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Hartman-Munick SM, Allen S, Powell A. Disordered Eating/Eating Disorders in Adolescents. Pediatr Clin North Am 2024; 71:631-643. [PMID: 39003006 DOI: 10.1016/j.pcl.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Abstract
The coronavirus disease 2019 pandemic was as tressful time for adolescents, with increased isolation, loss of routines, and changes in access to medical care. In this setting, the medical system saw a significant rise in the number of adolescents seeking care for eating disorders, as well as increased severity of patient presentation. Telehealth treatment for eating disorders was a unique shift during the pandemic, with some benefits but not universally positive experiences among patients, families and providers.
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Affiliation(s)
- Sydney M Hartman-Munick
- University of Massachusetts Memorial Children's Medical Center, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Suzanne Allen
- University of Massachusetts Memorial Children's Medical Center, UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Anne Powell
- University of Massachusetts Memorial Children's Medical Center, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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2
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Pehlivan MJ, Rodgers B, Schlage J, Maguire S, Miskovic-Wheatley J. Characteristics, correlates of burden and support service use of a help-seeking carers of loved ones with an eating disorder. EUROPEAN EATING DISORDERS REVIEW 2024; 32:458-475. [PMID: 38100163 DOI: 10.1002/erv.3059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Carers, vital in the care of individuals with an eating disorder (ED), experience substantial caregiving burden and unmet needs. This study aims to identify factors which contribute to the burden experienced by carers of a loved one with an ED and their support service usage. METHOD Carers (N = 245) completed an online questionnaire assessing demographic, carer-specific, individual and ED factors. Multivariate relationships with caregiving burden were examined using forwards elimination to produce a parsimonious model of carer burden. RESULTS The final model, consisting of caregiving factors (e.g., relationship type, skills), carer mental health) and loved one wellbeing (i.e., purging symptoms, depression/self-harm/suicidality) explained a large proportion (62%) of the variance in carers' burden. Carer mental health, caregiving skills and relationship type (e.g., parent, spouse, sibling) were key predictors of carers' burden. Nearly a third of carers had not used any carer support services, yet most carers expressed an interest in such services. CONCLUSION Caregiving burden is determined by experiences and skills of the carer as well as the person they are caring for. Carer support services should continue to address the general wellbeing of carers and caregiver skills. Research into the barriers to carer support uptake is needed.
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Affiliation(s)
- Melissa J Pehlivan
- InsideOut Institute of Eating Disorders, The University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Bethany Rodgers
- School of Arts, Design and Architecture, University of New South Wales, Paddington, Australia
| | - Jasmin Schlage
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute of Eating Disorders, The University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute of Eating Disorders, The University of Sydney, Sydney Local Health District, Sydney, Australia
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3
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Cheung VHI, Christie LJ, Maister T, Higgins D, Williams D, Woods N, Armstrong M, Hart S. Identifying potential cases of eating disorders in an acute medical hospital. Int J Eat Disord 2024. [PMID: 38647421 DOI: 10.1002/eat.24203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To identify patients presenting to an acute medical hospital with common signs and symptoms that occur in people with eating disorders (EDs), and determine by retrospective file audit if these are diagnosed cases of an ED. METHOD The investigators screened electronic medical records of people 16 years and older for common signs and symptoms of an ED such as hypokalemia, in patients presenting to an acute hospital in Sydney, Australia from 2018 to 2020. Cases where the clinical finding was unexplained had their file audited. Cases with a known ED diagnosis or coded with an ED were also retrieved to audit. RESULTS Investigators identified 192 definite ED cases with a total of 598 episodes of care from 2018 to 2020 presenting to the hospital. Eighty-three cases were identified as possible EDs due to unexplained clinical signs consistent with an ED, but were not confirmed cases due to lack of clinical history in the file. Only 19.1% of presentations were diagnostically coded with an ED in the electronic medical record. DISCUSSION Our study revealed a large number of definite ED cases presenting to an acute medical hospital via the emergency department, who were not recognized as having an ED. Greater awareness of clinical signs and symptoms of an ED, such as unexplained low body mass index and hypokalemia, is necessary among acute care clinicians. Correctly identifying EDs in those seeking somatic care should be a public health priority, to facilitate timely and equitable access to diagnostic assessment and evidence based treatment. PUBLIC SIGNIFICANCE People with eating disorders (EDs) present to acute care settings and have a relatively high utilization of generalist health services with nonspecific problems such as abdominal pain. An enhanced understanding of healthcare utilization by people with EDs, who may not disclose their symptoms, is crucial for improving access to treatment.
