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Biomedical subjects

Bryan Lask

Publications and source records attributed to Bryan Lask.

At least 19 recordsLinked to original sources
PubMed2005

Pattern of birth in early-onset anorexia nervosa: an equatorial study.

OBJECTIVE: Patients with anorexia nervosa (AN) born in the northern and southern hemispheres are more likely to be born during spring months than at any other time of the year. It has been hypothesized that environmental temperature at the time of conception may have a significant role in this pattern of findings. The current study aims to investigate the pattern of birth of early-onset AN patients in an equatorial region (Singapore), where there is little difference in environmental temperature throughout the year. METHOD: Dates of birth were collected for 102 patients who were born in Singapore and diagnosed with early-onset AN. The patterns of birth were analyzed using chi-square analysis. RESULTS: There was no difference across the year in the birth patterns of patients with early-onset AN in Singapore, nor were there any differences between patients with restrictive and binge/purge AN. DISCUSSION: This lack of seasonal variation in the equator adds support to the "temperature at conception" hypothesis.

Adolescent↗
PubMed2005

Functional neuroimaging in early-onset anorexia nervosa.

Previous neuroimaging studies in early-onset anorexia nervosa provide evidence of limbic system dysfunction. The current study adds support to the possibility by revealing a significant association between unilateral reduction of blood flow in the temporal region and impaired visuospatial ability, impaired visual memory, and enhanced speed of information processing.

Adolescent↗
PubMed2005

Family physician consultation patterns indicate high risk for early-onset anorexia nervosa.

OBJECTIVE: There is often a delay in the recognition of early-onset anorexia nervosa. The current study aimed to determine whether there are specific patterns in the frequency and content of family physician consultations that might predict its onset. METHOD: Lifetime number and type of family physician consultations were recorded for three groups: (a) an index group comprising 19 girls with anorexia nervosa, onset under 14; (b) a clinical control group comprising 19 girls with an emotional disorder; and (c) a nonclinical group comprising 19 girls with no history of mental health problems. RESULTS: Both clinical groups had an elevated number of consultations, particularly in the 5 years before diagnosis. The index group had a significantly higher number of eating, weight, and shape consultations (especially in the year before diagnosis), whereas the clinical control group had a greater number of psychological consultations. CONCLUSION: A single consultation about eating behaviour or weight and shape concerns is a strong predictor of the subsequent emergence of anorexia nervosa.

Adolescent↗
PubMed2005

Reliability and validity of the child version of the Eating Disorder Examination: a preliminary investigation.

OBJECTIVE: The Eating Disorder Examination (EDE) is a reliable and valid semistructured interview that measures the specific psychopathology of anorexia nervosa (AN) and bulimia nervosa. The current study aims to investigate the psychometric properties of the child adaptation of the EDE (ChEDE 12.0). METHOD: The ChEDE was administered to 15 children with AN, 15 children with other clinical eating disturbances, and two groups of 15 age-matched controls. The groups were compared using a two-sample matched groups design. RESULTS: Alpha coefficients for each of the ChEDE subscales indicated a high degree of internal consistency, and interrater reliability was found to be high (r = .91 to r = 1.00). The subscale scores of the AN group were significantly higher than those of the other groups, whereas the other eating disturbance group did not differ from its control group. DISCUSSION: The ChEDE differentiates children with AN from children with other forms of clinical eating disturbance and control children.

Adolescent↗
PubMed2004

Body checking and its avoidance in eating disorders.

OBJECTIVE: One expression of the core psychopathology of eating disorders is the repeated checking and avoidance of shape or weight. Two studies are reported. The primary purpose of the first was to describe the phenomenology of such body checking and avoidance. The aim of the second was to compare body checking and avoidance in women with and without a clinical eating disorder. METHOD: In Study 1, 64 female patients with clinical eating disorders participated in a semistructured interview assessing the features of body checking and avoidance. In the second study, a self-report questionnaire was used to compare body checking and avoidance in women with and without a clinical eating disorder (n = 110). RESULTS: The majority (92%) of the patients in Study 1 checked their bodies to assess their shape or weight and this was associated significantly with eating disorder symptoms. In Study 2, the clinical group had significantly more body checking and avoidance than the comparison group, and there was a strong association between eating disorder psychopathology and body checking and avoidance. CONCLUSIONS: These findings support the view that body checking and avoidance are direct expressions of the overevaluation of shape and weight. Further work is needed to determine whether these expressions contribute to the maintenance of eating disorders.

