Food for Thought on Eating Disorders

Research from the Agency for Healthcare Research and Quality has found that following a steady increase in the number of hospitalizations for eating disorders from 1999 to 2007, the number of individuals checking into hospitals with these principal diagnoses has fallen by 23 percent from 2007 to 2009, the latest year for which numbers are available. Eating disorders have the highest mortality rate of any psychiatric disorder, with anorexia specifically being the leading cause of mortality in women between the ages of 15 and 24. During this time period, the severity of reported eating disorders decreased, as well.

However, patients found to have eating disorders were often hospitalized for other presenting conditions, such as depression, fluid or electrolyte disorders, schizophrenia, or alcohol-related issues. Statistics showed that although 90 percent of those suffering from eating disorders were female, eating disorders in men increased 53 percent since 2007.

In light of the recent decrease in eating disorders, from 1999 to 2009, hospitalizations skyrocketed 93 percent for the disorder pica. Pica is usually diagnosed in women and children and causes them to eat inedible materials like clay, dirt, chalk, or feces. During the 10-year period, the number of hospitalizations for patients with pica increased from 964 to 1,862.

Why do you think the number of eating disorders in general has gone down while the number of individuals diagnosed with pica has increased?

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Meet the MMSE & MMSE-2 Authors: Marshal F. Folstein, MD & Susan E. Folstein, MD

What made you decide initially to develop the Mini-Mental® State Examination (MMSE)?

We developed the MMSE to solve a clinical problem on a geriatric psychiatric inpatient service. The diagnoses of patients on our unit included depression, dementia, delirium, and occasional late-life schizophrenia. We needed a practical quantitative cognitive exam in order to aide clinicians in determining the severity of cognitive impairment ranging from mild to severe and to document improvement or decline.

At the time, Susan was a psychiatry resident rotating on the geriatric psychiatric unit where I (Marshal) was a junior attending. Always a perfectionist, she was not happy when I repeatedly asked for cognitive information that she had not asked about. So she asked me to write down all the items that I wanted her to include.

What made you decide to update it and create the Mini-Mental® State Examination, Second Edition™ (MMSE®-2™)?

Over the years, students and other users made many suggestions about how to improve the MMSE. There was a need to clarify the instructions so that certain tasks were administered; there was a need for phrases that were more easily translated into other languages; and users requested multiple forms in order to minimize practice effects with serial administration. In addition, we had long wanted to develop a shorter version that could be given very quickly in busy clinical settings, and also a longer version that would eliminate ceiling effects. We wanted this longer version to be more sensitive than the original MMSE to disorders of executive function and to the kinds of memory impairment found in mild cognitive impairment.

What would you like to tell people about the MMSE-2 that they may not know?

The MMSE-2 Standard Version scores are equivalent to the original MMSE scores. We took care that subjects tested during development scored the same, regardless of whether they were given the original MMSE or the MMSE-2 Standard Version. Longitudinal studies currently underway can switch to the new version without any adjustment to scores. The original, unrevised MMSE is still available if users do not want to change to the revised versions.

How do you spend your free time?

Marshal takes flute lessons and is trying to improve his photography. Susan enjoys gardening and reading spy novels, biographies, Jane Austen, and Patrick O’Brian. She has a new job at the University of Miami School of Medicine with a joint appointment in psychiatry and in the Hussman Institute for Human Genomics. We both like to write and watch old movies.

Screen for cognitive impairment with a revised version of the most widely used cognitive status exam...