Consultation-liaison activities in Norway.
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Biomedical subjects
Publications and source records attributed to F Askevold.
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Biopsies from four young women with advanced anorexia nervosa were examined to investigate the effect of malnutrition on skeletal muscles. None of the patients showed signs of neuromuscular disease and all were physically active at the time of examination. Cryostat sections from the vastus lateralis muscle were stained with hematoxylin-azophloxin-safran and with stains for myofibrillar ATP-ase activity. In addition to routine examination of the sections, the size and distribution of the type 1 and type 2 fibres were calculated by means of a Kontron Digiplan MOP 02. Routine stained sections showed a small grouped atrophy in three cases and a more diffuse atrophy in the fourth. Enzyme histochemical stains revealed a distinct type 2 atrophy, a finding which should serve to distinguish the changes of pure malnutrition from those of conventional denervation. Exact measurements confirmed the predominant type 2 atrophy but showed definite atrophy also of the type 1 fibres. Compared with normal controls the type 1 fibres were reduced by 46% and the type 2 fibres by 75%. These findings are largely in agreement with the recent observations by Essén et al. (1981) on anorexia nervosa. However, in contrast to Essén et al. we did not find any change in the numerical distribution of the fibre types, especially no increase in type 1 fibres. Thus, we could not confirm the hypotheses of a conversion of the fibre types in cachexia.
In six diseases considered psychosomatic (asthma, angina pectoris, migraine, duodenal ulcer, ulcerative colitis and anorexia nervosa), two factors have been studied: social background and social mobility. For none of the first five has any influence of social status on the disease been demonstrated. This means that social learning (norms and values) does not influence the disease. The psychological conflict is rooted earlier in life, before formative learning takes place. For anorexia nervosa, on the other hand, there is a marked difference. Social status plays a significant role, especially middle-class values, those of sexuality being the most important.
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Two female monozygous twin pairs discordant for anorexia nervosa are reported, and literature reports on 18 other monozygous pairs are reviewed. Four of the reported pairs are inadequately described and there is doubt about the diagnosis. When the 2 pairs reported here are included, 16 pairs remain: l (38%) were concordant and 10 discordant. Only 3 pairs fulfilled rigorous criteria for anorexia nervosa and zygosity and one of the pairs was concordant. The population prevalence is probably about 2 promille for hospitalized cases, and there is a 6% risk for female sibs of anorectic probands. Hence, if about 1/3 of monozygotic pairs are in fact concordant, a role of genetic factors in the etiology may be suggested.
The classic textbook concepts of neuropathic traits--enuresis, nail-biting, finger-sucking, sleep-walking, anxiety, nightmares, fear of darkness--have been anamnestically recorded in patients in a somatic hospital who were referred for psychiatric interview. More than 50% of the patients could report having had one or more such traits with an even distribution between males and females except for enuresis, which was recorded more frequently in males. The presence of such traits was correlated to adult mental health. No correlation was found between one single trait and later disorders. There was a positive correlation between two or more traits and neurotic states of anxiety or conversion neurosis, but no correlation with depressive disorders or psychosomatic diseases (after Alexander's concept).
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A new, very simple and inexpensive METHOD FOR MEASUREING BODY IMage is described. A number of female patients with different somatic complaints were investigated. A specific patterning of body image related to the localization of somatic complaints is revealed. Anorexic and obese patients have an overall larger body image while the distortions in other conditions mostly go on the elevation in the vertical axis. Different aspects of this way of measuring body image are discussed, but the difference of the patterning is clear. This is a preliminary report on the new method.
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