This paper reviews the presence of catatonia in neurodevelopmental disorders, with emphasis on autism spectrum disorders. Clinical presentations are reviewed, followed by catatonia treatment algorithms including lorazepam and ECT.

A literature review of catatonia in autistic, developmentally disabled and neurologically impaired populations was conducted. This was combined with the author's experience with patients with autism as well as traumatic, infectious and congenital brain injuries, all of whom developed frank catatonia.

Catatonia is a unique neurobiological syndrome with multiple psychiatric, neurological, medical and drug-related etiologies. Most commonly associated with bipolar affective illness, catatonia has also been found in 12-17% of patients with autism. Other neurodevelopmental disorders may similarly present with catatonia. Blueprints for treatment of catatonia include lorazepam and electroconvulsive therapy. While current literature supports the appropriateness, safety and efficacy of ECT for catatonia in autistic and developmentally disabled populations, treatment barriers may persist. The following cases are presented:

Pt 1: A 14 year-old female with encephalitis of unknown origin and profound catatonia. Cultural barriers prevented treatment.

Pt 2: A 20 year-old male with high-functioning autism and catatonia characterized by alternating stupor and extreme psychomotor agitation with self-injury.

Pt 3: A 15 year-old male with congenital agenesis of the cerebellum and vermis in frank catatonic stupor mistakenly attributed to his disability.

Catatonia is readily diagnosed in a variety of neurodevelopmental conditions including autism, and is eminently treatable with lorazepam and/or ECT in this population. Treatment barriers should be recognized and remedied.

One of the most important attitudes which can affect personal, professional and social operation of individual, especially medical students is assertiveness.

The samples of this research consist of 412 students of Jahrom University who are studying in Doctoral, Nursing, Technician of operation room and technician of Narcosis. Ratus Assertiveness test was used for gathering data.

The score of assertiveness was between 73/8-173.82.3% of students were unassertive and 17/7% was assertive. The highest rate of assertiveness was observed in the students of Narcosis (121.44±19.19) and the lowest rate was seen among doctoral students (113.30±14.64).

The results reveal the prevalence of unassertiveness in the students of Jahrom University. The low assertiveness score in the male students is clear. Also students whose fathers are highly educated and also students who have better economic situation, have higher score.

The object of the research is the determination of the level of social dysfunction with the patients suffering from mental disorders.

There have been examined 327 out-of-clinic (the under-test group) and 211in-clinic (the comparison group) patients.

The structured interview and the social expert technique, statistic. The determination of the limits of the vital functions was performed with the help of the psychiatric scale of the limitation of the vital functions.

Prior to the rehabilitation measures, the performance of the social roles with the 6.1% of the patients of the under-test group has revealed “no dysfunction”, and following the rehabilitation - with the 24.5% of the ill. The comparison's group indices are 6.5% and 11.3% respectively. The minimal dysfunction has been determined with 7.5% and 22.2% respectively of the under-test group and 8.1% and 12,8% ( all ð< 0,05) of the comparison one. The redistribution of the patients into the minimal/no dysfunction subgroup was largely due to the patients with evident, serious and very serious dysfunction. The decrease of the dysfunction of the social roles of all the patients of the under-test group means that the true restoration of the patients’ functioning in the different domains of the society is possible only if there are developed rehabilitation measures targeting at the planning stage the so-called “troubled” social roles.

The true restoration of the patients’ social functioning is possible only if the rehabilitation measures target the “troubled” social roles.

Patients with eating disorders are reported to show emotional processing deficits compared to healthy controls.

To study and discuss the role of emotional processing in eating disorders.

Review of the literature.

Several studies found a marked impairment in emotional processing in eating disorder patients. These emotion-processing deficits seem to be independent of affective symptoms. Different studies address different concepts as emotional awareness, alexithymia and facial or voice emotional recognition. The emotional processing and functioning of eating disorder patients highly impact their relational styles and behaviour.

