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Bond L, Ong JZ, McNicholas F. Impact of a national audit on child and adolescent psychiatrists' prescribing practices. Ir J Psychol Med 2024:1-6. [PMID: 38738538 DOI: 10.1017/ipm.2024.11] [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: 05/14/2024]
Abstract
BACKGROUND A look back review of South Kerry Child and Adolescent Mental Health Services (CAMHS) in Ireland, known as the 'Maskey report' (MR), highlighted substandard prescribing practices. The aim of this 'Maskey Impact Study' (MIS) was to explore changes to child and adolescent psychiatrists' prescribing practices following the MR. METHOD The study was cross-sectional and mixed method. A study specific questionnaire was distributed electronically to psychiatrists working in CAMHS (n = 160). RESULTS 102 psychiatrists participated in the study (response rate 63.8%). Perceived improvement in prescribing practices included improved medical record keeping (63.7%), consent documentation (53.9%), medication information provision (41.2%) and physical health monitoring (60.8%). However, 43.1% of psychiatrists reported a reluctance to prescribe medication even when clinically indicated and 50% were more likely to avoid off-label use. Most respondents reported increased stress levels (80.4%) with higher stress being significantly associated with reticence in prescribing (χ2 = 11.746, p < .001) and avoiding off-label use (χ2 = 15.392, p < 0.001). Thematic analysis highlighted increased medication hesitancy, enforced 'meaningless' bureaucracy and medication mistrust among families. DISCUSSION Although improvements reported are welcomed, the increased hesitancy of medication use, avoidance of prescribing more than one medication, and avoidance of off-label use, is of concern with potential unintended adverse consequences. Reluctance in prescribing may deprive youth of access to evidence-based treatments and limit exposure of NCHDs to the safe practice of consultant-initiated psychopharmacology. Further research will be important to determine if this impacts clinical care. Continued education in psychopharmacology is essential along with increased public awareness of the evidence for medication, to help restore public confidence and trust in psychopharmacology.
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Affiliation(s)
- L Bond
- School of Medicine & Medical Science, University College Dublin, Dublin, Ireland
- Department of Paediatric Liaison Psychiatry, Children's Hospital Ireland, Crumlin, Ireland
| | - J Z Ong
- School of Medicine & Medical Science, University College Dublin, Dublin, Ireland
| | - F McNicholas
- School of Medicine & Medical Science, University College Dublin, Dublin, Ireland
- Department of Paediatric Liaison Psychiatry, Children's Hospital Ireland, Crumlin, Ireland
- CAMHS, Lucena Clinic, Rathgar, Ireland
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2
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Marchili MR, Bozzola E, Guolo S, Marchesani S, Spina G, Mascolo C, Vicari S, De Jacobis IT, Raponi M, Villani A. Pediatric acute hospitalization for anorexia nervosa: an economic evaluation. Ital J Pediatr 2024; 50:33. [PMID: 38413993 PMCID: PMC10900686 DOI: 10.1186/s13052-024-01605-0] [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: 11/28/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a psychiatric disorders which may potentially led to a high risk of health medical complications, suicide and self-harming behaviour. Since Covid-19 pandemic onset in March 2020, evidence suggested an increase occurrence of AN. The main aim of the retrospective analysis is to define the cost of hospitalization in the acute phase (HAP) at IRCCS Bambino Gesù Children Hospital, Rome, Italy, over 2 years study. Secondary purposes are defining the main risk factors for a prolonged hospitalization (including age, sex and comorbidities) and the possible influence of Covid-19 pandemic on AN admission and hospital stay. METHODS for the purpose of the study, we included children and adolescents aged less than 18 years, admitted to IRCCS Bambino Gesù Children Hospital, Rome, Italy, with a diagnosis of AN. Medical costs were calculated consulting the Lazio Regional Health Service Tariffs. Basing on the date of hospital admission, patients were later divided into two subgroups: subgroup A included patients hospitalized prior than Covid-19 onset (from March 2019 to February 2020) and subgroup B those admitted after (from March 2020 to October 2022). RESULTS a total of 260 patients has been included in the study with a median age of 15 years (range 6-18 years). The total health care cost of AN hospitalized patients was of EUR 3,352,333 with a median cost of EUR 11,124 for each admission (range EUR 930 - 45,739) and a median daily cost of EUR 593 (range EUR 557-930). Median cost was higher in case of comorbidities, guarded patients, enteral feeding. A prolonged hospitalization has been documented in subgroup A with a higher economic burden. CONCLUSIONS the economic burden of eating disorders is of note. Adequate sanitary policies as well as health economic analyses are required to gain insight into the cost-effectiveness of AN management. TRIAL REGISTRATION 2526-OPBG-2021.
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Affiliation(s)
| | - Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
- Child Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvio Marchesani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Spina
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristina Mascolo
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Sanitary Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Alberto Villani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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3
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Murray F, Houghton S, Murphy F, Clancy E, Fortune D, McNicholas F. A Qualitative Exploration of Prominent Factors Contributing to the Aetiology of Child and Adolescent Eating Disorder Presentations during the COVID-19 Pandemic: The Perspectives of Patients, Parents and Clinicians. J Clin Med 2024; 13:615. [PMID: 38276121 PMCID: PMC10816259 DOI: 10.3390/jcm13020615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024] Open
Abstract
AIM The aim of this study was to explore the prominent factors that contributed to the development of child and adolescent eating disorder presentations during the COVID-19 pandemic. METHODS This was achieved through a qualitative analysis of interviews gathered from (1) adolescent patients diagnosed with an eating disorder (ED) during the COVID-19 pandemic (aged 13-18) (n = 4), (2) parents of patients attending an ED service (n = 7) and (3) clinicians working within a specialist child and adolescent ED support service (n = 7). Reflexive thematic analysis was used to analyse the data and establish the most prominent aetiological factors reported. RESULTS The most prominent aetiological factors reported were (1) the accumulation of risk factors; (2) seeking control amid increased anxiety, stress and uncertainty; (3) social isolation; (4) an increased focus on exercise and "healthy eating"; (5) increased social media use promoting unhelpful attention towards ED triggers; and (6) a lack of both awareness and support services. CONCLUSION During the COVID-19 pandemic, the quantity and severity of ED presentations increased. The current study uncovered six themes perceived by patients, parents and clinical staff that contributed to the aetiology of ED presentations during the COVID-19 pandemic. It is hoped that the insight gained through this research study into ED aetiology may act as a basis for further research and support ED awareness, prevention and intervention in the future.
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Affiliation(s)
- Finán Murray
- Department of Psychology, University of Limerick, V94 T9PX Limerick, Ireland
| | - Sharon Houghton
- Clinical Psychology Programme, Department of Psychology, University of Limerick, V94 T9PX Limerick, Ireland;
| | - Fay Murphy
- Lucena Clinic Child & Adolescent Mental Health Services, 59 Orwell Road, Rathgar, D06 HX93 Dublin, Ireland; (F.M.); (F.M.)
| | - Emma Clancy
- Lucena Clinic Child & Adolescent Mental Health Services, 59 Orwell Road, Rathgar, D06 HX93 Dublin, Ireland; (F.M.); (F.M.)
| | - Dónal Fortune
- Department of Psychology, University of Limerick, V94 T9PX Limerick, Ireland
| | - Fiona McNicholas
- Lucena Clinic Child & Adolescent Mental Health Services, 59 Orwell Road, Rathgar, D06 HX93 Dublin, Ireland; (F.M.); (F.M.)
