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Amianto F, Oliaro T, Righettoni F, Davico C, Marcotulli D, Vitiello B. Psychological Effects of Nasogastric Tube (NGT) in Patients with Anorexia Nervosa: A Systematic Review. Nutrients 2024; 16:2316. [PMID: 39064759 PMCID: PMC11280399 DOI: 10.3390/nu16142316] [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: 06/19/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
AIM After the COVID-19 pandemic, the need for intensive nutritional care in patients affected with anorexia nervosa (AN) increased. The use of NGT was often used to overcome renutrition difficulties. This systematic review explores the evidence concerning the psychological effects of an enteral nasogastric tube (NGT) feeding on patients with AN. METHODS A systematic review following PRISMA guidelines was conducted on electronic databases, including papers from January 2010 to December 2023. The keywords used combined anorexia nervosa, NGT, nasogastric tube, and tube feeding, with MeSH terms. No language limit was imposed. Reviews were excluded from the search. RESULTS A total of 241 studies matched the keywords. Nevertheless, 236 studies were excluded from the review because they did not match the inclusion criteria. A total of six studies met the inclusion criteria. Of these, three studies were case series, one was a quantitative study of follow up and one was a qualitative exploratory study. The included studies described the hospitalization of patients with AN treated with a nasogastric tube; among these, only one study focused directly on the psychological correlates of nasogastric tube treatment using interviews with patients and medical staff. Included studies suggest that NGT feeding, even if faced in the first instance with prejudices and fears by patients, parents, and staff, is useful not only for weight increase in treatment-resistant patients with AN, but also alleviates their stress from feeding and, in general, it is psychologically well tolerated. Nevertheless, recent in-depth research on the issue is lacking and the existing has a low methodological quality; thus, many psychological effects of NGT application remain underexplored. CONCLUSIONS Although the results suggest good psychological tolerance of the device, the limited data available recommend that more attention should be addressed by the researchers to the psychological consequences of the use of NGT in the treatment of AN since it is a nutrition disorder with prominent psychological roots. Further studies are needed.
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Affiliation(s)
- Federico Amianto
- Neurosciences Department, University of Torino, Via Cherasco 15, 10126 Turin, Italy
- Department of Pathology and Care of the Child, AOU Città della Salute e della Scienza di Torino, OIRM, 10126 Turin, Italy; (T.O.); (F.R.); (C.D.); (D.M.); (B.V.)
| | - Tomaso Oliaro
- Department of Pathology and Care of the Child, AOU Città della Salute e della Scienza di Torino, OIRM, 10126 Turin, Italy; (T.O.); (F.R.); (C.D.); (D.M.); (B.V.)
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Francesca Righettoni
- Department of Pathology and Care of the Child, AOU Città della Salute e della Scienza di Torino, OIRM, 10126 Turin, Italy; (T.O.); (F.R.); (C.D.); (D.M.); (B.V.)
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Chiara Davico
- Department of Pathology and Care of the Child, AOU Città della Salute e della Scienza di Torino, OIRM, 10126 Turin, Italy; (T.O.); (F.R.); (C.D.); (D.M.); (B.V.)
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Daniele Marcotulli
- Department of Pathology and Care of the Child, AOU Città della Salute e della Scienza di Torino, OIRM, 10126 Turin, Italy; (T.O.); (F.R.); (C.D.); (D.M.); (B.V.)
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Benedetto Vitiello
- Department of Pathology and Care of the Child, AOU Città della Salute e della Scienza di Torino, OIRM, 10126 Turin, Italy; (T.O.); (F.R.); (C.D.); (D.M.); (B.V.)
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
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Bogár N, Dukay-Szabó S, Simon D, Túry F. Higher orthorexia tendency among female fashion models: an empirical international study. Eat Weight Disord 2024; 29:44. [PMID: 38937320 PMCID: PMC11211108 DOI: 10.1007/s40519-024-01674-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/16/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE Female fashion models are more at risk for developing eating disorders than non-models due to the intense occupational pressure they face. The present study focuses on assessing whether female models are more prone to report orthorexia nervosa signs and symptoms than non-models. METHODS Female fashion models (n = 179, mean age: 25.9 SD = 4.40 years) and an age adjusted control group (n = 261, mean age: 25.0 SD = 4.97 years) were selected by snowball sampling. Participants filled out an online survey containing anthropometric questions and the 18-item Eating Habits Questionnaire. RESULTS According to BMI, fashion models were underweight (mean BMI = 18.1 SD = 1.68) while control participants' BMI was in the normal range (mean = 22.1 SD = 4.23, p < 0.001). On all three of Eating Habits Questionnaire subscales fashion models showed significantly higher average value (Knowledge subscale: M = 2.42 among models versus M = 2.08 in the control group, p < 0.01, Cohen's d = 0.52; Problems subscale: M = 1.93 among models versus M = 2.61 in the control group, p < 0.01, Cohen's d = 0.49; Feelings subscale: M = 3.20 among models versus M = 2.96 in the control group, p < 0.01, Cohen's d = 0.38). Orthorexic tendencies were reported by 35.1% of the models versus 20.2% of controls. CONCLUSION Fashion models are at risk for the development of eating disorders. Even though not yet included in the DSM-5, the assessment of orthorexia nervosa among fashion models seems to be important. It is suggested to take appropriate measures to prevent the spread of disordered eating habits among models as they can lead to the development of anorexia nervosa or bulimia nervosa. LEVEL OF EVIDENCE Level III, well-designed cohort study.
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Affiliation(s)
- Nikolett Bogár
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | | | - Dávid Simon
- Department of Statistics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Ferenc Túry
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.
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Fusar-Poli P, Estradé A, Esposito CM, Rosfort R, Basadonne I, Mancini M, Stanghellini G, Otaiku J, Olanrele O, Allen L, Lamba M, Alaso C, Ieri J, Atieno M, Oluoch Y, Ireri P, Tembo E, Phiri IZ, Nkhoma D, Sichone N, Siadibbi C, Sundi PRIO, Ntokozo N, Fusar-Poli L, Floris V, Mensi MM, Borgatti R, Damiani S, Provenzani U, Brondino N, Bonoldi I, Radua J, Cooper K, Shin JI, Cortese S, Danese A, Bendall S, Arango C, Correll CU, Maj M. The lived experience of mental disorders in adolescents: a bottom-up review co-designed, co-conducted and co-written by experts by experience and academics. World Psychiatry 2024; 23:191-208. [PMID: 38727047 PMCID: PMC11083893 DOI: 10.1002/wps.21189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
We provide here the first bottom-up review of the lived experience of mental disorders in adolescents co-designed, co-conducted and co-written by experts by experience and academics. We screened first-person accounts within and outside the medical field, and discussed them in collaborative workshops involving numerous experts by experience - representing different genders, ethnic and cultural backgrounds, and continents - and their family members and carers. Subsequently, the material was enriched by phenomenologically informed perspectives and shared with all collaborators. The inner subjective experience of adolescents is described for mood disorders, psychotic disorders, attention-deficit/hyperactivity disorder, autism spectrum disorders, anxiety disorders, eating disorders, externalizing disorders, and self-harm behaviors. The recollection of individuals' past histories also indexes the prodromal (often transdiagnostic) features predating the psychiatric diagnosis. The experience of adolescents with mental disorders in the wider society is described with respect to their family, their school and peers, and the social and cultural context. Furthermore, their lived experience of mental health care is described with respect to receiving a diagnosis of mental disorder, accessing mental health support, receiving psychopharmacological treatment, receiving psychotherapy, experiencing peer support and mental health activism, and achieving recovery. These findings can impact clinical practice, research, and the whole society. We hope that this co-designed, co-conducted and co-written journey can help us maintain our commitment to protecting adolescents' fragile mental health, and can help them develop into a healthy, fulfilling and contributing adult life.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College London, London, UK
| | - Cecilia M Esposito
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - René Rosfort
- S. Kierkegaard Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Ilaria Basadonne
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Milena Mancini
- Department of Psychological Sciences, Health and Territory, G. D'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Diego Portales University, Santiago, Chile
| | - Jummy Otaiku
- Young Person's Mental Health Advisory Group, King's College London, London, UK
| | | | - Lucas Allen
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Judy Ieri
- Global Mental Health Peer Network, Nairobi, Kenya
| | | | | | - Phides Ireri
- Global Mental Health Peer Network, Nairobi, Kenya
| | - Ephraim Tembo
- Global Mental Health Peer Network, Lusaka, Zambia
- University of Zambia, Lusaka, Zambia
| | | | | | - Noah Sichone
- Global Mental Health Peer Network, Lusaka, Zambia
| | - Candy Siadibbi
- Global Mental Health Peer Network, Lusaka, Zambia
- Psychology Association of Zambia, Lusaka, Zambia
| | | | - Nyathi Ntokozo
- Global Mental Health Peer Network, Bulawayo, Zimbabwe
- Youth Support Network Trust, Bulawayo, Zimbabwe
| | - Laura Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Valentina Floris
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Martina M Mensi
- National Neurological Institute, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Neurological Institute, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Umberto Provenzani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ilaria Bonoldi
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joaquim Radua
- Institut d'Investigacions Biomediques August Pi i Sunyer, CIBERSAM, Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Kate Cooper
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Solent NHS Trust, Southampton, UK
- Department of Precision and Regenerative Medicine and Jonic Area, University of Bari, Bari, Italy
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National and Specialist Child and Adolescent Mental Health Service Clinic for Trauma, Anxiety and Depression, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Bendall
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario G. Marañón, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Universitätsmedizin Berlin, Berlin, Germany
- Departments of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Fuller SJ, Tan J, Nicholls D. Nasogastric tube feeding under restraint: understanding the impact and improving care. BJPsych Bull 2024; 48:163-167. [PMID: 37485906 PMCID: PMC11134022 DOI: 10.1192/bjb.2023.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/26/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Nasogastric tube feeding under physical restraint is an intervention that clinicians working in specialist mental health in-patient units may need to implement. AIMS To examine the impact of this intervention on people with lived experience, carers and staff. METHOD People with lived experience and parents and/or carers were recruited via UK eating disorder charity Beat. Clinicians were recruited via the British Eating Disorders Society's research forum. Qualitative semi-structured interviews were conducted and transcribed, and the results were thematically analysed. RESULTS Thirty-six participants took part, and overlapping themes were identified. All participants spoke in relation to four themes: (a) the short-term impact on the patient; (b) the impact on those around the patient; (c) the long-term impact; and (d) the positive impact. Subthemes were identified and explored. CONCLUSION This lifesaving intervention can also negatively affect patients, parents and carers, peers and staff. Further research is needed to understand how interactions and environmental modifications can mitigate the negative impacts.
