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No consistent evidence for association between mtDNA variants and Alzheimer disease.
OBJECTIVE: Although several studies have described an association between Alzheimer disease (AD) and genetic variation of mitochondrial DNA (mtDNA), each has implicated different mtDNA variants, so the role of mtDNA in the etiology of AD remains uncertain. METHODS: We tested 138 mtDNA variants for association with AD in a powerful sample of 4,133 AD case patients and 1,602 matched controls from 3 Caucasian populations. Of the total population, 3,250 case patients and 1,221 elderly controls met the quality control criteria and were included in the analysis. RESULTS: In the largest study to date, we failed to replicate the published findings. Meta-analysis of the available data showed no evidence of an association with AD. CONCLUSION: The current evidence linking common mtDNA variations with AD is not compelling.
Hopelessness and positive and negative future thinking in parasuicide.
OBJECTIVES: Hopelessness about the future is a key element in suicidal behaviour. The aim of the present study was to examine possible components of hopelessness, in particular, to contrast positive and negative future thinking and to examine separately number, expectancy, and value of anticipated positive and negative future experiences. DESIGN: A correlational design. METHOD: Repeat parasuicide patients (N = 441) were administered the Beck Hopelessness Scale, the Hospital Anxiety and Depression Scale and the future thinking task, a measure of future positive and negative thinking that assesses number, perceived likelihood, and perceived value of anticipated future positive and negative events. RESULTS: Consistent with predictions, hopelessness correlated more strongly with lack of positive thoughts about the future than it did with presence of negative thoughts. Both positive and negative future thinking showed a relationship to hopelessness over and above their relationships to depression (positive future thinking) and anxiety (negative future thinking). Number and likelihood of positive events and likelihood and value of negative events showed both simple and partial relationships to hopelessness. Number of negative events related to hopelessness but only after the other future thinking variables had been controlled for and value of positive events no longer related to hopelessness after controlling for the other variables. CONCLUSIONS: Hopelessness about the future in suicidal individuals is a multi-faceted construct but lack of positive future thinking is more important than presence of negative future thinking.
A qualitative study of the experience of caring for a person with bulimia nervosa. Part 1: The emotional impact of caring.
OBJECTIVE: Family carers of individuals with mental disorders have been found to experience mental health difficulties of their own. There has been little research into the impact of caring for individuals with eating disorders. A preliminary study found that carers of individuals with anorexia nervosa experience more difficulties and distress than carers of people with psychoses (Treasure et al., [2001]. Social Psychiatry and Psychiatric Epidemiology, 36, 343-347). This is the first study to qualitatively investigate the experiences of carers of individuals with bulimia nervosa (BN). METHOD: Twenty carers of individuals with BN were interviewed using a semistructured interview. Interviews were transcribed and the texts analyzed using content analysis to identify themes. RESULTS: The principal themes to emerge were the impact of the discovery of BN on the carer, the ongoing impact of care-giving, coping strategies used by the carer, and the positive impact of the illness for both the carers and the persons in their care. DISCUSSION: BN has a potent impact on carers' lives. This has implications in terms of service provision and future research in this area.
A qualitative study of the experience of caring for a person with bulimia nervosa. Part 2: Carers' needs and experiences of services and other support.
OBJECTIVE: Family carers of people with mental disorders have specific needs to safeguard their own mental health. The needs of carers of individuals with eating disorders have received little attention. A focus group with carers of people with anorexia nervosa identified a number of specific needs (Haigh & Treasure [2003]. European Eating Disorders Review, 11(2), 125-141). However, there has been no published research into the needs of carers of individuals with bulimia nervosa (BN). METHOD: Twenty carers of individuals with BN were interviewed using a semistructured interview schedule. Interviews were transcribed and the texts were analyzed using a content analysis approach to identify themes. RESULTS: Carers expressed the need for more information, practical advice, guidance, and the need to talk to others about their experiences. DISCUSSION: Further research is recommended to explore how the needs expressed by carers may best be translated into services that effectively meet the requirements of both patients and carers and reduce the risk to carers' mental health.
