Differences In Course Research Articles

Observational study to compare the clinical efficacy of the natural surfactants Alveofact and Curosurf in the treatment of respiratory distress syndrome in premature infants

Natural surfactants have been shown to be superior to synthetic surfactants in the treatment of neonatal respiratory distress syndrome (RDS). In Germany, Alveofact (A) and Curosurf (C) are the most frequently used natural surfactant preparations. The aim of this retrospective, observational study was to compare the effects of A and C on gas exchange and outcome in premature infants. During a 5-year period in our neonatal intensive care unit (NICU), 187 premature infants were treated with surfactant, with 82 receiving A and 105 receiving C. We recorded F(I)O(2) and gas exchange (PaO(2)/F(I)O(2) ratio, PaCO(2), SaO(2)) during the first 72h after surfactant application and the incidence of outcome parameters at day 28 (bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH grade III or IV), patent ductus arteriosus (PDA), pneumothorax, necrotizing enterocolites (NEC) and death). The differences between the patient groups were assessed by ANOVA or the calculation of relative risks. Bonferroni correction was used for multiple comparisons. There were no statistically significant differences between infants treated with A and C in mean gestational age (28.4 vs. 28.4 weeks), birth weight (1210 vs.1258 g) and time of first surfactant application (60 vs. 90 min postnatal). We observed no significant between group differences in course of F(I)O(2) and blood gases, or in incidence at day 28 of BPD (41.7% vs. 42.8%), IVH III/IV (18.3% vs. 14.3%), pneumothorax (9.8% vs. 4.8%), PDA (23.2% vs. 21.9%), PVL (7.3% vs. 9.5%) and death (17% vs. 17.1%). There were also no statistically significant differences in the subgroup of infants <28 weeks. The lower incidence of NEC in A compared with C (1.2% vs. 10.5%, P=0.01) was not statistically significant after Bonferroni correction. Independent of gestational age no significant difference in the clinical efficacy of A and C was observed.

What Is Bipolar Disorder?

What Is Bipolar Disorder?

Cross-generational effects on gender differences in psychoactive drug abuse and dependence

Background: Studies of patients with cocaine and heroin use disorders have shown gender differences in prevalence, course, and outcome. These differences may be decreasing in successive generations. Less is known about gender differences in course and symptomatology for other illicit drug use disorders, especially in community samples. Method: Participants (1323 men and 1384 women) who were biological or step-parents of twins and born in the 1940–1960s, from the Minnesota Twin-Family Study (MTFS) were divided into two cohorts based on the median birth year. A structured interview was used to assess DSM-III-R cannabis, amphetamine, cocaine and hallucinogen use disorders. Results: There was a higher prevalence of each of these drug disorders and earlier onset of cannabis and amphetamine use disorders in later-born participants. For most drug use disorder categories, men and women were similar with respect to age of onset and severity of disorder but women had a shorter course of drug use disorders. Women with amphetamine disorders were atypical with respect to having a higher frequency of use but similar number of lifetime uses compared to men, and more emotional effects of amphetamine intoxication than men. In addition, women with amphetamine disorders were more likely to have anorexia nervosa than those without amphetamine disorders. Conclusions: These results have several implications for prevention, etiology and treatment.

Arthritic syndromes that defy diagnosis.