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Affiliation(s)
- Sarah J. Fuller
- Imperial College London, UK
- Northamptonshire Healthcare NHS Foundation Trust, UK
| | - Jacinta Tan
- Oxford Health NHS Foundation Trust, UK
- University of Oxford, UK
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Fuller SJ, Tan J, Nicholls D. The importance of individualised care, good communication and trust for reducing nasogastric tube feeding under physical restraint: qualitative multi-informant study. BJPsych Open 2024; 10:e86. [PMID: 38629302 PMCID: PMC11060075 DOI: 10.1192/bjo.2024.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/18/2023] [Accepted: 02/06/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Nasogastric tube (NGT) feeding against a patient's consent is an intervention that clinicians working in specialist mental health in-patient units may need to implement from time to time. Little research has explored clinician, patient and carer perspectives on good practice. AIMS To use qualitative data from people with lived experience (PWLE), parents/carers and clinicians, to identify components of best practice when this intervention is required. METHOD PWLE and parents/carers were recruited via BEAT UK's eating disorder charity. Clinicians were recruited via a post on The British Eating Disorders Society's research page. Semi-structured interviews were administered, transcribed and thematically analysed. RESULTS Thirty-six interviews took place and overlapping themes were identified. Participants spoke in relation to three themes: first, the significance of individualised care; second, the importance of communication; third, the impact of staff relationships. Sub-themes were identified and explored. CONCLUSIONS Good care evolved around positive staff relationships and individualised care planning rather than standard processes. The centrality of trust as an important mediator of outcome was identified, and this should be acknowledged in any service that delivers this intervention.
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Affiliation(s)
- Sarah J. Fuller
- Division of Psychiatry, Imperial College London, UK
- Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Jacinta Tan
- Retired Consultant Child and Adolescent Psychiatrist, Swansea, UK
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Jaiprakash HH, MacKinnon A, Arnaud S, Neal JP. Valuing patient perspectives in the context of eating disorders. Eat Weight Disord 2024; 29:12. [PMID: 38310613 PMCID: PMC10838845 DOI: 10.1007/s40519-023-01635-3] [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] [Received: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 02/06/2024] Open
Abstract
PURPOSE This paper advocates for the inclusion of patient perspectives in the diagnosis and treatment of eating disorders (EDs) for ethical, epistemological, and pragmatic reasons. We build upon the ideas of a recent editorial published in this journal. Using EDs as their example, the authors argue against dominant DSM-oriented approaches in favor of an increased focus on understanding patients' subjective experiences. We argue that their analysis stops too soon for the development of practical-and actionable-insights into how to effect the integration of first-person and third-person accounts of EDs. METHODS Contextual analysis was used to make the case for patient perspectives. RESULTS We use anorexia nervosa (AN) as an example to demonstrate how the integration of patient manifestations and voices offers a promising methodology to improve patient diagnosis and treatment. We suggest that Acceptance and Commitment Therapy (ACT) can support patients with AN by reconciling their values with the values that arise from a clinician's duty of care. CONCLUSIONS We conclude that there are no good scientific reasons to exclude first-person perspectives of EDs in psychiatry. LEVEL OF EVIDENCE Level V: Opinions based on clinical experience.
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Affiliation(s)
- Harshita H Jaiprakash
- Department of Philosophy and the Rotman Institute of Philosophy, Western University, London, ON, Canada.
| | - Amy MacKinnon
- Department of Philosophy and the Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Sarah Arnaud
- Department of Philosophy, Clemson University, Clemson, SC, USA
| | - Jacob P Neal
- Department of Philosophy and the Rotman Institute of Philosophy, Western University, London, ON, Canada
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Rienecke RD, Dimitropoulos G, Duffy A, Le Grange D, Manwaring J, Nieder S, Sauerwein J, Singh M, Watters A, Westmoreland P, Mehler PS. Involuntary treatment: A qualitative study from the perspectives of individuals with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023; 31:850-862. [PMID: 37424216 DOI: 10.1002/erv.3010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Involuntary treatment for anorexia nervosa (AN) is sometimes necessary and lifesaving but can be experienced negatively by some individuals. The purpose of this qualitative study was to better understand participants' perceptions about their experience with involuntary treatment for AN. METHOD Thirty adult participants, who had been treated involuntarily for AN in the past, completed self-report measures and qualitative interviews. Interview transcripts were coded using thematic analysis. RESULTS Three themes were identified: (1) mixed perceptions about involuntary treatment, (2) the impact of involuntary treatment on external factors, including relationships, education, and employment, and (3) lessons learned from the experience. Participants who endorsed a positive shift in perspective regarding the need for involuntary treatment also reported favorable changes in their eating disorder recovery, whereas individuals whose perspective about their involuntary treatment remained negative, showed no changes in their recovery post-treatment. CONCLUSIONS Involuntary treatment for AN was recognized, in retrospect, as being beneficial by individuals with AN who were doing well, but individuals who continued to struggle with their eating disorder reported negative consequences.
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Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Gina Dimitropoulos
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Jamie Manwaring
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
- ACUTE, Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | | | - Jessica Sauerwein
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Manya Singh
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Ashlie Watters
- ACUTE, Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Patricia Westmoreland
- Department of Psychiatry, University of Colorado, Denver, Colorado, USA
- Aurora Medical Center, Aurora, Colorado, USA
| | - Philip S Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
- ACUTE, Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
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Oketah NO, Hur JO, Talebloo J, Cheng CM, Nagata JM. Parents' perspectives of anorexia nervosa treatment in adolescents: a systematic review and metasynthesis of qualitative data. J Eat Disord 2023; 11:193. [PMID: 37904246 PMCID: PMC10617236 DOI: 10.1186/s40337-023-00910-z] [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: 06/25/2023] [Accepted: 10/12/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Studies have established the central role of the family in the recognition, treatment, and recovery of anorexia nervosa. The objective of this study was to review, synthesize, and critically appraise the literature on parents' views on the treatment and recovery process of anorexia nervosa in their adolescent child. METHOD A systematic search of Medline, PsychINFO, CINHAL, EMBASE, Cochrane library, and SSCI was conducted for qualitative studies published regarding parents' views about the treatment of anorexia nervosa. The quality of articles was assessed using the critical appraisal skills program (CASP) and findings were analysed using thematic synthesis. RESULTS A total of 25 studies from nine countries reporting the views of 357 parents met the inclusion criteria. Four major themes were developed from the analysis: understanding the child and the disease, experience of services and treatment modalities, the role of professionals, and the experience of recovery. CONCLUSION Parents report struggles with delays in finding help, judgmental attitudes of professionals, and uncertainty about the future. Recognition of the challenges faced by parents and families empowers clinicians to build stronger therapeutic relationships essential for long-term recovery from anorexia nervosa.
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Affiliation(s)
- Ngozi O Oketah
- Department of Paediatrics, Children's Health Ireland (CHI) at Crumlin & Connolly Hospitals, Cooley Road, Dublin, D12 N512, Ireland
| | - Jacqueline O Hur
- Division of Adolescent and Young Adult Medicine, Department of Paediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Jonanne Talebloo
- Division of Adolescent and Young Adult Medicine, Department of Paediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Chloe M Cheng
- Division of Adolescent and Young Adult Medicine, Department of Paediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Paediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA.
