A Review of the Concepts, Terminologies and Dilemmas in the Assessment of Decisional Capacity: A Focus on Alcoholism.
A review of the concepts, terminologies and dilemmas in the assessment of decisional capacity: a focus on alcoholism.
Australas Psychiatry. 2013 Jul 24;
Restifo S
The formal assessment of a person’s capacity for making reasoned decisions is an infrequent and usually unappealing clinical task. The purpose of this paper is to dissect the task, consider the component parts, clarify those aspects that can be problematic and highlight those that remain so.The paper reviews the concepts, terminologies and dilemmas around alcoholism, insight, lack of insight, denial, judgement, will, decisional capacity and competence.Assessments of patients suffering from alcoholism (or any other dyscontrol problem such as deliberate self-harm, problem gambling or eating disorders) are likely to evoke unease because of the interweaving of potentially disputable phenomenological, clinical, ethical, semantic and legal aspects. Familiarity with the concepts and terms around decisional capacity helps to orientate clinicians in their work. There remain some particular conceptual issues that are in need of further scholarly attention. HubMed – eating
Resveratrol Prevents ?-cell Dedifferentiation in Non-Human Primates Given a High Fat/ High Sugar Diet.
Diabetes. 2013 Jul 24;
Fiori JL, Shin YK, Kim W, Krzysik-Walker SM, González-Mariscal I, Carlson OD, Sanghvi M, Moaddel R, Farhang K, Gadkaree SK, Doyle ME, Pearson KJ, Mattison JA, de Cabo R, Egan JM
Eating a ‘Westernized’ diet high in fat and sugar leads to weight gain and numerous health problems, including the development of type 2 diabetes mellitus (T2DM). Rodent studies have shown that resveratrol supplementation reduces blood glucose, preserves ?-cells in islets of Langerhans, and improves insulin action. While rodent models are helpful for understanding ?-cell biology and certain aspects of T2DM pathology, they fail to reproduce the complexity of the human disease as well as non-human primates. Rhesus monkeys were fed a standard diet (SD), or a high fat/ high sugar diet in combination with either placebo (HFS) or resveratrol (HFS+Resv) for 24 months and pancreata were examined before overt dysglycemia occurred. Increased glucose-stimulated insulin secretion and insulin resistance occurred in both HFS and HFS+Resv diets compared to SD. While islet size was unaffected, there was a significant decrease in ?-cells and increase in ?-cells, containing glucagon and GLP-1, with HFS diets. Islets from HFS+Resv monkeys were morphologically similar to SD. HFS diets also resulted in decreased expression of essential ?-cell transcription factors, FOXO1, NKX6-1, NKX2-2, and PDX1 which did not occur with resveratrol supplementation. Similar changes were observed in human islets where the effects of resveratrol were mediated through SIRT1. These findings have implications for the management of humans with insulin resistance, pre-diabetes, and diabetes. HubMed – eating
Early Life Loss and Trauma: Eating Disorder Onset in a Middle-Aged Male–A Case Study.
Am J Mens Health. 2013 Jul 23;
McCormack L, Lewis V, Wells JR
The onset of an eating disorder in middle-age men is poorly researched as are eating disorders in men generally. Therefore, life events that influence eating disorders in men, including delayed onset of an eating disorder remains unknown. Given the limited understanding of males with eating disorders and limited access to large samples of men with eating disorders, an in-depth analysis of a single case of a male in middle age with an eating disorder was chosen to gain insight and understanding into this phenomenon. A Life History approach explored the case of Joseph (pseudonym), who was diagnosed at age 44 years with an Eating Disorder Not Otherwise Specified. Data were collected through (a) life course open-ended questioning through interviews, (b) written statements, and (c) comments on transcripts. Three themes emerged, loss and unworthiness, becoming bigger, and wanting to change reflecting eating behaviors associated with attachment disruption, loss and trauma, body dissatisfaction, and negative affect. Later in life, an emotional “tipping point” precipitated an eating disorder. Results indicate traumatic loss leading to early attachment disruption as influential in Joseph’s delayed onset of an eating disorder. The value of thorough narrative life histories during therapy when eating disorders occur late in life is discussed as well as the significance for men. HubMed – eating
Nutrition and neurodevelopment in children: focus on NUTRIMENTHE project.
Eur J Nutr. 2013 Jul 25;
Anjos T, Altmäe S, Emmett P, Tiemeier H, Closa-Monasterolo R, Luque V, Wiseman S, Pérez-García M, Lattka E, Demmelmair H, Egan B, Straub N, Szajewska H, Evans J, Horton C, Paus T, Isaacs E, van Klinken JW, Koletzko B, Campoy C,
There is growing evidence that early nutrition affects later cognitive performance. The idea that the diet of mothers, infants, and children could affect later mental performance has major implications for public health practice and policy development and for our understanding of human biology as well as for food product development, economic progress, and future wealth creation. To date, however, much of the evidence is from animal, retrospective studies and short-term nutritional intervention studies in humans. The positive effect of micronutrients on health, especially of pregnant women eating well to maximise their child’s cognitive and behavioural outcomes, is commonly acknowledged. The current evidence of an association between gestational nutrition and brain development in healthy children is more credible for folate, n-3 fatty acids, and iron. Recent findings highlight the fact that single-nutrient supplementation is less adequate than supplementation with more complex formulae. However, the optimal content of micronutrient supplementation and whether there is a long-term impact on child’s neurodevelopment needs to be investigated further. Moreover, it is also evident that future studies should take into account genetic heterogeneity when evaluating nutritional effects and also nutritional recommendations. The objective of the present review is to provide a background and update on the current knowledge linking nutrition to cognition and behaviour in children, and to show how the large collaborative European Project NUTRIMENTHE is working towards this aim. HubMed – eating
What Are Eating Disorders Not Otherwise Specified? – Dr. Stephen Touyz Sydney Australia FAQ
http://www.stephentouyz.com.au In this video, Dr. Stephen Touyz answers one of the most frequently asked questions on the subject of eating disorders, “What …