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Szupiany-Janeczek T, Rutkowski K, Pytko-Polończyk J. Oral Cavity Clinical Evaluation in Psychiatric Patients with Eating Disorders: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4792. [PMID: 36981701 PMCID: PMC10049687 DOI: 10.3390/ijerph20064792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Bulimia nervosa and anorexia nervosa are not the only disorders the symptoms of which may be present in the oral cavity. The assessment of the clinical condition of patients with eating disorder symptoms was aimed at in this study. The study group consisted of 60 patients with diagnoses from categories F4.xx, F5x.x, and F6x.x ICD-10 (International Classification of Diseases, Tenth Revision). Patients were qualified for the study based on the answers provided in the symptom checklists "O". An adequate control group was selected. All patients underwent a dental examination, including the assessment of API (aproximal plaque index) and DMF (decayed missing filled index). Studies have shown that patients with eating disorder symptoms were more likely to have dental erosions (in total, 28.81% of cases). The correlation of erosion with the symptoms of eating disorders was demonstrated for several assessed symptoms present in the symptom checklists "O". Such correlations have not been demonstrated in terms of gingival recession presence. The level of oral hygiene in patients with eating disorders was assessed as sufficient or bad and indicates the need to initiate dental treatment in this group. It is important to correlate the treatment of the underlying mental disease with dental treatment and regular dental checkups.
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Affiliation(s)
- Teresa Szupiany-Janeczek
- Department of Integrated Dentistry, Jagiellonian University Medical College, 31-155 Kraków, Poland
| | - Krzysztof Rutkowski
- Psychotherapy Department, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Jolanta Pytko-Polończyk
- Department of Integrated Dentistry, Jagiellonian University Medical College, 31-155 Kraków, Poland
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2
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Goel NJ, Thomas B, Boutté RL, Kaur B, Mazzeo SE. "What will people say?": Mental Health Stigmatization as a Barrier to Eating Disorder Treatment-Seeking for South Asian American Women. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2023; 14:96-113. [PMID: 37283957 PMCID: PMC10241369 DOI: 10.1037/aap0000271] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study used focus group methodology to identify culturally-specific barriers to, and facilitators of, eating disorder (ED) treatment-seeking for South Asian (SA) American women. Seven focus groups were conducted with 54 participants (Mage=20.11 years, SD=2.52), all of whom had lived in the United States (US) for at least three years (63.0% of the sample was born in the US). Transcripts were independently coded by a team of researchers (n=4) and the final codebook included codes present in at least half of the transcripts. Thematic analysis identified salient themes (barriers, n=6; facilitators, n=3) for SA American women. Barriers to ED-treatment seeking were inextricable from barriers to mental health treatment, more broadly. In addition to generalized mental health stigma, participants cited social stigma (i.e., a pervasive fear of social ostracization), as a significant treatment-seeking barrier. Additional barriers were: cultural influences on the etiology and treatment of mental illness, parents' unresolved mental health concerns (usually tied to immigration), healthcare providers' biases, general lack of knowledge about EDs, and minimal SA representation within ED research/clinical care. To address these obstacles, participants recommended that clinicians facilitate intergenerational conversations about mental health and EDs, partner with SA communities to create targeted ED psychoeducational health campaigns, and train providers in culturally-sensitive practices for detecting and treating EDs. SA American women face multiple family, community, and institutional barriers to accessing mental health treatment generally, which limits their ability to access ED-specific care. Recommendations to improve ED treatment access include: (a) campaigns to destigmatize mental health more systematically, (b) collaboration with SA communities and, (c) and training providers in culturally-sensitive care.
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Affiliation(s)
- Neha J. Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Institute for Inclusion, Inquiry and Innovation (iCubed), Office of Institutional Equity, Effectiveness and Success, Virginia Commonwealth University, Richmond, VA, USA
| | - Brogan Thomas
- Department of Rehabilitation and Mental Health Counseling, Virginia Commonwealth University, Richmond, VA, USA
| | - Rachel L. Boutté
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Brahmpreet Kaur
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Biology, Virginia Commonwealth University, Richmond, VA, USA
| | - Suzanne E. Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Institute for Inclusion, Inquiry and Innovation (iCubed), Office of Institutional Equity, Effectiveness and Success, Virginia Commonwealth University, Richmond, VA, USA
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Nagy H, Paul T, Jain E, Loh H, Kazmi SH, Dua R, Rodriguez R, Naqvi SAA, U. MC, Bidika E. A Clinical Overview of Anorexia Nervosa and Overcoming Treatment Resistance. Avicenna J Med 2022; 13:3-14. [PMID: 36969350 PMCID: PMC10038755 DOI: 10.1055/s-0042-1758859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractAnorexia nervosa (AN) is a type of eating disorder that has been increasing in incidence and has been encountered more commonly by physicians in their daily practice. Both environmental and genetic risk factors paired along with a more susceptible neurobiology are at play in the emerging resistance to treatment in AN. Preoccupations with intense fear of weight gain, dietary restrictions, excessive exercise, and how the individual is perceived by society mixed with underlying psychopathology all further add to the issue. Many patients who fall into this cycle of obsessive and restrictive patterns refuse to get treatment. As clinicians, it is essential we recognize the early signs of both eating disorders during the initial primary care appointments.To review the literature on the etiology of AN, possible misdiagnosis leading to inappropriate management of this condition, and understand the treatment-resistant AN and its management. Additionally, it will explore possible reasons that contribute to the resistance to treatment, the underlying psychopathology of anorexics, its genetic predisposition, psychiatric comorbidities, identification of the early signs and symptoms, and timely prevention.Early recognition by a physician includes a thorough history and physical examination, pertinent laboratory, and electrolyte studies, and identifying comorbid psychiatric conditions. The treatment of AN is intricate and requires a holistic approach. Treatment includes multiple modalities such as nutritional rehabilitation and psychosocial and pharmacological therapies. An interdisciplinary team of medical professionals for managing chronic AN is recommended.
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Affiliation(s)
- Hassan Nagy
- Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
| | - Tanya Paul
- Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
| | - Esha Jain
- Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
| | - Hanyou Loh
- Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
| | - Syeda Hafsa Kazmi
- Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
| | - Rishbha Dua
- Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
| | - Ricardo Rodriguez
- Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
| | - Syed Ali Abbas Naqvi
- Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
| | - Metu Chiamaka U.
- Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
| | - Erjola Bidika
- Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
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Papacharalampous KE, Dallas C, Dallas G. DETECTION OF EATING DISORDERS IN MALE AND FEMALE ARTISTIC GYMNASTS. SCIENCE OF GYMNASTICS JOURNAL 2022. [DOI: 10.52165/sgj.14.3.421-433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to investigate the trend of eating disorders in competitive male and female artistic gymnasts. The study involved 23 male and 42 female gymnasts, aged 7-27, from sports clubs throughout Greece. The EAT-26 Diet Attitudes scale was used to investigate participants' eating habits. The data collection process included communication with sports organizations throughout Greece on the content and purpose of the research. After consultation, the questionnaire was due to the COVID-19 pandemic provided in an electronic form and also included the consent form for participation in the research. The results of the study indicated that eleven of the sixty-five gymnasts had a total score of >20 on the EAT-26, a rate higher among female gymnasts (~ 24%) compared to male gymnasts (~ 4.4%) (p <.05). Although female gymnasts develop more eating disorders and bulimia than male gymnasts, no significant differences were found in the subscales of the questionnaire (p > .05). Therefore, this finding in combination with the fact that most of the gymnasts were teenagers (15.23 ± 6.35 years old) requires particular importance and attention from coaches and the family environment.
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Challenges in eating disorder diagnosis and management among family physicians and trainees: a qualitative study. J Eat Disord 2022; 10:45. [PMID: 35361258 PMCID: PMC8968091 DOI: 10.1186/s40337-022-00570-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family physicians are one of the first points of contact for individuals with eating disorders (EDs) seeking care and treatment, but training in this area is suboptimal and insufficient. Specialized ED treatment programs often have long wait lists, and family physicians are responsible for patients care in the interim. The aim of this study was to identify the learning needs and challenges faced by Canadian family physicians and trainees when caring for patients with EDs. METHODS We recruited six family medicine residents and five family physicians practicing in an academic unit in the Department of Family Medicine of a medical school in urban southwestern Ontario, Canada. We used purposive sampling, focusing on residents and faculty physicians from the department and conducted one focus group for the residents and another for the faculty physicians, exploring their clinical knowledge and challenges when managing ED patients. The focus groups were audio-recorded and transcribed verbatim prior to thematic coding. RESULTS Physicians and residents faced challenges in discussing, screening, and managing patients with EDs. Three themes that emerged from the qualitative data highlighted training needs related to: (a) improving communication skills when treating a patient with an ED, (b) more effective screening and diagnosis in primary care practice, and (c) optimizing management strategies for patients with an ED, especially patients who are waiting for more intensive treatment. A fourth theme that emerged was the distress experienced by family physicians as they try best to manage and access care for their patients with EDs. CONCLUSION Addressing the learning needs identified in this study through continuing education offerings could aid family physicians in confidently providing effective, evidence-based care to patients with EDs. Improvement in training and education could also alleviate some of the distress faced by family physicians in managing patients with EDs. Ultimately, system changes to allow more efficient and appropriate levels of care for patients with EDs, removing the burden from family medicine, are critical as EDs are on the rise. A person with an eating disorder will normally seek care from their family physician first. These conditions can dramatically reduce the quality of a person's life and health. Family physicians therefore need to know how best to help these patients or refer them to a more intensive level of care, which often has long wait lists. We asked a group of family physicians and a group of family medicine trainees about their experiences with patients with eating disorders and about the information they wished they had to help these patients. The results show that they need more information on how to talk to a patient about eating disorders without judgement, how to diagnose a patient with an eating disorder, and then what treatment and management is needed while they wait for more intensive treatment for sicker patients. The physicians and trainees both talked about the stress and worry that they faced when treating patients with eating disorders. Besides their lack of training about these conditions, family physicians also described difficulties when trying to access timely specialized services for their patients. Physicians can experience moral distress when they know that their patients need higher level care, but there are systemic barriers to specialized programs that block their patients from getting the care they need when they need it.
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Marí-Sanchis A, Burgos-Balmaseda J, Hidalgo-Borrajo R. Eating disorders in sport. Update and proposal for an integrated approach. ENDOCRINOL DIAB NUTR 2022; 69:131-143. [PMID: 35256056 DOI: 10.1016/j.endien.2022.02.016] [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: 12/28/2020] [Accepted: 04/24/2021] [Indexed: 06/14/2023]
Abstract
Eating disorders are a group of conditions which have a huge impact on the health and performance of athletes. The aetiology of eating disorders is multifactorial, being influenced by genetic and environmental factors, but also involving psychological factors and factors specific to the practising of sport. Eating disorders are highly prevalent in sport, particularly in disciplines involving endurance, those that have weight-categories or those where low weight is a competitive advantage and aesthetics are important. Athletes with eating disorders need to be assessed and receive early, comprehensive treatment. Close monitoring of nutritional status is vital, especially with female athletes. Prevention is crucial and plays an invaluable role in this type of disorder, but represents a significant challenge for all professionals who look after athletes. Priority needs to be given to implementing structured nutrition training programmes for the athlete and their entourage to help prevent eating disorders.
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Affiliation(s)
- Amelia Marí-Sanchis
- Servicio de Endocrinología y Nutrición, Unidad de Nutrición Clínica y Dietética, Complejo Hospitalario de Navarra (CHN), Navarra, Spain; Instituto de Investigación Sanitaria de Navarra (IdisNa), Navarra, Spain.
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Kaushik P, Ahlawat P, Singh K, Singh R. Chemical constituents, pharmacological activities, and uses of common ayurvedic medicinal plants: a future source of new drugs. ADVANCES IN TRADITIONAL MEDICINE 2021. [DOI: 10.1007/s13596-021-00621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Ivancic L, Maguire S, Miskovic-Wheatley J, Harrison C, Nassar N. Prevalence and management of people with eating disorders presenting to primary care: A national study. Aust N Z J Psychiatry 2021; 55:1089-1100. [PMID: 33722071 DOI: 10.1177/0004867421998752] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Primary care practitioners are well placed to support diagnosis and appropriate treatment of eating disorders as they are often the first point of contact with the health care system. However, little is known about management of eating disorders in primary care. We aimed to estimate the prevalence of management of eating disorders in primary care and identify how these disorders are managed. METHODS This study used data from the Bettering the Evaluation of Care of Health programme, which annually surveys 1000 randomly sampled general practitioners in Australia who each record details of 100 successive patient encounters. In total, data were utilised from 1,568,100 primary care encounters between 2000/2001 and 2015/2016. RESULTS Eating disorders were managed in less than 1% of primary care encounters between 2000/2001 and 2015/2016. When extrapolated to the Australian population, up to 0.32% of the population were managed in primary care for a primary or probable eating disorder. In the majority of encounters where an eating disorder was managed (58.5%), the encounter was initiated for reasons other than the eating disorder itself. Of a group of patients identified with a clinically significant low body mass index (N = 5917), a small number (n = 118) had either no other diagnosis or a related condition that may be indicative of an eating disorder. In encounters where an eating disorder was managed, referrals to a mental health specialist/service, medical specialist and nutritionist/dietician were provided in 20%, 8% and 6% of encounters, respectively. Mental health treatment plans, which provide subsidised access to mental health services, were ascribed in approximately 7.7% of encounters where an eating disorder was managed. CONCLUSION Primary care provides an opportunity to improve detection and management of eating disorders, particularly when patients present for 'other' issues or with unexplained low body mass index and one or more symptoms related to an eating disorder.
