688
CORRESPONDENCE
in k a e i g h t in m2, reflecting body shape) is a significant contributor to the phenomenology of fat phobia and bulimic behaviour [7]. Whitaker et a1 [8] similarly demonstrated that, irrespective of social class, 95% of American adolescent girls above the median body mass index of 20.5 k g / d feared fatness and wanted to weigh less. Unfortunately, no weight indices were examined by Russell and Gilbert. Crisp [9] theorised that anorexia nervosa represents a psychobiological regressive and phobic stance towards the tasks of adolescence, and this can occur in subjects of all ages. Nonetheless, tardive anorexia is a potentially useful subgroup to study seriously. I suggest that Russell and Gilbert should put their findings into perspective, and examine more closely clinical features (eg. fear of obesity, bulimia) and long-term outcome in their future endeavours. References 1. Russell J, Gilbert M. Is tardive anorexia a discrete diagnostic entity? Australian and New Zealand Journal of Psychiatry 1992; 26:429-435. 2. Kendall RE. Clinical validity. Psychological Medicine 1989; 19:45-55. 3. Hsu LKG. Outcome of anorexia nervosa - a review of the literature. Archives of General Psychiatry 1980; 37:1041-1046. 4. Lee S. Anorexia nervosa in Hong Kong - a Chinese perspective. Psychological Medicine 199 1 ; 2 1 :703-71 1 . 5. Khandelwal SK, Saxena S. Anorexia nervosa in people of Asian extraction. British Journal of Psychiatry 1990; 157:784. 6. Ong YL, Tsoi WF.A clinical and psychosocial study of seven cases of anorexia nervosa in Singapore. Singapore Medical Journal 1982; 23:255-261. 7. Lee S. How abnormal is the desire for slimness? A survey of eating attitudes and behaviour among Chinese undergraduates in Hong Kong. Psychological Medicine (in press). 8. Whitaker A, Davies M. Shaffer D e t a / .The struggle to be thin: a survey of anorexic and bulimic symptoms in a non-referred adolescent population. Psychological Medicine 1989; 19:143-163. 9. Crisp AH. Anorexia nervosa: let me be. London: Plenum, 1980.
Professional accountabilityand peer review Peter Wurth, Chatswood, New South Wales: Twelve months ago I accepted the responsibility for coordinating peer review activities at a small private hospital. I phoned the Chairman of the NSW Branch of the College with a number of questions about this vexed area, seeking the official view of the College, if indeed one existed. At his invitation I put my questions in writing to him in December. In February I phoned him as I had received no reply and he was unaware of my letter. I wrote back to him in May enclosing a copy
of the original letter and I have still had no reply of any sort. I am compelled to reach the conclusion that the College is still not really serious about the issue of professional accountability and review. From what I have been able to establish there is no method or process of peer review that has the sanction of the College, and in particular the difficult question of what steps should be taken to deal with colleagues identified as falling below acceptable standards has yet to be addressed satisfactorily. At a recent meeting the Section of Psychotherapy of the NSW Branch, there was a resolution to further investigate the possibility of establishing Peer Review Meetings for members of the Section in order to help allay Medicare concerns about unnecessarily prolonged or intensive therapies at public expense. Everyone seems to be talking about peer review but no-one is able to say exactly what it means. Can the College help?
