Case study: suprasellar germinoma presenting with psychotic and obsessive-compulsive symptoms

This case describes a 13-year-old boy who had a suprasellar germinoma involving the bilateral basal ganglia. His presenting symptoms included left-sided weakness, diabetes insipidus, a decline in academic functioning as well as psychotic and obsessive-compulsive symptoms. His neuroradiological findings and clinical symptoms lend support to the potential role of the basal ganglia in psychotic and obsessive-compulsive symptomatology.

Bacille Calmette-Guérin (BCG)-associated inflammation and fibrosis: modulation by recombinant BCG expressing interferon-gamma (IFN-gamma)

Immunization with existing BCG vaccines has failed to confer consistent protection against tuberculosis. One of the ways to improve the efficacy of BCG is by enhancing its ability to induce a type-1 T cell response. However, this approach carries the risk that enhanced immunoreactivity may exacerbate tissue pathology associated with vaccination. The aim of the present study was to determine whether use of a recombinant BCG expressing IFN-gamma (BCG-IFN) would result in an alteration in the pattern of inflammation and local tissue fibrosis. A murine intravenous BCG infection model was used in which there was a time- and dose-dependent increase in the weight and number of granulomas in the liver. Infection was associated with increased inflammatory activity in the liver, as shown by the increase in expression of inducible nitric oxide synthase (iNOS) assessed by immunochemistry and by measurement of specific mRNA, and in fibrosis measured by hydroxyproline content of the liver and percentage of granuloma cells staining positively for type 1 procollagen. Infection with BCG-IFN resulted in a reduction in organ weight and bacterial load on day 21 compared with infection with control BCG transformed with vector alone (BCG-plasmid). By day 21, there was also a reduction in iNOS mRNA and iNOS+ cells in granulomas in mice infected with BCG-IFN compared with infection with BCG-plasmid, and a similar reduction in both total number of granulomas and liver hydroxyproline content. These results demonstrate that the granulomas in the areas of mycobacterial infection are active sites of both inflammation and fibrosis, and that the local expression of IFN-gamma by the recombinant BCG results in more efficient bacterial clearance which is accompanied by a reduction in tissue pathology.

Comparison of Mycobacterium tuberculosis genomes reveals frequent deletions in a 20 kb variable region in clinical isolates

The Mycobacterium tuberculosis complex is associated with a remarkably low level of structural gene polymorphism. As part of a search for alternative forms of genetic variation that may act as a source of biological diversity in M. tuberculosis, we have identified a region of the genome that is highly variable amongst a panel of unrelated clinical isolates. Fifteen of 24 isolates examined contained one or more copies of the M. tuberculosis-specific IS6110 insertion element within this 20 kb variable region. In nine of the isolates, including the laboratory-passaged strain H37Rv, genomic deletions were identified, resulting in loss of between two and 13 genes. In each case, deletions were associated with the presence of a copy of the IS6110 element. Absence of flanking tri- or tetra-nucleotide repeats identified homologous recombination between adjacent IS6110 elements as the most likely mechanism of the deletion events. IS6110 insertion into hot-spots within the genome of M. tuberculosis provides a mechanism for generation of genetic diversity involving a high frequency of insertions and deletions.

Cerebral bioenergetics in stable chronic obstructive pulmonary disease

Cerebral intracellular energy production (cerebral bioenergetics) via oxidative phosphorylation and the production of adenosine triphosphate (ATP) is critical to cerebral function. To test the hypothesis that patients with chronic stable hypoxia also generate neuronal ATP via an anaerobic metabolism, we studied the changes in cerebral (31)P magnetic resonance spectra ((31)P MRS) in patients with stable chronic obstructive pulmonary disease (COPD), and compared the results with MR spectra from similar areas of the brain in control subjects. Ten patients with stable COPD (age: 65 +/- 9 yr [mean +/- SD]; Pa(O(2)): 8.8 +/- 1.2 kPa; Pa(CO(2)): 6.1 +/- 0.8 kPa; pH 7.42 +/- 0.03, and FEV(1): 41 +/- 20% predicted) and five healthy volunteers underwent cerebral (31)P MRS (TR-5,000 ms) at 1.5 T. When COPD patients were compared with controls, the percentage MR signal with respect to total MR-detectable phosphorus-containing metabolites was increased from inorganic phosphate (Pi) (7.1 +/- 1. 3% versus 3.9 +/- 0.7%, p = 0.0001) and phosphomonoesters (PMEs) (9. 4 +/- 1.2% versus 6.9 +/- 0.3%, p = 0.0001), whereas the signal from phosphodiesters was reduced (34.8 +/- 3.2 versus 40.4 +/- 3.3%, p = 0.015). The ratios of Pi to betaATP (0.8 +/- 0.2 versus 0.4 +/- 0.1, p = 0.001) and of PME to betaATP (1.0 +/- 0.2 versus 0.7 +/- 0.1, p = 0.015) were increased, but the phosphocreatine-to-Pi ratio (2.1 +/- 0.6 versus 3.2 +/- 0.6, p = 0.01) was reduced in patients as compared with controls. This alteration in phosphorus-containing metabolites within cerebral cells provides evidence of extensive use of anaerobic metabolism in hypoxic COPD patients.