The catalogue of diseases and syndromes that af ict the supporting structures of the body contains more than 100 diagnoses. Many of these are names of convenience, grouping seemingly related symptoms and signs that often occur in conjunction as a single diagnostic entity. Rheumatoid arthritis, the sine qua non of rheumatology, and osteoarthritis, the most prevalent joint disorder, are cases in point. Common features on presentation account for the classiŽ cations, but for rheumatoid arthritis, the cause or causes remain puzzling and the differences in course, prognosis, and ages of patients may suggest different etiologies. For osteoarthritis, the Ž nal common pathway of af ictions of the joints, the contentious issue remains why only a proportion develops symptoms of a severity that requires intervention. Some others among the rheumatic diseases are more distinct, united by shared epiphenomena and immunologic or molecular abnormalities. However, the most prevalent rheumatic symptoms remain self-reported chronic pains and associated self-reported features, such as cognitive dysfunction, sleep disturbances, tiredness bordering on fatigue and a variety of bowel dysfunctions. There are no organic Ž ndings to back up these contentions, but they assuredly are self-perceived by those reporting them and have resulted in some labels: Ž bromyalgia, myofascial pain syndrome, chronic fatigue syndrome, and others that may include Gulf War illnesses. In many cases, physicians diagnose the disorders by these labels and may succumb to post hoc ergo propter hoc reasoning to assign causation. The event preceding the onset, whether it be an accident, a breast implant or problematic exposure to vaccines or chemicals, deŽ nes the complaints and is assumed to be responsible for them. For this conclusion there is enthusiastic acclamation from so-called support groups that usually have the category in their name and in

The Course of Bipolar Disorder and the Nature of Agitated Depression

The Course of Bipolar Disorder and the Nature of Agitated Depression

Chronicity, relapse, and illness--course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up.

Anxiety disorders are chronic illnesses that occur more often in women than men. Previously, we found a significant sex difference in the 5-year clinical course of uncomplicated panic disorder that was attributable to a doubling of the illness relapse rate in women compared to men. However, we have not detected a sex difference in the clinical course of panic with agoraphobia, generalized anxiety disorder (GAD), or social phobia (SP), which are conditions generally thought to be more chronic than uncomplicated panic disorder. Given that a longer follow-up period may be required to detect differences in clinical course for more enduring illnesses, we conducted further analyses on this same cohort after a more protracted interval of observation to determine whether sex differences would emerge or be sustained. Data were analyzed from the Harvard/Brown Anxiety Research Program (HARP), a naturalistic, longitudinal study that repeatedly assessed patients at 6 to 12 month intervals over the course of 8 years. Data regarding remission and relapse status were collected from 558 patients and treatment was observed but not prescribed. Cumulative remission rates were equivalent among men and women with all diagnoses. Patients who experienced remission were more likely to improve during the first 2 years of study. Women with GAD continued remitting late into the observation period and experienced fewer overall remission events by 8 years. However, the difference in course failed to reach statistical significance. Relapse rates for women were comparable to those for men who suffered from panic disorder with agoraphobia, GAD, and SP. Again, initial relapse events were more likely to occur within the first 2 years of observation. However, relapse events for uncomplicated panic in women were less restricted to the first 2 years of observation and by 8 years, the relapse rates for uncomplicated panic was 3-fold higher in women compared with men. Anxiety disorders are chronic in the majority of men and women, although uncomplicated panic is characterized by frequent remission and relapse events. Short interval follow-up shows sex differences in the remission and relapse rates for some but not all anxiety disorders. These findings suggest important differences in the clinical course among the various anxiety disorders and support nosological distinctions among the various types of anxiety. It may be that sex differences in the clinical course of anxiety disorders hold prognostic implications for patients with these illnesses.

Erratum to: Systemic and cavernous plasma levels of endothelin (1–21) during different penile conditions in healthy males and patients with erectile dysfunction