The literature suggests global emotion-processing deficits in eating disorders. The emotion-processing deficits in eating disorder patients may contribute to the poor interpersonal communication, lack of social cognition and lack of empathy frequently seen in these patients. It is extremely important a better understanding of these complex relationships as they can act as maintenance factors of the eating disorder, contributing to social isolation and therapeutic failure. The prognostic implications of these findings, as well as potential therapeutical interventions are topics valuable for future research in this area.

Several studies report that women with a history of eating disorders are at higher risk of pregnancy complications and major adverse perinatal outcomes.

To report a case of anorexia nervosa during pregnancy, in order to underline the impact of eating disorders on pregnancy.

Case study and review of the literature.

A 32 year old woman was hospitalized in an obstetric service of a general hospital for high risk pregnancy complications. She maintained a disturbed eating behaviour, with periods of restrictive eating and bulimic-purging episodes. She was underweight, did not reach the recommended weight gain during pregnancy and showed intrauterine growth restriction. The Psychiatry Liasion Unit was asked to follow the case during the obstetric hospitalization.

Pregnant women with eating disorders have higher risk of pregnancy and neonatal complications. Pregnancy is a privileged opportunity to maximize intervention in eating disorders, since women show higher levels of motivation for therapy. Some cases of anorexia nervosa may warrant special obstetric care to ensure adequate prenatal nutrition and fetal development. Since there are few studies on this topic and they report conflicting results, it is a relevant area for future research.

The present study investigated the impact of different types of media images (associating the product with thin versus overweight models) on females’ attitudes to chocolate.

Eighty-four female participants were recruited from the general community. Age ranged from 17 to 63 years (mean=35). Mean BMI was 23.4. Participants were allocated randomly to one of three conditions: Chocolate with thin models, Chocolate with overweight models, and Control (non-chocolate related products). Groups did not differ on age and BMI. They were assessed before and after exposure using the Orientation to Chocolate Questionnaire, which measures three dimensions of chocolate craving: guilt, approach and avoidance.

Participants in the thin exposure condition experienced more guilt and were more likely to report both heightened approach and avoidance of chocolate after exposure. In contrast, participants in the overweight exposure condition had lower guilt and lower approach to chocolate, with no change in avoidance, after exposure. No changes were obtained for the females in the control condition.

These findings suggest that viewing thin images in association with chocolate intensifies women's ambivalence towards the product. It is argued that ambivalence is stressful and fosters disordered eating patterns.

Morbid Hunger or persistent Hyperphagia are rare conditions after TBI and can pose life threatening health risks to the patient, risks of aggression towards professional and family carers managing this behaviour, and the ability to function in social settings.

1. 1. Systematic search of Medline, Embase, PsychInfo, CINAHL, DARE, Cochrane Database of Systematic Reviews, and Cochrane Clinical Trials Register, using terms Eating Disorders, Organic Eating Disorders, Binge Eating, Anorexia Nervosa, Hyperphagia, Morbid Hunger, Satiety, Hypothalamus, Pituitary Glands, Traumatic Brain Injury, and Acquired Brain Injury.

2. 2. Diagnostic review of currently admitted hospital patients at a tertiary care brain injury rehabilitation centre in order to establish point prevalence.

3. 3. Review of Dietetic records to establish clinical presentation and management principles.

1. Systematic review identified case reports and case series of these disorders, providing description of three distinct traumatic presentations:

   • a. Persistent Hyperphagia after head injury.

   • b. Serious food seeking behaviour and overeating after surgery for neoplasm resulting in pituitary/ hypothalamic injury.

   • c. Head Injury variant of Kleine Levine Syndrome presenting with Hyperphagia, Hypersomnolence, and Hypersexuality.

2. Diagnostic review of 88 admitted patients identified 2 (3%) patients presenting with this condition.

3. Review of dietetic records confirmed the persistent and serious nature of this presentation and identified a high need for environmental and cue exposure control in management of this condition.

Organic eating disorders are rare but potentially life threatening conditions, requiring formal cataloguing and recognition in diagnostic classifications to facilitate systematic study of pathophysiology and relevant management strategies.

To translate SCOFF questionnaire in French and evaluate its metrological features for the screening of eating disorders (ED) in a student French population.