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Affiliation(s)
- Lorraine Ivancic
- InsideOut Institute, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, NSW, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, NSW, Australia
| | - Christopher Harrison
- Menzies Centre for Health Policy, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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10
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Levinson CA, Spoor SP, Keshishian AC, Pruitt A. Pilot outcomes from a multidisciplinary telehealth versus in-person intensive outpatient program for eating disorders during versus before the Covid-19 pandemic. Int J Eat Disord 2021; 54:1672-1679. [PMID: 34245028 DOI: 10.1002/eat.23579] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Eating disorders (EDs) are serious mental illnesses with high rates of mortality, morbidity, and personal and societal costs. Onset of the Covid-19 pandemic led to increased ED diagnoses in the general public, as well as worsening of ED symptoms in those with an existing ED diagnosis. Heightened prevalence and severity of EDs during the pandemic is complicated by the fact that traditional modes of ED care (specialty intensive treatment provided by a multidisciplinary team) have been difficult to access during the pandemic. METHODS The current between-groups study (N = 93 ED) tested a multidisciplinary intensive outpatient program (IOP) delivered via in-person (pre-pandemic; n = 60) and virtually via telehealth (during the pandemic; n = 33). RESULTS We found no differences in outcomes via delivery mode, such that regardless of in-person versus telehealth programming, ED symptoms, depression, and perfectionism significantly decreased and body mass index significantly increased. CONCLUSIONS Our findings suggest that a multi-disciplinary telehealth ED IOP program is feasible and has comparable outcomes to in-person IOP treatment. These findings have implications for treatment beyond the pandemic, suggesting that adoption of telehealth IOPs is warranted. Such delivery modes of intensive treatments for EDs could be expanded to reach underserved populations, especially in rural areas where treatment is often difficult to access.
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Samantha P Spoor
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Ani C Keshishian
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Alexandria Pruitt
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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Marí-Sanchis A, Burgos-Balmaseda J, Hidalgo-Borrajo R. Eating disorders in sport. Update and proposal for an integrated approach. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00125-7. [PMID: 34148864 DOI: 10.1016/j.endinu.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 11/15/2022]
Abstract
Eating disorders are a group of conditions which have a huge impact on the health and performance of athletes. The aetiology of eating disorders is multifactorial, being influenced by genetic and environmental factors, but also involving psychological factors and factors specific to the practising of sport. Eating disorders are highly prevalent in sport, particularly in disciplines involving endurance, those that have weight-categories or those where low weight is a competitive advantage and aesthetics are important. Athletes with eating disorders need to be assessed and receive early, comprehensive treatment. Close monitoring of nutritional status is vital, especially with female athletes. Prevention is crucial and plays an invaluable role in this type of disorder, but represents a significant challenge for all professionals who look after athletes. Priority needs to be given to implementing structured nutrition training programmes for the athlete and their entourage to help prevent eating disorders.
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Affiliation(s)
- Amelia Marí-Sanchis
- Servicio de Endocrinología y Nutrición, Unidad de Nutrición Clínica y Dietética, Complejo Hospitalario de Navarra (CHN), Navarra, España; Instituto de Investigación Sanitaria de Navarra (IdisNa), Navarra, España.
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12
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Reardon CL, Bindra A, Blauwet C, Budgett R, Campriani N, Currie A, Gouttebarge V, McDuff D, Mountjoy M, Purcell R, Putukian M, Rice S, Hainline B. Mental health management of elite athletes during COVID-19: a narrative review and recommendations. Br J Sports Med 2020; 55:bjsports-2020-102884. [PMID: 32967853 DOI: 10.1136/bjsports-2020-102884] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 12/18/2022]
Abstract
Elite athletes suffer many mental health symptoms and disorders at rates equivalent to or exceeding those of the general population. COVID-19 has created new strains on elite athletes, thus potentially increasing their vulnerability to mental health symptoms. This manuscript serves as a narrative review of the impact of the pandemic on management of those symptoms in elite athletes and ensuing recommendations to guide that management. It specifically addresses psychotherapy, pharmacotherapy and higher levels of care. Within the realm of psychotherapy, crisis counselling might be indicated. Individual, couple/family and group psychotherapy modalities all may be helpful during the pandemic, with novel content and means of delivery. Regarding pharmacotherapy for mental health symptoms and disorders, some important aspects of management have changed during the pandemic, particularly for certain classes of medication including stimulants, medications for bipolar and psychotic disorders, antidepressants and medications for substance use disorders. Providers must consider when in-person management (eg, for physical examination, laboratory testing) or higher levels of care (eg, for crisis stabilisation) is necessary, despite potential risk of viral exposure during the pandemic. Management ultimately should continue to follow general principles of quality health care with some flexibility. Finally, the current pandemic provides an important opportunity for research on new methods of providing mental health care for athletes, and consideration for whether these new methods should extend beyond the pandemic.