The changing nature of psychiatry Gavin Andrews, Darlinghurst, New South Wales: It is interesting when an article still excites correspondence 12 months after it was published. The changing nature ofpsychiatry (25: 453-459,1991) has been the focus of such continuing attention. It argued that new developments in diagnosis and psychological treatments would change the nature of psychiatric practice. The article contains one error concerning the case of Dr. Osheroff who received intensive psychotherapy without benefit and was finally diagnosed and his illness relieved by antidepressants. As the Editor and Gaughwin (26: 132-134, 1992) pointed out, his case was heard before a tribunal and settled out of court, thus providing no precedent in law. Moms (26: 322-323,1992) and Blom (26: 323-326, 1992) question whether a structured diagnostic interview such as the CIDI (and in particular the computerised CIDI-Auto) can be a valid diagnostic measure. The CIDI was conceived as an epidemiological tool and functions as a clinician’s aid by identifying symptoms and matching them to diagnostic criteria, although whether the patient suffers from the condition whose diagnostic criteria are satisfied is for a clinician to decide. The CIDI is in wide use and it is estimated 100,000 will have been administered throughout the world by the end of 1992. The instrument is sophisticated. It asks questions about symptoms that are pertinent to each ICDlO and
CORRESPONDENCE
in k a e i g h t in m2, reflecting body shape) is a significant contributor to the phenomenology of fat phobia and bulimic behaviour [7]. Whitaker et a1 [8] similarly demonstrated that, irrespective of social class, 95% of American adolescent girls above the median body mass index of 20.5 k g / d feared fatness and wanted to weigh less. Unfortunately, no weight indices were examined by Russell and Gilbert. Crisp [9] theorised that anorexia nervosa represents a psychobiological regressive and phobic stance towards the tasks of adolescence, and this can occur in subjects of all ages. Nonetheless, tardive anorexia is a potentially useful subgroup to study seriously. I suggest that Russell and Gilbert should put their findings into perspective, and examine more closely clinical features (eg. fear of obesity, bulimia) and long-term outcome in their future endeavours. References 1. Russell J, Gilbert M. Is tardive anorexia a discrete diagnostic entity? Australian and New Zealand Journal of Psychiatry 1992; 26:429-435. 2. Kendall RE. Clinical validity. Psychological Medicine 1989; 19:45-55. 3. Hsu LKG. Outcome of anorexia nervosa - a review of the literature. Archives of General Psychiatry 1980; 37:1041-1046. 4. Lee S. Anorexia nervosa in Hong Kong - a Chinese perspective. Psychological Medicine 199 1 ; 2 1 :703-71 1 . 5. Khandelwal SK, Saxena S. Anorexia nervosa in people of Asian extraction. British Journal of Psychiatry 1990; 157:784. 6. Ong YL, Tsoi WF.A clinical and psychosocial study of seven cases of anorexia nervosa in Singapore. Singapore Medical Journal 1982; 23:255-261. 7. Lee S. How abnormal is the desire for slimness? A survey of eating attitudes and behaviour among Chinese undergraduates in Hong Kong. Psychological Medicine (in press). 8. Whitaker A, Davies M. Shaffer D e t a / .The struggle to be thin: a survey of anorexic and bulimic symptoms in a non-referred adolescent population. Psychological Medicine 1989; 19:143-163. 9. Crisp AH. Anorexia nervosa: let me be. London: Plenum, 1980.
Professional accountabilityand peer review Peter Wurth, Chatswood, New South Wales: Twelve months ago I accepted the responsibility for coordinating peer review activities at a small private hospital. I phoned the Chairman of the NSW Branch of the College with a number of questions about this vexed area, seeking the official view of the College, if indeed one existed. At his invitation I put my questions in writing to him in December. In February I phoned him as I had received no reply and he was unaware of my letter. I wrote back to him in May enclosing a copy
of the original letter and I have still had no reply of any sort. I am compelled to reach the conclusion that the College is still not really serious about the issue of professional accountability and review. From what I have been able to establish there is no method or process of peer review that has the sanction of the College, and in particular the difficult question of what steps should be taken to deal with colleagues identified as falling below acceptable standards has yet to be addressed satisfactorily. At a recent meeting the Section of Psychotherapy of the NSW Branch, there was a resolution to further investigate the possibility of establishing Peer Review Meetings for members of the Section in order to help allay Medicare concerns about unnecessarily prolonged or intensive therapies at public expense. Everyone seems to be talking about peer review but no-one is able to say exactly what it means. Can the College help?
The changing nature of psychiatry Gavin Andrews, Darlinghurst, New South Wales: It is interesting when an article still excites correspondence 12 months after it was published. The changing nature ofpsychiatry (25: 453-459,1991) has been the focus of such continuing attention. It argued that new developments in diagnosis and psychological treatments would change the nature of psychiatric practice. The article contains one error concerning the case of Dr. Osheroff who received intensive psychotherapy without benefit and was finally diagnosed and his illness relieved by antidepressants. As the Editor and Gaughwin (26: 132-134, 1992) pointed out, his case was heard before a tribunal and settled out of court, thus providing no precedent in law. Moms (26: 322-323,1992) and Blom (26: 323-326, 1992) question whether a structured diagnostic interview such as the CIDI (and in particular the computerised CIDI-Auto) can be a valid diagnostic measure. The CIDI was conceived as an epidemiological tool and functions as a clinician’s aid by identifying symptoms and matching them to diagnostic criteria, although whether the patient suffers from the condition whose diagnostic criteria are satisfied is for a clinician to decide. The CIDI is in wide use and it is estimated 100,000 will have been administered throughout the world by the end of 1992. The instrument is sophisticated. It asks questions about symptoms that are pertinent to each ICDlO and
