Descriptions of disordered eating in German psychiatric textbooks, 1803–2017

The most common eating disorders (EDs) according to DSM-5 are anorexia nervosa(AN), bulimia nervosa (BN) and binge eating disorder (BED). These disorders havereceived increasing attention in psychiatry due to rising prevalence and high morbidityand mortality. The diagnostic category “anorexia nervosa,” introduced by Ernest-CharlesLasègue and William Gull in 1873, first appears a century later in a German textbook ofpsychiatry, authored by Gerd Huber in 1974. However, disordered eating behavior hasbeen described and discussed in German psychiatric textbooks throughout the past 200years. We reviewed content regarding eating disorder diagnoses but also descriptionsof disordered eating behavior in general. As material, we carefully selected eighteenGerman-language textbooks of psychiatry across the period 1803–2017. Previously, inGerman psychiatry, disordered eating behaviors were seen as symptoms of depressivedisorders, bipolar disorder or schizophrenia, or as manifestations of historical diagnosesno longer used by the majority of psychiatrists such as neurasthenia, hypochondria andhysteria. Interestingly, 19th and early 20th century psychiatrists like Kraepelin, Bumke,Hoff, Bleuler, and Jaspers reported symptom clusters such as food refusal and vomitingunder these outdated diagnostic categories, whereas nowadays they are listed as corecriteria for specific eating disorder subtypes. A wide range of medical conditions such asendocrinopathies, intestinal or brain lesions were also cited as causes of abnormal foodintake and body weight. An additional consideration in the delayed adoption of eatingdisorder diagnoses in German psychiatry is that people with EDs are commonly treatedin the specialty discipline of psychosomatic medicine, introduced in Germany after WorldWar II, rather than in psychiatry. Viewed from today’s perspective, the classification ofdisorders associated with disordered eating is continuously evolving. Major depressivedisorder, schizophrenia and physical diseases have been enduringly associated withabnormal eating behavior and are listed as important differential diagnoses of EDsin DSM-5. Moreover, there are overlaps regarding the neurobiological basis andpsychological and psychopharmacological therapies applied to all of these disorders

Cervicothoracic Intradural Arachnoid Cyst Misdiagnosed as Motor Neuron Disease

Recognizing syndromes which mimic ALS is crucial both to avoid giving this diagnosis erroneously and since there may be appropriate treatments. We report a 63-year-old woman diagnosed with possible ALS five years ago based on upper and lower motor neuron signs with typical electrophysiology and normal cranial MRI. At reassessment, spinal MRI revealed a cervicothoracic cyst with cord compression that was successfully treated neurosurgically. Histopathology confirmed an arachnoid origin as suspected from MRI. Spinal cysts may mimic ALS and need to be thoroughly excluded by appropriate imaging

Моделирование литья алюминия в кокиль

На основе моделирования процесса заливки алюминиевого сплава в металлическую форму разработан технологический процесс минимизирующий количество дефектов в теле отливки

Clinicians' perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings

BACKGROUND: Admissions to intensive treatment (i.e., inpatient [IP] and/or day patient [DP]) for individuals with severe anorexia nervosa (AN) are common. Growing literature indicates potential risks and benefits of each intensive treatment approach; however, existing research has focused on patient and carer perspectives of these treatments. Also, there is scant empirical evidence available for guiding the parameters of intensive treatments for AN. We therefore explored clinicians' perspectives and experience of supporting adults with severe AN in intensive settings. METHODS: We conducted twenty one semi-structured interviews with clinicians who deliver intensive treatments (i.e., IP and/or DP) for individuals with severe AN across four specialist Eating Disorder Services in the United Kingdom between May 2020 and June 2021. We asked clinicians about their views and experiences of supporting individuals with severe AN in intensive treatment settings and the challenges and opportunities associated with IP and DP treatment. Data were analysed using reflexive thematic analysis supported by NVivo software. RESULTS: Five broad and interrelated themes were identified: (1) Intensive Support; (2) The Severity of Patients' Illnesses; (3) Hope and Recovery; (4) Which Treatment When; (5) Limited Resources; and (6) Carer Burden. We identified various similarities between the two intensive treatment approaches, including the value of intensive and multidisciplinary support and carer involvement, and the challenge of managing complex and unique needs in resource-limited intensive settings. We also found differences in the relationship of treatment to patients' home environments, the necessity of patient motivation, and the management of risk. CONCLUSIONS: Both intensive treatment settings are valued by clinicians; however, there are unique challenges and opportunities for supporting individuals with severe AN within each. Our findings suggest DP treatment may be used as an alternative to IP treatment for individuals with severe AN. However, clear questions remain over which intensive treatment setting is best suited to which patient when and should be the focus of future research

Autopsy of a failed trial part 1: A qualitative investigation of clinician's views on and experiences of the implementation of the DAISIES trial in UK-based intensive eating disorder services

Objective: The DAISIES trial, comparing inpatient and stepped-care day patient treatment for adults with severe anorexia nervosa was prematurely terminated in March 2022 due to poor recruitment. This qualitative study seeks to understand the difficulties faced during the trial by investigating stakeholders' views on and experiences of its implementation. / Method: Semi-structured interview and focus group transcripts, and trial management and oversight group meeting minutes from May 2020-June 2022 were analysed using thematic analysis. Participants were 47 clinicians and co-investigators involved with the DAISIES trial. The Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework was applied to the interpretive themes to classify barriers and facilitators to implementation. / Results: Five themes were identified: incompatible participation interests; changing standard practice; concerns around clinical management; systemic capacity and capability issues; and Covid-19 disrupting implementation. Applying the NASSS framework indicated the greatest implementation challenges to arise with the adopters (e.g. patients, clinicians), the organisational systems (e.g. service capacity), and the wider socio-political context (e.g. Covid-19 closing services). / Conclusions: Our findings emphasise the top-down impact of systemic-level research implementation challenges. The impact of the Covid-19 pandemic accentuated pre-existing organisational barriers to trial implementation within intensive eating disorder services, further limiting the capacity for research