The relationship between affect expression and affect recognition in schizophrenia

To examine the relationship between affect expression and affect recognition, we assessed 30 clinically stable, medicated schizophrenic inpatients. Affect expression was assessed using both a standard clinical rating scale (SANS) and a computerized acoustic voice analysis (VOXCOM). Affect recognition was assessed using the Florida Affect Battery (FAB). The schizophrenics' performance on the FAB was impaired, indicating broad deficits in affect recognition (p<0.05). There were no significant correlations between measures of affect expression and affect recognition, suggesting that the expressive impairment in schizophrenia is not related to their ability to discern emotions in others. SANS Inappropriate Affect, however, was negatively correlated with facial affect recognition (p = 0.001), suggesting that raters' impression of inappropriate affect may indicate a failure in the process of affect attunement.

HIV and tuberculosis co-infection in an inner London hospital--a prospective anonymized seroprevalence study

OBJECTIVES

Since 1987 there has been an increase in tuberculosis notifications in the U.K., with this increase disproportionately affecting London. A recent national survey suggests that co-infection with HIV occurs in less than 5% of tuberculosis patients. This study asked if local co-infection rates in Inner London differed from the national results.

METHODS

157 consecutive patients starting antituberculous chemotherapy were venesected 2 weeks into treatment. Anonymized blood samples were screened for antibodies for HIV-1 and HIV-2 by enzyme-linked immunosorbent assay (ELISA). Epidemiological data were collected on each patient which was also coded before HIV test results were known.

RESULTS

Of 157 patients commencing antituberculous therapy, 39 patients (24.8%) were found to be co-infected with HIV-1. HIV-negative and positive patients were similar in terms of age and sex. When 98 patients giving their country of origin as other than Europe were considered there were 22 co-infected with HIV (22.4%). Of the 39 HIV-positive identified in this study, 37 were also identified by our voluntary HIV testing programme.

CONCLUSIONS

This study has shown that there may be very different rates of co-infection at a local level in the U.K. The local variation may be missed by national surveys and diverse local testing procedures. Anonymous testing identified only two patients with tuberculosis and HIV infection who were not identified by our voluntary HIV testing programme and this suggests that offering HIV tests to patients with tuberculosis is largely taken up by those at risk of HIV infection. Surveillance studies of this type are important in identifying marked local variation from the national pattern of HIV and Mycobacterium tuberculosis infection.

Genotypic analysis of Mycobacterium tuberculosis from medieval human remains

Three medieval bone samples with osteological evidence of tuberculosis infection were analysed for the presence of DNA sequences from Mycobacterium tuberculosis using a series of PCRs. In each case amplification of IS6110 and part of the beta-subunit of RNA polymerase identified infection with a bacterium belonging to the M. tuberculosis complex. Amplification of the mtp40 genome fragment and the presence of a guanine residue at position 285 in the oxyR pseudogene, demonstrated the infecting strain to be similar to present day M. tuberculosis isolates rather than to Mycobacterium bovis. Spoligotyping, based on amplification of the direct repeat (DR) region of the mycobacterial genome, provided further evidence of similarity to M. tuberculosis and indicated a close relationship between isolates associated with two separate medieval burials. The study demonstrates the feasibility of amplifying multiple M. tuberculosis loci in ancient human remains and suggests important applications in the study of the palaeoepidemiology and virulence of tuberculosis in past populations.