SCOFF questionnaire is composed by 5 questions and it has been developed for the screening of ED and Its French version isn't currently available. The translation and the transcultural validation were done using international criteria. The validation study employed the Mini International Neuropsychiatric Interview as the gold standard and the French version of SCOFF questionnaire (QD-TCA) paper and pencil form was applied to female students attending yearly evaluation in the Students Health clinic.

The sample was composed of 120 women with a mean age of 20 years (standard deviation - SD - 3.1 years, range 18-35). Thirteen cases (10.8%) of ED were diagnosed having ED (3 cases (2.8%) of anorexia nervosa and 10 cases (8%) of bulimia nervosa). Diagnostic threshold was calculated using the receiver operating characteristics (ROC) curve and fixated at two positive answers. The sensitivity of QD-TCA was of 92% with a specificity of 91.5%. Its positive and negative predictive values for ED were 57.1% and 99%, respectively. Similar results were obtained for AN and BN. Intraclass correlation-R was of 89%.

The French version of SCOFF questionnaire developed by our team (QD-TCA) seems to be a reliable and practical eating disorder's screening tool in a moderate risk student setting.

To examine the natural course of eating disorders (ED) prospectively over 6 years and to examine link between stressful life events (SLEs) and ED relapse among women with personality-disorders (PDs).

Subjects were 132 female patients with bulimia nervosa (N=40) or EDNOS (N=92) in the Collaborative Longitudinal Personality Disorders Study. EDs were assessed with the Structured Clinical Interview for DSM-IV Axis-I, and monitored with the Longitudinal Interval Follow-up Evaluation during follow-up. PDs were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV), and monitored with the Follow-Along version of the DIPD-IV during follow-up. SLEs were assessed with the Life Events Assessment (LEA). Follow-up assessments were conducted at 6- and 12-months and then yearly through 72 months. Proportional hazard regression analyses were performed to examine the link between time-varying levels of SLEs and ED relapse. Cox regressions controlled for the same covariates used in prior work: duration of ED, number of co-morbid psychiatric disorders, and time-varying status of PDs.

Of the 132 patients, 59% had remissions from ED, 68% of whom subsequently relapsed over the course of 6 years (BN and EDNOS did not differ in relapse). Total number of negative SLEs reported by ED patients significantly predicted subsequent ED relapse (HazardRatio=1.5, p< .05). The types of SLEs that predicted ED relapse were elevated work stressors (HazardRatio=3.0, p< .01) and elevated recreation stressors (HazardRatio=3.1, p< .05).

Higher work stress and higher recreation stress represent significant warning signs for triggering relapse for women in remission from BN and EDNOS.

This study aims to examine the effectiveness of a behavioral approach for the treatment of toddlers with infantile anorexia; and the psychopathology and psychological functioning of their mothers before, during and after a structured treatment program.

Three groups of 30 toddlers of either sex, aged 12 - 36 months (inclusive) were included to the study. The groups consisted of toddlers with 1- Infantile Anorexia 2- Picky Eating and 3- Healthy Eating who were referred for a psychiatric evaluation by pediatricians and gastroenterologists at the Department of Pediatrics, Istanbul School of Medicine. Groups were matched by age, sex, and socioeconomic status. Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Symptom Check List - 90 (SCL-90), and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) are used for assessing the maternal psychopathology of cases.

In our sample, mothers of toddlers with IA and PE had more psychiatric symptoms than healthy group. The difference between IA and PE shows that the nutritional status of the child contributes to the psychopathological well-being of the mothers. There was a resolution of depression and anxiety during and after the treatment protocol. Then the psychological status seems to be not the reason but may be the result of the feeding problems. Also interventions that focus primarily on maternal psychopathology may not be effective as a behavioral treatment that focuses on both child and mother.

The aim of this study was to investigate the characteristics of the risk factors for anorexia nervosa (AN) in East Asian subjects.

Two sets of case-control comparisons were conducted, in which 33 women with lifetime AN from Seoul, S. Korea, were compared with 42 women with lifetime AN from the UK and also with 90 Korean healthy controls in terms of their childhood risk factors. A questionnaire designed to conduct retrospective assessments of the childhood risk factors was administered to all participants.