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Mac Donald B, Gustafsson SA, Bulik CM, Clausen L. Living and leaving a life of coercion: a qualitative interview study of patients with anorexia nervosa and multiple involuntary treatment events. J Eat Disord 2023; 11:40. [PMID: 36915181 PMCID: PMC10010243 DOI: 10.1186/s40337-023-00765-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND A small but significant group of patients with anorexia nervosa (AN) undergo multiple involuntary treatment (IT) events. To enhance our understanding of IT and potentially inform treatment, we explored experiences and perspectives on IT of these patients. METHODS We designed a qualitative semi-structured interview study and used reflexive thematic analysis. Participants were at least 18 years of age, had multiple past IT events (≥ 5) related to AN over a period of at least one month of which the last IT event happened within the preceding five years. Participants had no current IT, intellectual disability, acute psychosis, or severe developmental disorder. We adopted an inductive approach and constructed meaning-based themes. RESULTS We interviewed seven participants. The data portrayed a process of living and leaving a life of coercion with a timeline covering three broad themes: living with internal coercion, coercive treatment, and leaving coercion; and five subthemes: helping an internal battle, augmenting suffering, feeling trapped, a lasting imprint, and changing perspectives. We highlighted that patients with AN and multiple IT events usually experienced internal coercion from the AN prior to external coercion from the health care system. IT evoked significant negative affect when experienced, and often left an adverse imprint. Moreover, IT could help an internal battle against AN and perspectives on IT could change over time. CONCLUSIONS Our study suggests that feeling internally coerced by AN itself sets the stage for IT. Clinicians should be conscious of the potential iatrogenic effects of IT, and reserve IT for potentially life-threatening situations.
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Affiliation(s)
- Benjamin Mac Donald
- Department of Clinical Medicine, Aarhus University, Palle Juul Jensens-Boulevard 99, 8200, Aarhus, Denmark.
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Aarhus, Denmark.
| | - Sanna A Gustafsson
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Palle Juul Jensens-Boulevard 99, 8200, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Aarhus, Denmark
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10
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Fuller SJ, Thomson S, Tan J. Nasogastric tube feeding under restraint: practical guidance for children's nurses. Nurs Child Young People 2023; 35:18-23. [PMID: 36408588 DOI: 10.7748/ncyp.2022.e1457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/22/2022]
Abstract
The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children's nurses, supporting them to provide safe, compassionate and person-centred care to their patients.
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Affiliation(s)
- Sarah J Fuller
- child and adolescent mental health, East London NHS Foundation Trust, Bedford, England
| | - Sharon Thomson
- child and adolescent mental health, East London NHS Foundation Trust, Bedford, England
| | - Jacinta Tan
- child and adolescent mental health, Oxford Health NHS Foundation Trust, Bedford, England
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11
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Tsiandoulas K, McSheffrey G, Fleming L, Rawal V, Fadel MP, Katzman DK, McCradden MD. Ethical tensions in the treatment of youth with severe anorexia nervosa. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:69-76. [PMID: 36206789 DOI: 10.1016/s2352-4642(22)00236-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022]
Abstract
Treatment of anorexia nervosa poses a moral quandary for clinicians, particularly in paediatrics. The challenges of appropriately individualising treatment while balancing prospective benefits against concomitant harms are best highlighted through exploration and discussion of the ethical issues. The purpose of this Viewpoint is to explore the ethical tensions in treating young patients (around ages 10-18 years) with severe anorexia nervosa who are not capable of making treatment-based decisions and describe how harm reduction can reasonably be applied. We propose the term AN-PLUS to refer to the subset of patients with a particularly concerning clinical presentation-poor quality of life, lack of treatment response, medically severe and unstable, and severe symptomatology-who might benefit from a harm reduction approach. From ethics literature, qualitative studies, and our clinical experience, we identify three core ethical themes in making treatment decisions for young people with AN-PLUS: capacity and autonomy, best interests, and person-centred care. Finally, we consider how a harm reduction approach can provide direction for developing a personalised treatment plan that retains a focus on best interests while attempting to mitigate the harms of involuntary treatment. We conclude with recommendations to operationalise a harm reduction approach in young people with AN-PLUS.
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Affiliation(s)
- Kate Tsiandoulas
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Health Science Research Program, University of Toronto, Toronto, ON, Canada
| | - Gordon McSheffrey
- Department of Pediatrics, Scarborough Health Network, Toronto, ON, Canada; Child, Youth, Family Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lindsay Fleming
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Vandana Rawal
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Marc P Fadel
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Division of Child and Youth Mental Health, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Genetics & Genome Biology, Peter Gilgan Centre for Research & Learning, Toronto, ON, Canada.
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12
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Jafar AJN, Jafar WJJ, Everitt EK, Gill I, Sait HM, Tan J. Recognising and managing eating disorders in the emergency department. Postgrad Med J 2021; 99:postgradmedj-2021-140253. [DOI: 10.1136/postgradmedj-2021-140253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/23/2021] [Indexed: 11/03/2022]
Abstract
Compared with other mental health conditions or psychiatric presentations, such as self-harm, which may be seen in emergency departments, eating disorders can seem relatively rare. However, they have the highest mortality across the spectrum of mental health, with high rates of medical complications and risk, ranging from hypoglycaemia and electrolyte disturbances to cardiac abnormalities. People with eating disorders may not disclose their diagnosis when they see healthcare professionals. This can be due to denial of the condition itself, a wish to avoid treatment for a condition which may be valued, or because of the stigma attached to mental health. As a result their diagnosis can be easily missed by healthcare professionals and thus the prevalence is underappreciated. This article presents eating disorders to emergency and acute medicine practitioners from a new perspective using the combined emergency, psychiatric, nutrition and psychology lens. It focuses on the most serious acute pathology which can develop from the more common presentations; highlights indicators of hidden disease; discusses screening; suggests key acute management considerations and explores the challenge of mental capacity in a group of high-risk patients who, with the right treatment, can make a good recovery.
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13
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van Elburg A, Danner UN, Sternheim LC, Lammers M, Elzakkers I. Mental Capacity, Decision-Making and Emotion Dysregulation in Severe Enduring Anorexia Nervosa. Front Psychiatry 2021; 12:545317. [PMID: 33776810 PMCID: PMC7991306 DOI: 10.3389/fpsyt.2021.545317] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 01/28/2021] [Indexed: 12/20/2022] Open
Abstract
Severe and Enduring Anorexia Nervosa (SE-AN) is a chronic eating disorder characterized by long-term starvation and its physical and psychological sequelae, and severe loss of quality of life. Interactions between neurobiological changes caused by starvation, vulnerability (personality) traits, and eating behaviors play a role. Several other factors, such as increased fear and decreased social cognition, have also been found in relation to SE-AN. With this in mind, we aim to add to the understanding of SE-AN by introducing the concept of mental capacity (MC), which refers to the ability to understand and process information-both on a cognitive and an emotional level-and then make a well-informed choice. MC may be an important construct within the context of SE-AN. Furthermore, we will argue how impaired decision-making processes may underlie, fuel, or contribute to limited MC in SE-AN. We will speculate on the importance of dysfunctional emotion processing and anxiety-related processes (e.g., a high intolerance of uncertainty) and their potential interaction with decision-making. Lastly, we will propose how these aspects, which to our knowledge have previously received little attention, may advise research and treatment or help in dealing with the "want but cannot" situation of life-threatening AN.
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Affiliation(s)
- Annemarie van Elburg
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands.,Rintveld Center for Eating Disorders, Altrecht Mental Health Institute, Zeist, Netherlands
| | - Unna Nora Danner
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands.,Rintveld Center for Eating Disorders, Altrecht Mental Health Institute, Zeist, Netherlands
| | - Lot Catharina Sternheim
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Isis Elzakkers
- Rintveld Center for Eating Disorders, Altrecht Mental Health Institute, Zeist, Netherlands
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14
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Walker DC, Heiss S, Donahue JM, Brooks JM. Practitioners' perspectives on ethical issues within the treatment of eating disorders: Results from a concept mapping study. Int J Eat Disord 2020; 53:1941-1951. [PMID: 32918314 DOI: 10.1002/eat.23381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Treating patients with eating disorders (EDs) is associated with an array of ethical concerns, including balancing patients' health and autonomy, access to care, and use of harm-reduction versus recovery-oriented treatment models. The primary aim of the current study is to gain a better understanding of ethical issues faced by ED practitioners by using a concept mapping, or Q-sort, approach. METHOD A total of 12 practitioners completed the brainstorming phase and generated statements regarding ethical issues they faced while treating patients with EDs. A subsequent 38 practitioners completed a sorting task, where they created and labeled piles, into which they grouped each statement. Of those 38 participants, 30 rated both the frequency with which they encountered each ethical issue and its impact on patient care. RESULTS A total of six clusters emerged: Insufficient Level of Care, Lack of Evidence-Based Practice, Insurance Barriers, Family Involvement, Patient Autonomy, and Limited Access to Expertise. Lack of Evidence-Based Practice, Insurance Barriers, and Insufficient Level of Care was the most frequent problem faced by ED practitioners, whereas Insurance Barriers and Patient Autonomy had the greatest impact. DISCUSSION Findings outline frequent and impactful areas of ethical concern that arise when treating patients diagnosed with EDs. Practitioners most commonly reported that patient- and insurance-driven factors limited patient access to appropriate care. Regulations supporting the provision of evidence-based care should be emphasized in public health policy and advocacy efforts, given their impact in limiting the delivery of adequate patient care.