The role of the sympathetic adrenergic nerves in mediating the constant tone of penile flaccidity and returning the erect penis to its flaccid state is fairly well established. However, it is not yet known whether additional nonadrenergic transmitters are involved in this process. The peptide endothelin-1 (ET-1) may be one of the factors contributing to such a control. Moreover, it has been speculated by various authors that ET-1 might be involved in the pathophysiology of erectile dysfunction. The present study was undertaken to determine whether or not there is a difference in the courses of ET-1/-2 plasma levels registered in systemic and cavernous blood cavities taken from healthy males and patients with ED during different penile conditions (flaccidity, tumescence/rigidity, detumescence). Thirty-two healthy adult males and 25 patients were exposed to visual and tactile erotic stimuli in order to elicit penile tumescence and, in the group of healthy volunteers, rigidity. Whole blood was aspirated from the corpus cavernosum and the cubital vein, and ET-1/-2 was determined in plasma aliquots by means of an enzyme-linked immunoassay (ELISA). Mean systemic and cavernous plasma level of ET-1/-2 in blood samples obtained from the volunteers was 0.2-0.7 fmol/ml. In the healthy males, no changes in ET-1/-2 levels were observed in the systemic and cavernous blood during penile tumescence, rigidity and detumescence. In the group of patients, mean plasma ET-1/-2 levels in the phase of penile flaccidity and detumescence were found to be higher in the systemic circulation than in the cavernous blood (flaccidity: 0.52+/-0.38 fmol/ml vs. 0.48+/-0.46 fmol/ml, respectively; detumescence: 0.53+/-0.33 fmol/ml vs. 0.27+/-0.11 fmol/ml, respectively). No differences in the plasma courses of ET-1/-2 were found between patients with an organogenic and psychogenic etiology of ED. In the phase of detumescence, the mean ET-1/-2 level was lower in the cavernous blood cavities taken from the patients than in the samples obtained from the healthy males. Our study revealed a difference in the profiles of ET-1/-2 registered in the cavernous blood of healthy subjects and patients with erectile dysfunction. Nevertheless, since this difference seems to be of no physiological significance, our data counteract the hypothesis of an ultimate importance of ET-1 in the control of penile flaccidity and detumescence and do not support speculations regarding an involvement of ET-1 in the pathophysiology of erectile dysfunction.

Systemic and cavernous plasma levels of endothelin (1-21) during different penile conditions in healthy males and patients with erectile dysfunction.

The role of the sympathetic adrenergic nerves in mediating the constant tone of penile flaccidity and returning the erect penis to its flaccid state is fairly well established. However, it is not yet known whether additional nonadrenergic transmitters are involved in this process. The peptide endothelin-1 (ET-1) may be one of the factors contributing to such a control. Moreover, it has been speculated by various authors that ET-1 might be involved in the pathophysiology of erectile dysfunction. The present study was undertaken to determine whether or not there is a difference in the courses of ET-1/-2 plasma levels registered in systemic and cavernous blood cavities taken from healthy males and patients with ED during different penile conditions (flaccidity, tumescence/rigidity, detumescence). Thirty-two healthy adult males and 25 patients were exposed to visual and tactile erotic stimuli in order to elicit penile tumescence and, in the group of healthy volunteers, rigidity. Whole blood was aspirated from the corpus cavernosum and the cubital vein, and ET-1/-2 was determined in plasma aliquots by means of an enzyme-linked immunoassay (ELISA).Mean systemic and cavernous plasma level of ET-1/-2 in blood samples obtained from the volunteers was 0.2-0.7 fmol/ml. In the healthy males, no changes in ET-1/-2 levels were observed in the systemic and cavernous blood during penile tumescence, rigidity and detumescence. In the group of patients, mean plasma ET-1/-2 levels in the phase of penile flaccidity and detumescence were found to be higher in the systemic circulation than in the cavernous blood (flaccidity: 0.52 ± 0.38 fmol/ml vs. 0.48 ± 0.46 fmol/ml, respectively; detumescence: 0.53 ± 0.33 fmol/ml vs. 0.27 ± 0.11 fmol/ml, respectively). No differences in the plasma courses of ET-1/-2 were found between patients with an organogenic and psychogenic etiology of ED. In the phase of detumescence, the mean ET-1/-2 level was lower in the cavernous blood cavities taken from the patients than in the samples obtained from the healthy males.Our study revealed a difference in the profiles of ET-1/-2 registered in the cavernous blood of healthy subjects and patients with erectile dysfunction. Nevertheless, since this difference seems to be of no physiological significance, our data counteract the hypothesis of an ultimate importance of ET-1 in the control of penile flaccidity and detumescence and do not support speculations regarding an involvement of ET-1 in the pathophysiology of erectile dysfunction.

