Paul Hyman Robinson

University College London | UCL · Mental Health Sciences Unit

BACKGROUND: In this multi-centre RCT we compared modified Mentalization Based Therapy (MBT-ED) to Specialist Supportive Clinical Management (SSCM-ED) in patients with Eating disorders (ED) and Borderline Personality Disorder symptoms (BPD). This group of patients presents complex challenges to clinical services and a treatment which addresses their...

This study aims to explore perceptions of eating disorder service strengths and to develop a clearer picture of improvements clinicians would like to see occur in the services they lead. A survey designed by the Royal College of Psychiatrists' Section of Eating Disorders was completed by 83 lead clinicians in both public and private sector services...

The MARSIPAN (MAnagement of Really SIck Patients with Anorexia Nervosa) project was established in response to reports of patients admitted to medical wards and proving refractory to treatment, sometimes dying on the ward. Psychiatrists, physicians and other clinicians in nutrition and eating disorders were brought together to discuss key issues in...

This study aimed to investigate the specific risk factors, correlates, and markers associated with the development of symptomatology of early-onset BN and subclinical BN. Two semi-structured interviews were used to examine symptomatology and antecedent factors of bulimic symptoms in a sample of British adolescents. Adolescents with early-onset eati...

Objective:This study aimed to investigate the specific risk factors, correlates, and markers associated with the development of symptomatology of early-onset BN and subclinical BN.Method:Two semi-structured interviews were used to examine symptomatology and antecedent factors of bulimic symptoms in a sample of British adolescents.Results:Adolescent...

We explore the level of disability and quality of life in participants with severe and enduring eating disorder (anorexia nervosa). We use qualitative and quantitative methods to assess in detail eleven participants with a 10-year history of anorexia nervosa. Outcomes for quality of life are compared with those of a sample of primary care patients...

We wanted to know whether adolescents with eating disorder not otherwise specified (EDNOS) differ from those with bulimia nervosa (BN) in clinical features, comorbidity, risk factors, treatment outcome or cost. Adolescents with EDNOS (n = 24) or BN (n = 61) took part in a trial of family therapy versus guided self-care. At baseline, eating disorder...

One hundred and ten people in an university population responded to emailed eating disorder questionnaires. Ninty-seven fulfilling criteria for eating disorders (bulimia nervosa (BN), binge eating disorder (BED), EDNOS) were randomised to therapist administered email bulimia therapy (eBT), unsupported Self directed writing (SDW) or Waiting list con...

REASON FOR THE STUDY: Little is known about how motivation to change evolves over the course of an eating disorder. The present study compared 'stage of change' and motivation, confidence and readiness to change in two groups of patients with bulimia nervosa (BN), adolescents with a short duration of illness and adults with a long duration of illne...

To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified. Eighty-five adolescents with bulimia nervo...

This exploratory study focuses on the mental health (MH) and caregiving experience of carers of adolescents with Bulimia Nervosa (BN)/Eating Disorder not otherwise specified (EDNOS), aiming to determine: levels of MH problems in carers and if a negative experience of caregiving predicts carer MH status and which factors predict a negative experienc...

The book is intended as a practical guide to setting up, staffing and running eating disorders services. The guidance and advice given is based on the experience of the eating disorder service at the Royal Free, which does not have specialised beds, but which is nevertheless considered to offer one of the best services in the UK. Each element of th...

Although the use of family therapy for adolescents with anorexia nervosa is well established, there has been limited research into the efficacy of family therapy in adolescents with bulimia nervosa (BN). No previous research has investigated why individuals with BN do or do not involve their parents in treatment. This is an exploratory study aimed...

The aims of the present study were (1) to examine the association between a cognitive distortion ('thought-shape fusion') and eating disorder psychopathology and (2) to examine the degree of thought-shape fusion in people with eating disorders and a non-eating-disorder control group. Associations between thought-shape fusion and eating disorder psy...

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 clini...