- Children’s Health Ireland Crumlin, D12 N512 Dublin, Ireland
- School Medicine & Medical Sciences, University College Dublin, D04 V1W8 Dublin, Ireland
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4
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Meneguzzo P, Di Pascoli L, Bindolo MC, Collantoni E, Meregalli V, Zanetti T, Veronese A, Tenconi E, Favaro A. The Psychological and Medical Landscape of Anorexia Nervosa over a Decade: A Retrospective Study of Possible Physical and Psychological Shifts. J Clin Med 2023; 12:7294. [PMID: 38068346 PMCID: PMC10707422 DOI: 10.3390/jcm12237294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 02/16/2024] Open
Abstract
In recent years, the definition, clinical characteristics, and psychological aspects of anorexia nervosa (AN) have undergone notable changes, influenced by various factors such as biology, psychology, and the environment. The COVID-19 pandemic is one such external factor that has been preliminarily identified as affecting the clinical presentation of AN. This study specifically aims to assess the alterations in psychological and medical features observed in individuals with AN during the pandemic. This study is a retrospective case review of 252 people diagnosed with AN from two different cohorts: 2010-2012 and 2021. A comparison of psychological and medical data was conducted to identify specific differences in the initial clinical evaluation. Additionally, different effects of the pandemic on age cohorts were assessed, with a focus on distinctions between adolescents and adults. Results revealed that the pandemic cohort had a higher number of new cases, with patients being younger and experiencing more severe psychological symptoms. Hospitalization rates upon first access were also elevated, but no significant differences in medical values were observed. Adolescents during the pandemic showed increased episodes of binge eating, decreased obsessive-compulsive symptoms, and greater difficulty in interoceptive awareness. This study reveals distinct differences in symptomatology among patients, with a particular focus on psychological characteristics such as impulsive behaviors and interoceptive awareness. These behavioral and interoceptive changes could have potential considerations in the treatment pathway. Further investigations are warranted to gain a deeper understanding of the evolving clinical presentation of anorexia nervosa after the pandemic.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, 35122 Padova, Italy; (E.C.); (V.M.); (E.T.); (A.F.)
- Padova Neuroscience Center, University of Padova, 35122 Padova, Italy
| | - Lorenza Di Pascoli
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, Padova University Hospital, 35128 Padova, Italy
- Eating Disorders Unit, Padova University Hospital, 35128 Padova, Italy
| | - Maria Cristina Bindolo
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, Padova University Hospital, 35128 Padova, Italy
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, 35122 Padova, Italy; (E.C.); (V.M.); (E.T.); (A.F.)
- Padova Neuroscience Center, University of Padova, 35122 Padova, Italy
| | - Valentina Meregalli
- Department of Neuroscience, University of Padova, 35122 Padova, Italy; (E.C.); (V.M.); (E.T.); (A.F.)
- Padova Neuroscience Center, University of Padova, 35122 Padova, Italy
| | - Tatiana Zanetti
- Eating Disorders Unit, Padova University Hospital, 35128 Padova, Italy
| | - Angela Veronese
- Eating Disorders Unit, Padova University Hospital, 35128 Padova, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, 35122 Padova, Italy; (E.C.); (V.M.); (E.T.); (A.F.)
- Padova Neuroscience Center, University of Padova, 35122 Padova, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, 35122 Padova, Italy; (E.C.); (V.M.); (E.T.); (A.F.)
- Padova Neuroscience Center, University of Padova, 35122 Padova, Italy
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5
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Pereira Santos PJ, Soares L, Faria AL. Narrative Therapy as an innovative approach to Anorexia Nervosa treatment: a literature review. JOURNAL OF POETRY THERAPY 2023. [DOI: 10.1080/08893675.2023.2189532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
| | - Luísa Soares
- Faculty of arts and humanities, Psychology department, University of Madeira, Lisboa, Portugal
| | - Ana Lúcia Faria
- Faculty of arts and humanities, NOVA Laboratory for Computer Science and Informatics, University of Madeira, Lisboa, Portugal
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6
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Vyver E, Han AX, Dimitropoulos G, Patten SB, Devoe DJ, Marcoux-Louie G, Katzman DK. The COVID-19 Pandemic and Canadian Pediatric Tertiary Care Hospitalizations for Anorexia Nervosa. J Adolesc Health 2023; 72:344-351. [PMID: 36202680 PMCID: PMC9529357 DOI: 10.1016/j.jadohealth.2022.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/16/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Global studies show an increase in hospitalizations for pediatric eating disorders (EDs). No published Canadian studies have confirmed these findings in pediatric ED programs for one-year post onset of the COVID-19 pandemic. The primary objective was to examine health administrative data from two pediatric tertiary care ED programs: Alberta Children's Hospital (ACH) and Hospital for Sick Children (SickKids) to determine the number of pediatric hospitalizations with the most responsible discharge diagnosis of anorexia nervosa (AN). METHODS This hospital-based design explored monthly pediatric hospitalizations in seven-year-olds to 18-year-olds between March 11, 2014 and March 11, 2021 using the Discharge Abstract databases. The analysis used negative binomial regression with robust standard errors to compare hospitalization counts in the months preceding and following the World Health Organization pandemic declaration (March 11, 2020). RESULTS Hospitalizations due to pediatric AN increased by 63% and 132% at SickKids (p < .001) and ACH (p < .001), respectively, in the first year of the pandemic compared to the previous six years. The total number of non-ED hospitalizations decreased by 29.3% and 2.4% at SickKids and ACH, respectively. DISCUSSION This is the first Canadian study to show a rise in pediatric hospitalizations over one year due to AN in two tertiary care hospitals following the onset of the pandemic, confirming the impact that the pandemic has had on children and adolescents with AN in Canada.
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Affiliation(s)
- Ellie Vyver
- Department of Pediatrics, Section of Adolescent Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Calgary Eating Disorder Program, Alberta Health Services, Calgary, Alberta, Canada.
| | - Angela X. Han
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Gina Dimitropoulos
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Calgary Eating Disorder Program, Alberta Health Services, Calgary, Alberta, Canada,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada,Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Scott B. Patten
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Community Health Sciences, Cumming School of Medicine, Cuthbertson and Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, Alberta, Canada,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada,Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J. Devoe
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Psychology, Mount Royal University, Calgary, Alberta, Canada
| | - Gisele Marcoux-Louie
- Calgary Eating Disorder Program, Alberta Health Services, Calgary, Alberta, Canada,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Debra K. Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
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7
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Güzel Â, Mutlu NL, Molendijk M. COVID-19-related changes in eating disorder pathology, emotional and binge eating and need for care: a systematic review with frequentist and Bayesian meta-analyses. Eat Weight Disord 2023; 28:19. [PMID: 36805344 PMCID: PMC9941242 DOI: 10.1007/s40519-023-01547-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has been a leading cause of stress and feelings of loss of control, both of which have been related to eating disorder (ED) pathology onset and deterioration. We aim to estimate the magnitude of changes in the prevalence rates of, and indicators for, ED psychopathology in the face of the COVID-19 pandemic. METHOD Pre-registered systematic review with frequentist and Bayesian meta-analyses. Searches for eligible studies were performed in PubMed, Web of Science and pre-print servers until January 15 2023. RESULTS Our searches yielded 46 eligible studies reporting on a total of 4,688,559 subjects. These data provide strong evidence indicating increased rates of diagnosed and self-reported ED's and a concordant increased need for care in the face of the pandemic. ED symptom severity scores in patients were not elevated during the pandemic, except for those related to anorexia nervosa. On average, people in the general population report relatively high levels of emotional and binge eating during the pandemic, although the evidential strength for these associations is only anecdotal to moderate. Moderators of between-study heterogeneity were not detected. CONCLUSIONS Altogether, our results suggest that the COVID-19 pandemic is associated with a wide spread negative effect on ED pathology in patient samples and the general population. The development of online prevention and intervention programs for EDs during stressful times like a pandemic is encouraged. A limitation is that the results reported here may be prone to biases, amongst others, self-report bias. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis. PREREGISTRATION Prospero [ https://www.crd.york.ac.uk/prospero ] ID: CRD42022316105.
