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Aims and methodThis is a longitudinal cohort study describing the demand, capacity and outcomes of adult specialist eating disorder in-patient services covering a population of 3.5 million in a South-East England provider collaborative before and since the COVID-19 pandemic, between July 2018 and March 2021.ResultsThere were 351 referrals for admission; 97% were female, 95% had a diagnosis of anorexia nervosa and 19% had a body mass index (BMI) v. 16% BMI >19), compared with traditional eclectic in-patient treatment.Clinical implicationsIntegrated enhanced cognitive behaviour theapy reduced length of stay and improved outcomes, and can offer more effective use of healthcare resources.

Aims/Methods: This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) to NHSE commissioning guidance. Results: Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016/17 and 2019/20 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% were aged 18–25, 54%>25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for co-morbidities, offer assertive outreach, or provide seamless transitions. For patient volume, ACEDS workforce budget was 15% compared to the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for ACEDS. Clinical Implications: This study highlights the severe pressure in ACEDS, which has increased since the pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance for adults, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.

Pilot results and lessons learned from the HOPE New Care Model (Provider Collaborative) are reported. Pre-pandemic 12 beds were needed per million population. More investment is required to address demand and capacity in adult community and inpatient eating disorder services.

Background Inpatient treatment of anorexia nervosa (AN) often results in poor outcomes. To address this, the Oxford service has adapted the multistep enhanced cognitive behavioural (CBTE) treatment model, first developed in Italy, to an NHS setting.Aim: to evaluate short- and long-term outcomes of Integrated CBTE (I-CBTE) with alternative treatment models in routine clinical practice.Methods This is a longitudinal cohort study, involving all adults with AN admitted from a geographical area in England covering a total population of 3.5 million between 2017-2020 using routinely collected data. We compared treatment as usual (TAU) with the Oxford model, which included: 1. short term planned admission with partial weight restoration; 2. I-CBTE (weight restoration defined as BMI 20, combined with 7 weeks day treatment followed by outpatient CBTE); 3. standalone inpatient CBTE. Primary outcome measures (min. 1 year after discharge from hospital) were defined as: 1. good outcome: BMI>19.5 and no binge purging behaviour; 2. poor outcome: BMI19.0 in the CBTE groups, 16.0 in the short admission and 17.0 in the TAU groups.At one year follow up, 70% of patients receiving I-CBTE maintained good outcomes, in contrast with

Aims and Method: This is a longitudinal cohort study describing the demand and capacity for specialist inpatient treatment of patients with severe eating disorders covering a population of 3.5 million. We compared and the impact of the pandemic and the outcomes between different inpatient services.Results: Between July 2018 and 1 November 2020 there were 293 referrals. 97% were female. 93% had a diagnosis of anorexia nervosa. 19.5% of referrals were below BMI 13, and a further 40% had extreme malnutrition. Referrals and emergency admissions to acute hospitals have increased by 20% since the pandemic. Waiting times have doubled from 33 to 67 days.A novel integrated CBTE model has shown better outcomes and shorter length of stay compared to traditional eclectic treatment.Clinical Implications.The pandemic has worsened the mismatch of demand and capacity, causing increasing serious risks and this needs to be addressed as a matter of urgency.

After the inquest into five deaths, the assistant coroner for Cambridgeshire and Peterborough concluded that NHS treatment for patients with anorexia is “not a safe system” and risks “future deaths.”1 These statements echo those of the Parliamentary Health Service Ombudsman (PHSO) which published a report titled Ignoring the alarms: how NHS eating disorder services are failing patients in 2017.2 As I’m …

Background: Psychotropic drugs are not recommended for child and adolescent eating disorders, though they are used empirically for symptomatic treatment and co-morbid conditions. Little is known about rates of prescribing or the beneficial and adverse effects. Objective: To ascertain rates and outcomes of psychotropic drug prescribing in child and adolescent eating disorder services. Method: Retrospective case note study of eating disorder cases (n = 308), seen in one year in seven specialist UK services, covering indications, response to treatment, beneficial and adverse effects. Results: Drugs were prescribed for 27%, (mainly anorexia nervosa), 12% before referral to specialist services. The most commonly prescribed drugs were fluoxetine and olanzapine, but 26 different drugs were used. The most common indications were depression, anxiety and 'pseudo-psychotic' concerns about weight. Drugs were generally well tolerated, but their effectiveness was uncertain. Conclusions: Non-specialists commonly prescribe psychotropic medication to this vulnerable group without reference to specialist services. Specialists prescribe regularly on empirical grounds, without apparent undue consequences, though these may be under-reported. A prospective clinical trial would further clarify risks and benefits. Key Practitioner Message: • Guidelines do not recommend the use of psychotropic drugs as first line treatments for child and adolescent eating disorders. • Nevertheless drugs are often prescribed on symptomatic grounds, in Primary Care and General CAMHS and more commonly by specialist eating disorder services. • Despite concerns about physical health, psychotropic drugs appear to be tolerated well, though adverse effects may be under-reported. • Antidepressants and major tranquillisers are considered by clinicians to often have beneficial effects on the symptoms they target, though other concurrent treatments may confound these impressions.