A recent cognitive-behavioural theory of eating disorders proposes that people with eating disorders interpret symptoms of dietary restraint in terms of control. The primary aim of the present study was to test this hypothesis. A second aim was to test the hypothesis derived from clinical observation that people with eating disorders view these sym...

Many ethical and practical questions have been asked in relation to the delivery of therapy via e-mail including: is therapy delivered via e-mail acceptable to clients? Are people recruited into treatment via an e-mailed advertisement similar to a clinical sample? Is such therapy effective? Is there a therapeutic relationship which involves express...

Current screening instruments for eating disorders are cumbersome to administer and have not been validated in primary care populations. We compared the performance characteristics of 2 screening tools, the SCOFF clinical prediction guide, and a new set of questions, the Eating disorder Screen for Primary care (ESP), using the Questionnaire for Eat...

Multi-family group therapy is a variant of family therapy in which members are able to gain insight and learn from each other, provide support and encouragement, alleviate their sense of isolation and improve communication and social functioning. This study describes a series of multi-family groups conducted within the eating disorder service of a...

Despite the great potential of new technologies, no systematic study of e-mail therapy for subjects with eating disorders has been published. We recruited, using a single announcement made via e-mail, from all 20 000 staff and students of a large college of the University of London, 23 individuals (all female) who appeared to fulfil diagnostic crit...

Eating disorders are serious illnesses affecting 1–2% of young women. Patients may present to any doctor, sometimes atypically (e.g. unexplained weight loss, food allergy, infertility, diarrhoea), delaying diagnosis and leading to needless investigation. The cardinal signs are weight loss, amenorrhoea, bingeing with vomiting and other compensatory...

This study investigated the extent of psychiatric disorder and abnormalities of weight and growth amongst children of mothers with eating disorders. The design was a cross-sectional study, in which mothers were identified by attendance at specialist eating disorder services. Assessments included interviews with the mothers and children, questionnai...

We investigated the effects of malnutrition and refeeding on albumin distribution and metabolism in patients undergoing treatment for anorexia nervosa. Using autologous 125I-labelled albumin, we measured the fractional catabolic rate and calculated the relative sizes of the plasma and extravascular albumin pools in 6 female anorexia nervosa subject...

Case records of 11 women with eating disorders who had children were examined to determine the prevalence of recorded disturbances in their children. In nine children of six mothers, disturbances that fell into three categories were documented. Some mothers had disturbed perceptions of their children, including the belief that the child was fat or...

The term cholecystokinin (CCK) was first used to describe a hormonal factor identified in extracts from the intestine which caused gall bladder contraction (Ivy and Oldberg, 1928). Later, Harper and Raper (1943) demonstrated that intestinal extracts could also stimulate pancreatic secretion and termed the responsible factor, pancreozymin. Further e...

SYNOPSIS The distribution of cholecystokinin binding sites has been visualized and quantified by quantitative autoradiography in the human hippocampus from post-mortem brains of 11 controls and 11 schizophrenics. CCK receptors were localized to subiculum and parahippocampal gyrus. In the cortical areas there was a particularly dense lamination of r...

Synopsis Seventeen patients with anorexia nervosa were examined by computed tomography (CT) and psychometry and compared with ten normal control subjects. The patients were found to have enlarged external cerebrospinal fluid spaces compared to controls. No differences were found in ventricular size and X-ray absorption density measurements between...

In rats allowed to eat for only 2 h per day, gastric emptying of three different meals [poached egg white, glucose (0.5 kcal/ml) and physiological saline, each labelled with 60 MBq of technetium-99m tin colloid visualized using a gamma camera] was markedly slowed 8 h after the last meal. Mean body weight in rats on the restricted feeding schedule w...

Gastric emptying of a mixed meal was measured in 22 patients with anorexia nervosa, ten with bulimia nervosa and ten controls. Ratings on a visual analogue scale (VAS) were made during the test. Patients with anorexia nervosa felt fuller and less hungry than controls, although satiety was not related to gastric emptying rate, controls showed a corr...