Dr. Klein Replies

Back to table of contents Previous article Next article Letter to the EditorFull AccessDr. Klein RepliesDANIEL N. KLEIN, PH.D., DANIEL N. KLEINSearch for more papers by this author, PH.D., Stony Brook, N.Y.Published Online:1 Jun 2001https://doi.org/10.1176/appi.ajp.158.6.976AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Patients with dysthymic disorder differ from patients with episodic major depressive disorder in a number of respects, including experiencing higher rates of axis I and II comorbidity (1, 2). Dr. Bourgeois raises the important question of whether the differences in patients with comorbid personality and substance use disorders explain why patients with dysthymic disorder had a poorer course and outcome than patients with episodic major depressive disorder in our 5-year follow-up study.To address this question, we conducted hierarchical multiple linear regression analyses to determine whether baseline diagnosis (dysthymic disorder versus episodic major depressive disorder) predicted mean level of depression across the follow-up period (3) and scores on the Modified Hamilton Rating Scale for Depression (4) at the 5-year follow-up evaluation after control for the presence of a personality disorder diagnosis (5) and lifetime alcohol and drug use disorders (few patients were currently abusing substances at entry into the study). Baseline scores on the modified Hamilton scale were included as a covariate in the analysis of 5-year scores on the modified Hamilton scale.After control for personality disorder and lifetime substance use disorder, a diagnosis of dysthymic disorder (as opposed to episodic major depressive disorder) significantly predicted a greater mean level of depression across the follow-up period (change: R2=0.18; F=33.73, df=1, 121, p<0.001). Similarly, after control for baseline score on the modified Hamilton scale, personality disorder, and lifetime substance use disorder, dysthymic disorder was found to be significantly associated with a higher score on the modified Hamilton depression scale at follow-up (change: R2=0.09; F=13.89, df=1, 107, p<0.001). Thus, although differences in patients with comorbid personality and substance use disorders may be a contributing factor, they do not account for the differences in course between patients with dysthymic disorder and patients with episodic major depressive disorder in our study. Nonetheless, the impact of comorbidity on the course of dysthymic disorder is an important issue that we plan to explore in greater detail in future analyses of our data.

Dr. Klein Replies

Back to table of contents Previous article Next article Letter to the EditorFull AccessDr. Klein RepliesDANIEL N. KLEIN, PH.D., DANIEL N. KLEINSearch for more papers by this author, PH.D., Stony Brook, N.Y.Published Online:1 Jun 2001https://doi.org/10.1176/appi.ajp.158.6.976AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Patients with dysthymic disorder differ from patients with episodic major depressive disorder in a number of respects, including experiencing higher rates of axis I and II comorbidity (1, 2). Dr. Bourgeois raises the important question of whether the differences in patients with comorbid personality and substance use disorders explain why patients with dysthymic disorder had a poorer course and outcome than patients with episodic major depressive disorder in our 5-year follow-up study.To address this question, we conducted hierarchical multiple linear regression analyses to determine whether baseline diagnosis (dysthymic disorder versus episodic major depressive disorder) predicted mean level of depression across the follow-up period (3) and scores on the Modified Hamilton Rating Scale for Depression (4) at the 5-year follow-up evaluation after control for the presence of a personality disorder diagnosis (5) and lifetime alcohol and drug use disorders (few patients were currently abusing substances at entry into the study). Baseline scores on the modified Hamilton scale were included as a covariate in the analysis of 5-year scores on the modified Hamilton scale.After control for personality disorder and lifetime substance use disorder, a diagnosis of dysthymic disorder (as opposed to episodic major depressive disorder) significantly predicted a greater mean level of depression across the follow-up period (change: R2=0.18; F=33.73, df=1, 121, p<0.001). Similarly, after control for baseline score on the modified Hamilton scale, personality disorder, and lifetime substance use disorder, dysthymic disorder was found to be significantly associated with a higher score on the modified Hamilton depression scale at follow-up (change: R2=0.09; F=13.89, df=1, 107, p<0.001). Thus, although differences in patients with comorbid personality and substance use disorders may be a contributing factor, they do not account for the differences in course between patients with dysthymic disorder and patients with episodic major depressive disorder in our study. Nonetheless, the impact of comorbidity on the course of dysthymic disorder is an important issue that we plan to explore in greater detail in future analyses of our data.