Objectives There is increasing evidence of the impact of ultra-processed foods on multiple metabolic and neurobiological pathways, including those involved in eating behaviors, both in animals and in humans. In this study we aimed to explore ultra-processed foods and their link with disordered eating in a clinical sample. Methods This was a single site, retrospective observational study in a specialist eating disorder service using self-report on the electronic health records. Patients with a Diagnostic and Statistical Manual of Mental Disorders (fifth edition) diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) were randomly selected from the service database in Oxford from 2017 to 2019. The recently introduced NOVA classification was used to determine the degree of industrial food processing in each patient's diet. Frequencies of ultra-processed foods were analyzed for each diagnosis at each mealtime and during episodes of binging. Results A total of 70 female and 3 male patients were included in the study; 22 had AN, 25 BN, and 26 BED. Patients with AN reported consuming 55% NOVA-4 foods, as opposed to approximately 70% in BN and BED patients. Foods that were consumed in a binge pattern were 100% ultra-processed. Conclusion Further research into the metabolic and neurobiological effects of ultra-processed food intake on disordered eating, particularly on binging, is needed.

ObjectiveWeight restoration is an integral part of managing anorexia nervosa patients and has been found to be associated with electrolyte and fluid abnormalities gathered under the umbrella term refeeding syndrome, which has led to cautious initiation of caloric regimes. This study looks at how a sample of severe anorexia nervosa patients were managed using higher rates of refeeding than the ones currently recommended.Designretrospective cohort study of consecutive patients with severe eating disorders admitted to an UK specialist tertiary centre. The treatment programme uses a weight restoration regime starting at 1000 kcal/day, increased to 1500 kcal/day after two days and to 2000 kcal/day after seven days. The main outcome was the rate of hypophosphatemia, hypokalemia and hypomagnesemia within the first two weeks of weight restoration. The secondary outcomes included rate of weight gain and tendency of electrolyte shift.Results83% of the patient sample were categorised as extreme anorexia nervosa (BMI ConclusionsThe majority of extremely ill patients with anorexia nervosa tolerate refeeding starting at 25-30kcal/kg. Oral supplementation is effective, so overcautious refeeding is unnecessary, provided that the patient is carefully monitored.

AimsDeliberate self-harm (DSH) is common but rarely studied among inpatients with eating disorders. We sought to investigate the frequency of DSH among inpatients in a specialist adult eating disorders unit, and the association of DSH with comorbidities and treatment outcomes. We also investigated changes in these parameters during the pandemic.MethodWe included the records of 70 patients consecutively admitted to Cotswold House in Oxford between April 2018 and November 2020. Data were analysed using Microsoft Excel using descriptive statistics. For comparisons, student T-tests were used for continuous variables and Chi-square tests used for categorical variables.Result99% of patients were female; their ages ranged from 17 to 67 years (mean 30.7). 81% had a primary diagnosis of anorexia nervosa, and 67% had a history of DSH prior to admission. There was a total of 100 incidences of DSH, of which 12% required transfer to a general hospital for medical treatment.Frequency of self-harm decreased with time throughout admission (17% self-harming on admission, vs 7% at discharge, p = 0.043).Compared to those with no history of DSH, patients who self-harmed during admission were more likely to be detained under the Mental Health Act (45% vs 17.4%, p = 0.003), and to have psychiatric comorbidities (85% vs 35%, p = 0.001). Patients whose self-harm required transfer for general hospital treatment had a lower mean discharge BMI (18.18kg/m2 vs 20.23kg/m2, p = 0.039), longer admission (105.9 days vs 78.1 days, p = 0.037), and gained weight at a slower rate (0.26kg/m2/week vs 0.43kg/m2/week, p = 0.048) than those who did not require transfer.During the pandemic, the frequency of DSH doubled on the ward. Overall outcomes were similar, however mean length of admission was lower during the pandemic (67.83 vs 89.94 days, p = 0.046), and patients regained weight more rapidly (0.43kg/m2/week vs 0.28kg/m2/week, p = 0.003) than prior to it.ConclusionSelf-harm during admission was seen in 29% of patients and was associated with the presence of comorbid psychiatric diagnoses. The frequency of DSH much reduced between admission and discharge, suggesting a beneficial effect of treatment. Medical transfer for DSH, considered as a proxy measure for severity, predicted poorer outcomes in weight restoration. We also noted an increase in rates of DSH during the pandemic, which may have resulted from a combination of increased psychosocial stressors and a reduction in admission capacity in eating disorder units.