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Affiliation(s)
- Claudia L Reardon
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- University Health Services, University of Wisconsin, Madison, Wisconsin, USA
| | | | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Niccolo Campriani
- Sports Department, International Olympic Committee, Lausanne, Switzerland
| | - Alan Currie
- Regional Affective Disorders Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
- Department of Sport and Exercise Sciences, University of Sunderland, Sunderland, Tyne and Wear, UK
| | - Vincent Gouttebarge
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- AMC/VUmc IOC Research Center of Excellence, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - David McDuff
- Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
- MD Sports Performance, Ellicott City, Maryland, USA
| | - Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Bureau, FINA, Lausanne, Switzerland
| | - Rosemary Purcell
- Department of Research and Translation, Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Margot Putukian
- Athletic Medicine, Princeton University, Princeton, New Jersey, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Simon Rice
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Research and Translation, Orygen The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
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Wasserfurth P, Palmowski J, Hahn A, Krüger K. Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention. SPORTS MEDICINE - OPEN 2020; 6:44. [PMID: 32910256 PMCID: PMC7483688 DOI: 10.1186/s40798-020-00275-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023]
Abstract
Low energy availability (LEA) represents a state in which the body does not have enough energy left to support all physiological functions needed to maintain optimal health. When compared to the normal population, athletes are particularly at risk to experience LEA and the reasons for this are manifold. LEA may result from altered dietary behaviours that are caused by body dissatisfaction, the belief that a lower body weight will result in greater performance, or social pressure to look a certain way. Pressure can also be experienced from the coach, teammates, and in this day and age through social media platforms. While LEA has been extensively described in females and female athletes have started fighting against the pressure to be thin using their social media platforms, evidence shows that male athletes are at risk as well. Besides those obvious reasons for LEA, athletes engaging in sports with high energy expenditure (e.g. rowing or cycling) can unintentionally experience LEA; particularly, when the athletes' caloric intake is not matched with exercise intensity. Whether unintentional or not, LEA may have detrimental consequences on health and performance, because both short-term and long-term LEA induces a variety of maladaptations such as endocrine alterations, suppression of the reproductive axis, mental disorders, thyroid suppression, and altered metabolic responses. Therefore, the aim of this review is to increase the understanding of LEA, including the role of an athlete's social environment and the performance effects related to LEA.
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Affiliation(s)
- Paulina Wasserfurth
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Am Kleinen Felde 30, [PW1] 30167, Hannover, Germany
| | - Jana Palmowski
- Institute of Sports Science, Department of Exercise Physiology and Sports Therapy, Justus-Liebig University Giessen, Kugelberg 62, 35394, Giessen, Germany
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Am Kleinen Felde 30, [PW1] 30167, Hannover, Germany
| | - Karsten Krüger
- Institute of Sports Science, Department of Exercise Physiology and Sports Therapy, Justus-Liebig University Giessen, Kugelberg 62, 35394, Giessen, Germany.
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Abstract
There are few systematic studies of treatment of bulimia nervosa (BN) in adolescents. Although family-based treatment has demonstrated preliminary evidence to support involvement of caregivers in treatment, there is significant opportunity for improvement in mitigating binge-eating and purging symptoms among adolescents afflicted with BN. When caregivers are unable to participate in treatment, there is evidence that BN-specific cognitive behavioral therapy approaches are helpful for some adolescents. Further research is needed to determine for whom, and under what conditions certain types of family involvement might be most effective in adolescent treatment of BN.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; The University of Chicago, Chicago, IL, USA.
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Simões-Capela N, Schiavone G, De Raedt W, Vrieze E, Van Hoof C. Toward Quantifying the Psychopathology of Eating Disorders From the Autonomic Nervous System Perspective: A Methodological Approach. Front Neurosci 2019; 13:606. [PMID: 31312117 PMCID: PMC6613494 DOI: 10.3389/fnins.2019.00606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/27/2019] [Indexed: 11/13/2022] Open
Abstract
The phenomenology of Eating Disorders (ED) relates with altered functioning of the Autonomic Nervous System (ANS). The lack of agreement in what comes to the direction and significance of such alterations is possibly due to the variability in the ED spectrum. As the stress response system is an integral part of the ANS, we propose to investigate ANS tonic variations and phasic activations in response to stressors. We hypothesize that, while using stress as a test probe, characteristic ANS dysregulations in ED may be found when considering several physiological signals measured over time, and weighted by the individual psychological profiles. In this article we describe a novel methodological approach to investigate this hypothesis with the aim of providing further clarification on the ED spectrum conceptualization. The proposed methodology has been designed to be easily integrated in clinical practice and, eventually, in daily life. The population under observation includes both patients in treatment for ED, and matched controls. The study session has the duration of 1 day, including: (1) the administration of a stress task in a controlled environment and (2) naturalistic data collection. The stress task is designed to elicit both mentally and physically driven ANS activation. The naturalistic component intends to illustrate the psychophysiology in everyday life. We use wearable devices to continuously and non-invasively measure bio-signals related to ANS functioning. This information is complemented with psychometric information from validated stress and ED scales and ecological momentary assessments. The protocol has received ethical approval and has been implemented in practice, currently accounting for 37 patients (out of 120) and 16 controls (out of 60). Ongoing work focus on the definition and implementation of a data processing pipeline to quantitatively test our hypothesis, both standard statistical methods and more exploratory machine learning approaches will be considered.
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Affiliation(s)
| | | | | | - Elske Vrieze
- University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Chris Van Hoof
- ESAT, KU Leuven, Heverlee, Belgium
- IMEC, Heverlee, Belgium
- IMEC-NL, Eindhoven, Netherlands
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16
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Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med 2019; 53:667-699. [DOI: 10.1136/bjsports-2019-100715] [Citation(s) in RCA: 349] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/03/2022]
Abstract
Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.
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Chao AM, Rajagopalan AV, Tronieri JS, Walsh O, Wadden TA. Identification of Binge Eating Disorder Criteria: Results of a National Survey of Healthcare Providers. J Nurs Scholarsh 2019; 51:399-407. [PMID: 30821428 DOI: 10.1111/jnu.12468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine whether general healthcare providers and adult psychiatrists recognized binge eating disorder (BED) symptoms and features. The aims were to examine how they delineated the core criteria of BED-eating a large amount of food and sense of loss of control over eating-and how their evaluations compared to ratings by BED experts. DESIGN This is a cross-sectional study of a nationwide U.S. sample of healthcare providers and a convenience sample of BED experts. METHODS Providers were mailed surveys that asked respondents about their perceptions of a large amount of food and whether they thought case vignettes met thresholds for loss of control. Participants were also asked to select BED diagnostic criteria from a symptom list. Results were analyzed using one-way analyses of variance with post-hoc comparisons and chi-squared tests. FINDINGS The survey was completed by 405 healthcare providers (response rate of 28.4%). Ratings of a large amount of food did not differ between BED experts and general healthcare providers (p = .10) or psychiatrists (p = .90). Provider groups did not differ significantly on whether five of the six vignettes met thresholds for loss of control (p > .05). Of the respondents, 93.0% of general healthcare providers and 88.6% of psychiatrists could not correctly identify the diagnostic criteria for BED. CONCLUSIONS Across provider groups, demarcation of a large amount of food and loss of control over eating were relatively consistent. However, general healthcare providers and psychiatrists were not able to correctly identify BED symptoms. CLINICAL RELEVANCE Training and education are greatly needed to improve knowledge of the diagnostic criteria for BED.