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Affiliation(s)
| | - Sydney Heiss
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - Joseph M Donahue
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Julia M Brooks
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
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15
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Becker K, Kölch M, Plener PL, Schepker R. Stellungnahme der DGKJP. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:335-338. [PMID: 32614277 DOI: 10.1024/1422-4917/a000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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16
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Lane NM. More than just filler: an empirically informed ethical analysis of non-surgical cosmetic procedures in body dysmorphic disorder. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-105746. [PMID: 32581013 DOI: 10.1136/medethics-2019-105746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 04/28/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To identify and analyse ethical considerations raised when individuals with body dysmorphic disorder (BDD) consult for non-surgical cosmetic procedures. METHODS Ethical analysis was conducted addressing the issues of best interests and capacity to consent for non-surgical cosmetic procedures in individuals with BDD. Analysis was informed by the findings of semistructured interviews with non-surgical cosmetic practitioners and mental health professionals. FINDINGS Non-surgical cosmetic interventions were viewed not to be in the best interests of individuals with BDD, as they fail to address core psychological issues, result in dissatisfaction post-procedure, and risk harm. Referral to mental health services was advocated, however numerous obstacles to this were perceived. The issue of capacity to consent to non-surgical cosmetic procedures raised questions regarding whether standard capacity assessment is sensitive to the manner in which BDD may influence decision-making processes. In addition, concerns were voiced that decisions made by individuals with BDD in this context may be judged foolish, and thus wrongly equated with lack of capacity. DISCUSSION/CONCLUSIONS Ethical analysis, informed by the available evidence base, suggests that it is generally not in the best interests of individuals with BDD to undergo non-surgical cosmetic intervention, and referral to mental health services is indicated. Analysis of capacity draws parallels between BDD and anorexia nervosa, as decision-making capacity in both conditions can be impaired by pathological values derived from the disorder. Means of differentiating clinical assessment of pathological values from inappropriate value judgements are advocated, in order to safeguard against the latter encroaching into capacity assessment.
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Affiliation(s)
- Natalie M Lane
- Department of Psychiatry, NHS Lanarkshire Mental Health Services, Glasgow, Scotland, UK
- Department of Global Health & Social Medicine, King's College London, London, UK
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17
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Falcoski P, Philpot U, Tan J, Hudson LD, Fuller SJ. Nasogastric tube feeding in line with new dietetic guidelines for the treatment of anorexia nervosa in a specialist children and adolescent inpatient unit: a case series. J Hum Nutr Diet 2020; 34:33-41. [PMID: 32394444 DOI: 10.1111/jhn.12765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The present study reports a case series where three adolescent patients with anorexia nervosa (AN) (two cases with typical AN and one case atypical AN) received nasogastric tube feeding under restraint in line with new dietetic clinical guidelines. METHODS Three cases were chosen out of 61 admitted patients over the period of 1 year who were fed via a nasogastric tube under restraint in a specialist eating disorders unit for children and adolescents. These cases were chosen to highlight a range of clinical scenarios that clinicians may encounter. They also represent clinical scenarios where decisions to feed patients under restraint were rendered more complex by additional concerns. RESULTS Despite the complexity of the cases, all patients tolerated the feeds well and were discharged home eating solid food. CONCLUSIONS The decision to feed a patient against their will is never an easy one. Sadly, there have been some recent high-profile deaths of adult patients on medical wards where treatment opinion was not considered, and the patient received no or minimal nutrition when awaiting specialist treatment. Dietetic guidelines have been published to help inform clinicians for whom feeding under restraint may be out of the scope of their daily practice. This case series highlights clinical scenarios that illustrate the utility of the guidelines, which we hope will support clinicians when making, potentially lifesaving decisions in children and young people.
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Affiliation(s)
- P Falcoski
- Rhodes Wood Hospital, Elysium Healthcare, London, UK
| | | | - J Tan
- Aneurin Bevan University Health Board, Wales, UK
| | - L D Hudson
- GOSH UCL Institute of Child Health, London, UK
| | - S J Fuller
- East London NHS Foundation Trust, Bedford, UK
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18
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Fuller SJ, Philpot U, Barrett N, Cooper E, Doyle M, Druce‐Perkins J, Elliott H, Falcoski P, Forster R, Hickley Y, Jennings R, Manson D, Street O, Vlachou P, Wade S, White S. The development of consensus‐based guidelines for dietetic practice in nasogastric tube feeding under restraint for patients with anorexia nervosa using a modified Delphi process. J Hum Nutr Diet 2020; 33:287-294. [DOI: 10.1111/jhn.12731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Abstract
Mukbang is a recent Internet phenomenon in which video recordings of hosts eating large amounts of food are streamed on an online video platform. It originated in South Korea around 2014 and has since become a global trend. The aim of this study was to explore how viewers of mukbang videos relate their audience experiences to symptoms of disordered eating. A qualitative analysis of YouTube comments and Reddit posts on the topic of mukbang and disordered eating was performed, employing a netnographic approach. Two overarching themes were identified: a viewer perspective, by which users discuss mukbang without describing any personal involvement, and a participant perspective, by which users describe their own experiences of affects and behaviors in response to watching mukbang. Several topical categories emerged, describing how watching mukbang can both limit and increase eating, reduce loneliness and guilt, and become self-destructive. For some, mukbang appears to be a constructive tool in increasing food intake, preventing binge eating, or reducing loneliness; for others, it is clearly a destructive force that may motivate restrictive eating or trigger a relapse into loss-of-control eating. Notably, watching mukbang is not necessarily experienced as either helpful or destructive, but instead as simultaneously useful and hurtful.
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Affiliation(s)
- Mattias Strand
- Stockholm Centre for Eating Disorders, Wollmar Yxkullsgatan 27B, 118 50, Stockholm, Sweden.
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, 171 77, Stockholm, Sweden.
| | - Sanna Aila Gustafsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
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20
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Clausen L. Perspectives on Involuntary Treatment of Anorexia Nervosa. Front Psychiatry 2020; 11:533288. [PMID: 33192651 PMCID: PMC7641604 DOI: 10.3389/fpsyt.2020.533288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/16/2020] [Indexed: 01/12/2023] Open
Abstract
Involuntary treatment of anorexia nervosa is an option in cases in which the patient's life or other people's lives are at risk or, in some countries, to prevent the deterioration of the illness. Involuntary treatment is often regarded as controversial and has been intensely debated, although typically with few references to documented knowledge. This paper provides a research perspective of the topic by examine data in the field of the involuntary treatment of anorexia nervosa to pinpoint present knowledge as well as areas demanding clinical action or research attention. The prevalence of involuntary treatment in general as well as specific measures is described and possible early markers of patients at risk of involuntary treatment are discussed. Studies including patients' perspectives of involuntary treatment show the complexity of this treatment, its initiation, and its consequences. To qualify future discussions, improve current practice, and minimize involuntary treatment in general as well as on an individual level, at least four areas need attention: (i) the present specific symptoms of anorexia nervosa and their imminent consequences, (ii) illness history, (iii) overall psychiatric symptoms and general functioning, and (iv) contextual sphere of the patient. In particular, the last two require attention from both clinicians and researchers. Furthermore, critical evaluation of the attitudes of both patients and health care professionals toward each other and the treatment is recommended.
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Affiliation(s)
- Loa Clausen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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21
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Mitrofan O, Petkova H, Janssens A, Kelly J, Edwards E, Nicholls D, McNicholas F, Simic M, Eisler I, Ford T, Byford S. Care experiences of young people with eating disorders and their parents: qualitative study. BJPsych Open 2019; 5:e6. [PMID: 30762506 PMCID: PMC6343117 DOI: 10.1192/bjo.2018.78] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perspectives of young people with eating disorders and their parents on helpful aspects of care should be incorporated into evidence-based practice and service design, but data are limited.AimsTo explore patient and parent perspectives on positive and negative aspects of care for young people with eating disorders. METHOD Six online focus groups with 19 young people aged 16-25 years with existing or past eating disorders and 11 parents. RESULTS Thematic analysis identified three key themes: the need to (a) shift from a weight-focused to a more holistic, individualised and consistent care approach, with a better balance in targeting psychological and physical problems from an early stage; (b) improve professionals' knowledge and attitude towards patients and their families at all levels of care from primary to 'truly specialist'; (c) enhance peer and family support. CONCLUSIONS Young people and parents identified an array of limitations in approaches to care for young people with eating disorders and raised the need for change, particularly a move away from a primarily weight-focused treatment and a stronger emphasis on psychological needs and individualised care.Declaration of interestNone.