Anorexia nervosa is a severe mental disorder that is characterised by dietary restriction, low weight and widespread endocrine abnormalities. Whilst the importance of weight restoration has been recognised in recent guidelines, the significance of normalising body fat mass has received less attention. A recent systematic review and meta-analysis found that a minimum of 20.5% body fat mass is necessary for regular menses in women with anorexia nervosa of reproductive age. This has significant implications for both treatment and research. It is important to help the patient and carers understand that a certain level of body fat percentage is essential for optimal health, such as the return of menstruation. Further research is needed into how best to use this information to help motivation to change as part of treatment. The benefit of the return of menstruation goes beyond improved fertility: it signals the normalisation of sexual hormones, which have a widespread impact on the body and multiple pathways in the brain. Given the complex functions of adipocytes in various organs of the body, the metabolic effects of the normal body fat tissue should not be underestimated. Further research is needed to elucidate the mechanisms behind the link between minimum body fat mass, menstruation, bone and brain health in anorexia nervosa.

SummaryEvolutionary science can serve as the high-level organising principle for understanding psychiatry. Evolutionary concepts generate new models and ideas for future psychiatric study, research, policy and therapy. The authors accordingly make the case for the inclusion of evolutionary biology in the postgraduate education of psychiatric trainees.

There is increasing demand for inpatient treatment of severe eating disorders, both in the UK and internationally. However, hospital treatment of severe eating disorders remains controversial, mainly because of poor long-term outcomes. This chapter provides a highly relevant and clinically focused review of the complex issues involved in inpatient care of people with severe eating disorders. The main guidelines and evidence base are critically reviewed from the point of view of a real-life clinical practice dealing with people with very low body mass indexes. Evidence, or lack of it, for a range of interventions is outlined, including artificial feeding and compulsory treatment. Practical issues regarding management of weight, physical morbidity, and psychological interventions are discussed.

Background Eating disorders affect 1%–4% of the population and they are associated with an increased rate of mortality and multimorbidity. Following the avoidable deaths of three people the parliamentary ombudsman called for a review of training for all junior doctors to improve patient safety. Objective To review the teaching and assessment relating to eating disorders at all levels of medical training in the UK. Method We surveyed all the UK medical schools about their curricula, teaching and examinations related to eating disorders in 2017. Furthermore, we reviewed curricula and requirements for annual progression (Annual Review of Competence Progression (ARCP)) for all relevant postgraduate training programmes, including foundation training, general practice and 33 specialties. Main outcome measures Inclusion of eating disorders in curricula, time dedicated to teaching, assessment methods and ARCP requirements. Results The medical school response rate was 93%. The total number of hours spent on eating disorder teaching in medical schools is Conclusions Eating disorder teaching is minimal during the 10–16 years of undergraduate and postgraduate medical training in the UK. Given the risk of mortality and multimorbidity associated with these disorders, this needs to be urgently reviewed to improve patient safety.

Objective: Caring for someone diagnosed with an eating disorder (ED) is associated with a high level of burden and psychological distress which can inadvertently contribute to the maintenance of the illness. The Eating Disorders Symptom Impact Scale (EDSIS) and Accommodation and Enabling Scale for Eating Disorders (AESED) are self-report scales to assess elements of caregiving theorised to contribute to the maintenance of an ED. Further validation and confirmation of the factor structures for these scales are necessary for rigorous evaluation of complex interventions which target these modifiable elements of caregiving. Method: EDSIS and AESED data from 268 carers of people with anorexia nervosa (AN), recruited from consecutive admissions to 15 UK inpatient or day patient hospital units, were subjected to confirmatory factor analysis to test model fit by applying the existing factor structures: (a) four-factor structure for the EDSIS and (b) five-factor structure for the AESED. Results: Confirmatory factor analytic results support the existing four-factor and five-factor structures for the EDSIS and the AESED, respectively. Discussion: The present findings provide further validation of the EDSIS and the AESED as tools to assess modifiable elements of caregiving for someone with an ED.