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Affiliation(s)
- Âmine Güzel
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands
| | - Naz Lâl Mutlu
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands
| | - Marc Molendijk
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands.
- Leiden Institute of Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands.
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8
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Winston AP, Taylor MJ, Himmerich H, Ibrahim MAA, Okereke U, Wilson R. Medical morbidity and risk of general hospital admission associated with concurrent anorexia nervosa and COVID-19: An observational study. Int J Eat Disord 2023; 56:282-287. [PMID: 36374243 PMCID: PMC10100157 DOI: 10.1002/eat.23851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/11/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Investigate medical morbidity and risk of general hospital admission for patients with concurrent coronavirus disease 2019 (COVID-19) and anorexia nervosa (AN) who have not received severe acute respiratory syndrome coronavirus 2 vaccination. METHODS United Kingdom eating disorders clinicians contributed to a database of patients with an eating disorder and COVID-19. We used this to investigate demography, symptoms, hospitalization, treatment, and outcomes for those with AN. RESULTS We describe data for 49 patients (median age 21.5 years [interquartile range 17.0-33.5], 46 female) including 36 adults and 13 under-18-year-olds. Three (6.1% [95% confidence interval 1.3%-17.9]) were admitted to a general hospital. For this sample, the expected age-standardized hospital admission rate per COVID-19 case (based on the general population of England) was 2.6% and therefore not significantly different to the hospitalization rate we observed. Three (including two of those admitted to hospital) contracted pneumonia. One had severe pneumonia and was admitted to an intensive care unit. No deaths or use of mechanical ventilation were recorded. DISCUSSION To our knowledge, this represents the first study investigating medical morbidity or frequency of hospitalization for patients with COVID-19 and AN. We did not find evidence that patients with AN are at increased risk of severe COVID-19. PUBLIC SIGNIFICANCE Medical morbidity and risk of hospitalization associated with concurrent COVID-19 and anorexia nervosa (AN) had not, to our knowledge, been studied before. We used a database of patients with eating disorders and COVID-19 (to which United Kingdom clinicians had contributed) to investigate presentation, treatment, outcomes, and COVID-19 severity for those with AN and COVID-19. We did not find evidence that patients with AN are at increased risk of severe COVID-19.
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Affiliation(s)
- Anthony P Winston
- The Aspen Centre, Coventry and Warwickshire Partnership Trust, Warwick, UK
| | - Michael J Taylor
- Healthcare Public Health Team, National Health Service England-Midlands, Nottingham, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Mohammad A A Ibrahim
- Immunobiology and Immunological Medicine, King's College London and King's Health Partners, London, UK
| | - Uju Okereke
- Healthcare Public Health Team, National Health Service England-Midlands, Nottingham, UK
| | - Robert Wilson
- Healthcare Public Health Team, National Health Service England-Midlands, Nottingham, UK
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9
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Spina G, Clemente A, Roversi M, Marchili MR, Silvestri P, Mascolo C, Zanna V, Diamanti A, Reale A, Villani A, Raucci U, Ammirati A. Early echocardiographic evaluation of children admitted to the emergency department for anorexia nervosa during the COVID-19 pandemic. Eat Weight Disord 2022; 27:3409-3417. [PMID: 36053460 PMCID: PMC9438386 DOI: 10.1007/s40519-022-01474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/21/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Anorexia nervosa (AN) is the most frequent eating disorder (ED), whose cardiac complications may have life-threatening consequences for both the physical and psychological health of affected children. In this study, we reported and analysed the echocardiographic anomalies found in pediatric patients diagnosed with AN. METHODS We reported the demographic and clinical characteristics of children aged 8 to 18 years, who were diagnosed with AN and underwent a complete cardiological evaluation at the Emergency Department of the Bambino Gesù Children's Hospital, IRCCS, Rome between the 1st January 2021 and the 30th June 2021. Furthermore, we compared the patients according to the presence of pericardial effusion and a BMI (body mass index) cut-off 14.5 kg/m2. RESULTS Forty-nine patients were included in the study. The mean age was 15.1 years. Most patients were female (89.8%). The mean length of hospitalization was 18 days. The mean BMI at admission was 14.8 kg/m2, with a median weight loss of 9 kg in the last year. Eleven patients (22.4%) presented with cardiovascular signs or symptoms at admission. Most patients had pericardial effusion on heart ultrasound, with a mean thickness of 6 mm (SD ± 4). The LV (left ventricle) thickness over age was significantly higher in patients with pericardial effusion, with a Z score of -2.0 vs -1.4 (p = 0.014). The administration of psychiatric drugs was significantly more frequent in patients with a lower BMI (37.5% vs 12%, p = 0.038). CONCLUSION Our study suggests that a non-urgent baseline echocardiographic evaluation with focus on left-ventricular wall thickness and mass in children with anorexia nervosa is advisable. LEVEL III Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Giulia Spina
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Clemente
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Roversi
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Maria Rosaria Marchili
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Silvestri
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristina Mascolo
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Valeria Zanna
- Anorexia Nervosa and Eating Disorders Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonella Diamanti
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Antonio Ammirati
- Consultant Cardiologist at Pediatric Emergency Unit, Department of Emergency, Acceptance and General Pediatrics, Pediatric Emergency Department, Bambino Gesù Children's Hospital, Rome, Italy
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10
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Serur Y, Dikstein H, Shilton T, Gothelf D, Latzer Y, Lewis Y, Enoch-Levy A, Pessach I, Gur E, Stein D. The emotional-behavioral state of Israeli adolescent and young adult females with anorexia nervosa during the COVID19 pandemic. J Eat Disord 2022; 10:145. [PMID: 36209127 PMCID: PMC9547577 DOI: 10.1186/s40337-022-00668-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic in Israel, the number of patients with eating disorders (EDs) seeking treatment increased significantly. The present study sought to evaluate whether, during the pandemic (2020-21), patients with anorexia nervosa (AN) would show more ED-related, comorbid, and COVID-19-related symptoms in comparison to a naturalistic control group, and whether differences would be found between adult and adolescent patients with AN. We also examined attitudes to telemedicine use during the pandemic in patients receiving long-distance interventions. METHODS Using online self-report questionnaires, we assessed general and COVID-19-specific symptoms with a secure digital platform (REDCap®) in 36 female adolescents with AN, 35 female adults with AN, and 25 female controls. RESULTS Compared with controls, patients with AN showed more symptoms of EDs, anxiety, depression, and post-traumatic stress disorder (PTSD), elevated suicidal ideation, more COVID-related emotional-behavioral disturbances, and lower resilience. Adult patients with AN fared worse than adolescent patients on most of these measures. Adult patients using telemedicine during the COVID-19 pandemic showed fewer positive attitudes toward this treatment than adolescents (telemedicine was offered to all, but used by 18/35 adolescents and 21/36 adults with AN). Last, elevated COVID-19-related symptomatology was correlated with more symptoms of ED, anxiety, depression and PTSD, and with lower resilience. CONCLUSIONS Our findings suggest that the emotional-behavioral state of Israeli females with AN, particularly adults, was worse during the COVID-19 pandemic in comparison to controls. Many patients did not use telemedicine for their treatment. Adult patients using telemedicine were less satisfied with it than adolescent patients.
