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There have been many observations of the relationship between infectious disease and behaviour changes such as the development of tics documented in medical literature over a long period of time. Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a controversial diagnosis because it relies on linking a causal association between a common childhood illness with less common psychiatric symptoms. This case report describes a possible case of PANDAS in a young person, the course of treatment and its outcome.

o investigate factors which predict positive treatment outcome in inpatients with anorexia nervosa (AN), particularly the role of early treatment response. METHOD: 102 patients entering specialist inpatient treatment were assessed for eating disorder history, psychopathology and motivation to change. Predictive factors assessed were: early treatment response defined as weight increase of at least 0.5-1 kg/week during the first six weeks of treatment; admission BMI; onset age; chronicity; motivation to change; diagnosis; and previous hospitalization for AN. Positive treatment outcome was defined as achieving BMI 17.5 kg/m2 within an individual timeframe. RESULTS: Logistic regression indicated that patients were 18 times more likely to reach positive treatment outcome if they met NICE weight guidelines within the first six weeks of hospitalization. Higher admission BMI was also found to predict positive treatment outcome. DISCUSSION: Higher entry BMI and early weight gain predict positive treatment outcome in individuals receiving specialist AN inpatient treatment.

Normative data for measures of eating disorder (ED) psychopathology provide a fundamental description of a presentation and a means to establish clinically significant change following an intervention. Clinical norms for the ED population are lacking and out of date following the publication of Diagnostic and Statistical Manual of Mental Health Disorders (DSM) 5. This study aimed to show that scores from the Eating Disorder Examination Questionnaire (EDE-q) and the Eating Disorder Inventory (EDI) differ across ED diagnosis groups and provide norm data for DSM-5 ED diagnoses. Patients (n = 932) presenting to an out-patient service over 5 years were retrospectively re-diagnosed based on DSM-5 criteria. Statistical analysis showed a significant difference on most subscale scores of the EDE-q and the EDI across diagnosis. Means, standard deviations and percentile ranks are presented by diagnosis. The norms detailed contribute to improving the accuracy with which scores are interpreted when using DSM-5 and aid with the assessment of clinically significant change following treatment. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

Objective: To determine predictors of treatment outcomes in patients with Bulimic Eating Disorders treated with Interpersonal Psychotherapy (IPT). Design: Fo- llowing initial assessment, 80 patients with diagnoses of Bulimia Nervosa or Eating Disorders Not Otherwise Specified (EDNOS), entered treatment in the form of 16 sessions of IPT. Patients were assessed using a validated semi-structure interview (Clinical Eating Disorders Rating Instrument-CEDRIC) and completed mea- sures of self-esteem (Rosenberg Self-esteem Scale-RSE), eating psychopathology (Eating Disorders Examination Questionnaire-EDE-Q), interpersonal functioning (Inventory of Interpersonal Functioning- IIP-32), and depression (Beck Depression Inventory-BDI). Method: Remission and recovery after 16 sessions of IPT were the two outcomes of interest. Univariate analysis and a series of backwards stepping logistic regressions were performed to determine the variables associated with remission and recovery. Result: Low self-esteem and less interpersonal problems were the main predictors of poor outcome. Conclusion: As patients with Bulimic Disorders with low levels of interpersonal problems and high levels of low self-esteem are likely to do less well with IPT, different type of treatment should be offered to them. A randomized controlled trial could explore this hypothesis in more detail. Key words: Interpersonal Psychotherapy, Bulimia Nervosa, EDNOS, Predictors. Resumen. Objetivo: Determinar los factores de pronóstico del tratamiento de la bulimia nerviosa con terapia interpersonal. Diseño: 80 pacientes con el diagnostico de Bulimia Nerviosa (BN) o trastornos del comportamiento alimentario no especificados con características de BN (TCANE) fueron tratados con 16 sesiones de terapia inter- personal. Los pacientes fueron evaluados utilizando una entrevista semi-estructural (Clinical Eating Disorders Rating Instrument-CEDRIC). También completaron una batería de cuestionarios para evaluar los niveles de estima personal (Rosenberg Self-esteem Scale -RSE), la psicopatología de los trastornos de la alimentación (Eating Disorders Examination Questionnaire-EDE-Q), la función interpersonal (Inventory of Interpersonal Functioning-IIP-32) y los niveles de depresión (Beck Depression Inventory-BDI). Método: El pronóstico de interés fue definido por la variable de remisión y recuperación. Para el análisis del estudio se realizaron una serie de regresiones logísticas. Resultado: Baja estima personal, y una menor patología en la función interpersonal fueron los factores de peor pronóstico. Conclusión: Aunque la terapia interpersonal es un tratamiento efectivo para las personas que sufren de bulimia nerviosa, los pacientes con estas patologías con baja estima personal y menos problemas interpersonales deberían de ser tratados con otro tipo de terapia. Palabras clave: Terapia interpersonal, Bulimia Nerviosa, TCANE, Pronóstico.

To investigate factors which predict positive treatment outcome in inpatients with anorexia nervosa (AN), particularly the role of early treatment response.102 patients entering specialist inpatient treatment were assessed for eating disorder history, psychopathology, and motivation to change. Predictive factors assessed were: early treatment response defined as weight increase of at least 0.5-1 kg/week during the first 6 weeks of treatment (n=87), admission body mass index (BMI), onset age, chronicity, motivation to change, diagnosis, and previous hospitalization for AN. Positive treatment outcome was defined as achieving a BMI of 17.5 kg/m(2) within an individual time frame.Logistic regression indicated that patients were 18 times more likely to reach positive treatment outcome if they met the National Institute for Health and Care Excellence weight guidelines within the first 6 weeks of hospitalization. Higher admission BMI was also found to predict positive treatment outcome.Higher entry BMI and early weight gain predict positive treatment outcome in individuals receiving specialist AN inpatient treatment. Copyright © 2016 John WileySons, Ltd and Eating Disorders Association.

Bulimia nervosa that is complicated by borderline personality disorder can be challenging to treat. Particular problems that may be encountered by those trying to treat patients with these diagnoses include anxiety, splitting, and therapist burnout. There is also the problem of motivation to change, whether they should be predominantly treated as in-patient or outpatient and the role of medication. Dialectical behaviour therapy is one way of treating this sub-group and its main components are described.

Interpersonal psychotherapy (IPT) is an effective treatment for depressive disorder. Over the last two decades, IPT has been modified to treat different mental health problems, including eating disorders. When working with patients presenting with eating disorder psychopathology, the eating disorder behaviour is used as a marker of “abnormality” that is linked to the person’s interpersonal difficulty. Non-suicidal self-injury behaviour (NSSI) within the eating disorder individual can be treated in the same way as the eating disorder behaviour. Within IPT, the therapist firstly aims to identify the interpersonal focus associated with the unhealthy behaviour, in order to work through this focus to reduce the behaviour. This chapter describes the modified version of IPT for eating disorders. It also makes suggestions how IPT may be used in a population of patients with eating disorders and NSSI, by including NSSI in addition to eating disorder behaviour as a marker of distress.

Bipolar disorder is a severe and enduring mental illness. Sildenafil (Viagra) is an increasingly popular drug for the treatment of erectile dysfunction. We believe this to be the first published report to suggest a link between sildenafil and relapse in bipolar illness. We also postulate a mechanism by which this may occur. The Committee on Safety in Medicine (UK) has received two reports whereby sildenafil seems to have been linked with manic relapse (Saeed A, personal communication: 2003).