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Affiliation(s)
| | - Lauren J Christie
- Allied Health Research Unit, St Vincent's Health Network Sydney, Australia
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, North Sydney, Australia
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia
| | - Terri Maister
- Nutrition and Dietetic Services, St Vincent's Health Network Sydney, Australia
| | - Devlin Higgins
- The O'Brien Centre Mental Health Services, St Vincent's Health Network Sydney, Australia
| | - David Williams
- Gastroenterology and Hepatology, St Vincent's Health Network Sydney, Australia
| | - Nikki Woods
- Emergency Department, St Vincent's Health Network Sydney, Australia
| | - Melissa Armstrong
- Nutrition and Dietetic Services, St Vincent's Health Network Sydney, Australia
| | - Susan Hart
- Nutrition and Dietetic Services, St Vincent's Health Network Sydney, Australia
- Eating Disorders and Nutrition Research Group, Western Sydney University, Australia
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4
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Dimitropoulos G, Singh M, Mushquash C, Kimber M, Hutt-MacLeod D, Moore EK, Perri A, Webb C, Norman L, Sauerwein J, Nicula M, Couturier J. TransitionED: A protocol for Co-designing and implementing Canadian practice guidelines for transitions for youth with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 37690096 DOI: 10.1002/erv.3026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/16/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Limited guidelines inform the transition from paediatric to adult healthcare for youth and young adults (YYA) with eating disorders (EDs). This study will develop, implement, and evaluate Canadian Clinical Practice Guidelines for ED transition, including identifying the relevant measurement and evaluation tools for transition readiness and continuity of care. METHODS This study consists of three phases. Phase 1 involves conducting a scoping review of the evidence on transition interventions, outcomes, and measurement tools for YYA with EDs, along with guideline development using the modified Delphi method. Phase 2 identifies the contextual/cultural factors relevant to guideline implementation and co-designing an implementation protocol with governance committees and research partners. Phase 3 involves the application and evaluation of the proposed guide lines using the implementation protocol, and assessing the acceptability and feasibility of a prototype transition intervention in two Canadian paediatric ED programs. CONCLUSIONS Results will provide the knowledge needed to enhance the lives of YYA, improve the effectiveness of the ED care system, and support the scale of the transition guidelines across Canada. These guidelines will have international relevance by potentially informing the field on how to support young people with EDs transitioning in similar funding structures and systems of care.
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Affiliation(s)
- Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Manya Singh
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
- Dilico Anishinabek Family Care, Fort William First Nation, Ontario, Canada
- Thunder Bay Regional Health Sciences Centre/Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Andrea Perri
- Child and Adolescent Addictions, Mental Health and Psychiatry Program, Alberta Health Services, Edmonton, Alberta, Canada
| | - Cheryl Webb
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lia Norman
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Sauerwein
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Maria Nicula
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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Duriez P, Goueslard K, Treasure J, Quantin C, Jollant F. Risk of non-fatal self-harm and premature mortality in the three years following hospitalization in adolescents and young adults with an eating disorder: A nationwide population-based study. Int J Eat Disord 2023; 56:1534-1543. [PMID: 37092760 DOI: 10.1002/eat.23974] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Eating disorders (ED) are associated with high rates of suicide attempts and premature mortality. However, data in large samples of adolescents and young adults are limited. This study aims to assess the risk of self-harm and premature mortality in young people hospitalized with an ED. METHODS Individuals aged 12 to 25 years old hospitalized in 2013-2014 in France with anorexia nervosa and/or bulimia nervosa as a primary or associated diagnosis were identified from French national health records. They were compared to two control groups with no mental disorders, and with any other mental disorder than ED. The main outcomes were any hospitalization for deliberate self-harm and mortality in the 3 years following hospitalization. Logistic regression models were used. RESULTS This study included 5, 452 patients hospitalized with an ED, 14,967 controls with no mental disorder, and 14,242 controls with a mental disorder other than an ED. During the three-year follow-up, 13.0% were hospitalized for deliberate self-harm (vs. 0.2 and 22.0%, respectively) and 0.8% died (vs. 0.03 and 0.4%). After adjustment, hospitalization with an ED was associated with more self-harm hospitalizations (hazard ratio [HR] = 46.0, 95% confidence interval [32.3-65.3]) and higher all-cause mortality (HR = 12.6 [4.3-37.3]) relative to youths without any mental disorder; less self-harm hospitalizations (HR = 0.5 [0.5-0.6]) but higher mortality (HR = 1.6 [1.0-2.4]) when compared to youths with any other mental disorder. CONCLUSION Young patients hospitalized with an ED are at high risk of self-harm and premature mortality. It is urgent to evaluate and implement the best strategies for post-discharge care and follow-up. PUBLIC SIGNIFICANCE We found that the risk of being hospitalized for a suicide attempt is 46 times higher and mortality 13 times higher than the general population in adolescents and young adults during the 3 years following hospitalization with an eating disorder. Eating disorders are also associated with a 1.5 higher risk of premature mortality relative to other mental disorders. This risk is particularly high in the 6 months following hospitalization. It is therefore crucial to implement careful post-discharge follow-up in patients hospitalized for eating disorders.
