Interdisciplinary model for the inpatient treatment of adolescents with anorexia nervosa

Canadian practice guidelines for the treatment of children and adolescents with eating disorders

OBJECTIVES

Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline.

METHODS

Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders.

RESULTS

Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed.

CONCLUSIONS

Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.

Outcomes of inpatient psychological treatments for children and adolescents with eating disorders at time of discharge: a systematic review

BACKGROUND

Recommended first line treatment for children and adolescent eating disorders is outpatient therapy. However, a significant number of children and adolescents with eating disorders continue to require inpatient treatment during the course of their illness. The effect of psychological treatments in an inpatient setting on outcomes at the time of discharge remains unclear. This paper presents the results of a review of the literature on outcomes at the time of discharge following inpatient psychological treatment for children and adolescents with eating disorders.

MAIN BODY

The majority of studies found were observational and of low quality. The most consistently reported positive outcome of inpatient treatment is weight gain. Results related to symptom change and motivation vary between studies. Within the inpatient setting, there is considerable heterogeneity in the types of treatments offered, goals of treatment, length of stay and outcomes measured.

CONCLUSION

There remains a paucity of high-quality studies examining the effect of psychological treatments provided to children and adolescents in an inpatient setting. The significant heterogeneity between studies makes it not possible to compare across studies. Future research should aim to resolve these deficiencies in order to better determine the specific factors that contribute to positive outcomes of inpatient treatment for children and adolescents with eating disorders.

Total parenteral nutrition in the pediatric patient

Over the past 50 years, tremendous advances have been made in the management of children who cannot receive enteral nutrition. Challenges for the future include devising techniques to decrease catheter sepsis, particularly in children with a short bowel, who have a disproportionate number of septic episodes, possibly related to bacterial translocation. The delineation of risk factors for cholestasis associated with total parenteral nutrition and refinement of administration of such nutrition in premature neonates to decrease the incidence of this complication, as well as the morbidity of osteopenia, will extend our ability to help these children.

The present status of operant conditioning for the treatment of anorexia nervosa

Operant conditioning appears to be an effective short-term method of weight restoration in anorexia nervosa, although it may offer only modest advantages over alternative methods of inducing weight gain. Programs differ widely in the selection of treatment setting, target behaviors, positive and negative reinforcers, reinforcement schedules, facilitating conditions, and supplementary modalities employed, and it remains unclear how each of these variables may contribute to treatment outcome. The scarcity of long-term follow-up data after 20 years of investigation is puzzling; by default, the calculation of risk/benefit ratios has depended on the theoretical biases of the observer. The accumulation of clinical experience does appear to have had some moderating effect on the polarized positions initially assumed by the advocates and opponents of operant conditioning. The approach has gained acceptance as a useful but circumscribed component of multimodal treatment programs, and in recent years is often supplemented with a variety of behavioral and cognitive-behavioral strategies designed to deal with a broader range of anorexic symptomatology.