Adolescent↗
PubMed2003

Early-onset anorexia nervosa: is there evidence of limbic system imbalance?

OBJECTIVE: This study, part of a continuing effort to understand the pathophysiology of the brain in early-onset anorexia nervosa, attempts to validate findings from an earlier study of regional cerebral blood flow and to correlate any abnormalities in blood flow with eating disorder psychopathology. METHOD: Fifteen newly referred children and adolescents with a diagnosis of anorexia nervosa (AN) underwent regional cerebral blood flow (rCBF) examination using single-photon computerized tomography (SPECT) and the Eating Disorders Examination (EDE) for children. RESULTS: Mean age was 14 years 11 months (SD = 1.35). Mean weight for height ratio was 82.79 % (SD = 10.66). SPECT findings showed that 11 (73%) had asymmetry (hypoperfusion) of blood flow in at least one area. Regions of the brain showing hypoperfusion included the temporal lobe (n = 9), parietal lobe (n = 5), frontal lobe (n = 3), thalamus (n = 3), and the caudate nuclei (n = 1). The median EDE subscale scores were high for all four subscales. Those patients with hypoperfusion had higher median EDE subscale scores than those without hypoperfusion, although the differences were not statistically significant. CONCLUSIONS: Most patients in our study had abnormal rCBF, predominantly affecting the temporal lobe, confirming our previous findings. There was no association with the EDE scores. The findings support earlier suggestions of an imbalance in neural pathways or circuits, possibly within the limbic system. This hypothesis is considered within the context of current knowledge and suggestions made with regard to how it might be tested.

Adolescent↗
PubMed2003

The use of the Pros and Cons of Anorexia Nervosa (P-CAN) Scale with children and adolescents.

OBJECTIVE: The Pros and Cons of Anorexia Nervosa (P-CAN) Scale was developed out of a previous qualitative study [Int J Eat Disord 25 (1999) 177] in which the positive and negative aspects of anorexia nervosa (AN) were elicited from individuals with AN. Principal components analysis was then used in an adult sample to reduce the number of items and to derive empirically and theoretically based subscales [Serpell et al., submitted]. The aim of the current study was to validate the P-CAN in children and adolescents with AN and compare the pros and cons of young people with AN with those of adults. METHODS: Forty-eight young people with AN completed the P-CAN and the Eating Disorders Examination, a semistructured interview used to aid in the diagnosis of eating disorders. RESULTS: Validity in younger patients appeared to be good. Children and adolescents showed both similarities and differences from adults tested in a previous study. CONCLUSIONS: The measure is the first to measure attitudes of children and adolescents with AN towards their illness and may prove a useful tool for the measurement of attitudes towards AN in both clinical and research settings.

Adolescent↗
PubMed2003

Family functioning in anorexia nervosa: British and Italian mothers' perceptions.

This study tested the hypothesis that cultural differences would influence individuals' perceptions of family functioning. Mothers of British and Italian children and adolescents with anorexia nervosa completed the Family Assessment Device (FAD). British mothers perceived their families' communication and role definition as less healthy than did the Italian mothers. In contrast, the Italians perceived their families' behavior control methods as less healthy than did the British mothers. The findings might be explained by differences between British and Italian interpretations of the role of "family," particularly giving the British emphasis on independence and the Italian emphasis on family life. It is suggested that these culturally divergent attitudes towards family life might have different influences on anorexia nervosa. Finally, implications for family therapy are discussed, taking into account those characteristics that are more relevant for each cultural group.