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Affiliation(s)
- Philibert Duriez
- CMME, Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris, France
- UMR_S1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Inserm, Paris, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Karine Goueslard
- Service de Biostatistiques et d'Information Médicale (DIM), CHRU Dijon, Dijon, France
| | - Janet Treasure
- Psychology and Neuroscience, Section of Eating Disorders, Institute of Psychiatry, London, UK
| | - Catherine Quantin
- CIC 1432, INSERM, Dijon, France
- Clinical Epidemiology Clinical Trials Unit, Clinical Investigation Center, CHU Dijon, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Fabrice Jollant
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Department of Psychiatry, CHU Bicêtre, Le Kremlin-Bicêtre, France
- Department of Psychiatry, CHU de Nîmes, Nîmes, France
- Department of Psychiatry, Faculty of Medicine, and McGill Group For Suicide Studies, McGill University, Montréal, Québec, Canada
- Team MOODS, Centre de recherche en Épidémiologie et Santé des Populations (CESP), Inserm, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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Kustov GV, Zinchuk MS, Popova SB, Mishin IN, Voinova NI, Yakovlev AA, Akzhigitov RG. Factors associated with lifetime history of eating disorder in non-psychotic patients with suicidal ideation. CONSORTIUM PSYCHIATRICUM 2023; 4:53-63. [PMID: 38250641 PMCID: PMC10795959 DOI: 10.17816/cp6555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/23/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Data on the sociodemographic, biographical, and clinical factors associated with a lifetime diagnosis of eating disorders (ED) in patients with non-psychotic mental disorders (NPMD) and suicidal ideation (SI) are scarce. METHODS A cohort study was conducted at the Moscow Research and Clinical Center for Neuropsychiatry. The sample consisted of consecutive patients with non-psychotic mental disorders and SI, aged 1845 years. Participants with a lifetime diagnosis of anorexia and/or bulimia (then in remission or recovery) were compared with those without ED in terms of their sociodemographic profile, clinical characteristics, lifetime traumatic events, and some behavioral patterns. All participants underwent the Russian version of the Self-Injurious Thoughts and Behaviors Interview and completed the Brief Reasons for Living Inventory, the State and Trait Anxiety Inventory, and the Beck Depression Inventory. RESULTS A total of 892 patients with non-psychotic mental disorders and SI were included in the study. The mean age was 25.7 years, and 84% were assigned female at birth. Same-sex experience was more common in the ED group. Patients with an ED were more likely to have a history of physical and sexual abuse and to have witnessed domestic violence. The proportion of participants with piercings, tattoos, or severe body modifications was significantly higher in the ED group. Patients with a lifetime ED were more likely to engage in nonsuicidal self-injurious behaviors and to have a history of suicide attempts. CONCLUSION Lifetime ED in NPMD patients with SI is associated with younger age, being assigned female at birth, having an alternative gender identity, having same-sex experience, having more than one psychiatric diagnosis, having been diagnosed with bipolar disorder, experiencing severe depression and anxiety, being exposed to multiple traumatic experiences, having various body modifications, practicing NSSI, and having a lifetime story of suicide attempts.