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Affiliation(s)
- Oana Mitrofan
- Academic Clinical Lecturer in Child and Adolescent Psychiatry,University of Exeter College of Medicine and Health,University of Exeter,UK
| | - Hristina Petkova
- Health Economist, King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience,King's College London,UK
| | - Astrid Janssens
- Senior Research Fellow,University of Exeter College of Medicine and Health,University of Exeter,UK
| | | | | | | | - Fiona McNicholas
- Professor of Child and Adolescent Psychiatry,School of Medicine,University College Dublin,Ireland
| | - Mima Simic
- Consultant Child and Adolescent Psychiatrist,Child and Adolescent Eating Disorders Service,South London and Maudsley NHS Trust,UK
| | - Ivan Eisler
- Professor of Family Psychology and Family Therapy, Institute of Psychiatry, Psychology and Neuroscience,King's College London,UK
| | - Tamsin Ford
- Professor of Child and Adolescent Psychiatry,University of Exeter College of Medicine and Health,University of Exeter,UK
| | - Sarah Byford
- Professor of Health Economics, King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience,King's College London,UK
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22
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Clausen L, Larsen JT, Bulik CM, Petersen L. A Danish register-based study on involuntary treatment in anorexia nervosa. Int J Eat Disord 2018; 51:1213-1222. [PMID: 30414329 DOI: 10.1002/eat.22968] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Involuntary treatment is controversial and widely debated, but remains a significant component of treatment for severe anorexia nervosa. Given how little is known about this topic, we describe the frequency of various involuntary measures in a national cohort of all patients diagnosed with anorexia nervosa. In a subsample of patients, we explored predictors of the first involuntary measure recorded. METHOD Descriptive statistics and Cox proportional hazard analyses were conducted using the national registers of Denmark covering the total population. Data from the National Patient Register and the Psychiatric Central Research Register including all psychiatric visits from 1969 onwards were merged with data from the National Register on Coercion covering 1999 onward. Involuntary measures registered between 2000 and 2013 were analyzed. RESULTS A total of 4,727 patients with a diagnosis of anorexia nervosa representing 16,592 admissions were included. Eighteen percent experienced at least one involuntary measure. A variety of measures were used with tube feeding being the most frequent followed by mechanical restraint, involuntary medication, physical restraint, constant observation, and sedative medication. A subsample of 2% of AN patients had more than 100 involuntary measures recorded. The first recorded involuntary measure was predicted by most but not all psychiatric comorbidities, especially schizophrenia, autism spectrum, and personality disorders, older age at first diagnosis, and previous admissions. DISCUSSION It is important to develop a more granular understanding of patients at risk of requiring involuntary treatment and to determine how best to treat them effectively with minimal use of involuntary measures.
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Affiliation(s)
- L Clausen
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - J T Larsen
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
| | - C M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - L Petersen
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
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23
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Elzakkers IFFM, Danner UN, Grisso T, Hoek HW, van Elburg AA. Assessment of mental capacity to consent to treatment in anorexia nervosa: A comparison of clinical judgment and MacCAT-T and consequences for clinical practice. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 58:27-35. [PMID: 29853010 DOI: 10.1016/j.ijlp.2018.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 01/22/2018] [Accepted: 02/13/2018] [Indexed: 06/08/2023]
Abstract
Informed consent requires adequate mental capacity to consent to treatment. Mental capacity (MC) to consent to treatment refers to the ability to make medical decisions. MC is assessed in a general psychiatric interview, but this clinical assessment is known to overestimate mental capacity in patients and the inter rater reliability is low. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) has emerged as the gold standard to assess mental capacity to consent to treatment. The MacCAT-T is a semi-structured interview designed to aid clinicians in this assessment and has shown good inter rater reliability in patients with schizophrenia and other mental disorders, but has hardly been studied in patients with anorexia nervosa. Patients with anorexia nervosa (AN) regularly avoid treatment, even when severely ill and discussion includes assessing MC to consent to treatment. The aim of this study is to compare clinical judgment and the MacCAT-T in evaluating MC in patients with AN which in turn may influence use of the MacCAT-T in daily practice. In a sample of 70 consecutively referred severely ill patients with AN with a mean BMI of 15.5 kg/m2 and a mean duration of illness of 8.6 years, clinical assessment of MC by experienced psychiatrists and the outcome of the MacCAT-T interview were compared. Agreement (κ-value) was calculated. Agreement between clinical assessment and outcome of the MacCAT-T was questionable (κ 0.23). Unlike in other psychiatric populations, clinicians judged a high proportion of patients with AN as having diminished MC. The MacCAT-T can be useful in assessing MC in AN when used in addition to clinical judgment to aid clinicians in complex cases. Why clinicians judge a relatively high proportion of patients with AN as having diminished MC, in contrast to lower proportions in other psychiatric disorders, is an area in need of further research.
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Affiliation(s)
- Isis F F M Elzakkers
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht University, Department of Psychology, The Netherlands
| | - Thomas Grisso
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Hans W Hoek
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Psychiatry, University Medical Center Groningen, The Netherlands; Department of Epidemiology, Mailman School of Public Health, Columbia University New York, USA
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht University, Department of Psychology, The Netherlands.
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24
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Abstract
SummaryThis article provides an overview of classification and outcome of eating disorders, before focusing on current evidence-based treatment for the two main disorders of anorexia nervosa and bulimia nervosa.
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25
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Zugai JS, Stein-Parbury J, Roche M. Therapeutic alliance, anorexia nervosa and the inpatient setting: A mixed methods study. J Adv Nurs 2017; 74:443-453. [PMID: 28792604 DOI: 10.1111/jan.13410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to understand the context of the inpatient setting for the treatment of anorexia nervosa and the implications for the therapeutic alliance between nurses and consumers. BACKGROUND The nature of the therapeutic alliance is dependent on the contextual factors that influence interactions. The inpatient setting for the treatment of anorexia nervosa is one such setting where the therapeutic alliance is operative, yet challenging and poorly understood. DESIGN A two-phase explanatory sequential design was employed. Descriptive statistics from phase one informed phase two interviews. Phase two data were analysed through thematic analysis. METHODS A convenience sample of nurses and consumers were recruited from six wards, in five hospitals. Phase one involved the completion of a survey (N = 128) that measured the strength of the therapeutic alliance, as well as other elements of ward context. Phase two interviews (N = 54) were focused on the therapeutic alliance between nurses and consumers and the implications of the inpatient setting. Data collection occurred between May 2014 - February 2015. RESULTS Anorexia nervosa as an illness carries destructive implications for the quality of the therapeutic alliance. Nurses' intimate position in the inpatient setting and interpersonal capacity is influential in overcoming the obstacles that impede the therapeutic alliance. CONCLUSION Nurses' capacity for developing therapeutic alliances is in part dependent on a supportive ward organization and the adequacy of resources to permit meaningful interactions with consumers with anorexia nervosa. Understanding the contextual factors specific to the inpatient setting enhances nurses' ability to develop therapeutic alliances.
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Affiliation(s)
- Joel S Zugai
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia.,Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane Stein-Parbury
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Michael Roche
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
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Conti JE. Recovering Identity from Anorexia Nervosa: Women's Constructions of Their Experiences of Recovery from Anorexia Nervosa Over 10 Years. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2016. [DOI: 10.1080/10720537.2016.1251366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Janet E. Conti
- Department of Psychology, Macquarie University, New South Wales, Australia, and School of Social Sciences and Psychology, Western Sydney University, Penrith, Australia
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Taborelli E, Easter A, Keefe R, Schmidt U, Treasure J, Micali N. Transition to motherhood in women with eating disorders: A qualitative study. Psychol Psychother 2016; 89:308-23. [PMID: 26493834 DOI: 10.1111/papt.12076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 07/12/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to examine in depth the individual experience of transition from pregnancy to motherhood, among women with current eating disorders (EDs), focusing on differences between the first and subsequent pregnancies. DESIGN AND METHODS We analysed the narratives of 12 women with severe ED during pregnancy using interpretative phenomenological analysis. We employed a sequential structure, and the emerging themes were ordered according to consecutive pregnancy stages. RESULTS Our results indicate that experiences of pregnancy vary across pregnancy stages and in the first pregnancy compared to subsequent pregnancies. In particular, during their first pregnancy women with an ED seem to experience an inner conflict and questioned the continuity of their ED identity leading them to be more open to change. CONCLUSIONS The first pregnancy, during its early stages, should be considered a potentially unique window for intervention for women with current ED. PRACTITIONER POINTS Eating disorders (EDs) are known to seriously affect fertility, pregnancy, and pregnancy outcomes. Our research sheds a light on experiences of pregnancy in women with ED and ultimately helps to define a window for intervention. Our findings have important implications in understanding mechanisms of relapse in the post-partum period and consequently could help in tailoring an adequate intervention for women with ED and in preventing ED relapse.