Why do adolescents with bulimia nervosa choose not to involve their parents in treatment?
BACKGROUND: Although the use of family therapy for adolescents with anorexia nervosa is well established, there has been limited research into the efficacy of family therapy in adolescents with bulimia nervosa (BN). No previous research has investigated why individuals with BN do or do not involve their parents in treatment. This is an exploratory study aimed at determining whether there are any differences between these individuals in terms of eating disorder symptomatology, psychopathology, familial risk factors, patients' perception of parental expressed emotion (EE) and family functioning. METHODS: Participants were 85 adolescents with BN or Eating Disorder Not Otherwise Specified, recruited to a randomised controlled evaluation of the cost-effectiveness of cognitive-behavioural guided self-care vs. family therapy. Participants were interviewed regarding the history of their eating disorder and completed self-report measures. RESULTS: Patients who did not involve their parents in treatment were significantly older, had more chronic eating disorder symptoms, exhibited more co-morbid and impulsive behaviours and rated their mothers higher in EE. However, they did not have more severe eating disorder symptomatology. CONCLUSIONS: These preliminary findings, although in need of replication with a larger sample and limited by the attrition rate in some of the self-report measures, indicate that patients who did not involve their parents in treatment may perceive their mothers as having a more blaming and negative attitude towards the patient's illness. Public awareness about BN needs to be raised, focusing on reducing the stigma and negative views attached to this illness.
Do adolescents with eating disorder not otherwise specified or full-syndrome bulimia nervosa differ in clinical severity, comorbidity, risk factors, treatment outcome or cost?
OBJECTIVE: We wanted to know whether adolescents with eating disorder not otherwise specified (EDNOS) differ from those with bulimia nervosa (BN) in clinical features, comorbidity, risk factors, treatment outcome or cost. METHOD: Adolescents with EDNOS (n = 24) or BN (n = 61) took part in a trial of family therapy versus guided self-care. At baseline, eating disorder symptoms, risk factors, and costs were assessed by interview. Patients were reinterviewed at 6 and 12 months. RESULTS: Compared with EDNOS, BN patients binged, vomited and purged significantly more, and were more preoccupied with food. Those with EDNOS had more depression and had more current and childhood obsessive-compulsive disorder. 66.6% of EDNOS versus 27.8% of BN patients were abstinent from bingeing and vomiting at 1 year. Diagnosis did not moderate treatment outcome. Costs did not differ between groups. CONCLUSION: EDNOS in adolescents is not trivial. It has milder eating disorder symptoms but more comorbidity than BN.
Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study.
BACKGROUND: We carried out a large randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behaviour therapy (MACT) versus treatment as usual (TAU) for deliberate self-harm. METHOD: Patients presenting with recurrent deliberate self-harm in five centres were randomized to either MACT or (TAU) and followed up over 1 year. MACT patients received a booklet based on cognitive behaviour therapy (CBT) principles and were offered up to five plus two booster sessions of CBT from a therapist in the first 3 months of the study. Ratings of parasuicide risk, anxiety, depression, social functioning and global function, positive and negative thinking, and quality of life were measured at baseline and after 6 and 12 months. RESULTS: Four hundred and eighty patients were randomized. Sixty per cent of the MACT group had both the booklet and CBT sessions. There were seven suicides, five in the TAU group. The main outcome measure, the proportion of those repeating deliberate self-harm in the 12 months of the study, showed no significant difference between those treated with MACT (39%) and treatment as usual (46%) (OR 0.78, 95% CI 0.53 to 1.14, P=0.20). CONCLUSION: Brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition, but the findings taken in conjunctin with the economic evaluation (Byford et al. 2003) indicate superiority of MACT over TAU in terms of cost and effectiveness combined.
Motivation to change in recent onset and long-standing bulimia nervosa: are there differences?