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Affiliation(s)
- George V. Kustov
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
| | - Mikhail S. Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
| | - Sofya B. Popova
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
| | - Ilya N. Mishin
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
| | - Nadezhda I. Voinova
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
| | - Alexander A. Yakovlev
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
- Department of Functional Biochemistry of Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences
| | - Renat G. Akzhigitov
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
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Crone C, Fochtmann LJ, Attia E, Boland R, Escobar J, Fornari V, Golden N, Guarda A, Jackson-Triche M, Manzo L, Mascolo M, Pierce K, Riddle M, Seritan A, Uniacke B, Zucker N, Yager J, Craig TJ, Hong SH, Medicus J. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. Am J Psychiatry 2023; 180:167-171. [PMID: 36722117 DOI: 10.1176/appi.ajp.23180001] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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8
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Chauvet-Gelinier JC, Roussot A, Vergès B, Petit JM, Jollant F, Quantin C. Hospitalizations for Anorexia Nervosa during the COVID-19 Pandemic in France: A Nationwide Population-Based Study. J Clin Med 2022; 11:jcm11164787. [PMID: 36013026 PMCID: PMC9409983 DOI: 10.3390/jcm11164787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic has had a detrimental impact on mental health, including on food-related behaviors. However, little is known about the effect of the pandemic on anorexia nervosa (AN). We sought to assess an association between the COVID-19 pandemic and a potential increase in hospitalizations for AN in France. We compared the number of hospitalizations with a diagnosis of AN during the 21-month period following the onset of the pandemic with the 21-month period before the pandemic using Poisson regression models. We identified a significant increase in hospitalizations for girls aged 10 to 19 years (+45.9%, RR = 1.46[1.43−1.49]; p < 0.0001), and for young women aged 20 to 29 (+7.0%; RR = 1.07[1.04−1.11]; p < 0.0001). Regarding markers of severity, there was an increase in hospitalizations for AN associated with a self-harm diagnosis between the two periods. Multivariate analysis revealed that the risk of being admitted for self-harm with AN increased significantly during the pandemic period among patients aged 20−29 years (aOR = 1.39[1.06−1.81]; p < 0.05 vs. aOR = 1.15[0.87−1.53]; NS), whereas it remained high in patients aged 10 to 19 years (aOR = 2.40[1.89−3.05]; p < 0.0001 vs. aOR = 3.12[2.48−3.98]; p < 0.0001). Furthermore, our results suggest that the pandemic may have had a particular effect on the mental health of young women with AN, with both a sharp increase in hospitalizations and a high risk of self-harming behaviors.
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Affiliation(s)
- Jean-Christophe Chauvet-Gelinier
- Department of Psychiatry, Dijon University Hospital, 21000 Dijon, France
- INSERM, LNC-UMR 1231, University of Burgundy, 21078 Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, 21000 Dijon, France
| | - Bruno Vergès
- INSERM, LNC-UMR 1231, University of Burgundy, 21078 Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 21000 Dijon, France
| | - Jean-Michel Petit
- INSERM, LNC-UMR 1231, University of Burgundy, 21078 Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 21000 Dijon, France
| | - Fabrice Jollant
- Department of Psychiatry and Psychotherapy, Jena University Hospital, 07743 Jena, Germany
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, 75014 Paris, France
- McGill Group for Suicide Studies, McGill University, Montreal, QC H3A 0G4, Canada
- Nîmes Academic Hospital (CHU), 30900 Nîmes, France
- Moods Team, INSERM, UMR-1178, CESP, 94276 Le Kremlin-Bicêtre, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, 21000 Dijon, France
- INSERM, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, 21000 Dijon, France
- INSERM, CESP, UVSQ, Université Paris-Saclay, 94807 Villejuif, France
- Correspondence: ; Tel.: +33-38029-3629
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9
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Scott GG, Pinkosova Z, Jardine E, Hand CJ. “Thinstagram”: Image content and observer body satisfaction influence the when and where of eye movements during instagram image viewing. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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10