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Affiliation(s)
- Yaffa Serur
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Hadar Dikstein
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Tal Shilton
- Psychiatric Division, Psychiatric Department, Sheba Medical Center, Safra Children's Hospital, 5265601, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- Psychiatric Division, Psychiatric Department, Sheba Medical Center, Safra Children's Hospital, 5265601, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Latzer
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Psychiatric Division, Eating Disorders Institution, Rambam Health Care Campus, Haifa, Israel
| | - Yael Lewis
- Shalvatah Mental Health Center, Hod Hasharon, Israel
| | - Adi Enoch-Levy
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Itai Pessach
- Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Gur
- Center for the Treatment of Eating Disorders and Obesity, Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel. .,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel. .,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel. .,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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11
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Cerniglia L, Cimino S. Eating Disorders and Internalizing/Externalizing Symptoms in Adolescents before and during the COVID-19 Pandemic. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2022; 42:445-451. [PMID: 35579970 DOI: 10.1080/07315724.2022.2063206] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aimed at assessing the prevalence of eating disorders and symptoms of dieting, food preoccupation, and oral control and internalizing/externalizing problems in a group of adolescents before and during the COVID-19 pandemic. METHODS A sample of N = 813 adolescents (age range = 14-15 years) was recruited in the general population and administered the SCOFF, EAT-26 and YSR questionnaires at two assessment points: before the COVID-19 pandemic outbreak and during it. RESULTS In males and females, the YSR scores at T1 were significantly lower than T2, especially for the subscales of Withdrawn, Somatic complaints, Anxious/depressed, Social problems. As for the EAT-26 scores, adolescents scored significantly lower at T1 for all four subscales of dieting, food preoccupation and oral control. The prevalence of eating disorders among males and females increased respectively from 13.2% to 18.4% and from 17.5 to 25.3 from T1 to T2. CONCLUSION This study confirms previous research showing an increase in eating disorders prevalence and higher psychopathological symptoms both in males and females adolescents during the pandemic.
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Affiliation(s)
- Luca Cerniglia
- Faculty of Psychology, International Telematic University Uninettuno, Rome, Italy
| | - Silvia Cimino
- Department of Dynamic, Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
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12
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Haghshomar M, Shobeiri P, Brand S, Rossell SL, Akhavan Malayeri A, Rezaei N. Changes of symptoms of eating disorders (ED) and their related psychological health issues during the COVID-19 pandemic: a systematic review and meta-analysis. J Eat Disord 2022; 10:51. [PMID: 35418108 PMCID: PMC9006500 DOI: 10.1186/s40337-022-00550-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/02/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic and its related social restrictions have profoundly affected people's mental health. It can be assumed that symptomatic behaviors and mental health of individuals with eating disorders (ED) deteriorated during this time. To get a thorough overview, we conducted a systematic review and meta-analysis with the following aims: First, to provide a comprehensive overview of symptoms of ED during the COVID-19-related confinement; second, to identify psychological mechanisms which impacted the emergence and maintenance of ED symptoms; third, to describe changes of daily routine and changes of access to healthcare in individuals with ED during confinement. METHODS We searched Embase, PubMed, and Scopus databases for observational studies published between January 1st, 2020, to July 1st, 2021, which investigated the symptomatology of ED during the COVID-19 pandemic. RESULTS After the screening, 13 studies with 7848 participants were included in the present systematic review and meta-analysis. The overall pooled prevalence of exacerbation of binge eating, food restriction, purging behaviors, and concerns about food intake in the pooled sample of 7848 was 59.65% (95% CI: 49.30%; 69.60%), and the overall prevalence of improved symptoms of ED in the pooled sample of 741 individuals was 9.37% (95% CI: 3.92%; 16.57%). Furthermore, COVID-19-related social restrictions negatively impacted the psychological health, daily routines, and physical activity of individuals with ED. More specifically, symptoms of anxiety and depression related to ED were increased significantly over time. However, there were also positive aspects to the COVID-19 pandemic. The main positive consequences included more emotional support from the family, less pressure to engage in social activities, and more flexible meal planning. Individuals with ED reported having difficulties getting access to healthcare centers and using telemedicine. They also found a hard time communicating via online sessions. CONCLUSIONS According to our interpretation, based on the data included in the systematic review and meta-analysis, the COVID-19 pandemic and its related social restrictions detrimentally impacted the mental health of majority of individuals with ED. Limited and impaired access to healthcare interventions appeared to have further exacerbated mental health issues of individuals with ED. Given this background, it seems that individuals with ED demand more attention during the COVID-19 crisis, and it is necessary to ensure that their course of treatment remains uninterrupted.
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Affiliation(s)
- Maryam Haghshomar
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Dr. Gharib St, Keshavarz Blvd, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Serge Brand
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, 4002, Basel, Switzerland.,Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, University of Basel, 4052, Basel, Switzerland.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
| | | | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Dr. Gharib St, Keshavarz Blvd, Tehran, Iran. .,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran. .,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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13
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Irigoyen-Otiñano M, González-Pinto A, Llorca-Bofí V, Adrados-Pérez M, Arenas-Pijoan L, Torterolo G, Sánchez-Cazalilla M, Buil E, Nicolau-Subires E, Albert-Porcar C, Ibarra-Pertusa L, Puigdevall-Ruestes M. Increase in urgent care for patients with an eating disorder during the COVID-19 pandemic in a Spanish province. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:142-146. [PMID: 35840281 PMCID: PMC9274210 DOI: 10.1016/j.rpsmen.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has had a great impact on people's mental health. Patients with eating disorders (ED) are also highly sensitive to the pandemic situation due to their physical and mental health. The objective of this study is to evaluate the impact that the COVID-19 pandemic may have had on the reasons for the urgent care of patients with an eating disorder, comparing the reasons for care with those from a previous period. METHOD We compared the visits to the emergency room and their characteristics before and after the pandemic of patients with an eating disorder in the province of Lleida. Information regarding sociodemographic status, reason for consultation, diagnosis, characteristics of suicidal behaviour, and other data were obtained from the electronic medical records. RESULTS Within the total emergency attendances, eating disorders increased from 1.7% in the pre-pandemic period to 3.1% during the pandemic (p=0.030). Regarding the reason for consultation, a change in the pattern is observed, decreasing consultations for anxious decompensation (p<0.001) and increasing suicidal behaviour (p=0.016) and behavioural disorder (p=0.022). CONCLUSIONS In our study we ascertained an increase in urgent care given to patients with an eating disorder during the two states of alarm, while consultations for anxiety symptoms decreased notably. However, care for suicidal behaviour increased, especially in women with comorbidity of personality disorders and who were unemployed.