Journal Article↗
PubMed2003

The psychosocial correlates of transplant survival.

BACKGROUND: due to the shortage of organs, half of the patients on the waiting list for transplantations die. Clinicians have a duty to identify those patients whom might benefit most. The correlation between psychosocial factors and survival in children who have received lung transplantation for CF has not been investigated. AIMS: to examine: (1) differences in physical, demographic and psychological factors between two groups of children with CF, those who did or did not survive the waiting period for transplantation. (2) Correlations between these factors pre-transplantation and length of survival post transplantation. METHODS: 81 children--mean age 11 years 6 months--and their parents underwent semi-structured standardised interviews and completed standardised instruments prior to being placed on the transplantation waiting list. The following domains were measured: child's disability, psychiatric status and self-esteem; quality of marital relationship and parental psychiatric status; and family attitudes and functioning. RESULTS: 20% of the children on the waiting list had a psychiatric disorder and 60% of the parents scored within the psychiatric disorder range. One third of the parents had marital difficulties, and 20% of the families showed chaotic functioning. Only half of the children survived to receive transplantation. Survivors and non-survivors were comparable with regard to all psychological measures. A follow up of the transplanted children, ranging from 3 to 156 months post-transplantation, produced a group of nine survivors and 30 non-survivors. Only two pre-transplant factors showed a significant association with length of survival after transplantation. Severe physical disability was associated with longer survival (P=0.01), and parental hostility to partner was associated with a shortened life span (P=0.04). No other factors were significantly associated with length of survival. CONCLUSION: there is no evidence to suggest that adverse psychosocial factors should be used as a contraindication to transplantation.

Adolescent↗
PubMed2003

Survival against the odds.

While the majority of patients with cystic fibrosis (CF) survive well into adulthood, some do so against the odds. The severity of their illness, their psychosocial environment, or their failure to adhere to treatment are such that survival could not have been predicted. It appears that some patients are more resilient than others. Some specific components of resilience include comprehensibility, manageability and meaningfulness. These are defined and case examples provided to illustrate their significance.

Adult↗
PubMed2003

Patient-clinician conflict: causes and compromises.

Conflict is an everyday phenomenon, a part of everyday life. It is hardly surprising that it also occurs in a clinical setting, not only between clinicians and within teams, but also between patients, their families and clinicians. This is all the more the likely in a setting that deals with a chronic disease such as CF. The physical, emotional, social and practical burdens of the illness are such that coping mechanisms are stretched to their limits. Disagreements, misunderstandings, impaired trust and different expectations may all challenge the patient-clinician relationship. In a context in which children and adolescents form at least half the clientele, the potential for conflict is intensified because of the involvement of parents. This paper emphasises the normality of such conflicts, and using case illustrations, explains the reasons for conflicts and explores how best to resolve them. The basic principles of conflict-resolution are outlined, and useful techniques, readily applicable in everyday practice, are described.

Adolescent↗
PubMed2002

Pattern of birth in anorexia nervosa. I: Early-onset cases in the United Kingdom.

OBJECTIVES: Previous studies suggest that adults with anorexia nervosa are more likely to be born in spring and early summer. This study examines whether this pattern of birth is true of early-onset anorexia nervosa, and whether there is a relationship between environmental temperature at assumed time of conception and a later diagnosis of anorexia nervosa. METHOD: The population were children and adolescents with diagnoses of anorexia nervosa (N = 259) or "other eating disorders" (N = 149). Distribution of births across the year was compared between groups and relative to standard population norms. Temperature at assumed time of conception was taken from meteorological records. RESULTS: There was a significant preponderance of births among those with anorexia nervosa between April and June, compared with the other months of the year and with the "other eating disorders" group. Anorexia nervosa was also associated with higher environmental temperature at assumed time of conception. CONCLUSIONS: Among early-onset cases in the United Kingdom, patients with anorexia nervosa are more likely to be born between April and June, and to be conceived during warmer months. A tentative "temperature at conception" hypothesis is advanced to explain these findings and to generate further research.