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Lengvenyte A, Strumila R, Maimoun L, Seneque M, Olié E, Lefebvre P, Renard E, Courtet P, Guillaume S. A specific association between laxative misuse and suicidal behaviours in patients with anorexia nervosa and bulimia nervosa. Eat Weight Disord 2022; 27:307-315. [PMID: 33797033 DOI: 10.1007/s40519-021-01180-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/22/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Eating disorders (ED) are associated with an in increased risk of suicidal behaviours. Laxative abuse might alter the gut-brain axis signaling, that might be implicated in the pathophysiology of suicide. This study aims to determine the association between laxative misuse and suicide attempt (SA) and suicidal ideation (SI) in patients with ED. METHODS 277 patients with ED were recruited from an Eating Disorder Unit of Lapeyronie Academic Hospital, Montpellier, France. Sociodemographic and clinical data were collected. Chi-square and t test were used, with Bonferroni corrections where required. Multiple regression models assessed the relationships between laxative misuse, SA, and SI. RESULTS 62 (22.4%) patients reported lifetime laxative misuse. They were more likely to have a history of SA than non-misusers [43.83 vs 19.9%, p < 0.001, odds ratio (OR) 3.68]. In the multivariate model, adjusted for other confounders, lifetime laxative misuse remained associated with SA (adjusted OR 3.79, p = 0.041). In past 28 days, patients with SA history reported misusing laxatives for more days than patients without SA history (6 vs 1.5 days, p = 0.01, adjusted for vomiting and ED severity). Laxative use days during past 28 days was associated with current SI, adjusted for vomiting in the same period (p = 0.017). CONCLUSIONS Current and lifetime laxative misuse were associated with SA history and current SI in patients with ED, at least in part independently of other suicide-related factors. LEVEL OF EVIDENCE Level III cohort, cross-sectional study.
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Affiliation(s)
- Aiste Lengvenyte
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Robertas Strumila
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France.
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France.
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania.
| | - Laurent Maimoun
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
- Département de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier, 34295, Montpellier, France
| | - Maude Seneque
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Emilie Olié
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Patrick Lefebvre
- Department of Endocrinology, Diabetes, and Nutrition, CHRU Montpellier, Montpellier, France
| | - Eric Renard
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- UMR CNRS 5203, INSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Sebastien Guillaume
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
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11
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Rynkiewicz A, Dembiński Ł, Koletzko B, Michaud PA, Hadjipanayis A, Grossman Z, Korslund K, King BH, Treasure J, Peregud-Pogorzelski J, Del Torso S, Valiulis A, Mazur A. Adolescents With Eating Disorders in Pediatric Practice - The European Academy of Paediatrics Recommendations. Front Pediatr 2022; 10:806399. [PMID: 35558369 PMCID: PMC9086960 DOI: 10.3389/fped.2022.806399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
In the face of the growing number of adolescents suffering from eating disorders (EDs) and access to psychiatric care limited by the epidemiological and demographic situation, the primary care pediatrician's role in diagnosing and treating EDs is growing. The European Academy of Paediatrics (EAP) decided to summarize knowledge about EDs and formulate recommendations to support European pediatricians and improve care for adolescents with EDs.
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Affiliation(s)
- Agnieszka Rynkiewicz
- Department of Psychiatry, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszow, Rzeszow, Poland.,Center for Diagnosis, Therapy and Education SPECTRUM ASC-MED, Gdańsk, Poland
| | - Łukasz Dembiński
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Berthold Koletzko
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Paediatrics, Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Pierre-André Michaud
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Faculté de Biologie et de Médecine, Université de Lausanne, Lausanne, Switzerland
| | - Adamos Hadjipanayis
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,School of Medicine, European University Cyprus, Nicosia, Cyprus.,Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus
| | - Zachi Grossman
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Adelson School of Medicine, Ariel University, Ariel, Israel.,Maccabi Health Services, Tel Aviv, Israel
| | | | - Bryan H King
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Janet Treasure
- Eating Disorder Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jarosław Peregud-Pogorzelski
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland.,Polish Society of Paediatrics, Warsaw, Poland
| | - Stefano Del Torso
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,ChildCare WorldWide-CCWWItalia OdV, Padova, Italy
| | - Arunas Valiulis
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University Medical Faculty, Vilnius, Lithuania.,Department of Public Health, Institute of Health Sciences, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Artur Mazur