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Affiliation(s)
- María Irigoyen-Otiñano
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain; Biological Foundations of Mental Disorders Group, IRB Lleida, Lleida, Spain.
| | | | - Vicent Llorca-Bofí
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
| | | | | | - Giovanni Torterolo
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
| | | | - Esther Buil
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
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14
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Irigoyen-Otiñano M, González-Pinto A, Llorca-Bofí V, Adrados-Pérez M, Arenas-Pijoan L, Torterolo G, Sánchez-Cazalilla M, Buil E, Nicolau-Subires E, Albert-Porcar C, Ibarra-Pertusa L, Puigdevall-Ruestes M. Increase in urgent care for patients with an eating disorder during the COVID-19 pandemic in a Spanish province. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:142-146. [PMID: 34868411 PMCID: PMC8628540 DOI: 10.1016/j.rpsm.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction The COVID-19 pandemic has had a great impact on people's mental health. Patients with eating disorders (ED) are also highly sensitive to the pandemic situation due to their physical and mental health. The objective of this study is to evaluate the impact that the COVID-19 pandemic may have had on the reasons for the urgent care of patients with an eating disorder, comparing the reasons for care with those from a previous period. Method We compared the visits to the emergency room and their characteristics before and after the pandemic of patients with an eating disorder in the province of Lleida. Information regarding sociodemographic status, reason for consultation, diagnosis, characteristics of suicidal behaviour, and other data were obtained from the electronic medical records. Results Within the total emergency attendances, eating disorders increased from 1.7% in the pre-pandemic period to 3.1% during the pandemic (p = 0.030). Regarding the reason for consultation, a change in the pattern is observed, decreasing consultations for anxious decompensation (p < 0.001) and increasing suicidal behaviour (p = 0.016) and behavioural disorder (p = 0.022). Conclusions In our study we ascertained an increase in urgent care given to patients with an eating disorder during the two states of alarm, while consultations for anxiety symptoms decreased notably. However, care for suicidal behaviour increased, especially in women with comorbidity of personality disorders and who were unemployed.
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Affiliation(s)
- María Irigoyen-Otiñano
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
- Biological Foundations of Mental Disorders Group, IRB Lleida, Lleida, Spain
| | | | - Vicent Llorca-Bofí
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
| | | | | | - Giovanni Torterolo
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
| | | | - Esther Buil
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
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15
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Gao Y, Bagheri N, Furuya-Kanamori L. Has the COVID-19 pandemic lockdown worsened eating disorders symptoms among patients with eating disorders? A systematic review. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 30:2743-2752. [PMID: 35369670 PMCID: PMC8961480 DOI: 10.1007/s10389-022-01704-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/06/2022] [Indexed: 01/05/2023]
Abstract
Objective During the coronavirus pandemic lockdowns, general medical complications have received the most attention, and few studies have examined the association between the COVID-19 lockdown and eating disorders (ED). This study aimed to investigate the impact of the coronavirus lockdowns on ED symptoms severity and summarize factors associated with lockdowns that led to changes in eating disorders. Method PubMed, Scopus, and Cochrane Library databases were searched for studies measuring the impact of coronavirus lockdowns on ED symptoms. Results A total of 132 studies were retrieved, after abstract screening and removal of duplicates, 21 papers were full-text screened, and 11 eligible papers were identified. Factors associated with symptomatic deterioration in ED patients during COVID-19 lockdowns included disruption of lifestyle routine, social isolation, reduced access to usual support networks, limited or no access to healthcare and mental care services, and social anxiety. Discussion Overall, the pandemic lockdowns were associated with worsening of eating disorders. This triggering environment can lead to increased anxiety and depression symptoms, change in dietary habits, and eventually result in worsening eating disorder symptoms.
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Affiliation(s)
- Yunqi Gao
- Centre for Research on Ageing, Health & Wellbeing, Australian National University, Acton, ACT 2601 Australia
| | - Nasser Bagheri
- Centre for Mental Health Research, Australian National University, Acton, ACT 2601 Australia.,The Visual and Decision Analytics (VIDEA) Lab, Health Research Institute, The University of Canberra, Bruce, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD 4029 Australia
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16
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McDonnell T, Conlon C, McNicholas F, Barrett E, Barrett M, Cummins F, Hensey C, McAuliffe E, Nicholson E. Paediatric hospital admissions for psychiatric and psychosocial reasons during the first year of the COVID-19 pandemic. Int Rev Psychiatry 2022; 34:128-139. [PMID: 35699100 DOI: 10.1080/09540261.2022.2061840] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Increases in youth psychiatric presentations to out-patient and emergency department settings during COVID-19 have been reported. This study, using data from five hospitals in Ireland, examines changes in the number and type of paediatric admissions during COVID-19 (March 2020 - February 2021) compared to the previous two years. ICD-10 classification was used to establish admissions with mental, behavioural, neuro-developmental disorders and psychosocial reasons (MBN-PS). Overall hospital admissions fell by 25.3%, while MBN-PS fell by only 2.6%, mostly during an initial lockdown. Admissions for MBN-PS increased in July-August (9.2%), increased further in September-December (28.3%), returning to pre-COVID-19 levels in January-February 2021. Significant increases were observed among youths with anorexia nervosa (47.8%), other eating disorders (42.9%), and admissions for anxiety (29.6%), with these effects relating to females only. Although admissions for self-harm increased (3%) and rates of ASD admissions reduced (17%), these were not statistically significant. The disproportionate increase in admissions for MBN-PS compared to medical admissions suggests an adverse effect of COVID-19 on youth mental health, for females in particular, and supports previous reports of a pandemic specific increase in eating psychopathology. Combined community and acute service delivery and capacity planning are urgently needed given the prior underfunding of services pre-pandemic.
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Affiliation(s)
- T McDonnell
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - C Conlon
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - F McNicholas
- Children's Health Ireland at Crumlin, Dublin, Ireland.,UCD Child and Adolescent Psychiatry, University College Dublin, Belfield, Ireland.,Lucena Clinic, Rathgar, Ireland
| | - E Barrett
- UCD Child and Adolescent Psychiatry, University College Dublin, Belfield, Ireland.,Children's Health Ireland at Temple Street, Dublin, Ireland
| | - M Barrett
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - F Cummins
- ALERT, REDSPOT, Emergency Department, Limerick University Hospital, Limerick, Ireland
| | - C Hensey
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - E McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - E Nicholson
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.,School of Psychology, Dublin City University, Dublin, Ireland
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17
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[Anorexia nervosa: does the incidence increase during the coronavirus pandemic?]. PADIATRIE UND PADOLOGIE 2022; 57:247-253. [PMID: 36320420 PMCID: PMC9614737 DOI: 10.1007/s00608-022-01022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Seit Beginn der Coronapandemie und den damit einhergehenden Lockdownmaßnahmen steigen die Behandlungszahlen für Kinder und Jugendliche mit Essstörungen und insbesondere mit Anorexia nervosa in der Klinik für Kinder und Jugendliche, KJF Klinik St. Elisabeth in Neuburg/Donau deutlich. Eine verstärkte Fokussierung auf die Kontrolle des Körpergewichts durch restriktives Essverhalten oder anderweitig herbeigeführte Gewichtsabnahme (Sport) kann Ängste vor Kontrollverlust kompensieren. Anorexietypische Denk- und Verhaltensmuster können als dysfunktionale Bewältigungsstrategien (Coping-Strategien), ausgelöst durch Lockdownmaßnahmen im Rahmen der Coronapandemie, gewertet werden, um Kontrollerleben (im Sinne einer Ersatzstruktur) wiederzuerlangen, aber auch um Depressions- und Angstgefühle besser bewältigen zu können.