A case of weight loss from food avoidance and vomiting in a young Ethiopian torture victim is described, and possible aetiological factors discussed.

All referrals from two general practices to psychiatrists in hospital and primary-care out-patient clinics were examined. Women in all diagnostic groups were preferentially referred to the primary-care clinics, which provided especially for psychotic and chronic illnesses, and at which attendance rates on first and subsequent appointments were subs...

The ability of the octapeptide of cholecystokinin (CCK-8) to inhibit independent ingestion was examined in 8-h deprived 1- to 10-day-old rat pups consuming milk from the surface of a test chamber. CCK significantly reduced the volume of milk ingested in 1-day-old rat pups at a dose of 100 ng/kg. The threshold effective dosage for inhibition of inta...

Gastric emptying was measured using a gamma camera in 22 patients with anorexia nervosa, in 10 patients of normal or high weight with bulimia nervosa and in 10 controls. Patients with anorexia nervosa were tested (1) while underweight and selecting their own diet (10 patients); (2) underweight, but receiving an adequate diet on an inpatient unit (r...

Thirteen black patients were referred over 5 years to the eating-disorders unit at the Maudsley Hospital. Two suffered from anorexia nervosa and 11 from bulimia nervosa. This group was compared with a matched white control group from the total clinic population during that period. The Blacks had more commonly experienced parental divorce or separat...

In an attempt to identify potential target sites for the satiety action of bombesin (BN), the distribution and pharmacological specificity of bombesin binding sites were examined in the rat gastrointestinal tract by in vitro autoradiography utilizing (125I-Tyr4) bombesin. Specific BN binding was localized to the circular muscle level of the gastric...

Inhibition of gastric emptying leads to enhanced satiety and this mechanism may contribute to the undereating observed after administration of cholecystokinin (CCK) and fenfluramine, and in patients with anorexia nervosa. Pyloric smooth muscle bears specific CCK receptors and the evidence suggests that a major site of action for CCK satiety is in t...

Autoradiography using 125I-labeled Bolton Hunter-CCK-33 was used to study the distribution of cholecystokinin binding sites at different stages of development in the rat upper gastrointestinal tract. Cholecystokinin (CCK) binding was present in the distal stomach, esophagus, and gastroduodenal junction in the rat fetus of gestational age of 17 days...

Synopsis Nine male patients with bulimia nervosa, accounting for one in 24 bulimic patients attending a clinic for eating disorders, are described. Symptomatology and demographic characteristics were similar in males and females. A history of either anorexia nervosa or obesity was always present, and a chronic course was seen in 6 patients. Five of...

To assess the mechanism by which the anorectic agent fenfluramine influences feeding, we examined in Macaca mulatta the effect of intragastric fenfluramine (2 mg/kg) on both feeding and the gastric emptying of saline and glucose test meals. Gastric emptying was measured by the dye-dilution technique, using chronic indwelling intragastric cannulas....

The distribution and relative specificity of cholecystokinin (CCK) receptors in the rat brain was mapped by in vitro autoradiography with [125I]CCK-33. We identified two distinct binding patterns, suggesting two CCK receptor types. The first is widespread and relatively non-specific. The second, localized to a few subcortical nuclei, has the specif...

Fifteen patients with bulimia nervosa received fenfluramine (60 mg po) or placebo under double-blind, randomly ordered conditions. Two hours later food was presented. Significantly less food was eaten after fenfluramine and the quantity eaten was inversely correlated with serum fenfluramine levels. Significantly fewer patients reported bulimic symp...

Five cases of anorexia nervosa in black American patients are presented. All had lost parents by death or divorce. Three had a family history of obesity and of a physical illness related to obesity. Two were male and both of these had a previous history of serious psychiatric disturbance. Three patients had a first or second degree relative with af...

In the present study, a total of 19 patients were seen in three different series of 12 sessions. The patients were assessed using psychosocial measures and the study was controlled. The results of these evaluations will be reported elsewhere. This article is an account of some of the issues raised in the groups and is based on reports written after...