Sixteen morbidly obese patients (12 females, four males) underwent the Scopinaro operation according to Gazet. Profound weight loss occurred, along with marked improvements in eating patterns, mood and psychosocial functioning which were reported retrospectively 1 year and repeated 2 years after surgery. Continued binge eating, comfort eating and 'eating sensibly/making up in private' were associated with reduced weight loss, suggesting that a therapeutic cognitive behavioral program to correct eating problems in association with the Scopinaro operation may increase weight loss. Some physical symptoms were related to increased (burping) or decreased (hunger, thirst) intake of food, but the patterns of preoperative symptoms did not predict postoperative physical symptoms or weight loss. Subjects were divided into two subgroups with (n = 8) or without (n = 8) a history of self-damaging and addictive behaviors. The aberrant behavior subgroup had more disturbed eating patterns preoperatively (higher BITE severity scores) but similar BITE scores postoperatively. Mean BMIs were similar before and after surgery. This suggested that patients with these aberrant behaviors should not be denied surgery. Half of the female patients reported early sexual abuse, and were lighter than the non-abused group. This merits further investigation.
The effect of a satiating meal on the serum and urinary concentrations of procolipase propeptide (Ala-Pro-Gly-Pro-Arg, APGPR) immunoreactivity, as measured by enzyme linked immunosorbent assay (ELISA) specific for free APGPR, has been studied in normal and morbidly obese human subjects. The normal subjects displayed a biphasic response with coordinate increases in both serum and urine APGPR immunoreactivity both occurring within the first two hours after the meal. In two of three of the morbidly obese subjects, this early rise in APGPR concentration in urine was not seen but was foliowed by a slow rise in urinary APGPR immunoreactivity at four to six hours. In both the normal and obese groups, the urinary immunoreactive signal was found to coelute with synthetic APGPR on gel chromatography. In rats, procolipase propeptide (Val-Pro-Asp-Pro-Arg, VPDPR) specifically inhibits fat intake early in the postprandial period when given peripherally or centrally. This study suggests that in humans APGPR reaches the circulation shortly after feeding and is excreted in the urine. These findings are consistent with the hypothesis that human procolipase propeptide may also act as a satiety signal. In addition the late appearance of the peptide in some of the morbidly obese patients could be associated with perturbation of appetite control in these subjects.
This clinical study examines the prevalence of stealing and the personal and behavioural factors which distinguish stealing and non-stealing behaviour in a population of 312 female normal-weight bulimics. Bulimic patients who stole had poorer early interpersonal relationships, earlier onset of sexual feelings with greater subsequent sexual activity and increased illicit drug use. The suggestion is made that stealing is a marker of severity. In addition, bulimics who stole appeared to exhibit more obsessional qualities with increased ritualisation.
Objective: To describe some of the practical considerations and dilemmas that were faced in setting up an Early Psychosis program in the Noarlunga region of Adelaide, South Australia. Conclusions: The clients had high rates of illicit drug use and forensic problems and experienced rates of rehospitalisation of around 60% over the first two years after registration. It was noteworthy that 19% of admissions occurred within three months of registration. The therapeutic relationship between staff and clients with early psychosis was complex, and the ambivalence noted by clients in satisfying dependence/independence needs in the therapeutic relationship appeared to reflect the influences of illness and life stage development. Collaborative relationships with clients were supported by steps such as feedback from clients, leading to simplification of the content of the psychoeducation program, reduction in written information, and co-facilitation of the group by a client who had undergone a psychotic episode. A change in the venue to a local youth group was well received by clients. However, at other times, clients appeared to seek more direction from staff and possess more basic care needs, particularly when seriously ill. Maslow's ‘Hierarchy of Needs’ offered a useful framework for conceptualising many of these issues. A local community network of agencies was formed, allowing clients to address self-identified needs.
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