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18
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[Anorexia nervosa: does the incidence increase during the coronavirus pandemic?]. Monatsschr Kinderheilkd 2021; 170:430-434. [PMID: 34961799 PMCID: PMC8696971 DOI: 10.1007/s00112-021-01385-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 10/26/2022]
Abstract
Since the beginning of the coronavirus pandemic and the associated lockdown measures, the number of children treated in this children's hospital for eating disorders and in particular anorexia nervosa has significantly increased.An increased focus on the control of body weight with restrictive eating habits or otherwise induced weight loss (sport) can compensate for fears of loss of control. Thinking and behavioral patterns which are typical for anorexia can be assessed as dysfunctional coping strategies of the corona pandemic in order to regain control (in the sense of a substitute structure) but also as a means of coping better with feelings of depression and anxiety.
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19
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Maunder K, McNicholas F. Exploring carer burden amongst those caring for a child or adolescent with an eating disorder during COVID-19. J Eat Disord 2021; 9:124. [PMID: 34602093 PMCID: PMC8487672 DOI: 10.1186/s40337-021-00485-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 09/24/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Carer burden amongst carers of youth with an eating disorder is substantial and if not addressed can lead to negative outcomes for the patient, carer and family. The Coronavirus Disease 2019 (COVID-19) pandemic has made caring for youth with an ED even more onerous and preliminary research is beginning to emerge demonstrating the profound negative impact the pandemic is having upon individuals with EDs and their carers. MAIN: In this review, we briefly summarize what is known about carer burden in families where a young person has an ED, consider the additional impact consequent to COVID-19 and highlight the need for interventions aimed at alleviating this. Pre-COVID-19 research identifies high levels of psychological and physical strain amongst those caring for a child with an ED. Themes are beginning to emerge as to why COVID-19 may further exacerbate carer burden: (1) reduced access to ED services; (2) increased physical vulnerability and exacerbation of psychiatric co-morbidity amongst youth with EDs; (3) increased practical demands placed on carers; and (4) social isolation and decreased social support. CONCLUSION The COVID-19 pandemic poses a specific threat to the mental health of youth with EDs and their carers. Given the salient role families play in caring for youth with an ED, attending to carer burden is imperative. Supporting carers through all phases of their child's ED journey by offering adaptive and flexible supportive services which accommodate time constraints, geographic barriers and possible COVID-19 spread is essential.
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Affiliation(s)
- Kristen Maunder
- School of Medicine and Medical Science, University College Dublin, Dublin 4, Belfield, Republic of Ireland. .,Department of Child and Adolescent Psychiatry, Our Lady's Children's Hospital Crumlin, Dublin 12, Crumlin, Republic of Ireland.
| | - Fiona McNicholas
- School of Medicine and Medical Science, University College Dublin, Dublin 4, Belfield, Republic of Ireland.,Department of Child and Adolescent Psychiatry, Our Lady's Children's Hospital Crumlin, Dublin 12, Crumlin, Republic of Ireland.,Lucena Clinic Services, Rathgar, Rathfarnham, Dublin 6, Republic of Ireland
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20
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McNicholas F. Childhood onset exercise addiction or atypical anorexia nervosa during Covid-19: case report. J Eat Disord 2021; 9:96. [PMID: 34372925 PMCID: PMC8351770 DOI: 10.1186/s40337-021-00450-4] [Citation(s) in RCA: 6] [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: 05/21/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood-onset Anorexia Nervosa (AN) is recognised to be atypical in presentation, both in terms of extent and nature of eating pathology, exercise and compensatory behaviours with many falling short of full diagnostic criteria. Failure to consider an eating disorder diagnosis in youth who present with extreme weight loss may have serious immediate and long term implications. However, failure to consider other non-organic causes of weight loss may be equally detrimental to the child's health. CASE PRESENTATION This case reports on the acute presentation of a 12-year old boy, who presented to hospital in a severely malnourished state eight weeks into lockdown. To compensate for Covid-19 induced restrictions on sporting activity, this boy had followed a self-imposed daily schedule of arduous exercise, without increasing his nutritional intake. This report examines the clinical features suggestive of AN and other differential diagnosis. A discussion on the specific diagnostic differential of exercise addiction and challenges faced by youth during Covid-19 restrictions are presented. CONCLUSION Accepting that AN may present atypically in pre-pubertal youth, it is important that clinicians maintain an open mind in youth presenting without goal directed weight loss. Although weight loss was significant in this case, it was due to an excessive exercise regime. This may have commenced as a coping strategy in response to Covid-19 restrictions but subsequently became excessive and impairing in nature. The collateral damage of Covid-19 mandated restrictions, aimed at containing the spread of the virus, are evident in this case. Clinicians need to be alert to potentially maladaptive coping strategies and unusual or altered pathways of presentation, especially in younger children during these challenging times.
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Affiliation(s)
- F McNicholas
- Department of child & adolescent psychiatry, School of Medicine and Medical Sciences, Belfield, UCD, Dublin 4, Ireland. .,Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland. .,Lucena Clinic Rathgar, Dublin 6, Ireland.
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21
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Hunter R, Gibson C. Narratives from within 'lockdown': A qualitative exploration of the impact of COVID-19 confinement on individuals with anorexia nervosa. Appetite 2021; 166:105451. [PMID: 34171411 DOI: 10.1016/j.appet.2021.105451] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 06/05/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The COVID-19 pandemic and associated 'lockdown' confinement restrictions have resulted in multiple challenges for those living with eating disorders. This qualitative study aimed to examine the lived, psychosocial experiences of individuals with anorexia nervosa from within COVID-19 'lockdown' confinement. METHODS Audio-recorded semi -structured interviews were conducted online during the first wave of the COVID-19 pandemic during confinement with a purposive sample of 12 participants who identified as having Anorexia Nervosa. Interviews were transcribed and anonymous data analysed using Thematic Analysis (Braun & Clarke, 2006). RESULTS Three key themes with six contributory subthemes were identified. Key themes were: loss of control,supportduring confinement, and time of reflection on recovery. Theme content varied according to stage of recovery and current clinical management. Availability of 'safe' foods, increases in compensatory exercise and symptomology, and enhanced opportunities for "secrecy" were described. CONCLUSIONS These findings provide a unique insight for a vulnerable group from within COVID-19 confinement. The data demonstrated that the impact for individuals with anorexia nervosa has been broadly negative, and participants voiced concerns over the long-term effects of the pandemic on their recovery. The findings highlight the risks of tele-health support and an important role for health professionals in enhancing targeted support during, and after confinement.