The obesity epidemic started in the 1970s, initially in the United States and subsequently spreading worldwide.1 Approximately 60-80% of adults and 20-30% of children in most Western countries are now overweight or obese, which is unprecedented in human history.23 The BMJ asks whether this change should be regarded a consequence of individual choices or a disease affecting the population.4 …

We agree with Astrup and colleagues that the World Health Organization should reconsider its dietary recommendations and prioritise a food based approach in future dietary guidelines.1 People consume foods and not individual nutrients. Reduced intake of saturated fats and their replacement with vegetable oils was first recommended in US dietary guidelines in 1977.2 Vegetable oils have been promoted as healthier alternatives to …

Objective A cognitive interpersonal maintenance model of anorexia nervosa (AN) was first proposed in 2006 and updated in 2013 (Schmidt and Treasure, J Br J Clin Psychol, 45, 343-366, 2006; Treasure and Schmidt, J Eat Disorders, in press.). The aim of this study was to test the interpersonal component of this model in people with AN requiring intensive hospital treatment (inpatient/daypatient). Method On admission to hospital women with AN or eating disorder not otherwise specified (AN subtype; n = 152; P) and their primary carers (n = 152; C) completed questionnaires on eating symptoms (P), depression and anxiety (P, C), accommodation and enabling (C), and psychological control (C). Structural equation modeling was used to examine relationships among these components. Results Carers' expressed emotion and level of psychological control were significantly related to carers' distress, which in turn, was related to patients' distress. This pathway significantly predicted eating symptoms in patients. Discussion The cognitive interpersonal maintenance model of eating disorders (EDs) was confirmed in part and suggests that interventions targeting interpersonal maintaining factors such as carer distress might impact on patient outcomes. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:867–874)

Rationale Anorexia nervosa (AN) is a serious psychiatric disorder with high morbidity and mortality. There are no established pharmacological treatments and the neurobiology of the condition is poorly understood. Previous studies using magnetic resonance spectroscopy (MRS) have shown that AN may be associated with reductions in indices of brain glutamate; however, at conventional field strengths (≤3 T), it is difficult to separate glutamate from its precursor and metabolite, glutamine. Objectives The objective of the present study was to use high field (7 T) MRS to measure concentrations of glutamate, in three separate brain voxels, in women with AN. Methods We studied 13 female participants with AN and 12 healthy female controls who underwent MRS scanning at 7 T with voxels placed in anterior cingulate cortex, occipital cortex and putamen. Neurometabolites were calculated using the unsuppressed water signal as a reference and corrected for individual cerebrospinal fluid concentration in the voxel. Results We found that participants with AN had significantly lower concentrations of glutamate in all three voxels (mean reduction 8%, p = 0.002) but glutamine levels were not altered. Concentrations of N-acetylaspartate, creatine, GABA and glutathione were also unchanged. However, inositol was lower in AN participants in anterior cingulate (p = 0.022) and occipital cortex (p = 0.002). Conclusions Women with AN apparently have widespread reductions in brain glutamate. Further work will be needed to assess if this change has pathophysiological relevance or whether it is a consequence of the many physical changes produced in AN by food restriction. Electronic supplementary material The online version of this article (doi:10.1007/s00213-016-4477-5) contains supplementary material, which is available to authorized users.

There is a shortage of comprehensive and validated instruments to measure satisfaction with Child and Adolescent Mental Health Services (CAMHS). This study chose the Verona Service Satisfaction Scale (VSSS as a template for the development of a new CAMHS Satisfaction Scale (CAMHSSS). The new questionnaires were developed by involving service users and members of the multidisciplinary team in several stages. The psychometric qualities of the 39-item draft were tested on a random sample. A total of 56 adolescents and 104 parents participated in the study. The acceptability of the questionnaires was excellent, and internal consistency was high. Test-retest reliability was between substantial to moderate for individual items, and high for the seven dimension and the final versions of the scale. The questionnaires differentiated well between satisfied and dissatisfied service users. Two versions were generated to measure service satisfaction among outpatients (CAMHSSS-39 and 20) and one for inpatients and day-patients (CAMHSSS-Unit). All have good psychometric properties and can be recommended for future studies.