Inhaled corticosteroids for adult asthma: impact of formulation and delivery device on relative pharmacokinetics, efficacy and safety

Metered dose inhalers (MDIs) are the mainstay of inhaled steroid therapy for asthma. With the phasing out of traditional chlorofluorocarbon (CFC) propellants and their replacement with a new generation of CFC-free products, it is becoming clear that formulation and inhaler characteristics can markedly affect the drug delivery. It now seems necessary to compare inhalers not only on the basis of the properties of the steroid molecules but also to take into account the effect of propellants and other inhaler characteristics. The impact of formulation and delivery device on relative pharmacokinetics, therapeutic efficacy and tolerability is illustrated by a new preparation of beclomethasone dipropionate (BDP) in an inhaler containing hydrofluoroalkane (HFA) propellant, called Qvar (3M Health Care, U.K.). This drug preparation delivers the majority of particles (60%) in the fine particle range. This appears to be associated with improved lung deposition, a halving of dose requirements of BDP, but no evidence of clinically relevant adrenal suppression when used in therapeutic doses. Prescribers need to be aware of the impact of formulation on pharmacokinetics of inhaled steroids in order to offer the lowest effective dose and give clear instructions to patients who are changing to a CFC-free product.

Studies on the role of mucus and mucosal hypersensitivity reactions during rejection of Trichostrongylus colubriformis from the intestine of immune sheep using an experimental challenge model

Nematode-naive sheep and sheep immunised by truncated infections with Trichostrongylus colubriformis were fitted with intestinal cannulae to allow administration of challenge infection and collection of intestinal fluids. Sheep were slaughtered at various times after challenge and the distribution of larvae along the small intestine was determined. Results showed that immune sheep had significantly fewer larvae in their intestines and that some sheep could expel the challenge infection within 2 h. Mucus samples from immune sheep contained increased parasite-specific antibody, histamine and anti-parasite activity as measured by larval migration inhibition assay. Higher levels of antibody and histamine were seen in intestinal fluids of immune sheep after challenge. Immunisation of sheep by truncated infections stimulated serum IgE and resulted in significantly higher numbers of IgE-positive cells in gut tissue sections before challenge and at 2 h and 24 h after challenge. Immune sheep also had greater numbers of mucosal mast cells and globule leucocytes after challenge, compared with naive sheep. When challenge larvae were mixed with mucus from immune sheep and infused back into naive recipient sheep, there was a distinct displacement of the larval population towards the distal part of the intestine, compared with the profile of larval establishment after infusion with mucus from naive sheep. These results are further evidence for an immediate hypersensitivity reaction in the intestine of immune sheep, where challenge larvae are expelled within 2 h and confirm the direct anti-larval properties of mucus. The cannulated-sheep challenge model described here will be a useful tool to unravel the mechanism of larval rejection from immune sheep and could lead to novel therapies.

A descriptive study of the demography, symptomology, management and outcome of the first 300 patients admitted to an independent hospice in Singapore

The aims of this study were: 1) to describe the demography, symptomology, investigations conducted, non-pharmacological interventions and outcome of patients admitted to an inpatient hospice and 2) to identify the nursing and medical needs of terminally ill patients. Case-notes of the first 300 patients admitted to Dover Park Hospice were studied retrospectively. There were 159 men and 141 women making up 325 admissions. The racial distribution was: Chinese 95.0%, Malays 3.0%, Indians 1.3% and Others 0.6%. Two-thirds of the men (64.2%) had spouses while 44.7% of the women were widowed. The mean age was 64.7 years. The 3 most common cancers were lung (21.7%), colorectal (14.6%) and hepatobiliary (12.5%). A proportion of patients (39.5%) were not known to have any metastases. Most patients were referred from hospitals and the home-care based Hospice Care Association. The commonest reason for admission was for "terminal care" (57.2%). At admission, only 38% of the patients were aware of their diagnoses and prognosis while 30% did not know either. The average length of stay was 25 days with 7.7% of patients having more than one admission. The most common symptoms were pain, anorexia, breathlessness, insomnia, constipation and dry skin. Non-pharmacological interventions ranged from manual evacuation of the rectum to transfers to tertiary hospitals for surgery and other more invasive interventions. Many patients also attended day-care activities (23.1%). Outcome of the 325 admissions were as follows: went home 20%, died in the hospice 73.2%, went home to die 4.9% and others 1.8%.