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Affiliation(s)
| | - Chloe Gibson
- Psychology Department, Swansea University, Wales, UK
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22
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Dumitrașcu MC, Șandru F, Carsote M, Petca RC, Gheorghisan-Galateanu AA, Petca A, Valea A. Anorexia nervosa: COVID-19 pandemic period (Review). Exp Ther Med 2021; 22:804. [PMID: 34093760 DOI: 10.3892/etm.2021.10236] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/16/2021] [Indexed: 12/14/2022] Open
Abstract
Anorexia nervosa is an eating disorder characterized by restrictive eating and an intense fear of gaining weight. It is a disease with an increasing incidence during the last few decades, and represents a complex psychiatric condition which includes secondary amenorrhea, nutritional and metabolic damage, and impaired endocrine panel up to bone loss as well as cardiac, gastrointestinal and hematological complications. This is a narrative review which includes an update on this eating disorder from the perspective of an endocrine panel of anomalies, especially of the skeleton, considering the pressure of the recent global COVID-19 pandemic changes. Practically affecting every organ, anorexia nervosa needs to be taken into consideration during the pandemic period because of the higher risk of relapse due to new living conditions, social distancing, self-isolation, changes in food access, more intense use of social media platforms, disruption of daily habits, and more difficult access to healthcare practitioners. The lack of physical activity in addition to vitamin D deficiency related to low sun exposure or to the use of facial masks may also be connected to further bone damage related to this disease.
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Affiliation(s)
- Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Florica Șandru
- Department of Dermatology, 'Elias' Emergency University Hospital, 011461 Bucharest, Romania.,Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 011863 Bucharest, Romania.,Department of Endocrinology 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Razvan Cosmin Petca
- Department of Urology, 'Prof. Dr. Th. Burghele' Clinical Hospital, 050659 Bucharest, Romania.,Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ancuta Augustina Gheorghisan-Galateanu
- Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 011863 Bucharest, Romania.,Department of Molecular and Cellular Biology, and Histology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Elias' Emergency University Hospital, 011461 Bucharest, Romania
| | - Ana Valea
- Department of Endocrinology, Clinical County Hospital, 400000 Cluj-Napoca, Romania.,Department of Endocrinology, 'I. Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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23
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McNicholas F, Kelleher I, Hedderman E, Lynch F, Healy E, Thornton T, Barry E, Kelly L, McDonald J, Holmes K, Kavanagh G, Migone M. Referral patterns for specialist child and adolescent mental health services in the Republic of Ireland during the COVID-19 pandemic compared with 2019 and 2018. BJPsych Open 2021; 7:e91. [PMID: 33938419 PMCID: PMC8111180 DOI: 10.1192/bjo.2021.48] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/26/2021] [Accepted: 04/03/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Countries worldwide are experiencing a third wave of the coronavirus disease 2019 (COVID-19) pandemic. Government-imposed restrictive measures continue with undetermined effects on physical and mental health. AIMS To compare child and adolescent mental health services (CAMHS) referrals over 11 months (January-November) in 2020, 2019 and 2018 and examine any impact the different phases of the COVID-19 restrictions might have on referral rates. METHOD Monthly CAMHS Health Service Executive data were examined, covering a catchment population of 260 560 or 12.7% of all youth (age group 0-18 years) in Ireland. The total number of urgent and routine referrals, appointments offered, rates of non-attendances and discharge outcome are presented. RESULTS There was a significant drop in referrals in 2020, compared with prior years (χ2 = 10.3, d.f. = 2, P = 0.006). Referrals in 2020 dropped from March to May by 11% and from June to August by 10.3%. From September, both routine and urgent referrals increased by 50% compared with previous years (2018/2019), with the highest increase in November 2020 (180%). Clinic activity also increased from September, with double the number of out-patient appointments offered, compared with previous years (χ2 = 5171.72, d.f. = 3, P < 0.001) and lower (6.6%) rates of non-attendance (χ2 = 868.35, d.f. = 3, P < 0.001). CONCLUSIONS In 2020, following an initial decline, referrals to CAMHS increased consistently from September. Such unprecedented increase in referrals places further strain on services that are already underresourced and underfunded, with the likelihood of increased waiting lists post COVID-19. It is envisaged that once the pandemic is over, resources will be even more constrained, and CAMHS will be urgently in need of additional ring-fenced funding.
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Affiliation(s)
- Fiona McNicholas
- Department of Child & Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Ireland; Children Health Ireland, Dublin, Ireland; and Lucena Clinics, St. John of God Community Services, Ireland
| | - Ian Kelleher
- Lucena Clinics, St. John of God Community Services, Ireland
| | - Elma Hedderman
- Lucena Clinics, St. John of God Community Services, Ireland
| | | | - Elaine Healy
- Lucena Clinics, St. John of God Community Services, Ireland
| | | | - Edwina Barry
- Lucena Clinics, St. John of God Community Services, Ireland
| | - Lisa Kelly
- Lucena Clinics, St. John of God Community Services, Ireland
| | - James McDonald
- Lucena Clinics, St. John of God Community Services, Ireland
| | - Keith Holmes
- Lucena Clinics, St. John of God Community Services, Ireland
| | | | - Maria Migone
- Lucena Clinics, St. John of God Community Services, Ireland; Department Academic Child & Adolescent Psychiatry UCD, Dublin
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24
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Couturier J, Pellegrini D, Miller C, Bhatnagar N, Boachie A, Bourret K, Brouwers M, Coelho JS, Dimitropoulos G, Findlay S, Ford C, Geller J, Grewal S, Gusella J, Isserlin L, Jericho M, Johnson N, Katzman DK, Kimber M, Lafrance A, Leclerc A, Loewen R, Loewen T, McVey G, Norris M, Pilon D, Preskow W, Spettigue W, Steinegger C, Waite E, Webb C. The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond. J Eat Disord 2021; 9:46. [PMID: 33863388 PMCID: PMC8050997 DOI: 10.1186/s40337-021-00394-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/11/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond. METHODS Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers. RESULTS Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended. CONCLUSIONS Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.
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Affiliation(s)
- Jennifer Couturier
- McMaster University, Hamilton, ON, Canada.
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.
| | | | - Catherine Miller
- Canadian Mental Health Association - Waterloo Wellington, Waterloo, ON, Canada
| | | | | | - Kerry Bourret
- St. Joseph's Care Group - Thunder Bay, Thunder Bay, ON, Canada
| | | | | | | | - Sheri Findlay
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Catherine Ford
- Ontario Ministry of Health and Long-Term Care, Toronto, ON, Canada
| | - Josie Geller
- The University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Natasha Johnson
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | | | | | | | - Anick Leclerc
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | | | | | - Gail McVey
- University of Toronto, Toronto, ON, Canada
| | | | | | - Wendy Preskow
- National Initiative for Eating Disorders, Toronto, ON, Canada
| | | | | | | | - Cheryl Webb
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
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25
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Trianti SM, Soßalla L, Schmitzer I. Anxiety Due to COVID-19 in Different Palliative Care Settings in Germany. J Hosp Palliat Nurs 2021; 23:135-139. [PMID: 33633093 DOI: 10.1097/njh.0000000000000719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Epidemics exert significant psychological impact. We conducted a survey in different palliative care settings focusing on anxiety caused by coronavirus disease 2019 (COVID-19). A questionnaire was given from April 1 through May 8, 2020, to 154 patients in 3 distinct populations: (1) hospice patients, (2) patients under ambulatory palliative care, (3) as controls, patients visiting a general practitioner (GP) practice. Items captured were age, anxiety caused by COVID-19 on a visual analog scale from 0 to 10, influence on everyday life, insomnia, and appetite loss. Palliative care patients were older than GP visitors (median [interquartile range], 72 [61-78] years in the hospice, 76 [67-83] years in ambulatory palliative care, and 62 [56-74] years in GP practice, P < .001). Anxiety scores were 0 (0-2) in the hospice, 3 (0-6) in ambulatory palliative care and 4.5 (2-6) in the GP practice (P = .004 for hospice vs GP practice, P = .177 for ambulatory palliative care vs GP practice). Age did not correlate with anxiety (P = .063). Anxiety-caused insomnia ranged from 0% to 12%. Patients' everyday life was influenced in 15% to 31% in the 3 groups (P = .480). Patients in ambulatory palliative care experienced comparable anxiety caused by COVID-19 with other patients, whereas anxiety was negligible in hospice patients. Addressing the psychological impact of the pandemic should be considered in management of palliative patients.