Gender aspects in schizophrenia: bridging the border between social and biological psychiatry.

This paper tries to show that gender differences in mental diseases are a valuable paradigm for research into the interplay between biological and psychosocial factors--not only regarding pathogenetic mechanisms, but also concerning therapeutic approaches. Based on relevant literature, this topic is highlighted using schizophrenia as an example. Schizophrenic disorders show a later age of onset in women and a slightly better course, especially in young women. As to pathogenesis, there is some evidence that the age difference might be due at least partly to the female sex hormone oestradiol being a protective factor. Differences in course might also have to do with this biological factor, but at the same time with the psychosocial advantages of a higher age of onset and other psychosocial factors. Concerning therapy, these gender differences have important implications for pharmacotherapy, but also psychotherapy and social measures. A gender-sensitive approach in psychiatry improves our understanding of mental illness and our therapeutic strategies and at the same time illustrates that comprehensive psychiatry cannot be practised in artificially separated 'drawers' called 'biological psychiatry', on one hand, and 'social psychiatry' on the other.

More than one way to change: a study of course heterogeneity during and after short-term psychiatric in-patient treatment.

This study describes differences in course and outcome, defined by GSI (SCL-90) at admission, discharge, and one-year follow-up, in 458 patients receiving in-patient treatment for long-standing symptom and/or personality disorders. A K-mean cluster analysis identified seven subgroups of patients, representing four clinical distinct, meaningful patterns of change: early improvement, late improvement, relapsing after discharge, and a severe chronic course. the subgroups had unique correlates among socio-demographic, diagnostic, and treatment-related characteristics. One of the relapsing groups had a high rate of Cluster C personality disorders, whereas the other had low participation in the anxiety programme. The group with severe chronic course showed occupational maladjustment and high number of both Axis I and II disorders. anxiety patients should participate in anxiety-treatment programmes, Cluster C patients should be followed and monitored for relapse, and severe chronic patients should be offered specialised treatment for their co-existing substance abuse and/or eating disorders.

Time course of differences in lymphocyte proliferation rates after laparotomy vs CO2 insufflation

Our laboratory has previously demonstrated that cell-mediated immune function is significantly more suppressed after both laparotomy and laparoscopic-assisted bowel resection than after peritoneal insufflation or open bowel resection, as assessed by delayed-type hypersensitivity (DTH) response. The purpose of this study was to further evaluate cell-mediated immunity by examining lymphocyte proliferation rates after laparotomy vs CO(2) insufflation. Female Balb/C mice (n = 75) were randomly divided into the following three groups: (a) anesthesia control (A/C), (b) CO(2) insufflation (INS), and (c) sham laparotomy (OPEN). The A/C group mice underwent no procedure. The INS group underwent insufflation with CO(2) gas at 4-6 mmHg for 20 min. The OPEN group underwent a midline incision from xiphoid to pubic symphysis, which was clipped closed after 20 min. Splenocytes were obtained via splenic harvest and lymphocyte isolation on postoperative days (POD) 1, 2, 3, 4, and 8. Lymphocyte proliferation was determined by a nonradioactive colorimetric MTS/PMS assay 72 h after concanavalin A stimulation. The laparotomy group's lymphocyte proliferation rates were significantly lower than both the control and the insufflation groups on POD 2, POD 3, and POD 4. On POD 1 and POD 8, there were no significant differences in lymphocyte proliferation among the three groups. No differences were found between the control and insufflation groups at any point. After stimulation, lymphocytes proliferate at a lower rate after laparotomy than after CO(2) insufflation. Significant differences in lymphocyte proliferation rates between groups persist at least through POD 4. By POD 8, the mean lymphocyte proliferation rate in the laparotomy group was back to the baseline level. Our results suggest greater immunosuppression after sham laparotomy than after CO(2) insufflation.