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Affiliation(s)
- Ariana M Chao
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | | | - Jena Shaw Tronieri
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Olivia Walsh
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Thomas A Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
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Martin RE, Villanueva Y, Stephano T, Franz PJ, Ochsner KN. Social influence shifts valuation of appetitive cues in early adolescence and adulthood. J Exp Psychol Gen 2018; 147:1521-1530. [PMID: 30272465 DOI: 10.1037/xge0000469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Other people can profoundly affect one's opinions and decisions. In the current study, we compared the effects of peer influence on responses to a primary reward-food-in both young adolescents and adults. Food is critical for survival, and in addition to its rewarding properties, habits and practices surrounding eating are heavily influenced by social and cultural norms. To address the impact of peer influence on food valuations, young adolescents ages 10-14 and young adults ages 18-22 rated the desirability of foods before and after seeing peer opinions about those foods. We then compared the degree to which participants changed their ratings of food desirability as a function of the type of social information received (e.g., peers liking a food more or less than did the participant). We found that all participants' ratings conformed to the peer ratings and that adolescents had less stable valuations across all conditions over time. These results provide evidence for the effectiveness of peer influence in shifting valuations of appetitive stimuli and can inform interventions aimed at improving healthy eating choices. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Risk of eating disorders in a non-western setting: an exploratory study in Khartoum state, Sudan. Eat Weight Disord 2017; 22:649-656. [PMID: 27585924 PMCID: PMC5680385 DOI: 10.1007/s40519-016-0311-7] [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: 04/05/2016] [Accepted: 08/02/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Recent research suggests an emergence of eating disorders [ED] in non-western settings for unknown reasons. This research investigates the presence of ED in Khartoum State [Sudan], and explores relevant factors amongst women at risk of ED and stakeholders involved with mental health care and policy-making. METHODS Women from four summer schools were approached and screened for risk of ED using a validated and adapted form of the Eating Attitudes Test-26. Focus groups were performed within the schools, selected participants at high risk were interviewed, and interviews with stakeholders were performed. RESULTS Around a third (32.6%) of participants scored as having high risk of ED. Interviews showed recurring themes determining eating attitudes including: intention, knowledge, environment and habit. Stakeholders' opinions depended on whether they work directly with those affected by ED or in policy-making. The former advocated increased attention on ED, the latter did not. Overall, services for ED were lacking. CONCLUSIONS A high presence of negative eating attitudes was found amongst screened participants with high risk of ED. Individual intention overrides all other determinants for abnormal eating. Moreover, evidence suggests that westernization may attribute to ED, supporting the view that ED are culturally bound. The differing stakeholders' views, together with other data found in this study, allow a number of recommendations for increasing awareness and identification of ED in Sudan.
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20
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Fisher EB, Thorpe CT, McEvoy DeVellis B, DeVellis RF. Healthy Coping, Negative Emotions, and Diabetes Management. DIABETES EDUCATOR 2016; 33:1080-103; discussion 1104-6. [DOI: 10.1177/0145721707309808] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Edwin B. Fisher
- Department of Health Behavior and Health Education,
School of Public Health, University of North Carolina at Chapel Hill,
| | - Carolyn T. Thorpe
- Center for Health Services Research in Primary Care,
Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Brenda McEvoy DeVellis
- Department of Health Behavior and Health Education,
School of Public Health, University of North Carolina at Chapel Hill
| | - Robert F. DeVellis
- Department of Health Behavior and Health Education,
School of Public Health, University of North Carolina at Chapel Hill
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21
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Ibeziako P, Rohan JM, Bujoreanu S, Choi C, Hanrahan M, Freizinger M. Medically Hospitalized Patients With Eating Disorders and Somatoform Disorders in Pediatrics: What Are Their Similarities and Differences and How Can We Improve Their Care? Hosp Pediatr 2016; 6:730-737. [PMID: 27856605 DOI: 10.1542/hpeds.2016-0080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of the current study is to describe the demographic and clinical characteristics and health care use of medically hospitalized patients with eating disorders (ED) and somatoform disorders (SFD) in a pediatric setting and to use the findings to explore opportunities for improved care. METHODS Retrospective chart reviews of 125 patients with SFD and 125 patients with ED (N = 250) seen at a tertiary pediatric facility over a 12- and 19-month period, respectively. RESULTS Patients in both groups were predominantly girls, white, came from households with above average incomes, and had academic pressures, internalizing coping styles, and high rates of anxiety disorders. Compared with SFD patients, ED patients had longer medical admissions (P < .001), more depressive disorders (P < .01), higher lifetime rates of suicidal ideation and self-injurious behaviors (P < .05), and were more frequently discharged to intensive psychiatric treatment programs (P < .001). SFD patients were referred later to psychiatry (P < .001), had more emergency department visits (P < .001) and more visits to other hospitals (P < .05) and also had higher rates of learning difficulties (P < .001), bullying (P < .05), and trauma (P < .01) compared with ED patients. CONCLUSIONS Identifying overlapping features and key differences in the clinical characteristics and health care use of patients with primary psychiatric disorders like ED and SFD, who are frequent users of medical services, is the first step toward developing innovative, integrated hospital-based care approaches and clinical pathways that can reduce service utilization and improve patient outcomes.
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Affiliation(s)
- Patricia Ibeziako
- Departments of Psychiatry, and
- Harvard Medical School, Boston, Massachusetts; and
| | - Jennifer M Rohan
- Departments of Psychiatry, and
- Harvard Medical School, Boston, Massachusetts; and
| | - Simona Bujoreanu
- Departments of Psychiatry, and
- Harvard Medical School, Boston, Massachusetts; and
| | - Christine Choi
- Departments of Psychiatry, and
- Boston College, Chestnut Hill, Massachusetts
| | | | - Melissa Freizinger
- Departments of Psychiatry, and
- Harvard Medical School, Boston, Massachusetts; and
- Adolescent Medicine, Boston Children's Hospital, Boston, Massachusetts
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22
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Abstract
While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.