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Paediatrics, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszow, Rzeszow, Poland
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12
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Cliffe C, Seyedsalehi A, Vardavoulia K, Bittar A, Velupillai S, Shetty H, Schmidt U, Dutta R. Using natural language processing to extract self-harm and suicidality data from a clinical sample of patients with eating disorders: a retrospective cohort study. BMJ Open 2021; 11:e053808. [PMID: 34972768 PMCID: PMC8720985 DOI: 10.1136/bmjopen-2021-053808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine risk factors for those diagnosed with eating disorders who report self-harm and suicidality. DESIGN AND SETTING This study was a retrospective cohort study within a secondary mental health service, South London and Maudsley National Health Service Trust. PARTICIPANTS All diagnosed with an F50 diagnosis of eating disorder from January 2009 to September 2019 were included. INTERVENTION AND MEASURES Electronic health records (EHRs) for these patients were extracted and two natural language processing tools were used to determine documentation of self-harm and suicidality in their clinical notes. These tools were validated manually for attribute agreement scores within this study. RESULTS The attribute agreements for precision of positive mentions of self-harm were 0.96 and for suicidality were 0.80; this demonstrates a 'near perfect' and 'strong' agreement and highlights the reliability of the tools in identifying the EHRs reporting self-harm or suicidality. There were 7434 patients with EHRs available and diagnosed with eating disorders included in the study from the dates January 2007 to September 2019. Of these, 4591 (61.8%) had a mention of self-harm within their records and 4764 (64.0%) had a mention of suicidality; 3899 (52.4%) had mentions of both. Patients reporting either self-harm or suicidality were more likely to have a diagnosis of anorexia nervosa (AN) (self-harm, AN OR=3.44, 95% CI 1.05 to 11.3, p=0.04; suicidality, AN OR=8.20, 95% CI 2.17 to 30.1; p=0.002). They were also more likely to have a diagnosis of borderline personality disorder (p≤0.001), bipolar disorder (p<0.001) or substance misuse disorder (p<0.001). CONCLUSION A high percentage of patients (>60%) diagnosed with eating disorders report either self-harm or suicidal thoughts. Relative to other eating disorders, those diagnosed with AN were more likely to report either self-harm or suicidal thoughts. Psychiatric comorbidity, in particular borderline personality disorder and substance misuse, was also associated with an increase risk in self-harm and suicidality. Therefore, risk assessment among patients diagnosed with eating disorders is crucial.
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Affiliation(s)
- Charlotte Cliffe
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Aida Seyedsalehi
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Katerina Vardavoulia
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - André Bittar
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Sumithra Velupillai
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Hitesh Shetty
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Ulrike Schmidt
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Rina Dutta
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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13
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What can we learn about eating disorder mortality from eating disorder diagnoses at initial assessment? A Danish nationwide register follow-up study using record linkage, encompassing 45 years (1970-2014). Psychiatry Res 2021; 303:114091. [PMID: 34246009 DOI: 10.1016/j.psychres.2021.114091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 06/11/2021] [Accepted: 06/27/2021] [Indexed: 12/14/2022]
Abstract
Increased risk for premature mortality is well established for women and girls diagnosed with anorexia nervosa (AN), but less is known for other types of eating disorder (ED), and especially the mortality outcome for boys and men is under-studied. In this registry-based observational epidemiological study, we included all people appearing in the Danish Psychiatric Central Research Register with an eating disorder (ED) diagnosis in the time period from Jan 1,1970 to Dec 31, 2014 (N: 22,633). For each patient four controls without ED were selected, matched for age, sex and place of residence (N: 90486). In all 802 people with ED died over 255762.6 person-years of observation. Standardized mortality ratio (SMR) for all-cause mortality and suicide mortality was significantly increased for all ED-diagnoses in women. The SMRs for men were similar, but only reached significance for the diagnoses AN and unspecified ED. Mortality by natural causes and accidents was significantly increased in most ED-diagnoses in women. The unequal female-to-male ratio in this, and most other studies of ED-patients, suggests that boys and men with ED have unmet needs.