There has been little research examining the link between dietary fat intake and the symptoms and consequences of anorexia nervosa. In this selective literature review, the potential significance of poly-unsaturated fatty acids is discussed. It is hypothesised that dietary restriction causes essential fatty acid deficiencies and poly-unsaturated fatty acid abnormalities, which might contribute to the physical and mental symptoms and the maintenance of the disorder. The examination of epidemiology, symptoms, co-morbidity, and consequences suggest that poly-unsaturated fatty acid and phospholipid abnormalities are significant in anorexia nervosa. This will be an important area for future research, and may lead to the development of new interventions.

ResumenAntecedentes.Las repeticiones de trinucleótidos se han asociado con la esquizofrenia, pero los datos, basados en información clínica transversal, son equívocos.Propósitos.Examinar la relación entre el tamaño de la repetición de CAG/CTG genómico y el desarrollo premórbido en la esquizofrenia.Método.Se evaluó por entrevistas con los padres el desarrollo temprano y el funcionamiento premórbido de 22 pacientes con diagnóstico de esquizofrenia del DSM IV. Se utilizó la técnica de detección de la expansión de repeticiones (DER) para medir el tamaño de la repetición de CAG/CTG genómico, y la RCP para el tamaño de la repetición de CAG en los loci ERDA-1 y CTG 18.1.Resultados.Hubo una asociación inversa entre el tamaño de CAG/CTG y las complicaciones perinatales. Los pacientes con retraso evolutivo del habla y motor tenían repeticiones mayores. Los resultados no se debían a la expansión en los genes ERDA-1 y CTG 18.1.Conclusiones.La expansión de la repetición de CAG/CTG se asocia con retraso evolutivo del habla y motor en la esquizofrenia. Proponemos que el modelo evolutivo puede ser útil para la investigación en la genética de la esquizofrenia.

SummaryBackground.Trinucleotide repeats have been associated with schizophrenia, but the evidence, based on cross-sectional clinical information, is equivocal.Aims.To examine the relationship between genomic CAG/CTG repeat size and premorbid development in schizophrenia.Method.Early development and premorbid functioning of 22 patients with DSM-IV diagnosis of schizophrenia were assessed by parental interviews. Repeat expansion detection (RED) technique was used to measure genomic CAG/CTG repeat size, and PCR for CAG repeat size at the ERDA-1 and CTG 18.1 loci.Results.There was an inverse association between CAG/CTG size and perinatal complications. Patients with speech and motor developmental delay had larger repeats. The results were not due to expansion in the ERDA-1 and CTG 18.1 genes.Conclusions.CAG/CTG repeat expansion is associated with speech and motor developmental delay in schizophrenia. We propose that the developmental model may be useful for research into the genetics of schizophrenia.

We agree with Womersley and Ripullone that nutrition should be prioritised in medical education.1 This is essential not only for prevention, but also for recognising and managing malnutrition in all patient groups, including people with mental disorders. People with eating disorders, in particular, are often overlooked in medical education. Eating disorders are often regarded as rare and self limiting …

INTRODUCTION: Patients with psychotic illness are frequently dissatisfied with psychiatric services although it is unclear whether this can be explained as being due to the mental disorder itself, or to the lower quality of care received by this group of patients. We explored this issue by comparing service satisfaction from different user perspectives: patients and key relatives. METHOD: The satisfaction and needs of 52 patients with schizophrenia and 66 of their relatives were assessed using the Verona Service Satisfaction Scale (VSSS). RESULTS: Patients were generally more satisfied with services than relatives, but there was a high degree of consistency between the groups regarding the aspects of the service which they were most, and least, satisfied with. CONCLUSION: Patient satisfaction surveys can be used as reliable indicators of service quality and can highlight specific strengths and shortcomings in mental health service provision. Such surveys can be very useful to help improve the quality of c...