Diagnosis and management of tuberculosis

Traditional laboratory methods used in the diagnosis of Mycobacterium tuberculosis are hindered by the organism being fastidiously slow growing. This has previously meant that species identification and drug sensitivity testing could take several weeks. New molecular biological techniques, which can be applied to both clinical samples and cultured isolates, have accelerated this diagnostic process to a number of days. The molecular biological methods used to identify M. tuberculosis and allow rapid drug susceptibility testing are reviewed. Novel molecular strain typing ("fingerprinting") techniques to discriminate between different isolates are discussed. The impact of these new methods on management is also reviewed.

"The spotlight initiative": evidence from oral and maxillofacial surgery

In 1996 Strathclyde Police launched a campaign in order to reduce crime, especially violent crime in the region. Surgical data have been previously suggested as a more accurate reflection of violent activity than police statistics. Whilst police figures record success in reducing serious violent crime during this initiative, there was a slight increase in facial fractures resulting from assault in public places in the same period although this increase was not significant at the p < 0.05 level.

Age differences in context integration in memory

This research examined the role of contextual integration in memories of younger and older adults. In 2 experiments, recall of a target picture to a context picture cue was better when sentences were generated that integrated the picture pair and when the picture pairs were already related to each other. Age differences were smallest when sentences were generated for semantically related pairs. Older adults generated the same type sentences as younger adults, although they generated fewer integrations for unrelated pairs. In a 3rd experiment, younger adults could not differentiate between younger- and older-generated sentences from Experiment 1, and the sentences did not differentially affect recall performance. The results are discussed in terms of age differences in self-initiated processing when using context.

Pulmonary tuberculosis in Harare, Zimbabwe: analysis by spoligotyping

BACKGROUND

Over the last 10 years there has been a fourfold increase in cases of tuberculosis in Harare, Zimbabwe. The use of molecular epidemiology to understand tuberculosis transmission in this epidemic has been hampered by the availability of suitable culture facilities. A study was therefore undertaken to explore the potential of spoligotyping, a polymerase chain reaction based technique that does not require tuberculosis culture.

METHODS

Adults attending a chest clinic with clinical or radiological pulmonary tuberculosis and one smear positive sputum were enrolled over one month. Demographic, socioeconomic, and clinical data were gathered using a standardised questionnaire. Molecular fingerprinting of genomic DNA recovered from sputum was performed by spoligotyping.

RESULTS

Sixty one subjects (median age 28 years (range 18-73); 61% men) were recruited and 57 provided adequate sputum samples. Recent rural-urban migration or immigration was not common; 40% of subjects lived in crowded living conditions. DNA suitable for spoligotyping was recovered from 28 patients and 20 different genotypes of Mycobacterium tuberculosis were identified. Fifteen patients were infected with an M tuberculosis strain shared by one or more individuals. Patients infected with a shared spoligotype were not closely linked geographically within Harare, but were more likely to live in overcrowded conditions (69% versus 23%; odds ratio 6.85 (95% CI 1.2 to 47), p = 0.026). Analysis of the patients' original rural family homes revealed two geographically related spoligotype clusters.

CONCLUSIONS

Spoligotyping may yield valuable molecular typing information in populations where tuberculosis culture is not available. This novel technique requires further development and evaluation in larger epidemiological studies.

Defense style and family environment

Prospective observations of the defense styles of normal individuals suggest that the quality of the childhood family environment may influence the maturity of defense styles used in adulthood. In this study, 106 female adolescent psychiatric patients completed the Defense Style Questionnaire, and the Family Environment Scale (FES). Positive family characteristics such as cohesion and expressiveness, as measured by the FES, were correlated with the report of Mature Defenses. Negative family characteristics such as conflict were correlated with the report of Immature Defenses. Similar although weaker correlations were found after controlling for the effects of depression and defensiveness on the self-report measures.

Localization and functional domains of the neurofibromatosis type II tumor suppressor, merlin

The neurofibromatosis type II (NF2) tumor suppressor gene is inactivated in the development of familial and sporadic schwannomas and meningiomas. The encoded protein, merlin, is closely related to ezrin, radixin, and moesin, which are members of the band 4.1 family of membrane/cytoskeletal linker proteins. We have examined the localization and effects of overexpressing epitope-tagged full-length isoforms of merlin as well as amino- and carboxyl-terminal truncations. The full-length and the amino-terminal domain of merlin localize to cortical actin, particularly areas of dynamic actin rearrangements such as membrane ruffles. Furthermore, overexpression of the carboxyl half of merlin induces cell death in NIH3T3 cells. The effect is splice-form specific and is not observed in the context of the full-length molecule. Thus, as has been described for the erzin, radixin, and moesin proteins, the activities of the carboxyl-terminal domain of merlin may be suppressed by the amino-terminal domain.

