1
|
Li Z, Chubinidze D, Croft P, Webb J, Sarpong A, Zesch E, Tchanturia K. "Don't talk to me like I am an illness": exploring patients' needs using the communication passport in an eating disorder service. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024:10.1007/s40211-024-00501-7. [PMID: 38995527 DOI: 10.1007/s40211-024-00501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/05/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE Social challenges are common in patients with eating disorders (ED). The presence of autistic characteristics often exacerbates social difficulties within this group, potentially affecting treatment outcomes. This study investigates the communication preferences, challenges, dislikes, and support needs of patients with ED, both with and without autistic traits, using a communication passport in a national inpatient ED service. METHODS An explorative qualitative analysis of 38 completed communication passports was conducted to investigate patients' communication preferences, sensory needs, struggles and dislikes, and areas of support required, paying particular attention to the distinct needs of patients with high levels of autistic traits. RESULTS The communication passport provided valuable insights into patients' communication preferences, sensory sensitivities, challenges, and support needed. Patients also used the passports to share information about their strengths, personal identity, and life beyond the hospital. CONCLUSION The communication passport fosters a deeper understanding of patients' needs and may support clinicians in care planning and communication strategies tailored to each patient's needs. Regular evaluation and updates are warranted to ensure its usability and accessibility by the wider care team.
Collapse
Affiliation(s)
- Zhuo Li
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Dimitri Chubinidze
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Philippa Croft
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jessica Webb
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Amanda Sarpong
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Elisa Zesch
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Psychology, Ilia State University, Tbilisi, Georgia.
| |
Collapse
|
2
|
Chubinidze D, Li Z, Slovak P, Baudinet J, Dufour E, Tchanturia K. Introducing a Smart Toy in Eating Disorder Treatment: A Pilot Study. Nutrients 2024; 16:467. [PMID: 38398792 PMCID: PMC10891985 DOI: 10.3390/nu16040467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Individuals with eating disorders (EDs) often encounter challenges related to body image, emotional, and sensory difficulties during nutritional rehabilitation. To address these challenges, a novel technology-enabled smart toy, Purrble, designed for immediate assistance in emotion regulation, is being explored. A mixed-method approach involving workshops, diaries, and focus groups was employed to examine the feasibility of Purrble as a therapeutic tool and its impact on participants' daily routines, sensory experiences, and emotional states. The study results demonstrate the engagement and acceptability of this device. Qualitative analysis revealed that participants independently used and integrated Purrble into their emotional and sensory regulation practices. These pilot results support the potential for a shift in the delivery of adjunct therapeutic tools through technology, particularly for ED patients with complex presentations. Future research is necessary to further explore the psychological benefits of this intervention.
Collapse
Affiliation(s)
- Dimitri Chubinidze
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (D.C.); (Z.L.); (J.B.)
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK;
| | - Zhuo Li
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (D.C.); (Z.L.); (J.B.)
| | - Petr Slovak
- Department of Informatics, King’s College London, London WC2B 4BG, UK;
| | - Julian Baudinet
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (D.C.); (Z.L.); (J.B.)
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, London SE5 8AZ, UK
| | - Emmanuelle Dufour
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK;
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (D.C.); (Z.L.); (J.B.)
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK;
- Department of Psychology, Ilia State University, Tbilisi 0162, Georgia
| |
Collapse
|
3
|
Li Z, Holetic V, Webb J, Chubinidze D, Byford S, Tchanturia K. In-person and online sensory wellbeing workshop for eating disorders: updated case series. J Eat Disord 2023; 11:117. [PMID: 37443135 DOI: 10.1186/s40337-023-00834-8] [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: 04/14/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND A one-off sensory wellbeing workshop has been developed to help patients with eating disorders (ED) manage sensory sensitivities. The aim of this study was to evaluate and compare the outcomes of the workshop in online versus face-to-face (F2F) formats among a sample of patients with ED. METHODS Cumulative link models were applied to the outcome measures (awareness of sensory wellbeing, awareness of strategies to enhance sensory wellbeing, and confidence in managing sensory wellbeing) to test the differences between online and F2F workshops. Participants' ratings of usefulness of the workshop were also compared between online and F2F workshops. RESULTS A total of 14 workshops (4 online and 10 F2F) were run from 2020 to 2023. All participants reported significant and substantial improvements in all outcome measures. There was no significant difference in outcomes between online and F2F workshops. The majority of patients rated the workshops as useful. CONCLUSIONS Both online and face-to-face formats of the sensory workshop led to improvement in sensory wellbeing management for patients with ED. Future studies are warranted to test the impact of the workshop on ED treatment outcomes.
