments include psychotherapies that focus on the patient's attitudes and relationships, not just the binge eating behaviour. About 50% of patients make a complete recovery, but the long term outcome is unknown.

Bulimia↗
PubMed1998

Eating disorders revisited. I: Anorexia nervosa.

Anorexia nervosa is a serious psychiatric illness with a high morbidity and a significant lifetime mortality. Recurring themes in such patients centre on issues of self-worth and control. Treatment is difficult and prolonged, and may require hospitalisation. Therapy focuses on altering the misperceptions that patients have of themselves, both psychologically and physically. A multi-disciplinary team based in a specialised unit provides the treatment of choice, but if this is not available, a consistent, supportive relationship with an individual therapist familiar with the condition will be beneficial. Successful outcome should be based not simply on body weight but also on the resolution of anorexic thinking.

Anorexia Nervosa↗
PubMed1997

Telepsychiatry: 'tele' yes, but what about the 'psychiatry'?

To investigate what is lost or gained in a psychiatric evaluation when it takes place via telepsychiatry we compared the interrater reliability between two psychiatrists interviewing 63 subjects in an observer/interviewer split configuration in telepsychiatry and same-room settings. The measures used were the BPRS and interviewer ratings from a semi-structured interview. Patients also rated their experience. There were some clear differences between the telepsychiatry and same-room evaluations. Despite these variations, diagnoses were as reliably made by telepsychiatry. Patient acceptance of telepsychiatry was high.

Adolescent↗
PubMed1997

Recall of the visual body image using a novel boundary detection task.

A new task for eliciting a pictorial mental image of the body or other objects is described. The task involved relating a pair of crosses to the boundary of a mental image 'projected' onto a computer screen. Responses were assessed for accuracy defined as identifying a relationship between a cross and an image that would hold when a photograph (of the same object) was substituted for the mental image. A group of 30 female students achieved between 70 to 80% accuracy when using this task to assess mental images of their own faces, torsos, or a familiar nonbody object. Accuracy was similar for body and nonbody objects. The presence of some kind of quasipictorial representation of the body is confirmed. Its characteristics await further elucidation.

Body Image↗
PubMed1996

Low levels of interrater reliability in a standard measure of outcome in eating disorders (the modified Morgan-Russell Assessment Schedule).

OBJECTIVE: The interrater reliability of the modified version of the widely used Morgan-Russell Assessment Schedule was assessed. METHOD: Sixty-six female patients presenting for treatment for the first time in a general hospital and a community health center were assessed by a treating clinician and a researcher during sequential interviews. Two extra items were added to the Schedule to allow for the assessment of bulimic behaviors. Ratings were analyzed using the Cohen's weighted kappa. RESULTS: Poor to very poor levels of agreement were found between rater pairs assessing the 66 separate patients. DISCUSSION: The necessity for a specific, standardized format in using the Morgan-Russell Schedule is discussed. In its current, unstandardized format the Schedule may not be suitable for comparing outcome in eating disorders across different centers.

Adult↗
PubMed1996

Psychiatric and substance abuse disorder diagnoses as predictors of length of hospital stay.

The mental health and substance abuse components of AN-DRG 3 were examined using data from all inpatient separations in two Australian States over a two-year period. Assignment to a mental health or a substance abuse diagnosis related group (DRG) predicted about 20 per cent of the variability in average length of stay of patients treated for such conditions. Assignment to a substance abuse DRG was a much less robust predictor of length of hospital stay than assignment to a mental health DRG. There was little variation between years or States. Day-only intent patients were excluded, as were long-stay outliers identified using an inter-quartile range trimming process. Psychiatric DRGs are similar to a number of other non-surgically focused diagnosis related groups in their capacity to predict length of hospital stay. They are likely to remain an important component of casemix classification systems.

Health Services Research↗
PubMed1996

Effects of serotonin reuptake inhibitors on hemostasis.

OBJECTIVE: To examine the hematologic safety profile of the selective serotonin reuptake inhibitors (SSRIs), with particular emphasis on the effects of these drugs on platelet aggregation. METHODS: Platelet aggregation studies were undertaken at baseline, and repeated 2 and 4 weeks after the initiation of treatment with an SSRI. Other investigations undertaken included analysis of serum electrolyte and liver enzyme concentrations, complete blood count, and coagulation studies. Patients were also assessed for clinical signs of bleeding. Eight patients (7 treated with fluoxetine, 1 with paroxetine) completed the study protocol. RESULTS: Repeated ANOVA revealed no abnormalities in platelet aggregation, hematopoiesis, or coagulation profile. No patient developed clinical signs of abnormal hemostasis during the study period. A statistically significant elevation in the mean serum bilirubin concentration was detected, but this was not of clinical significance. CONCLUSIONS: Although the SSRIs may cause abnormal hemostasis, this effect is probably rare. Another possibility is that abnormal hemostasis is more likely to occur when high doses of SSRIs are administered.

Analysis of Variance↗
PubMed1995

Pictorial adaptation of Stroop measures of body-related concerns in eating disorders.

Patients with eating disorders were asked to color-name pictures of a variety of body shapes. The time taken to color-name these stimuli was compared with the time taken to color-name a series of neutral visual stimuli. There was a significant delay in naming body shapes in comparison to neutral stimuli, and this delay was greater in anorexic and bulimic patients than in controls. Previous Stroop adaptations have used verbal stimuli to assess the intensity of weight and shape-related concerns. The possible advantages of pictorial stimuli are discussed.

Body Image↗
PubMed1995

Body image, disfigurement and disability.

The body-related attitudes of groups of women suffering from physical conditions that are commonly regarded as being disfiguring and/or disabling were studied by means of the Body Attitudes Questionnaire. Despite their conditions, the women did not necessarily disparage their bodies. They also seemed to worry less about small changes in weight and shape than did comparable women without physical difficulties, and to have an enhanced sense of their own robustness. There was an indication that development of negative body attitudes might be linked to emergence of a chronic physical condition during adolescence, rather than from birth or during adulthood. If our results are confirmed, they point to the need to pay special attention to the psychological needs of women whose bodies become dysfunctional at this sensitive time.

Adolescent↗
PubMed1994

Making casemix work for psychiatry.

Providers of mental health and substance abuse care cannot afford to ignore the existence of casemix descriptions of their services. As casemix comes to be the predominant language used to describe the products of hospital care, its use will inevitably impinge upon psychiatric services. The psychiatric components of the Australian national diagnosis-related groups classification 1 and 2 (AN-DRG 1 and 2) do not describe the relevant products with great accuracy. We review some possible reasons for this and the effects on the homogeneity of resource consumption of technical procedures, such as trimming of data sets, in the context of the current casemix system and that proposed for AN-DRG-3. The evolution of a casemix system which does justice to current and future psychiatric services will be a complex process. Some of the crucial areas are discussed. Clinicians involved in mental health and substance abuse care must continue to advocate for the resources and effort needed to improve casemix information in their area.

Australia↗