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Relevance of diminished mental capacity in anorexia nervosa (AN) to course of disorder is unknown.
To examine prognostic relevance of diminished mental capacity in AN.
A longitudinal study was conducted in 70 adult female patients with severe AN. At baseline, mental capacity was assessed by psychiatrists, and clinical and neuropsychological data (decision-making) were collected. After 1 and 2 years, clinical and neuropsychological assessments were repeated, and remission and admission rates were calculated.
People with AN with diminished mental capacity had a less favourable outcome with regard to remission and were admitted more frequently. Their appreciation of illness remained hampered. Decision-making did not improve, in contrast to people with full mental capacity.
People with AN with diminished mental capacity seem to do less well in treatment and display decision-making deficiencies that do not ameliorate with weight improvement.
Mental capacity to consent to treatment in anorexia nervosa is a neglected area in clinical decision-making.
To examine clinical and neuropsychological parameters associated with diminished mental capacity in anorexia nervosa.
An explorative study was conducted in 70 adult female patients with severe anorexia nervosa. Mental capacity to consent to treatment was assessed by experienced psychiatrists. Further measurements included the MacCAT-T (to assess mental capacity status), a range of clinical measures (body mass index (BMI) and comorbidity) and neuropsychological tests assessing decision-making, central coherence and set-shifting capacity.
Diminished mental capacity occurs in a third of patients with severe anorexia nervosa and is associated with a low BMI, less appreciation of illness and treatment, previous treatment for anorexia nervosa, low social functioning and poor set shifting.
Assessment of diminished mental capacity in anorexia nervosa requires careful evaluation of not only BMI, but also the degree of appreciation of illness and treatment, history and the tendency to have a rigid thinking style.
Reactive nitrogen (Nr) has well-documented positive effects in agricultural and industrial production systems, human nutrition and food security. Limited Nr supply was a key constraint to European food and industrial production, which has been overcome by Nr from the Haber–Bosch process.
Given the huge diversity in Nr uses, it becomes a major challenge to summarize an overall inventory of Nr benefits. This full list of benefits needs to be quantified if society is to develop sound approaches to optimize Nr management, balancing the benefits against the environmental threats.
When reviewing trends in European Nr production rates, including those from chemical and biological fixation processes, and the consumption of this Nr in human activities, agriculture is by far the largest sector driving Nr creation.
Particular attention has been given to relationships between N application rates, productivity and quality of products from major crops and livestock types, including consideration of the mechanisms underlying variations in N response/outputs and the derived impacts on land use and land requirements.
Key findings/state of knowledge
The economic value of N benefits to the European economy is very substantial. Almost half of the global food can be produced because of Nr from the Haber–Bosch, and cereal yields in Europe without fertilizer would only amount to half to two-thirds of those with fertilizer application at economically optimal rates.
The link between degree of urbanisation and a number of mental disorders is
well established. Schizophrenia, psychosis and depression are known to occur
more frequently in urban areas. In our primary care-based study of eating
disorders, the incidence of bulimia nervosa showed a dose–response relation
with degree of urbanisation and was five times higher in cities than in
rural areas. Remarkably, anorexia nervosa showed no association with
urbanisation. We conclude that urban life is a potential environmental risk
factor for bulimia nervosa but not for anorexia nervosa. These findings
provide a promising avenue for further research into the aetiology of eating
No study outside the UK has examined the diagnostic stability of psychotic disorders in a population-based sample.
To determine diagnostic stability in a Dutch population-based psychosis incidence cohort, to examine the frequencies of diagnostic shifts to and from schizophrenic disorders and to report the revised relative risks of schizophrenic disorders for immigrants.
A 30-month follow-up study assessed the cohort (n=181) by means of face-to-face diagnostic interviews.
Diagnostic stability of schizophrenic disorders was high (91%), but lower for other psychotic disorders. At follow-up, the initial diagnosis was adjusted to schizophrenic disorder more often than that the reverse occurred. Almost half (49%) of the patients who were not initially diagnosed as having a schizophrenic disorder received this diagnosis at follow-up. The relative risks for most immigrant groups were stable.
Schizophrenic disorders are underdiagnosed, rather than overdiagnosed, at first presentation.
General practitioners using DSM-III criteria have studied the incidence and prevalence of anorexia nervosa and bulimia nervosa in a large (N = 151781) representative sample of the Dutch population. The incidence rate for anorexia nervosa is 6·3 and for bulimia nervosa 9·9 per year per 100000 population. The prevalence of bulimia nervosa is three times higher in larger cities than in smaller urbanized or rural areas, while anorexia nervosa is found with almost equal frequency in areas with a different degree of urbanization.
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