There were no overall differences in the childhood risk factors between the Korean and British women with AN. The Korean AN patients were more likely to report premorbid anxiety, perfectionism and emotional undereating and were less likely to report having supportive figures in their childhood than the healthy controls.

Our findings support the theory that AN is not a culture-bound syndrome. Larger epidemiologically based studies would be needed to validate these preliminary findings.

Obesity is associated with psychological, social and physical problems. The aim of this study was to examine the prevalence of subjective health complaints and their impact on work ability in a sample with morbid obesity.

Fortysix patients, 31 women and 15 men, aged 23 to 65 years (mean 43.7, s.d. 10.7), with BMI from 37 to 60 kg/m2 (mean 45 kg/m2, s.d. 5.02), on a waiting list for bariatric surgery participated. Subjective health complaints were measured by the 29-items Subjective Health Complaint Inventory. Five subscales were computed; Allergy, Flu, Musculoskeletal pain, Gastrointestinal problems and Pseudoneurology.

All participants reported subjective health complaints the last month, in particular they suffered from musculoskeletal (mean 8.2, s.d. 5.46), pseudoneurological (mean 4.7, s.d. 4.31) and gastrointestinal (mean 3.2, s.d. 5.46) complaints. Mean sickness absence the last year was 185 days (s.d. 163.32). Days of sickness absence were significant correlated with the Musculoskeletal (r = .35, p= .023) and Pseudoneurological (r= .40, p= .009) subscales.

All patients reported subjective health complaints, with mean levels of symptoms considerably higher than in the general population. In particular, levels of musculoskeletal and pseudoneurological complaints were high, and these complaints were significantly related to work absence. It thus seems like subjective health complaints influence work ability to a significant degree in patients with morbid obesity.

The classification of eating disorders has been a matter of debate. Recent research indicates the clinical significance of eating disorder not otherwise specified (EDNOS). However, EDNOS is defined by exclusion, i.e.that not to fulfil criteria for anorexia nervosa (AN) or bulimia nervosa (BN). The aim of the present study was to compare bulimic behavior and psychiatric diagnosis in women with BN and EDNOS.

All participants fulfilled the diagnosis according to DSM-IV. Women with BN (purging type, n=34) and age and body mass index matched women with EDNOS (n=31) were examined with respect to clinical condition, bulimic behaviour, purging methods and coexisting psychiatric conditions such as depression, anxiety disorders.

Apart from expected differences in binge eating and compensatory behavior, there were no differences between the two groups. Women with BN had higher scores for weight fobia, previous attempt to commit suicide, impulsive behaviour other than theft, and disturbed impulse control than women with EDNOS, while there were no differences in ten other psychiatric items such as depression, anxiety.

Individuals with partial bulimia (EDNOS) seem to have the same spectrum of psychiatric diagnosis as women with BN even though they fail to meet diagnostic criteria for frequency of binge eating. There is a need to further specified the diagnostic criteria for BN.

The problem of cognitive dysfunction in eating disorders remains controversial and the research results are not univocal. Because of that, research was undertaken on a homogenous group of young patients suffering from eating disorders, hospitalized in the adolescent unit.

The cognitive functions were assessed by Wisconsin Card Sorting Test (WCST) and Digit Span Test in the group of 60 adolescent girls (30 anorectic, 30 bulimic) of the same age and compared with the control group of 39 healthy adolescent girls. Also the relation of cognitive disorders with some clinical features of the illness such as the degree of weight loss, BMI at the admission and discharge and the results of EDI test were assessed.

Research results did not show statistically significant differences in the performance in the WCST between anorectic and bulimic patients and the control group. However, the group of anorectic patients show the tendency to perform worse in some parameters of WCST (TA, TE, PE, %PE, %CLR) than the control group, althought the results do not reach statistical significance. The results of the bulimic patients were better (p=0.04) than the control group in the Digit Span Test.

No correlation was found between clinical data and results in WCST in eating disorder groups of patients while the correlation was found between results of Digit Span Test and BMI at admission in both clinical groups.

The research does not fully confirms that patients suffering from eating disorders show deficits in cognitive functions.