UNLABELLED: REASON FOR THE STUDY: Little is known about how motivation to change evolves over the course of an eating disorder. The present study compared 'stage of change' and motivation, confidence and readiness to change in two groups of patients with bulimia nervosa (BN), adolescents with a short duration of illness and adults with a long duration of illness. METHOD: Patients completed the Severity of eating disorder symptomatology scale, Hospital Anxiety and Depression Scale and measures of stage of change and motivation, readiness and confidence to change their bulimic symptomatology at pre-treatment. MAIN FINDINGS: Short- and long duration groups did not differ in illness severity, comorbidity, stage of change, motivation, readiness, and confidence to change. There were, however, some differences between groups in terms of the relationship between motivational measures, illness severity, duration and comorbidity. CONCLUSIONS: There seem to be more similarities than differences between adolescents with short duration of illness and those with well-established BN in terms of their motivation to change.
Risk factors, correlates, and markers in early-onset bulimia nervosa and EDNOS.
OBJECTIVE: This study aimed to investigate the specific risk factors, correlates, and markers associated with the development of symptomatology of early-onset BN and subclinical BN. METHOD: Two semi-structured interviews were used to examine symptomatology and antecedent factors of bulimic symptoms in a sample of British adolescents. RESULTS: Adolescents with early-onset eating pathology were significantly more likely to report an earlier age of menarche than those developing the disorder at the typical age, and were found to have a different pathway of symptom development. DISCUSSION: Increased awareness of this may help identify those particularly at risk for developing an early-onset of eating pathology.
A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders.
OBJECTIVE: To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified. METHOD: Eighty-five adolescents with bulimia nervosa or eating disorder not otherwise specified were recruited from eating disorder services in the United Kingdom. Participants were randomly assigned to family therapy for bulimia nervosa or individual CBT guided self-care supported by a health professional. The primary outcome measures were abstinence from binge-eating and vomiting, as assessed by interview at end of treatment (6 months) and again at 12 months. Secondary outcome measures included other bulimic symptoms and cost of care. RESULTS: Of the 85 study participants, 41 were assigned to family therapy and 44 to CBT guided self-care. At 6 months, bingeing had undergone a significantly greater reduction in the guided self-care group than in the family therapy group; however, this difference disappeared at 12 months. There were no other differences between groups in behavioral or attitudinal eating disorder symptoms. The direct cost of treatment was lower for guided self-care than for family therapy. The two treatments did not differ in other cost categories. CONCLUSIONS: Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified.
Predictors of mental health problems and negative caregiving experiences in carers of adolescents with bulimia nervosa.
OBJECTIVE: This exploratory study focuses on the mental health (MH) and caregiving experience of carers of adolescents with Bulimia Nervosa (BN)/Eating Disorder not otherwise specified (EDNOS), aiming to determine: levels of MH problems in carers and if a negative experience of caregiving predicts carer MH status and which factors predict a negative experience of caregiving. METHOD: Hundred and twelve carers and 68 adolescents with BN/EDNOS completed self-report measures (General Health Questionnaire, Experience of Caregiving Inventory, Level of Expressed Emotion, Self-report Family Inventory, Inventory of Interpersonal Problems). RESULTS: Over half of the carers reported some MH problems and a minority (5.4%) were experiencing considerable difficulties. A negative experience of caregiving predicted carer MH status. Higher weekly contact hours and patient ratings of expressed emotion (EE) predicted a negative experience of caregiving. CONCLUSIONS: Interventions focusing on reducing EE and contact hours could prove beneficial for both patient and caregiver outcomes.
An evaluation of web-based information.
OBJECTIVE: To evaluate the quality of web-based information on the treatment of eating disorders and to investigate potential indicators of content quality. METHOD: Two search engines were queried to obtain 15 commonly accessed websites about eating disorders. Two reviewers evaluated the characteristics, quality of content, and accountability of the sites. Intercorrelations between variables were calculated. RESULTS: The overall quality of the sites was poor based on the outcome measures used. All quality of content measures correlated with a measure of accountability (Silberg, W.M., Lundberg, G.D., & Mussachio, R.A., 1993). DISCUSSION: There is a lack of quality information on the treatment of eating disorders on the web. Although accountability criteria may be useful indicators of content quality, there is a need to investigate whether these can be usefully applied to other mental health areas.