AK Ayton MD, MSC, MRCPsych (Corresponding author) Hull and East Riding Community Health NHS Trust, Child and Adolescent Service, 2062-68 Hessle Rd, Hessle. East Yorkshire, HU13 9NW E-mail: A.K.Ayton@hull.ac.uk A Azaz MBBch, DCH, MRCP, MRCPCH Hull Royal Infirmary, Department of Paediatrics, Anlaby Rd, Hull HU3 2JZ DF Horrobin MA, DPhil, BM, BCh Laxdale Research, Kings Park House, Laurelhill Business Park, Stirling FK7 9JQ

The aim of the study was to examine how carers cope practically and emotionally with caring for individuals with anorexia nervosa who require intensive hospital care. Method: This study explores objective burden (time spent with caregiving and number of tasks), subjective burden (psychological distress), and social support in a sample of parents (n 5 224) and partners (n 5 28) from a consecutive series of patients (n 5 178) admitted to inpatient units within the United Kingdom. Results: Most time was spent providing emotional support and less with practical tasks. Time spent with caregiving was associated with carer distress and was fully mediated by carer burden. This was ameliorated by social support. Partners received minimal support from others, and we found similar levels of burden and distress for mothers and partners. Discussion: The data indicate that professional and social support alleviates carer distress and may be of particular value for partners who are more isolated than parents. The data also suggest that time spent with practical support may be of more value than emotional support.

With increased awareness of under 12s, as well as older children, developing serious eating disorders there is an urgent need for early recognition and treatment, as Dr Agnes Ayton explains.

Background In England and Wales the compulsory treatment of young people with severe eating disorders is controversial. There is a concern that such treatment may impair patient autonomy and negatively influence the outcome. In this study, based in a specialist hospital, we compared patients treated under parental consent with those detained under the Mental Health Act: their characteristics and outcome up to 12 months after discharge. Results 34 patients were informal (treated under parental consent) (age: 16.2 ± 1.3 years) and 16 were treated under Section 3 of the Mental Health Act (age: 16.2 ± 1) in a 3-year period. Detained patients had an earlier age of onset (12.2 ± 5 vs. 14.3 ± 1.8) and more previous hospitalisation. On admission, their psychosocial functioning (Children's Global Assessment Scale (C-GAS): 13.6 ± 2 vs. 26.9 ± 9; Health of the Nation Outcome Scale for Children and Adolescents (HONOSCA): 41.7 ± 5 vs. 31.9 ± 5) were worse than voluntary patients', they had a higher level of co-morbid depression (BDI: 38.1 ± 15.6 vs. 26.6 ± 12.4) and a higher rate of suicidal behaviour. All physical and psychosocial measures improved substantially and clinically significantly by discharge and there was no statistically significant difference at this stage between the two patient groups. Two informal patients died within a year after discharge (6.3%), but there were no deaths amongst the detained patients. Comments In contrast with previous findings in adults, the outcome for detained patients was similar to that for informal patients, despite the former having more severe presentation on admission. There was no evidence of higher mortality in the detained group. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.

Anorexia nervosa (AN) carries the highest risk of morbidity and mortality amongst psychiatric disorders. The efficacy of current treatment approaches is limited. Despite the fat-phobic nature of the disease, poly-unsaturated fatty acids (PUFAs) have not received much research attention. Patients who consume western diet, which is rich in n-6 PUFAs and trans-fatty acids, are likely to develop severe n-3 PUFA deficiency during self-induced starvation. Re-feeding programmes do not take into consideration n-3 EFA intake, possibly leading to further n-3 PUFA deficiency during weight restoration, and this might contribute to the maintenance of the disorder. To test this hypothesis, we carried out a systematic case series of E-EPA supplementation in the treatment of AN. Seven young patients received 1 g/day E-EPA in addition to standard treatment, and were followed up for 3 months. Three of them recovered and four improved. Randomised controlled trials are warranted to examine the effectiveness of E-EPA in AN further.

BACKGROUND: It has been demonstrated that adult suicidal behaviour is associated with unemployment and social deprivation. The association between self-harm and social deprivation in young people is less clear. AIMS: To examine the relationship between social deprivation and deliberate self-harm in children and adolescents in an UK district. METHOD: Computer records of patients under 18 years of age presenting with self-harm at the district casualty department were analysed in Hull and East Yorkshire. The relationship with social deprivation was examined using Townsend scores. RESULTS: 730 young people presented with self-harm during a period of two years. Socio-economic deprivation was associated with overdose, self-injury, and poisoning by illicit substances. After controlling for the proportion of single parent households, moving households with children, and adult long-term sickness in each ward, partial correlations remained significant between overdose, self-injury, and Townsend scores. CONCLUSIONS: The results highlight the importance of socio-economic deprivation in the aetiology of deliberate self-harm in young people. Primary and secondary prevention programs cannot be successful without taking this into consideration. Language: en

The arguments put forward by Rose & Lucas ([2001][1]) are rather unclear. On the one hand, Professor Rose emphasises that “any understanding of the human mind and brain needs to locate its structure and workings in the context of evolution and development, as well as social, cultural and