Sex differences in the course of depression: evidence from a longitudinal study of a representative sample of the Belgian population.

Outcome studies of major depression indicate high rates of relapse and chronicity, and social role theories imply that chronicity should be greater for women, together suggesting that the well-known sex difference in depression is, at least partially, the result of differences in chronicity. Due to a lack of prospective longitudinal research answers to this empirical question are missing. Furthermore, the results of the few available surveys of the general population are inconsistent, showing either higher chronicity for older women or a lack of sex differences in the overall course of depression. Using data from three waves of the Panel Study of Belgian Households (complete data for 3204 women and 2907 men, aged 16 years and older) sex differences in the persistence of depressive behavior are estimated. Depression is measured using a self-report inventory on three occasions separated by intervals of 1 year (1992, 1993, 1994). Results show a significant influence of sex, other sociodemographic characteristics, and depression severity at baseline on depression persistence. Women experience more symptoms for a longer period of time, a difference that can be partially ascribed to sex differences in employment status, education and marital status. The findings are discussed.

Course of Health Status among Chronically Ill Persons: Differentials According to Level of Education

This article describes socioeconomic differences in the time course of several health indicators, encompassing perceived health and disabilities, among a population sample of persons reporting one or more chronic conditions. Data covering the period 1991–1993, were obtained from a Dutch follow-up study. Educational differences in the course of health status were estimated by ordinary least squares regression. The course of almost all health status measures was statistically significantly less favorable ( p < 0.05) for those with a low educational level compared to those with higher vocational training or a university degree, adjusting for age, sex, and marital status. After additional adjustment for health status in 1991, significant differences remained for perceived general health, long-term disabilities, and two subscales of the Nottingham Health Profile. These findings imply that socioeconomic differences in prevalence of health problems are not only attributable to differences in incidence of diseases by socioeconomic status, but also to a differential course of existing health problems. Implications for health care delivery are discussed.

Six-month outcomes for MRI-related vascular depression.

The purpose of this paper is to estimate the relative probabilities of 6-month recovery from an index episode of major depression for subjects with and without MRI-confirmed vascular brain changes. In this cohort study, 57 depressed subjects from the Duke University Mental Health Clinical Research Center (MHCRC) for Depression in Late Life who presented with MRI-related vascular and non-vascular depression were followed for 6 months, and the rates of recovery in the two risk groups were compared. Overall, the recovery rate in this sample was 57.9%. Subjects with MRI-related vascular depression demonstrated outcomes similar to subjects with non-vascular depression (crude RR = 0.67 [0.32, 1.43]). There was a trend that demonstrated that MRI-related vascular depression placed elderly subjects and subjects with first onset of depression after age 40 at increased risk of non-recovery. The study demonstrates overall no significant difference in course between patients with and without vascular depression. It also suggests that patients with vascular depression may have a different course depending on their age and age of onset of the disease.

Vulnerability of the recurrent laryngeal nerve in the anterior approach to the lower cervical spine.