Are top journals biased against eating disorders topics?
OBJECTIVE: This study investigated whether there is a bias against eating disorders research among the leading psychiatric, psychological, and medical journals. METHOD: The authors performed a comparison between the number of empirical articles published about anorexia nervosa and/or bulimia nervosa and the number of articles published about panic disorder and/or agoraphobia (i.e., disorders of comparable disease burden) in 29 high-impact journals over a 5-year period (1996-2001). RESULTS: There were almost twice as many published empirical articles about panic disorder and/or agoraphobia (N=365) as there were about anorexia nervosa and/or bulimia nervosa (N=169). CONCLUSIONS: The findings indicate a possible bias against eating disorders research among some leading psychiatric journals. Alternative explanations and implications are discussed.
Positive thinking elevates tolerance: Experimental effects of happiness on adolescents' attitudes toward asylum seekers.
Inducing emotional reactions toward social groups can influence individuals' political tolerance. This study examines the influence of incidental fear and happiness on adolescents' tolerant attitudes and feelings toward young Muslim asylum seekers. In our experiment, 219 16- to 21-year-olds completed measures of prejudicial attitudes. After being induced to feel happiness, fear, or no emotion (control), participants reported their tolerant attitudes and feelings toward asylum-seeking young people. Participants assigned to the happiness condition demonstrated more tolerant attitudes toward asylum-seeking young people than did those assigned to the fear or control conditions. Participants in the control condition did not differ from participants in the fear condition. The participants in the happiness condition also had more positive feelings toward asylum-seeking young people than did participants in the control condition. The findings suggest that one way to increase positive attitudes toward asylum-seeking young people is to improve general emotional state.
Residential greenness and prevalence of major depressive disorders: a cross-sectional, observational, associational study of 94 879 adult UK Biobank participants.
BACKGROUND: Increased urbanisation and the associated reduced contact of individuals with natural environments have led to a rise in mental disorders, including depression. Residential greenness, a fundamental component of urban design, has been shown to reduce the public health burden of mental disorders. The present study investigates the association between residential green exposure and prevalence of major depressive disorders using a large and diverse cross-sectional dataset from the UK Biobank. METHODS: In this cross-sectional, observational, associational study, we used baseline data from the UK Biobank cohort of participants aged 37-73 years from across the UK. Environmental exposure data were derived from a modelled and linked built environment database. Residential greenness was assessed with a 0·5 m resolution Normalised Difference Vegetation Index, which is derived from spectral reflectance measurements in remotely sensed colour infrared data and measured within geocoded dwelling catchments. Other environment metrics included street-level movement density, terrain, and fine particulate exposures. A series of logistic models examined associations between residential greenness and odds of major depressive disorder after adjusting for activity-influencing environments and individual covariates. FINDINGS: Of 122 993 participants with data on major depressive disorder, the study analytical sample comprised 94 879 (77·1%) participants recruited across ten UK Biobank assessment centres between April 29, 2009, and Oct 1, 2010. A protective effect of greenness on depression was consistently observed, with 4·0% lower odds of major depressive disorder per interquartile increment in Normalised Difference Vegetation Index greenness (odds ratio 0·960, 95% CI 0·93-0·99; p=0·0044). Interaction analyses indicated that the beneficial effects of greenness were more pronounced among women, participants younger than 60 years, and participants residing in areas with low neighbourhood socioeconomic status or high urbanicity. INTERPRETATION: The results point to the benefits of well designed green environments on mental health. Further longitudinal studies are needed to decipher causal pathways. In the UK, policies aimed at optimising allocation and design of green spaces might help preserve psychological ecosystem services, thereby, improving the mental wellbeing of populations and enhancing the mental capital of cities. FUNDING: University of Hong Kong, UK Biobank, and the UK Economic & Social Research Council.