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26
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Yaffa S, Adi EL, Itai P, Marit JM, Doron G, Daniel S. Treatment of eating disorders in adolescents during the COVID-19 pandemic: a case series. J Eat Disord 2021; 9:17. [PMID: 33568207 PMCID: PMC7874990 DOI: 10.1186/s40337-021-00374-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/29/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are among the most difficult psychiatric disorders to treat in normal conditions. They are likely even more difficult to manage in at-risk conditions such as the COVID-19 pandemic. Currently there is limited evidence about the particular needs and recommended treatment of adolescents with EDs during the COVID-19 outbreak, in particular regarding the use of telemedicine and the involvement of the family in long distance-treatment. AIMS We sought to discuss the advantages and problems associated with the use of multi-professional long-distance telemedicine treatment in the management of adolescents with EDs and their families during the COVID-19 outbreak. METHODS We gathered data about the treatment of adolescents with EDs in our pediatric ED-treatment center in Israel during the COVID-19 outbreak in the first 10 months of 2020, and compared it to the respective period in the past five years (2015-2019). Second, we described the management of four young females with anorexia nervosa (AN), treated in the ambulatory, daycare and inpatient facilities of our center during the COVID-19 pandemic. FINDINGS Slightly less patients were treated in our center during the COVID-19 pandemic than in the respective period in the past five years. These patients received at that time considerably more treatment sessions from all treatment providers (psychiatrists, clinical nutritionists and psychotherapists). This was related, in part, to the extensive use of telemedicine during that period (more than as third of all sessions were carried out with telemedicine in comparison to no use of long-distance treatment in the previous years). The condition of the four adolescents with AN was compromised at the start of the COVID-19 quarantine. The use of multi-disciplinary long-distance telemedicine treatment resulted in an improvement in the condition in three of the four adolescents, living in well-organized families, with the motivation and ability to adjust to the new conditions, but not in one adolescent whose family experienced more problems. These families might require the use of face-to-face interventions even during pandemic conditions. CONCLUSION The choice of the mode of treatment for adolescents with EDs during pandemic times (telemedicine vs. face-to-face) should consider the functioning of the family.
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Affiliation(s)
- Serur Yaffa
- Pediatric Psychosomatic Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Child and Adolescent Psychiatric Division, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel
| | - Enoch-Levy Adi
- Pediatric Psychosomatic Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Child and Adolescent Psychiatric Division, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel
| | - Pessach Itai
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Joffe-Milstein Marit
- Pediatric Psychosomatic Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Child and Adolescent Psychiatric Division, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel
| | - Gothelf Doron
- Child and Adolescent Psychiatric Division, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Stein Daniel
- Pediatric Psychosomatic Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel. .,Child and Adolescent Psychiatric Division, Sheba Medical Center, 5265601, Tel Hashomer, Israel. .,Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel.
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27
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Graell M, Morón-Nozaleda MG, Camarneiro R, Villaseñor Á, Yáñez S, Muñoz R, Martínez-Núñez B, Miguélez-Fernández C, Muñoz M, Faya M. Children and adolescents with eating disorders during COVID-19 confinement: Difficulties and future challenges. EUROPEAN EATING DISORDERS REVIEW 2020; 28:864-870. [PMID: 32729139 DOI: 10.1002/erv.2763] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To present the adaptations to treatment protocols made in a child and adolescent eating disorders (ED) unit during the eight-week confinement period mandated in response to the COVID-19 pandemic and examine clinical and treatment variables in the outpatient, day hospital, and inpatient care programs. METHOD Description of the implementation of a combined teletherapy program for outpatient and day-hospital patients and the adaptations made to the inpatient protocol. Retrospective review of medical records and analysis of general and specific variables related to the pandemic and confinement. RESULTS We held 1,329 (73.10%) telehealth consultations and 489 (26.9%) face-to-face outpatient visits with 365 patients undergoing treatment in the outpatient clinic or day hospital. Twenty-eight (7.67%) were initial evaluations. Twenty-two patients were newly admitted and 68 ED-related emergencies were attended. Almost half of the children and adolescents studied experienced reactivation of ED symptoms despite treatment, and severe patients (25%) presented self-harm and suicide risk. CONCLUSIONS The implementation of a combined teletherapy program has enabled continuity of care during confinement for children and adolescents with ED. Delivery of treatment to adolescents in the day hospital program posed the biggest challenge due to their greater degrees of severity and higher hospitalization rates. An adapted inpatient program should be maintained throughout confinement, as the need for hospitalization of children and adolescents with ED does not decrease with lockdown.
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Affiliation(s)
- Montserrat Graell
- Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - M Goretti Morón-Nozaleda
- Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ricardo Camarneiro
- Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ángel Villaseñor
- Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Silvia Yáñez
- Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Rudiger Muñoz
- Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Beatriz Martínez-Núñez
- Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - María Muñoz
- Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Mar Faya
- Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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28
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McCombie C, Austin A, Dalton B, Lawrence V, Schmidt U. "Now It's Just Old Habits and Misery"-Understanding the Impact of the Covid-19 Pandemic on People With Current or Life-Time Eating Disorders: A Qualitative Study. Front Psychiatry 2020; 11:589225. [PMID: 33192736 PMCID: PMC7653176 DOI: 10.3389/fpsyt.2020.589225] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Many aspects of the Covid-19 pandemic may make living with or recovery from an eating disorder (ED) particularly challenging. Understanding the processes which underlie the psychological and behavioral responses of people with EDs during this time are key to ensure tailored support in these unprecedented circumstances. Methods: People with lifetime EDs (n = 32) were recruited through social media from May to June 2020 during a period of strict infection control measures in the United Kingdom (i.e., "lockdown," "social distancing"). They completed open-ended questions in an online anonymous questionnaire that invited them to reflect on how various aspects of their lives have been affected by the Covid-19 pandemic, including ED symptoms and coping strategies. Responses were analyzed using thematic analysis. Results: Most respondents reported that their ED worsened or resurfaced. Isolation, low mood, anxiety, lack of structure, disruption to routines, and media/social media messages around weight and exercise seemed to contribute to this. There was a clear sense that individuals struggled with which aspects of psychological distress to prioritize, i.e., mood vs. ED cognitions and behaviors, particularly as attempts to cope with one often exacerbated the other. Nonetheless, some participants reported "silver linings" of the pandemic. Conclusions: In this self-selected sample, deterioration or recurrence of ED symptoms were the norm. This has implications for the provision of treatment and care for people with EDs both in the immediate short-term and in potential future waves of the pandemic, with a significant surge of new and re-referrals expected.
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Affiliation(s)
- Catherine McCombie
- Department of Health Services and Population Research, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Amelia Austin
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Vanessa Lawrence
- Department of Health Services and Population Research, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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