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14
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McMahon K, Stoddart K, Harris F. Rescripting-A grounded theory study of the contribution that fathers make to Family-Based Treatment when a young person has anorexia nervosa. J Clin Nurs 2021; 31:1598-1611. [PMID: 34448286 DOI: 10.1111/jocn.16013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
AIM To present a grounded theory of the contribution that fathers make to family-based treatment when a young person has anorexia nervosa. BACKGROUND Research indicates a potential to improve outcomes by involving both parents in the treatment of anorexia nervosa. However, fathers are underrepresented both within treatment and research. Family-based treatment requiring the involvement of both parents presents an opportunity to better understand the role of the father in treatment. DESIGN Classic grounded theory. METHODS Individual interviews conducted with fifteen fathers involved in family-based treatment. The COREQ checklist was followed. RESULTS Fathers valued being involved in family-based treatment and felt they had an important contribution to make. The analysis captures the overall contribution that fathers make and the impact of their involvement. Four categories; Being on the Outside, Finding a Way In, Finding a Way to Be and Finding a Way to Let Go and one core category Repositioning were generated from the data. A substantive theory of Rescripting, generated from categories and the core category, describes the way that participating in family-based treatment changes fathers and their role. CONCLUSIONS Fathers make an important and significant contribution to family-based treatment when a young person has anorexia nervosa. The findings inform clinicians about the importance of including fathers in the treatment of young people with anorexia nervosa. They highlight the importance of incorporating support mechanisms into family-based treatment to harness and maximise the paternal contribution. RELEVANCE TO CLINICAL PRACTICE Paternal contribution to family-based treatment can be maximised to improve outcomes for young people with anorexia nervosa.
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15
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Streatfeild J, Hickson J, Austin SB, Hutcheson R, Kandel JS, Lampert JG, Myers EM, Richmond TK, Samnaliev M, Velasquez K, Weissman RS, Pezzullo L. Social and economic cost of eating disorders in the United States: Evidence to inform policy action. Int J Eat Disord 2021; 54:851-868. [PMID: 33655603 DOI: 10.1002/eat.23486] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To estimate one-year costs of eating disorders in the United States (U.S.) from a societal perspective, including the costs to the U.S. health system, individual and family productivity costs, lost wellbeing, and other societal economic costs, by setting and payer. Findings will inform needed policy action to mitigate the impact of eating disorders in the U.S. METHOD Costs of eating disorders were estimated using a bottom-up cost-of-illness methodology, based on the estimated one-year prevalence of eating disorders. Intangible costs of reduced wellbeing were also estimated using disability-adjusted life years. RESULTS Total economic costs associated with eating disorders were estimated to be $64.7 billion (95% CI: $63.5-$66.0 billion) in fiscal year 2018-2019, equivalent to $11,808 per affected person (95% CI: $11,754-$11,863 per affected person). Otherwise Specified Feeding or Eating Disorder accounted for 35% of total economic costs, followed by Binge Eating Disorder (30%), Bulimia Nervosa (18%) and Anorexia Nervosa (17%). The substantial reduction in wellbeing associated with eating disorders was further valued at $326.5 billion (95% CI: $316.8-$336.2 billion). DISCUSSION The impact of eating disorders in the U.S. is substantial when considering both economic costs and reduced wellbeing (nearly $400 billion in fiscal year 2018-2019). Study findings underscore the urgency of identifying effective policy actions to reduce the impact of eating disorders, such as through primary prevention and screening to identify people with emerging or early eating disorders in primary care, schools, and workplaces and ensuring access to early evidence-based treatment.