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23
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Cadwallader JS, Godart N, Chastang J, Falissard B, Huas C. Detecting eating disorder patients in a general practice setting: a systematic review of heterogeneous data on clinical outcomes and care trajectories. Eat Weight Disord 2016; 21:365-381. [PMID: 27043947 DOI: 10.1007/s40519-016-0273-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/16/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The incidence and prevalence of eating disorders (ED) is low in general practice (GP) settings. Studies in secondary care suggest that the general practitioner has an important role to play in the early detection of patients with EDs. The aim of this study was to describe the effect (clinical outcomes and care trajectory) of screening for EDs among patients in general practice settings. METHODS A systematic review was conducted on Medline, PsycINFO, CINAHL, Embase and WOS. The studies included were to have been carried out in a primary care setting, with screening explicitly performed in GP practices and follow-up information. RESULTS Ten studies met the inclusion criteria. For all ED patients, there was an increase in the frequency of consultations in GP setting, referrals to psychiatric resources and drug prescriptions such as antidepressants, following screening procedures. Clinical outcomes remained unclear and heterogeneous. One study focused on the course and outcome of ED patients identified by screening in the GP setting and reported recovery for anorexia nervosa (AN) and BN in more than half of the cases, after 4.8 years of mean follow-up. In this study, early age at detection predicted better recovery. CONCLUSION Most of the literature on the role of the GP in screening for and managing EDs consists of opinion papers and original studies designed in a secondary care perspective. The impact of systematically screening for EDs in a primary care setting is not clarified and requires further investigation in collaborative cohort studies with a patient-centered approach, and outcomes focused on symptoms.
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Affiliation(s)
- Jean Sébastien Cadwallader
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Villejuif, France.
- Department of General Practice, Faculty of Medicine Pierre and Marie Curie, Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
| | - Nathalie Godart
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Villejuif, France
- Department of Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Julie Chastang
- Department of General Practice, Faculty of Medicine Pierre and Marie Curie, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Bruno Falissard
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Villejuif, France
| | - Caroline Huas
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Villejuif, France
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25
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Madowitz J, Matheson BE, Liang J. The relationship between eating disorders and sexual trauma. Eat Weight Disord 2015; 20:281-93. [PMID: 25976911 DOI: 10.1007/s40519-015-0195-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/29/2015] [Indexed: 01/01/2023] Open
Abstract
Research aimed at understanding the causes and comorbidities of eating disorders (ED) identifies sexual trauma as one potential pathway to the development and maintenance of eating disorders. Based on current literature, there are two main etiological pathways between sexual trauma and ED-body perceptions and psychological difficulties. However, previously published reviews on this topic are outdated and have not yielded consistent findings. Therefore, authors completed a literature review covering years 2004-2014 to examine the relationship between sexual trauma and ED according to both proposed pathway models. Authors utilized PubMed, GoogleScholar, and PsychINFO as search engines. Search terms included "sexual assault", "sexual abuse", "sexual trauma", and "rape" in conjunction with relevant ED terminology. Thirty-two studies met inclusion criteria for this review. Current data indicate an increased prevalence of sexual trauma for individuals with ED. Although limited, recent evidence suggests that sexual trauma precedes and contributes to the development of ED. Existing literature indicates that the body perceptions pathway may impact ED through body dissatisfaction, shame, sexual dysfunction, and fear of future sexual trauma. The psychological difficulties pathway indicates a link between ED and the desire to cope with the failure of the average expected environment, psychological diagnoses, the need for control, and the regulation of emotions. However, further research is needed to assess the potential causal role that sexual trauma may play in the etiology of ED.
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Affiliation(s)
- Jennifer Madowitz
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University / University of California, San Diego, California, USA,
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26
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Abstract
Anorexia nervosa is an eating disorder characterized by excessive restriction on food intake and irrational fear of gaining weight, often accompanied by a distorted body self-perception. It is clinically diagnosed more frequently in females, with type and severity varying with each case. The current report is a case of a 25-year-old female, married for 5 years, educated up to 10(th) standard, a homemaker, hailing from an upper social class Hindu (Marvadi) family, living with husband's family in Urban Bangalore; presented to our tertiary care centre with complaints of gradual loss of weight, recurrent episodes of vomiting, from a period of two years, menstrual irregularities from 1 year and amenorrhea since 6 months, with a probable precipitating factor being husband's critical comment on her weight. Diagnosis of atypical anorexia nervosa was made, with the body mass index (BMI) being 15.6. A multidisciplinary therapeutic approach was employed to facilitate remission. Through this case report the authors call for the attention of general practitioners and other medical practitioners to be aware of the symptomatology of eating disorders as most patients would overtly express somatic conditions similar to the reported case so as to facilitate early psychiatric intervention.
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Affiliation(s)
- Preeti Srinivasa
- Consultant Psychiatrist, Spandana Nursing Home, Bangalore, Karnataka, India
| | - M Chandrashekar
- Consultant Psychiatrist, Spandana Nursing Home, Bangalore, Karnataka, India
| | - Nikitha Harish
- Psychiatric Rehabilitator, Spandana Health Care, Bangalore, Karnataka, India
| | - Mahesh R Gowda
- Consultant Psychiatrist, Spandana Nursing Home, Bangalore, Karnataka, India
| | - Sumit Durgoji
- DNB Resident, Spandana Nursing Home, Bangalore, Karnataka, India
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Mitchell SL, Klein J, Maduramente A. Assessing the impact of an eating disorders treatment team approach with college students. Eat Disord 2015; 23:45-59. [PMID: 25298146 DOI: 10.1080/10640266.2014.959847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
An interdisciplinary treatment team approach is considered the standard of care for individuals with eating disorders; however, there is limited research on the efficacy of such teams. This study used retrospective chart review to compare client characteristics and treatment utilization for college students treated with psychotherapy alone versus an interdisciplinary treatment team approach (i.e., a mental health counselor, a physician, and a dietitian). Clients with prior counseling histories, a bulimia nervosa diagnosis, or a personality disorder diagnosis were more likely to be referred to the eating disorders treatment team. Female counselors were more likely than male counselors to refer clients to the team. Overall, findings suggest that the team approach is associated with students staying in therapy longer and terminating therapy in a planned fashion.
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Affiliation(s)
- Sharon L Mitchell
- a Counseling Services , University at Buffalo , Buffalo , New York , USA
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28
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Needleman I, Ashley P, Fine P, Haddad F, Loosemore M, de Medici A, Donos N, Newton T, van Someren K, Moazzez R, Jaques R, Hunter G, Khan K, Shimmin M, Brewer J, Meehan L, Mills S, Porter S. Oral health and elite sport performance. Br J Sports Med 2014; 49:3-6. [PMID: 25263651 PMCID: PMC4316856 DOI: 10.1136/bjsports-2014-093804] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.