To perform anatomic dissections and measurements of the recurrent laryngeal nerve between the inferior thyroid artery and superior border of the clavicle (mid-portion) on both sides. To determine quantitatively the differences in course and location between the recurrent laryngeal nerves on both sides and to relate this to the vulnerability of the recurrent laryngeal nerve during an anterior approach to the lower cervical spine. The midportion of the recurrent laryngeal nerve is usually encountered in the anterior approach to the lower cervical spine, especially on the right side. No quantitative regional anatomy describing the course and location of the mid-portion of the recurrent laryngeal nerve is available in the literature. Fifteen adult cadavers were used for dissections of the recurrent laryngeal nerve. The length of the recurrent laryngeal nerve between the superior border of the clavicle and the inferior thyroid artery, and the angle of the recurrent laryngeal nerve with respect to sagittal plane, were measured bilaterally. In addition, six cross-sections at C7 were obtained to determine the linear distances between esophagotracheal groove and the recurrent laryngeal nerve. The recurrent laryngeal nerve on the right runs in a superior and medial direction, with an angle of 25.0 degrees +/- 4.7 degrees relative to sagittal plane, compared with 4.7 degrees +/- 3.7 degrees on the left. The length of the recurrent laryngeal nerve between the superior border of the clavicle and the inferior thyroid artery is 23.0 +/- 4.4 mm on the left, and 22.8 +/- 4.3 mm on the right. The recurrent laryngeal nerve lies deep within the esophagotracheal groove on the left, but 6.5 +/- 1.2 mm anterior and 7.3 +/- 0.8 mm lateral to the esophagotracheal groove on the right. The recurrent laryngeal nerve on the right side is highly vulnerable to injury if ligature of the inferior thyroid vessels is not performed as laterally as possible or if retraction of the midline structures along with the recurrent laryngeal nerve is not performed intermittently. Avoiding injury to the recurrent laryngeal nerve, especially on the right side, is a major consideration during an anterior approach to lower cervical spine.

Explaining sex differences in course and outcome in the functional psychoses

We addressed the following three questions: (i) are there sex differences in outcome in the functional psychoses?, (ii) what is their effect size, and which variables mediate the effect of sex on outcome?, (iii) is the effect of sex diagnosis-specific? In a prospective study of 166 patients with recent onset psychosis, we established that 4-year outcome was more favourable for women. Female patients more often had a remitting illness course (OR = 3.0; 95% CI: 1.5–5.9), were living independently 14% (4–24%) more of the time, had less evidence of negative symptoms over the follow-up period (OR = 0.3; 0.2–0.7) and were more likely to be employed at follow-up (3.6; 1.8–7.6). The findings did not appear diagnosis-specific, although the sample size was small to test for interaction with diagnostic category. Baseline occupational and social adjustment, clinical expression of illness and age and type of onset explained up to 60% of the sex effect. The processes underlying these factors mediate the effect of sex on outcome.

Subtyping Eating Disorders: Is It Justified?

DSM-IV subtypes anorexia nervosa by the presence or absence of bulimic symptoms. Assessing whether bulimic symptoms are related to the probability of recovery can provide justification for subtyping of anorexia. Two hundred twenty-five treatment-seeking women with anorexia and/or bulimia nervosa were interviewed every 3 months for up to 4 years. Survival methods were used for analyses. Less than half of the entire cohort recovered; however, the great majority of the women became less symptomatic over time. Contrary to findings from previous studies, bulimic anorexics had a higher rate of recovery than restricting anorexics. Differences in course provide some support for the subtyping of anorexia nervosa. Additional prospective studies are needed before subtyping can be warranted.

Patient dynamics in early stages of vocational rehabilitation: A pilot study

Since little is known of the dynamics of the rehabilitation process, this pilot study aims to explore (1) the work performance and personal and social functioning of patients attending a vocational reintegration program; (2) any significant differences in course between successful and unsuccessful patients; and (3) whether these subgroups differed at entrance assessment. Using the 30-item Nurses' Observation Scale for Inpatient Evaluation (NOSIE) and a global work performance scale, the sample (N = 31) showed a significant decrease in work performance and a negative trend in most NOSIE scores, instead of the expected steady progress. The turning point is reached after 9 to 12 weeks. In the entrance assessment, the failure subgroup (n = 11) displayed more negative and general symptoms and fewer social skills. It seemed to be not their initial work performance but their resources to cope with the stress of the program that were insufficient. However, not every downhill trend leads automatically to failure, and some patients still have a chance of later improvement.