Caring for individuals with an eating disorder

A longitudinal study indicated that carers experienced long-term moderate levels of psychological distress and burden. High levels of negative expressed emotion, use of maladaptive coping strategies and unmet needs predicted burden longitudinally. Further, eating disorder sufferers underestimate the burden experienced by carers. The results support the use of carer-based intervention.

Unconscionable conduct : an evolving moral judgement

Statutory unconscionable conduct has been a controversial component of Australia's consumer laws since well before the first provision was introduced in 1986. Nevertheless, it has survived numerous reviews and has expanded beyond its early focus on consumers to provide small business - and, more recently, any business other than a listed company - statutory protection against unconscionable conduct occurring in trade or commerce.

Association between abnormal psychosocial situations in childhood, generalised anxiety disorder and oppositional defiant disorder

Objective: Psychosocial stressors are important in the pathogenesis of most mental disorders. However, little is known about the way psychosocial stressors uniquely combine to create risk for different expressions of child and adolescent psychopathology. The purpose of this study was to determine whether core dimensions of stressful psychosocial situations are differentially associated with childhood generalized anxiety disorder and oppositional defi ant disorder.

Method: A case-control design conducted in Trondheim (Norway) from 2002 to 2004 comparing exposure to ICD-10-defi ned abnormal psychosocial situations (Z-codes) among 21 children with oppositional defi ant disorder (ODD) and 22 children with generalized anxiety disorder (GAD) recruited from a university outpatient clinic with 42 non-patient school controls.

Results: Multigroup discriminant analysis extracted two signifi cant dimensions within the psychosocial variables assessed. Function 1 was characterized by overprotection, parental pressures and acute life events and was associated with GAD. Function 2 was characterized by parental abuse/hostility and interpersonal stress and was associated with ODD. Both dimensions were able to correctly classify 89.7% of the cases, compared to 35.9% by chance.

Conclusions: The results indicate that specifi c psychosocial dimensions are differentially related to childhood GAD and ODD. This may be useful in targeting at-risk populations for preventive intervention as well as informing more accurate alignment of psychosocial resources for treatment.

Childhood sexual abuse and adolescent eating disorder : findings from the Victorian Adolescent Health Cohort study

Objective: To examine the relationship between childhood sexual abuse (CSA) before the age of 16 years and later onset of bulimia and anorexia nervosa symptoms in females.

Design: A longitudinal cohort study of adolescents observed from August 1992 to March 2003. The cohort was defined in a 2-stage cluster sample using 44 Australian schools in Victoria.

Setting: Population based.

Participants: A total of 1936 persons participated at least once and survived to the age of 24 years, including 999 females. The mean (SD) age of females at the start of follow- up was 14.91 (0.39) years; and at completion, 24.03 (0.55) years.

Main Exposure: Self-reported CSA before the age of 16 years was ascertained retrospectively at the age of 24 years.

Outcome Measures: Incident Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)–defined partial syndromes of anorexia and bulimia nervosa were identified between waves 4 (mean age, 16.3 years) and 6 (mean age, 17.4 years) using the Branched Eating Disorder Test.

Results: The incidence of bulimic syndrome during adolescence was 2.5 (95% confidence interval, 0.80-8.0) times higher among those who reported 1 episode of CSA and 4.9 (95% confidence interval, 1.9-12.7) times higher among those who reported 2 or more episodes of CSA, compared with females reporting no episodes, adjusted for age and background factors. The association persisted after adjusting for possible confounders or mediators measured 6 months earlier, including psychiatric morbidity and dieting behavior. There was little evidence of an association between CSA and partial syndromes of incident anorexia nervosa.

Conclusion: Childhood sexual abuse seems to be a risk factor for the development of bulimic syndromes, not necessarily mediated by psychiatric morbidity or severe dieting.

Identification and genetic determination of an early life risk disposition for depressive disorder : atypical stress-related behaviour in early childhood

Progress in psychiatric genetics has been slow despite evidence of high heritability for most mental disorders. We argue that greater use of early detectable intermediate traits (endophenotypes) with the highest likely aetiological significance to depression, rather than complex clinical phenotypes, would be advantageous. Longitudinal data from the Western Australian Pregnancy Cohort (Raine) Study were used to identify an early life behavioural endophenotype for atypical hypothalamic-pituitaryadrenocortical function in adolescence, a neurobiological indicator of anxiety and depression. A set of descriptors representing rigid and reactive behaviour at age 1 year discriminated those in the top 20% of the free salivary cortisol exposure at age 17 years. Genetic association analysis revealed a male-sensitive effect to variation in three specific single nucleotide polymorphisms within selected genes underpinning the overall stress response. Furthermore, support for a polygenic effect on stress-related behaviour in childhood is presented.

Ability of predator odour exposure to elicit conditioned versus sensitised post traumatic stress disorder-like behaviours, and forebrain ΔFosB expression, in rats

At present, exposure of a rodent to the odour of a predator is one of the most common animal models of post traumatic stress disorder (PTSD). Despite this, the model remains incompletely characterized, particularly in regard to within subject assessment of major PTSD-like behaviours. In an attempt to redress this situation, we have extensively characterized the two broad categories of behaviour that are considered to characterize PTSD, that is sensitized behaviours such as social withdrawal and hypervigilance and conditioned behaviours such as avoidance of trauma linked cues. Specifically, we determined the presence and duration of both conditioned and sensitized behaviours, in the same cohort of animals, after three exposures to predator odour. Conditioned fear was assessed on the basis of inhibition of locomotor activity upon return to context 2, 7, 14, 21, and 28 days after the last odour exposure session. To assess the impact on sensitization behaviours, we monitored acoustic startle responses and social interaction behaviour 4, 9, 16, 23, and 30 days after the last exposure session. In addition to examining the behavioural consequences associated with odour exposure, we also determined the key brain regions that were activated using ΔFosB immunohistochemistry. Our results show that the two groups of behaviours thought to characterize PTSD (conditioned and sensitized) do not travel together in the predator odour model, with clear evidence of enduring changes in conditioned fear but little evidence of changes in social interaction or acoustic startle. With regard to associated patterns of activity in the brain, we observed that odour-exposed animals exhibited significantly higher numbers of FosB-positive nuclei in only the medial prefrontal cortex (mPFC), a finding that can be viewed as being consistent with the observed behavioural changes.