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Affiliation(s)
| | | | - Peter Fine
- UCL Eastman Dental Institute, London, UK
| | - Fares Haddad
- UCL Institute for Sport Exercise and Health, London, UK
| | | | | | | | | | | | | | - Rod Jaques
- English Institute of Sport, Bath, UK Faculty of Sport and Exercise Medicine, Edinburgh, UK
| | | | - Karim Khan
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - John Brewer
- St Mary's University, Twickenham, School of Sport, Health & Applied Science, UK
| | | | - Steve Mills
- Past President, Academy for Sports Dentistry, Farmersville, Illinois, USA
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29
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Prevalence, comorbidities and outpatient treatment of anorexia and bulimia nervosa in German children and adolescents. Eat Weight Disord 2013; 18:157-65. [PMID: 23760844 DOI: 10.1007/s40519-013-0020-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 11/22/2012] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study aimed at investigating the prevalence, psychiatric comorbidity and outpatient treatment in a sample of German children and adolescents with eating disorders (EDs). METHOD Data of a large German statutory health insurance company were analysed and outpatients aged between 10 and 21 years with an ED diagnosis in 2009 were identified. RESULTS Of 248,558 insured children and adolescents, 1,404 patients (79.9 % females, mean age: 16.7; SD: 3.3 years) matched the inclusion criteria. The large majority of patients with anorexia nervosa (AN) and bulimia nervosa (BN) were females (94.7 and 92.7 %), on which we focus in the following analyses. The prevalence in females was 0.28 % (AN) and 0.20 % (BN). Psychiatric comorbidity was diagnosed in 59.8 % (AN) and 64.1 % (BN) of patients, respectively. Most patients were treated with psychotherapy (AN: 75.7 %, BN: 78.5 %), 16.4 % (AN) and 20.2 % (BN) of our patients received pharmacotherapy with either antidepressants or antipsychotics. 23.5 % (AN) and 21.1 % (BN) received no treatment with psychotherapy, antidepressants or antipsychotics. DISCUSSION This naturalistic study suggests that in young ED outpatients, EDs seem to be underdiagnosed and treatment does not necessarily comply with current guidelines. Therefore, dissemination of state-of-the-art knowledge on diagnosis and treatment in children and adolescents with EDs constitutes an important educational goal.
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30
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Profiling disordered eating patterns and body mass index (BMI) in the English general population. Soc Psychiatry Psychiatr Epidemiol 2013; 48:783-93. [PMID: 23589099 DOI: 10.1007/s00127-012-0613-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Little national evidence exists on disordered eating patterns in the UK. This study examined the prevalence and nature of disordered eating patterns in the National Adult Psychiatric Morbidity Survey 2007. METHOD Responses to the screening tool for eating disorders (SCOFF) and body mass index (BMI) were analysed using latent class analysis (n = 7,001). Multinomial logistic regression explored the associations between latent classes and mental health comorbidities. RESULTS The prevalence of possible eating disorders in England using the SCOFF was 6.3 %; this decreased to 1.6 % when accounting for the negative impact feelings about food had on the respondent's life. Five latent classes were identified: classes 1 and 2 resembled known eating disorders ('marginal anorexia' relating to anorexia nervosa and 'binge eaters' relating to bulimia nervosa/binge eating disorder); class 3 consisted of people who were obese, but did not experience eating problems; class 4 was morbidly obese, with an elevated risk of anxiety disorders; class 5 was labelled as 'normal eaters', with a low probability of eating problems and a normal BMI. CONCLUSIONS Adults assigned to eating disorder type classes are at increased risk for mental health comorbidities and poorer social functioning. Information presented herein on clustering of disordered eating patterns may help clinicians identify those men and women risk for an eating disorder.
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31
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Reyes-Rodríguez ML, Ramírez J, Davis K, Patrice K, Bulik CM. Exploring barriers and facilitators in eating disorders treatment among Latinas in the United States. JOURNAL OF LATINX PSYCHOLOGY 2013; 1:112-131. [PMID: 24729950 PMCID: PMC3981100 DOI: 10.1037/a0032318] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to explore facilitators and barriers that may contribute to, or prevent, the engagement and retention of Latinos in eating disorders (EDs) treatment. OBJECTIVE The main objective of this investigation was to explore more fully the facilitators and barriers that may contribute to or prevent the engagement and retention of Latinos/as in EDs treatment. METHODS A qualitative design based on grounded theory was used to guide in-depth interviews with 5 Latinas (mean age 31.2 years) with history of EDs and with 5 Latino mental health providers (mean age 36.4 years). RESULTS Six main themes were found in the discussion with patients and mental health providers: immigration stress, treatment experience in the U.S., facilitators of help seeking, barriers to help seeking, treatment needs, and facilitators of treatment retention. For patients, lack of information about EDs and lack of bilingual treatment were identified as practical barriers. Other emotional factors such as stigma, fear of not being understood, family privacy and not being ready to change were identified as barriers to seeking help. Among facilitator factors that encouraged patients to seek help, the most salient were the perception of the severity of the ED and emotional distress. For treatment retention, family support was a key element among patients. For providers, offering short-term treatment and directive treatment were seen as relevant factors for treatment retention in Latinos. CONCLUSIONS A culturally sensitive intervention model for Latinas with EDs in the U.S. is discussed addressing four levels: patient; family; providers; and system.
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Affiliation(s)
| | - Juanita Ramírez
- Department of Psychology, University of North Carolina, Chapel Hill, NC
| | - Kendra Davis
- Department of Psychology, University of Georgia, Athens, GA
| | - Kesha Patrice
- Department of Psychology, California State University, Sacramento, CA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC ; Department of Nutrition, University of North Carolina, Chapel Hill, NC
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32
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Revelas A. Eating disorders are real treatable medical illnesses. S Afr Fam Pract (2004) 2013. [DOI: 10.1080/20786204.2013.10874346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- A Revelas
- Department of Pathology, St Nicolas General Hospital, Crete
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Hawkins LK, Gottlieb BR. Screening for Eating Disorders in Pregnancy: How Uniform Screening During a High-Risk Period Could Minimize Under-Recognition. J Womens Health (Larchmt) 2013; 22:390-2. [DOI: 10.1089/jwh.2013.4313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leah K. Hawkins
- Harvard Medical School and the Department of Society, Human Development and Health at the Harvard School of Public Health
| | - Barbara R. Gottlieb
- Harvard Medical School and the Department of Society, Human Development and Health at the Harvard School of Public Health
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Sala M, Reyes-Rodríguez ML, Bulik CM, Bardone-Cone A. Race, ethnicity, and eating disorder recognition by peers. Eat Disord 2013; 21:423-36. [PMID: 24044598 PMCID: PMC3779913 DOI: 10.1080/10640266.2013.827540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We investigated racial/ethnic stereotyping in the recognition and referral of eating disorders with 663 university students. We explored responses to problem and eating disorder recognition and health care referrals after subjects read a vignette concerning a patient of a different race/ethnic background presenting with eating disorders. A series of three 4 × 3 ANOVAs revealed significant main effects for eating disorders across all three outcome variables. There were no significant main effects across the four different race/ethnicity conditions and no significant race by condition interactions. Lack of general eating disorder recognition and health care referrals by student participants were found. [Supplemental files are available for this article. Go to the publishers's online edition of Eating Disorders for the following free supplemental resource: online appendix containing vignettes 1-3, as described in the "Methods" section].