Adolescent↗
PubMed2002

Pattern of birth in anorexia nervosa. II: A comparison of early-onset cases in the southern and northern hemispheres.

OBJECTIVE: In the northern hemisphere, people with anorexia nervosa are more likely to be born in the spring and early summer, particularly when environmental temperature at assumed time of conception is warmer. This study investigates whether there is a comparable effect in the southern hemisphere (Australia), where seasonal and temperature patterns are reversed. METHOD: Date of birth and temperature at assumed time of conception were collected for 199 Australian and 259 UK patients with early-onset anorexia nervosa. Analyses determined patterns of birth and links to temperature at conception. RESULTS: There was little change across the year in the birth patterns of young people with anorexia nervosa in the southern hemisphere. However, there was a significant link between temperature at assumed time of conception and diagnostic subtype. Compared with anorexics of the binge/purge subtype, restrictive anorexics from the southern hemisphere were less likely to be conceived in relatively cool weather. CONCLUSIONS: The findings support a temperature at conception hypothesis (modified for local temperature ranges), rather than suggesting a simple seasonal pattern of birth.

Age of Onset↗
PubMed2002

Restoration of ovarian and uterine maturity in adolescents with anorexia nervosa.

OBJECTIVE: To determine the optimal weight-to-height ratio to achieve maturity of the reproductive organs when visualized by pelvic ultrasound in adolescent girls with anorexia nervosa. To examine the distribution of weight-to-height ratios in the group of adolescents in whom pelvic maturity was attained. METHODS: Adolescent girls with anorexia nervosa received serial transabdominal pelvic ultrasound scans as they regained weight. A record of their weight-to-height ratio had been noted on each occasion. The scans were defined as mature or immature using strict criteria. RESULTS: There was a wide range of weight-to-height ratios in both the mature and immature groups of patients with a considerable overlap between the groups. However, 88% of the sample required a weight-to-height ratio of 100% (body mass index [BMI] 20) to achieve reproductive maturity. CONCLUSION: Previous target weights have been too low to ensure reproductive maturity. The resulting hypoestrogenic state increases the risk of future osteoporosis. Pelvic ultrasound is the safest and most reliable method for determining ovarian and uterine maturity in adolescent girls with anorexia nervosa.

Adolescent↗
PubMed2002

Anorexia nervosa: obsessive-compulsive disorder, obsessive-compulsive personality disorder, or neither?

Anorexia nervosa (AN) is a severe and often chronic disorder with uncertain aetiology and poor prognosis. New approaches to the understanding of the disorder are needed in order to aid the development of more effective treatments. Several authors have suggested that AN has a considerable overlap with obsessive-compulsive disorder (OCD) and that this may reflect common neurobiological, genetic, or psychological elements. However, more recent studies have suggested that AN may have a closer relationship with obsessive-compulsive personality traits such as those found in obsessive-compulsive personality disorder (OCPD). In this paper, evidence for links between the three conditions is reviewed, suggestions for further research are outlined and possible implications for the treatment of AN are presented.

Anorexia Nervosa↗
PubMed2002

Eating disorders in school-aged children.

It is widely accepted that eating disorders do occur in children. There is a growing literature on childhood-onset AN, and it seems that the core behavioral, psychologic, and physical features are similar to those in adults. The differences between children and adults also must be taken into account, however. Because children have lower levels of body fat, they tend to become emaciated and suffer the effects of starvation for more quickly than adults, which must be taken into account when considering treatment. Although cases of childhood-onset BN have been reported, they are so rare that empirical research is difficult. Clinical features reported regarding the atypical childhood-onset eating disorders generally concur, although empirical testing of these features has yet to be developed. Theories as to why children develop these disorders need further development. The general consensus is that all childhood-onset eating disorders must be considered using a multidimensional model that takes into account physical, psychologic, social, and family factors in origin, assessment, and treatment.

Anorexia Nervosa↗