Regulation of the neurofibromatosis type 2 tumor suppressor protein, merlin, by adhesion and growth arrest stimuli

The neurofibromatosis type 2 tumor suppressor gene is inactivated in the development of familial and sporadic schwannomas and meningiomas. The encoded protein, Merlin, is closely related to the Ezrin, Radixin, and Moesin family of membrane/cytoskeletal linker proteins. Examination of Merlin in several cell lines revealed that the protein migrates as two distinct species near 70 kDa. Phosphatase treatment and orthophosphate labeling demonstrated that the species with decreased mobility is phosphorylated. Given Merlin's localization to cortical actin structures, we examined the effect of cell-cell contact or other forms of growth arrest on Merlin expression and post-translational modification. Under conditions of confluency or serum deprivation, the levels of phosphorylated and unphosphorylated Merlin species increased significantly. Cells arrested in G1 by other methods or other phases of the cell cycle did not show changes in Merlin levels. Furthermore, loss of adhesion resulted in a nearly complete dephosphorylation of Merlin, which was reversed upon re-plating of cells, suggesting Merlin phosphorylation may be responsive to cell spreading or changes in cell shape. Thus, the tumor suppressor function of Merlin may involve the regulation of cellular responses to cues such as cell-cell contact, growth factor microenvironment, or changes in cell shape.

Age differences in context integration in memory

This research examined the role of contextual integration in memories of younger and older adults. In 2 experiments, recall of a target picture to a context picture cue was better when sentences were generated that integrated the picture pair and when the picture pairs were already related to each other. Age differences were smallest when sentences were generated for semantically related pairs. Older adults generated the same type sentences as younger adults, although they generated fewer integrations for unrelated pairs. In a 3rd experiment, younger adults could not differentiate between younger- and older-generated sentences from Experiment 1, and the sentences did not differentially affect recall performance. The results are discussed in terms of age differences in self-initiated processing when using context.

Soluble L-selectin concentration in bronchoalveolar lavage fluid obtained from infants who develop chronic lung disease of prematurity

AIMS

To explore the changes in neutrophil adhesion molecule expression and release into bronchoalveolar lavage fluid (BAL) obtained from infants who developed chronic lung disease (CLD).

METHODS

BAL fluid was obtained from 37 infants: 18 (median gestation 26 weeks, birthweight 835 g) who developed CLD, 12 (29 weeks, 1345 g) with respiratory distress syndrome (RDS) and seven control infants (33 weeks, 2190 g).

RESULTS

Soluble L-selectin (sL-selectin) in BAL fluid from the CLD and non-CLD groups was similar immediately after birth, but in infants who subsequently developed CLD, sL-selectin remained persistently increased (at day 7: CLD 42.6 vs RDS 6.0 ng/ml, p < 0.05; CLD vs controls 1.5 ng/ml; p < 0.05). CD11b/CD18 expression on neutrophils obtained by BAL increased with time to reach a maximum at 17 days of age in infants who developed CLD.

CONCLUSIONS

These results suggest that leucocyte traffic persists in infants who develop CLD and may have an important part to play in the pathogenesis of CLD.

Serum IgE responses during primary and challenge infections of sheep with Trichostrongylus colubriformis