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Affiliation(s)
- Emma Taborelli
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
| | - Abigail Easter
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
| | - Rosalind Keefe
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
| | - Ulrike Schmidt
- Eating Disorders Research Unit, Institute of Psychiatry, King's College London, UK
| | - Janet Treasure
- Eating Disorders Research Unit, Institute of Psychiatry, King's College London, UK
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
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Elzakkers IFFM, Danner UN, Hoek HW, van Elburg AA. Mental capacity to consent to treatment in anorexia nervosa: explorative study. BJPsych Open 2016; 2:147-153. [PMID: 27703767 PMCID: PMC4998943 DOI: 10.1192/bjpo.bp.115.002485] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mental capacity to consent to treatment in anorexia nervosa is a neglected area in clinical decision-making. AIMS To examine clinical and neuropsychological parameters associated with diminished mental capacity in anorexia nervosa. METHOD An explorative study was conducted in 70 adult female patients with severe anorexia nervosa. Mental capacity to consent to treatment was assessed by experienced psychiatrists. Further measurements included the MacCAT-T (to assess mental capacity status), a range of clinical measures (body mass index (BMI) and comorbidity) and neuropsychological tests assessing decision-making, central coherence and set-shifting capacity. RESULTS Diminished mental capacity occurs in a third of patients with severe anorexia nervosa and is associated with a low BMI, less appreciation of illness and treatment, previous treatment for anorexia nervosa, low social functioning and poor set shifting. CONCLUSIONS Assessment of diminished mental capacity in anorexia nervosa requires careful evaluation of not only BMI, but also the degree of appreciation of illness and treatment, history and the tendency to have a rigid thinking style. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
| | - Unna N Danner
- , PhD, Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
| | - Hans W Hoek
- , MD, PhD, Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Annemarie A van Elburg
- , MD, PhD, Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Department of Social Sciences, Utrecht University, Utrecht, The Netherlands
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Hein IM, De Vries MC, Troost PW, Meynen G, Van Goudoever JB, Lindauer RJL. Informed consent instead of assent is appropriate in children from the age of twelve: Policy implications of new findings on children's competence to consent to clinical research. BMC Med Ethics 2015; 16:76. [PMID: 26553304 PMCID: PMC4640170 DOI: 10.1186/s12910-015-0067-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background For many decades, the debate on children’s competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children’s competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally children of 11.2 years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children’s competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives. Discussion Although assessment of children’s competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad. Summary Previous research outcomes showed that children’s medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children’s competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated.
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Affiliation(s)
- Irma M Hein
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, Netherlands.
| | - Martine C De Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, Netherlands.
| | - Pieter W Troost
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, Netherlands.
| | - Gerben Meynen
- Faculty of Philosophy, VU University Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, Netherlands. .,Tilburg Law School, Tilburg University, Prof. Cobbenhagenlaan 221, 5037 DE, Tilburg, Netherlands.
| | - Johannes B Van Goudoever
- Academic Medical Center, Emma's Children Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. .,Department of Pediatrics, VU University Medical Center, De Boelelaan 1105, 1081 HV, Amsterdam, Netherlands.
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, Netherlands.
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Hein IM, De Vries MC, Troost PW, Meynen G, Van Goudoever JB, Lindauer RJL. Informed consent instead of assent is appropriate in children from the age of twelve: Policy implications of new findings on children's competence to consent to clinical research. BMC Med Ethics 2015. [PMID: 26553304 DOI: 10.1186/s12910-0150067-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND For many decades, the debate on children's competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children's competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally children of 11.2 years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children's competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives. DISCUSSION Although assessment of children's competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad. Previous research outcomes showed that children's medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children's competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated.
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Affiliation(s)
- Irma M Hein
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, Netherlands.
| | - Martine C De Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, Netherlands.
| | - Pieter W Troost
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, Netherlands.
| | - Gerben Meynen
- Faculty of Philosophy, VU University Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, Netherlands.
- Tilburg Law School, Tilburg University, Prof. Cobbenhagenlaan 221, 5037 DE, Tilburg, Netherlands.
| | - Johannes B Van Goudoever
- Academic Medical Center, Emma's Children Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
- Department of Pediatrics, VU University Medical Center, De Boelelaan 1105, 1081 HV, Amsterdam, Netherlands.
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, Netherlands.
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Campos LKS, Sampaio ABRF, Garcia Junior C, Magdaleno Junior R, Battistoni MMDM, Turato ER. Psychological characteristics of mothers of patients with anorexia nervosa: implications for treatment and prognosis. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2015; 34:13-8. [PMID: 25924214 DOI: 10.1590/s2237-60892012000100004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 10/26/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The complexity of factors involved in anorexia nervosa (AN) and the recommendations of prominent health organizations underscore the importance of reflecting on therapeutic interventions aimed at patients' family members. OBJECTIVE To expand knowledge about the mother-daughter relationship in AN, with a focus on developing a conceptual framework that is able to improve the treatment of the disorder, reduce factors that perpetuate it and improve prognosis. METHOD A clinical method, anchored by psychodynamic references, was employed in a group of family members of patients with eating disorders. The group met weekly, and sessions were led by psychologists from the eating disorder outpatient clinic of a university hospital. RESULTS AND DISCUSSION Common characteristics in the mother-daughter relationship in cases of AN were identified. The issue of mutual control, the dialectic between omnipotence and impotence, and the relationship of devotion, passion and annihilation between mothers and daughters are phenomena that form the basis of AN, with a direct influence on the severity of each case and on treatment success. CONCLUSION Our findings allowed us to identify important aspects in the mother-daughter relationship in AN, which may improve the clinical interventions aimed at treating the disorder.
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Douzenis A, Michopoulos I. Involuntary admission: the case of anorexia nervosa. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2015; 39:31-35. [PMID: 25660351 DOI: 10.1016/j.ijlp.2015.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Involuntary treatment of psychiatric disorders has always been controversial; this is especially true for eating disorders. Patients with anorexia nervosa of life threatening severity frequently refuse psychiatric hospitalization. Ambivalence toward treatment is characteristic of eating disorders and patients are often admitted to inpatient programs under pressure from family and doctors. In this article, we report research on the positive or negative impact of involuntary admission in the treatment of eating disorders, its application and effectiveness as well as the adverse consequences of coercive treatment in eating disorders. A literature review was done. From a total of 134 publications which were retrieved from the literature search, 50 studies were directly relevant to the scope of this review and fulfilled all inclusion criteria. There are trends and arguments for both sides; for and against involuntary treatment in anorexia nervosa. The scientific literature so far is inconclusive, although in the short term, involuntary hospitalization has benefits. This review has also shown that involuntary hospitalization can have adverse long-term consequences for the patient-therapist allegiance. We conclude that in some cases, involuntary treatment can save lives of young patients with anorexia nervosa; however, in other cases, it can break the psychotherapeutic relationship and make the patient abandon treatment. It is the clinician who has to decide for whom and when to approve involuntary treatment or not.
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Affiliation(s)
- Athanasios Douzenis
- Second Department of Psychiatry, Medical School, University of Athens, "Attikon" General Hospital, Athens, Greece
| | - Ioannis Michopoulos
- Second Department of Psychiatry, Medical School, University of Athens, "Attikon" General Hospital, Athens, Greece.
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Elzakkers IFFM, Danner UN, Hoek HW, Schmidt U, van Elburg AA. Compulsory treatment in anorexia nervosa: a review. Int J Eat Disord 2014; 47:845-52. [PMID: 24990434 DOI: 10.1002/eat.22330] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Compulsory in-patient refeeding of patients with severe anorexia nervosa (AN) has caused considerable controversy. The effects of such treatment on longer-term outcome are not well known. The objective of this article is to review the evidence on the outcome of compulsory treatment for AN. METHOD Three large databases were searched for studies regarding compulsory treatment in AN. RESULTS Detained patients have more severe symptoms and comorbidity and a longer duration of inpatient stay. In the short term compulsory refeeding in AN appears to be beneficial, but the longer term effects remain uncertain. Clinicians report no worsening of the therapeutic relationship after compulsory treatment. DISCUSSION In severe cases of AN where the patient refuses life-saving treatment compulsory treatment needs to be considered. Future research should focus on the longer term effects of compulsory treatment and also on questions related to mental capacity in AN.