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Affiliation(s)
- Jared Streatfeild
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
| | - Josiah Hickson
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
| | - S Bryn Austin
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | - Rebecca Hutcheson
- Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA.,School of Public Health, University of Washington, Seattle, Washington, USA
| | - Johanna S Kandel
- Alliance for Eating Disorders Awareness, West Palm Beach, Florida, USA
| | - Jillian G Lampert
- The Emily Program, St Paul, Minnesota, USA.,REDC Consortium (REDC), New York, New York, USA
| | | | - Tracy K Richmond
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | - Mihail Samnaliev
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | | | - Ruth S Weissman
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Lynne Pezzullo
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
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16
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Rania M, Monell E, Sjölander A, Bulik CM. Emotion dysregulation and suicidality in eating disorders. Int J Eat Disord 2021; 54:313-325. [PMID: 33205495 PMCID: PMC7984062 DOI: 10.1002/eat.23410] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Suicidality in eating disorders (EDs) is high, and identification of therapeutically targetable traits associated with past, current, and future suicidality is of considerable clinical importance. We examined overall and ED subtype-specific associations among suicidal ideation, suicide attempts, and general and specific aspects of emotion dysregulation in a large sample of individuals with ED, at presentation for treatment and 1-year follow-up. METHOD Using registry data from 2,406 patients, scores on the Difficulties in Emotion Dysregulation Scale (DERS) at initial registration were examined as predictors of recent suicidal ideation and self-report lifetime suicide attempts. Associations were examined in the full sample and in each ED subtype. In 406 patients, initial DERS scores were examined as predictors of suicidality at 1-year follow-up. RESULTS Overall DERS was associated with suicidal ideation and suicide attempts, even when adjusting for ED psychopathology and current depression. Perceived lack of emotion regulation strategies showed unique associations with suicidal ideation and suicide attempts, both in the full sample and in most ED subtypes. Initial DERS was also associated with follow-up suicidal ideation and suicide attempts, although this association did not remain when adjusting for past suicidality. DISCUSSION Results suggest that emotion dysregulation may be a potential mechanism contributing to suicidality in EDs, beyond the effects of ED psychopathology and current depression. Although the prevalence of suicidality differs across ED subtypes, emotion dysregulation may represent a risk trait for future suicidality that applies transdiagnostically. Results support addressing emotion dysregulation in treatment in order to reduce suicidality.
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Affiliation(s)
- Marianna Rania
- Department of Health SciencesUniversity Magna Graecia of CatanzaroCatanzaroItaly
- Center for Clinical Research and Treatment of Eating DisordersMater Domini University HospitalCatanzaroItaly
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Elin Monell
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesRegion StockholmStockholmSweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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17
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Marzola E, Rienecke RD, Cardi V, Levinson CA. Editorial: Full and Partial Hospitalization Interventions for Eating Disorders. Front Psychiatry 2021; 12:775715. [PMID: 34721121 PMCID: PMC8548463 DOI: 10.3389/fpsyt.2021.775715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 01/15/2023] Open
Affiliation(s)
- Enrica Marzola
- Department of Neuroscience "Rita Levi Montalcini," Eating Disorders Center, University of Turin, Turin, Italy
| | - Renee D Rienecke
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, Chicago, IL, United States.,Department of Psychiatry and Behavioral Neuroscience, Northwestern University, Chicago, IL, United States
| | - Valentina Cardi
- Department of General Psychology, University of Padova and Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States
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18
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Öhlund L, Ott M, Lundqvist R, Sandlund M, Salander Renberg E, Werneke U. Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort. Ther Adv Psychopharmacol 2020; 10:2045125320947502. [PMID: 32843959 PMCID: PMC7418477 DOI: 10.1177/2045125320947502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Currently, our understanding regarding treatment of adult attention deficit hyperactivity disorder (ADHD) co-occurring with bipolar disorder (BD) remains limited. The aim of this study was to evaluate the impact of central stimulant (CS) treatment on suicidal and non-suicidal self-injurious behaviour in patients with a pre-existing diagnosis of BD or schizoaffective disorder (SZD). Specifically, we tested the hypothesis that CS treatment significantly decreased the number of suicide attempts and non-suicidal self-injury events. METHODS A mirror-image study in patients with a dual diagnosis of BD or SZD and ADHD, comparing suicide attempts and non-suicidal self-injury events within 6 months and 2 years before and after CS initiation. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of BD as compared with other mood stabilisers. RESULTS Of 1564 eligible patients, 206 patients met the inclusion criteria. Within the 6 months after CS initiation, suicide attempts and non-suicidal self-injury events decreased significantly, both in terms of numbers of patients having such events (p = 0.013) and numbers of events experienced (p = 0.004). These effects were preserved 2 years after CS initiation. CONCLUSIONS CS treatment may reduce the risk of suicide attempts and non-suicidal self-injury events in patients with a dual diagnosis of BD or SZD and ADHD. Based on our findings, clinicians should not withhold CS treatment from patients with concomitant ADHD for fear of deterioration of the underlying BD. However, to minimise the risk of manic episodes concomitant mood stabiliser treatment and close monitoring remains warranted.
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Affiliation(s)
- Louise Öhlund
- Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit, Umeå University, Umeå, 901 87, Sweden
| | - Michael Ott
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Robert Lundqvist
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Luleå, Sweden
| | - Mikael Sandlund
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | | | - Ursula Werneke
- Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit, Umeå University, Luleå, Sweden
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