Serum IgE responses during primary or challenge infections with Trichostrongylus colubriformis were examined by measuring total IgE and parasite-specific IgE by ELISA. Three- to four-month-old lambs reared nematode-free received a single primary infection of 30,000 T. colubriformis-infective larvae (TcL3). Infections were terminated after 100 days by anthelmintic treatment, at which time faecal egg counts had fallen to low levels. Total serum IgE increased slowly from 20 days p.i. until anthelmintic treatment. The specific IgE response to T. colubriformis adult antigen peaked at 20-27 days p.i. before returning to near baseline levels. A further slight increase occurred between 56 and 100 days p.i. The animals were then divided equally into two groups. A first series of challenge infections consisting of either weekly 10,000 TcL3 infections (Group A) or a single 30,000 TcL3 infection (Group B) produced low faecal egg counts. Total and specific IgE to adult and L3-ES antigens increased rapidly over a 21-day period, then remained elevated irrespective of challenge regime. Termination of primary and the first challenge infections with anthelmintic resulted in a rapid decline in serum IgE responses but not other T. colubriformis-specific Ig responses. A second series of challenge infections consisting of repeated 10,000 (Group A) or 20,000 TcL3 infections (Group B) resulted in all IgE responses peaking within 7-8 days p.i. Marked softening of faeces coincided with peaks of specific and total IgE responses during challenge infections. The results of this study showed that infection of sheep with T. colubriformis leads to elevated levels of total and parasite-specific IgE in serum. IgE responses following challenge suggest involvement of this antibody isotype in protection from T. colubriformis infections.

RhoA-dependent phosphorylation and relocalization of ERM proteins into apical membrane/actin protrusions in fibroblasts

The ERM proteins (ezrin, radixin, and moesin) are a group of band 4. 1-related proteins that are proposed to function as membrane/cytoskeletal linkers. Previous biochemical studies have implicated RhoA in regulating the association of ERM proteins with their membrane targets. However, the specific effect and mechanism of action of this regulation is unclear. We show that lysophosphatidic acid stimulation of serum-starved NIH3T3 cells resulted in relocalization of radixin into apical membrane/actin protrusions, which was blocked by inactivation of Rho by C3 transferase. An activated allele of RhoA, but not Rac or CDC42Hs, was sufficient to induce apical membrane/actin protrusions and localize radixin or moesin into these structures in both Rat1 and NIH3T3 cells. Lysophosphatidic acid treatment led to phosphorylation of radixin preceding its redistribution into apical protrusions. Significantly, cotransfection of RhoAV14 or C3 transferase with radixin and moesin revealed that RhoA activity is necessary and sufficient for their phosphorylation. These findings reveal a novel function of RhoA in reorganizing the apical actin cytoskeleton and suggest that this function may be mediated through phosphorylation of ERM proteins.

Cryptogenic fibrosing alveolitis: lack of association with Epstein-Barr virus infection

BACKGROUND

Cryptogenic fibrosing alveolitis (CFA) is a well defined clinical entity of unknown aetiology. An association between CFA and the presence of protein indicating Epstein-Barr virus (EBV) replication within epithelial cells of the respiratory tract has recently been suggested, leading to speculation for a role for EBV in the pathogenesis of CFA.

METHODS

Lung tissue was obtained from patients in three groups: those with cryptogenic fibrosing alveolitis, either lone or associated with systemic sclerosis; patients with other pulmonary disorders; and patients with normal lung. Paraffin blocks were stained using three antibodies raised against well defined EBV antigens. In addition, EBER-1 and EBER-2 anti-sense nucleotide probes were used in an attempt to identify EBV RNA. DNA was also extracted from the tissue sections and evaluated for evidence of EBV DNA using the polymerase chain reaction.

RESULTS

Immunohistochemistry showed inconsistent focal positive staining with anti-EBV antibodies in all three groups, but there was no evidence of EBV RNA using in situ hybridisation. None of the samples from patients with pulmonary fibrotic disorders was found to contain EBV DNA following gene amplification.

CONCLUSION

Contrary to an earlier report, these results do not support the hypothesis that EBV has a role in the pathogenesis of CFA.

Bulimia as a disturbance of narcissism: self-esteem and the capacity to self-soothe

A review of the literature on eating disorders reveals that, although psychodynamic formulations linking narcissistic dynamics--particularly difficulties with self-soothing--and eating disorders are common in the theoretical and clinical literature, little empirical work has attempted to substantiate this claim. In this study, 117 women completed the Eating Disorder Inventory and the Bulimia Test Revised and four scales that measure different components of narcissism (the Multidimensional Self-Esteem Inventory, measuring self-esteem, the Self-Care Questionnaire, and two subscales of the Ego Functioning Assessment Questionnaire, measuring self-soothing). The four scales used to assess narcissism were all highly correlated with each other, indicating that they measure a similar construct. In addition, the eating-disorder measures were correlated with the measures of narcissism, suggesting that a relationship exists between bulimia and narcissism, as assessed using self-report instruments.