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Affiliation(s)
- Isis F F M Elzakkers
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands
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Duncan TK, Sebar B, Lee J. Reclamation of power and self: a meta-synthesis exploring the process of recovery from anorexia nervosa. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/21662630.2014.978804] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kendall S. Anorexia nervosa: the diagnosis. A postmodern ethics contribution to the bioethics debate on involuntary treatment for anorexia nervosa. JOURNAL OF BIOETHICAL INQUIRY 2014; 11:31-40. [PMID: 24366443 DOI: 10.1007/s11673-013-9496-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 12/05/2013] [Indexed: 06/03/2023]
Abstract
This paper argues that there is a relationship between understandings of anorexia nervosa (AN) and how the ethical issues associated with involuntary treatment for AN are identified, framed, and addressed. By positioning AN as a construct/discourse (hereinafter "AN: the diagnosis") several ethical issues are revealed. Firstly, "AN: the diagnosis" influences how the autonomy and competence of persons diagnosed with AN are understood by decision-makers in the treatment environment. Secondly, "AN: the diagnosis" impacts on how treatment and treatment efficacy are defined and the ethical justifiability of paternalism. Thirdly, "AN: the diagnosis" can limit the opportunity for persons with AN to construct an identity that casts them as a competent person. "AN: the diagnosis" can thus inherently affirm professional knowledge and values. Postmodern professional ethics can support professionals in managing these issues by highlighting the importance of taking responsibility for professional knowledge, values, and power and embracing moral uncertainty.
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Affiliation(s)
- Sacha Kendall
- UNSW Medicine, University of New South Wales, School of Women's and Children's Health, UNSW Randwick Hospital Campus, Level 2 McNevin Dickson Building, Randwick, NSW, 2031, Australia,
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Clausen L, Jones A. A systematic review of the frequency, duration, type and effect of involuntary treatment for people with anorexia nervosa, and an analysis of patient characteristics. J Eat Disord 2014; 2:29. [PMID: 25414793 PMCID: PMC4237771 DOI: 10.1186/s40337-014-0029-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/12/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Involuntary treatment of anorexia nervosa is controversial and costly. A better understanding of the conditions that determine involuntary treatment, as well as the effect of such treatment is needed in order to adequately assess the legitimacy of this model of care. The aim of the present study was to investigate the frequency and duration of involuntary treatment, the characteristics of this group of patients, the kind of involuntary actions that are applied and the effect of such actions. REVIEW Relevant databases were systematically searched for studies investigating the involuntary treatment of individuals diagnosed with anorexia nervosa. RESULTS The studies included in the review contained people treated in an inpatient setting for severe or severe and enduring anorexia nervosa. People that were treated involuntarily were characterised by a more severe psychiatric load. The levels of eating disorder pathology between involuntary and voluntary groups were similar and the outcome of involuntary treatment was comparable in terms of symptom reduction to that of voluntary treatment. CONCLUSION Despite inconsistent findings, the comparable levels of eating disorder pathology observed between involuntary and voluntary patient-groups together with findings of higher co-morbidity, more preadmissions, longer duration of illness and more incidences of self-harm for involuntary patients suggest that involuntary treatment is not a reaction to the severity of eating disorder symptoms alone, but is most likely a response to the complexity of the patient's situation as a whole.
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Affiliation(s)
- Loa Clausen
- Centre of Child- and Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, DK-8240 Risskov, Denmark
| | - Allan Jones
- Institute of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
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Bezance J, Holliday J. Adolescents with anorexia nervosa have their say: a review of qualitative studies on treatment and recovery from anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2013; 21:352-60. [PMID: 23765431 DOI: 10.1002/erv.2239] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Anorexia nervosa often begins in adolescence, and there is a growing body of quantitative literature looking at the efficacy of treatment for adolescents. However, qualitative research has a valuable contribution to make to the understanding of treatment and recovery. This paper aims to review qualitative studies on the experience of treatment and recovery for adolescents with anorexia nervosa. Key themes from the 11 studies identified the role of family, peers and professionals, family therapy, the inpatient setting, emphasis on physical versus psychological and conceptualisation of recovery. Future studies would benefit from relating their findings to adolescent theory and considering reflexivity. Implications for clinical practice are also discussed.
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Tan J, Bloodworth A, McNamee M, Hewitt J. Investigating eating disorders in elite gymnasts: conceptual, ethical and methodological issues. Eur J Sport Sci 2012; 14:60-8. [PMID: 24533496 DOI: 10.1080/17461391.2012.728632] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Elite gymnastics, and other sports where athletes and coaches are particularly concerned with aesthetic considerations, weight and shape, are fields within which the risk of eating disorders may be unusually high. Adolescent gymnasts, developing their own sense of self, at a time of life where body image concerns are common, often compete at the very top of the sport with a need to maintain a body shape and weight optimal for elite performance. Research into this field should address the range of sociological and ethical aspects of eating disorders in elite sport, their prevalence as well as the ethos of the sport itself. This paper addresses a range of conceptual, ethical and methodological issues relevant to conducting research in this sensitive yet important field.
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Affiliation(s)
- Jacinta Tan
- a College of Human and Health Sciences , Swansea University , Swansea , UK
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Holm JS, Brixen K, Andries A, Hørder K, Støving RK. Reflections on involuntary treatment in the prevention of fatal anorexia nervosa: a review of five cases. Int J Eat Disord 2012; 45:93-100. [PMID: 21344467 DOI: 10.1002/eat.20915] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Involuntary treatment in the prevention of fatal anorexia nervosa (AN) is still controversial. METHOD Five fatal cases of AN were identified out of 1,160 patients who attended a specialized eating disorder unit between 1994 and 2006. Information on inpatient, ambulatory, and emergency room treatment was extracted from a population-based registration system. RESULTS Personality disorders were diagnosed in all five patients and substance abuse in three patients. In all cases, illness duration was more than 10 years and late onset was seen in two cases. None of the deaths were due to suicide. Involuntary hospital admission was instituted for three patients, but only one patient was compulsory detained more than once. Four patients died after having discontinued treatment. DISCUSSION Compulsory treatment may be of crucial importance in the prevention of fatalities in patients with long-standing AN and psychiatric comorbidity who discontinue treatment.
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Affiliation(s)
- Janni Schmidt Holm
- Department of Endocrinology, Center for Eating Disorders, Odense University Hospital, Denmark
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Matusek JA, Wright MO. Ethical dilemmas in treating clients with eating disorders: A review and application of an integrative ethical decision-making model. EUROPEAN EATING DISORDERS REVIEW 2010; 18:434-52. [DOI: 10.1002/erv.1036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bryden P, Steinegger C, Jarvis D. The Ontario experience of involuntary treatment of pediatric patients with eating disorders. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2010; 33:138-143. [PMID: 20413158 DOI: 10.1016/j.ijlp.2010.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In this paper, the authors (two clinicians with specialized practices in child and adolescent eating disorders and a lawyer who practices health law in Ontario, Canada) review pertinent aspects of clinical capacity assessment, with elaboration of the specific unique and complex issues which shape that assessment in children and adolescents with eating disorders. The relevant Ontario legislation and institutional framework governing consent and capacity in children and adolescents are reviewed. The literature on involuntary treatment and consent and capacity in patients with eating disorders is reviewed. Specific cases involving child and adolescent patients with eating disorders that have been heard by the Ontario Consent and Capacity Board (OCCB) in the past decade are discussed in order to elucidate the Board's views of consent and capacity in this vulnerable and challenging patient population. Strategies to support clinicians' therapeutic alliances with their patients while both are going through what can be a lengthy and potentially adversarial-seeming legal process are also discussed.
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Affiliation(s)
- Pier Bryden
- Department of Psychiatry, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8 Canada
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Tan JOA, Stewart A, Fitzpatrick R, Hope T. Attitudes of patients with anorexia nervosa to compulsory treatment and coercion. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2010; 33:13-19. [PMID: 19926134 PMCID: PMC2808473 DOI: 10.1016/j.ijlp.2009.10.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The compulsory treatment of anorexia nervosa is a contentious issue. Research suggests that patients are often subject to compulsion and coercion even without formal compulsory treatment orders. Research also suggests that patients suffering from anorexia nervosa can change their minds in retrospect about compulsion. METHODS Qualitative interviewing methods were used to explore the views of 29 young women concerning compulsion and coercion in the treatment of anorexia nervosa. The participants were aged between 15 to 26years old, and were suffering or had recently suffered from anorexia nervosa at the time of interview. RESULTS Compulsion and formal compulsory treatment of anorexia nervosa were considered appropriate where the condition was life-threatening. The perception of coercion was moderated by relationships. What mattered most to participants was not whether they had experienced restriction of freedom or choice, but the nature of their relationships with parents and mental health professionals. CONCLUSIONS People with anorexia nervosa appear to agree with the necessity of compulsory treatment in order to save life. The perception of coercion is complex and not necessarily related to the degree of restriction of freedom.