Collapse
Affiliation(s)
- Zhuo Li
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Victoria Holetic
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jessica Webb
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Dimitri Chubinidze
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Tbilisi Ilia State University, Tbilisi, Georgia
| | - Sarah Byford
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK.
- Tbilisi Ilia State University, Tbilisi, Georgia.
| |
Collapse
|
4
|
Saure E, Ålgars M, Laasonen M, Raevuori A. Cognitive Behavioral and Cognitive Remediation Strategies for Managing Co-Occurring Anorexia Nervosa and Elevated Autism Spectrum Traits. Psychol Res Behav Manag 2022; 15:1005-1016. [PMID: 35480715 PMCID: PMC9035441 DOI: 10.2147/prbm.s246056] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022] Open
Abstract
Anorexia nervosa (AN) is a potentially severe eating disorder whose core characteristics include energy intake restriction leading to low body weight. Autism spectrum disorder (ASD) is a developmental disorder characterized by deficits in social interaction and communication as well as repetitive, stereotyped behavior and interests. Both high ASD traits and diagnosed ASD are overrepresented among individuals with AN, and AN and ASD appear to share certain neurocognitive features. These features are associated with the severity of eating disorder symptoms and prolongation of AN. Thus, individuals with AN and high ASD traits or ASD may benefit less from traditional treatment when compared to those with low ASD traits. No previous reviews have summarized what is known about treatment adaptations for individuals with AN and high ASD traits or ASD. The purpose of this narrative review was to investigate the feasibility of cognitive remediation therapy (CRT), cognitive remediation and emotional skill training (CREST), and cognitive behavioral therapy (CBT), and give an overview of treatment modifications for individuals with AN and co-occurring ASD or high ASD traits. We found nine studies that fulfilled our inclusion criteria. The combined results suggest that individuals with AN and high ASD traits or ASD benefit less from CRT, CREST, and CBT than those with AN and low ASD traits. However, CRT and CREST administered in individual format may be associated with improved cognitive flexibility, motivation for change, and decreased alexithymia among adults with AN and high ASD traits or ASD. Individuals with comorbid AN and ASD themselves highlight the importance of treatment adaptations that take the characteristics of ASD into account. In the future, controlled studies of the treatment strategies for individuals with AN and ASD/high ASD traits are needed in order to improve the outcome of individuals with this challenging comorbidity.
Collapse
Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- BABA Center and Department of Clinical Neurophysiology, Children’s Hospital, Helsinki, Finland
- Correspondence: Emma Saure, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 21, Helsinki, FI-00014, Finland, Tel +358443035828, Email
| | - Monica Ålgars
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Marja Laasonen
- Logopedics, School of Humanities, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Anu Raevuori
- Department Psychiatry, Division of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| |
Collapse
|
5
|
Leppanen J, Sedgewick F, Halls D, Tchanturia K. Autism and anorexia nervosa: Longitudinal prediction of eating disorder outcomes. Front Psychiatry 2022; 13:985867. [PMID: 36213911 PMCID: PMC9533087 DOI: 10.3389/fpsyt.2022.985867] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recently, elevated levels of autistic features and autism diagnoses have been reported among people with anorexia nervosa (AN). In clinical settings high levels of autistic features have been linked to more complex, highly comorbid illness presentation and poorer treatment outcome. This study aimed to examine whether autistic features predict AN symptom profile in long term. METHODS Altogether 118 women with lived experience of AN completed two autism assessments at time 1, the Autism Diagnostic Observation Schedule (ADOS) and the short version of the Autism Quotient (AQ10). Measures assessing AN symptom profile, including eating disorders symptoms, anxiety, depression, OCD symptoms, and Body Mass Index (BMI), were also recorded. The symptom profile measures were administered again 6 months and 2 years later. We conducted two analyses to examine the extent to which the ADOS and AQ10 scores predicted broad AN symptom profile at each three time points. RESULTS Overall, high levels of autistic features were consistently associated with worse psychological symptoms, but not BMI, across all time points. Both the analysis using baseline ADOS scores and self-reported AQ10 scores showed similar pattern. CONCLUSION The present findings consolidate previously reported associations between autistic features and worse psychological outcome among people with AN. The findings also suggest that self-report measures may be sufficient for assessing the impact of autistic features on illness outcome among people with AN. Importantly, the study highlights the need for development and further investigation of neurodiversity accommodations in the treatment of AN.
Collapse
Affiliation(s)
- Jenni Leppanen
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | | | - Daniel Halls
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust National Eating Disorder Service, London, United Kingdom.,Department of Psychology, Illia State University, Tbilisi, Georgia.,Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia
| |
Collapse
|