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Affiliation(s)
- Jacinta O A Tan
- The Ethox Centre, Department of Public Health and Primary Care, University of Oxford, Oxford, United Kingdom.
| | - Anne Stewart
- Oxfordshire and Buckinghamshire Mental Health Partnership Foundation NHS Trust, United Kingdom
| | | | - Tony Hope
- The Ethox Centre, Department of Public Health and Primary Care, University of Oxford, Oxford, United Kingdom
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Espíndola CR, Blay SL. Family perception of anorexia and bulimia: a systematic review. Rev Saude Publica 2009; 43:707-16. [PMID: 19503976 DOI: 10.1590/s0034-89102009005000035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 12/02/2008] [Indexed: 11/22/2022] Open
Abstract
A systematic literature review published between 1990 and 2006 using a qualitative approach was conducted to explore family members' perception of anorexia and bulimia nervosa patients. Articles were critically reviewed and a meta-synthesis analysis was carried out based on a meta-ethnographic method to analyze and summarize data. Of a total of 3,415 studies, nine met the study inclusion and exclusion criteria. Reciprocal translation was used for data interpretation allowing to identifying two concepts: disease awareness and disease impacts. Feelings of impotence were often described in family reorganization. The study results point to distortions in the concept of disease associated with family involvement, resulting in changes in communication, attitudes, and behaviors in a context of impotence.
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Affiliation(s)
- Cybele Ribeiro Espíndola
- Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). São Paulo, SP, Brasil.
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Feeding size 0: the challenges of anorexia nervosa. Managing anorexia from a dietitian's perspective. Proc Nutr Soc 2009; 68:281-8. [PMID: 19419589 DOI: 10.1017/s0029665109001281] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anorexia nervosa has the highest mortality rate of any psychiatric condition and its management is complex and multi-faceted, requiring a multidisciplinary team approach. Dietitians are an important part of the multidisciplinary team, offering objective nutritional advice with the aim of helping the patient to develop an improved relationship with food. Refeeding patients with a low body weight requires careful management; nonetheless, refeeding the low-weight patient with anorexia presents many additional complications, largely of a psychological nature. Treatment plans need to consider psychological, physical, behavioural and psycho-social factors relating to anorexia nervosa. Currently, there is no consistent approach and a paucity of evidence to support best practice for weight restoration in this group of patients. Tube feeding is utilised at varying BMI in anorexia nervosa, mainly in an inpatient setting. However, its use should be seen as a last resort and limited to a life-saving intervention. Weight restoration is best managed by an experienced dietitian within a specialist eating disorders team, using normal foods. This approach is ideal for nutrition rehabilitation, promoting skills for eating and normal behaviour and providing a longer-term solution by challenging unhelpful coping strategies from the onset. Dietitians have a unique mix of skills and knowledge in numerous areas including nutrition, physiology, psychology, sociology and behaviour change, which can be applied to support patients with thoughts and behaviours around food, weight and appetite. Further research is required into the effectiveness of dietetic interventions in eating disorders in order to establish an evidence base for best practice.
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Ayton A, Keen C, Lask B. Pros and cons of using the mental health act for severe eating Disorders in Adolescents. EUROPEAN EATING DISORDERS REVIEW 2009; 17:14-23. [DOI: 10.1002/erv.887] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tan JOA, Doll HA, Fitzpatrick R, Stewart A, Hope T. Psychiatrists' attitudes towards autonomy, best interests and compulsory treatment in anorexia nervosa: a questionnaire survey. Child Adolesc Psychiatry Ment Health 2008; 2:40. [PMID: 19091113 PMCID: PMC2649038 DOI: 10.1186/1753-2000-2-40] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 12/17/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The compulsory treatment of anorexia nervosa is a contentious issue. Research suggests that psychiatrists have a range of attitudes towards patients suffering from anorexia nervosa, and towards the use of compulsory treatment for the disorder. METHODS A postal self-completed attitudinal questionnaire was sent to senior psychiatrists in the United Kingdom who were mostly general adult psychiatrists, child and adolescent psychiatrists, or psychiatrists with an interest in eating disorders. RESULTS Respondents generally supported a role for compulsory measures under mental health legislation in the treatment of patients with anorexia nervosa. Compared to 'mild' anorexia nervosa, respondents generally were less likely to feel that patients with 'severe' anorexia nervosa were intentionally engaging in weight loss behaviours, were able to control their behaviours, wanted to get better, or were able to reason properly. However, eating disorder specialists were less likely than other psychiatrists to think that patients with 'mild' anorexia nervosa were choosing to engage in their behaviours or able to control their behaviours. Child and adolescent psychiatrists were more likely to have a positive view of the use of parental consent and compulsory treatment for an adolescent with anorexia nervosa. Three factors emerged from factor analysis of the responses named: 'Support for the powers of the Mental Health Act to protect from harm'; 'Primacy of best interests'; and 'Autonomy viewed as being preserved in anorexia nervosa'. Different scores on these factor scales were given in terms of type of specialist and gender. CONCLUSION In general, senior psychiatrists tend to support the use of compulsory treatment to protect the health of patients at risk and also to protect the welfare of patients in their best interests. In particular, eating disorder specialists tend to support the compulsory treatment of patients with anorexia nervosa independently of views about their decision-making capacity, while child and adolescent psychiatrists tend to support the treatment of patients with anorexia nervosa in their best interests where decision-making is impaired.
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Affiliation(s)
- Jacinta OA Tan
- The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK
| | - Helen A Doll
- Department of Public Health, University of Oxford, Oxford, UK
| | | | - Anne Stewart
- Oxfordshire and Buckinghamshire Mental Health Foundation NHS Trust, Oxford, UK
| | - Tony Hope
- The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK
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Abstract
PURPOSE OF REVIEW To consider clinical, ethical and legal approaches to forced feeding in patients with anorexia nervosa in the light of recent literature. RECENT FINDINGS An Australian retrospective record analysis compared 27 coercive with 96 informal hospitalizations and found more previous inpatient treatments, comorbidities, and a lower BMI at admission of 13.2 (SD 1.67) kg/m, but no significantly different weight gain [4.96 (SD 6.56) kg]. In a higher proportion of the involuntary group a re-feeding syndrome, treatment in a locked ward, and tube feeding were recorded. In Germany 25 women with anorexia nervosa with an admission BMI of 12.09 (SD 1.51) kg/m gained 12.44 (SD 1.21) kg. Twenty were treated involuntarily and 22 received tube feeding- 20 of whom were fed a via transdermal duodenal tube, four of whom as voluntary patients. SUMMARY As full recovery is possible in life-threatening anorexia nervosa, detention is sometimes justifiable and may indeed be necessary. Compulsory admission, however, does not necessarily imply a need for forced or tube feeding. Highly skilled nursing seems preferable, and so it may be better to admit the patient before the BMI drops below 13 kg/m. The validity of this proposal should be examined using a prospective research design with a follow-up period.
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Halvorsen I, Heyerdahl S. Treatment perception in adolescent onset anorexia nervosa: retrospective views of patients and parents. Int J Eat Disord 2007; 40:629-39. [PMID: 17607715 DOI: 10.1002/eat.20428] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate perception of treatment in former patients with anorexia nervosa (AN) and their parents, and to determine whether this was related to outcome and treatment characteristics. Client satisfaction is important for treatment engagement and adherence. METHOD Forty-six (of 55) girls with adolescent onset AN, 33 mothers and 26 fathers participated in a follow-up study conducted 8.8 (SD 3.3) years after start of treatment. The former patients were assessed using diagnostic interviews. Only nine participants (19%) had an eating disorder (ED) at follow-up. Perception of treatment was assessed by questionnaires. RESULTS Parents reported having an overall positive perception of treatment. However, reports from former patients were significantly more negative than from the parents. In former patients, the "perception of therapists" total score and the items "therapists' knowledge of ED" and "usefulness of pediatric inpatient treatment" correlated with ED symptoms at follow-up. The perception of therapists' scores of the parents were not associated with the ED outcome of their daughters. More family therapy sessions were associated with the former patients' satisfaction with the therapists, while higher age at admission was associated with their mothers' satisfaction. CONCLUSION In spite of good ED outcome, former patients were only moderately satisfied with their treatment, whereas parental satisfaction was high.
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Affiliation(s)
- Inger Halvorsen
- Department of Child and Adolescent Psychiatry, Buskerud Hospital, Drammen, Norway.
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Fedyszyn IE, Sullivan GB. Ethical re-evaluation of contemporary treatments for anorexia nervosa: Is an aspirational stance possible in practice? AUSTRALIAN PSYCHOLOGIST 2007. [DOI: 10.1080/00050060701326962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Izabela Ewa Fedyszyn
- School of Psychiatry, Psychology and Psychological Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gavin Brent Sullivan
- School of Psychiatry, Psychology and Psychological Medicine, Monash University, Melbourne, Victoria, Australia
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