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Affiliation(s)
- Margarita Sala
- a Department of Psychology , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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de Wit M, Winterdijk P, Aanstoot HJ, Anderson B, Danne T, Deeb L, Lange K, Nielsen AØ, Skovlund S, Peyrot M, Snoek F. Assessing diabetes-related quality of life of youth with type 1 diabetes in routine clinical care: the MIND Youth Questionnaire (MY-Q). Pediatr Diabetes 2012; 13:638-46. [PMID: 23173877 DOI: 10.1111/j.1399-5448.2012.00872.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 03/28/2012] [Accepted: 03/28/2012] [Indexed: 12/13/2022] Open
Abstract
AIM It is recommended to assess health-related quality of life (HRQoL) in teenagers with diabetes as part of their ongoing medical care. Here, we describe the development and psychometric evaluation of the Monitoring Individual Needs in Diabetes Youth Questionnaire (MY-Q), a multi-dimensional self-report HRQoL questionnaire designed for use in pediatric diabetes care. DESIGN AND METHODS In expert meetings, characteristics and domains of interest were defined. Existing questionnaires were reviewed, topics selected, and new items added, resulting in the 36-item MY-Q. To test face validity, we interviewed 22 teenagers. In addition, 84 teenagers with type 1 diabetes (age 10-18 yr) completed the MY-Q and Pediatric Quality of Life Inventory (PedsQL) generic and diabetes-modules to examine psychometric properties. Hemoglobin A1c (HbA1c) values were obtained by chart audit. RESULTS The MY-Q consists of seven subscales (social impact, parents, diabetes control perceptions, responsibility, worries, treatment satisfaction, and body image and eating behavior) as well as general HRQoL and emotional well-being. Cronbach's alpha for the total scale was 0.80. Strong correlations between MY-Q total and PedsQL generic and diabetes-module scores (r = 0.58 and r = 0.71, p < 0.001) confirmed concurrent validity. Higher HbA1c was associated with lower diabetes control perceptions (r = -0.35, p = 0.001), worries (r = -0.24, p = 0.029), and body image and eating behavior (r = -0.26, p = 0.019) scores. Younger age was associated with higher diabetes control perceptions (r = -0.26, p = 0.020) and body image and eating behavior (r = -0.23, p = .038), and lower responsibility (r = 0.25, p = 0.027) scores. CONCLUSION The MY-Q is the first HRQoL questionnaire designed for use in clinical care. It has acceptable measurement properties and seems suitable for implementation in routine care of teenagers with diabetes.
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Affiliation(s)
- Maartje de Wit
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
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Abstract
Context: The female athlete triad (the triad) is an interrelationship of menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density; it is relatively common among young women participating in sports. Diagnosis and treatment of this potentially serious condition is complicated and often requires an interdisciplinary team. Evidence Acquisition: Articles from 1981 to present found on PubMed were selected for review of major components of the female athlete triad as well as strategies for diagnosis and treatment of the conditions. Results: The main goal in treatment of young female athletes with the triad is a natural return of menses as well as enhancement of bone mineral density. While no specific drug intervention has been shown to consistently improve bone mineral density in this patient population, maximizing energy availability and optimizing vitamin D and calcium intake are recommended. Conclusions: Treatment requires a multidisciplinary approach involving health care professionals as well as coaches and family members. Prevention of this condition is important to minimize complications of the female athlete triad.
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Affiliation(s)
| | - Kathryn E. Ackerman
- Division of Sports Medicine, Children’s Hospital Boston and Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Address correspondence to Kathryn E. Ackerman, MD MPH Division of Sports Medicine Children’s Hospital Boston 319 Longwood Avenue, Boston, MA 02115 (e-mail: )
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Stiles-Shields EC, Labuschagne Z, Goldschmidt AB, Doyle AC, Le Grange D. The use of multiple methods of compensatory behaviors as an indicator of eating disorder severity in treatment-seeking youth. Int J Eat Disord 2012; 45:704-10. [PMID: 22331840 PMCID: PMC3355214 DOI: 10.1002/eat.22004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2011] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study investigated the use and frequency of multiple methods of compensatory behaviors and how they relate to eating-related and general psychopathology for youth with eating disorders (ED). METHOD Participants were 398 referrals to a pediatric ED treatment program (91.2% female; M age = 14.9 ± 2.2). ANOVA and chi-square tests compared participants reporting multiple methods of compensatory behaviors, single method of compensatory behaviors, and no compensatory behaviors on measures of ED and general psychopathology. Partial correlations examined associations between compensatory behavior, frequency and severity of ED and general psychopathology. RESULTS Participants reporting multiple methods of compensatory behaviors had significantly greater ED and general psychopathology than the other groups (ps < .001). Frequency of compensatory behaviors was associated with ED psychopathology (partial r = .14; p = .007) but not with general psychopathology. DISCUSSION Engaging in multiple methods of compensatory behaviors is related to greater ED and general psychopathology, whereas frequency is only related to greater ED symptom severity.
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Affiliation(s)
| | - Zandrè Labuschagne
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, 60637
| | - Andrea B. Goldschmidt
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, 60637
| | | | - Daniel Le Grange
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, 60637
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Campo-Arias A, Villamil-Vargas M. Riesgo de trastorno del comportamiento alimentario (TCA) en estudiantes de medicina en Colombia*. ACTA ACUST UNITED AC 2012; 41:328-39. [DOI: 10.1016/s0034-7450(14)60008-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/29/2012] [Indexed: 11/28/2022]
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Kawai K, Yamashita S, Yamanaka T, Gondo M, Morita C, Nozaki T, Takakura S, Hata T, Yamada Y, Matsubayashi S, Takii M, Kubo C, Sudo N. The longitudinal BMI pattern and body composition of patients with anorexia nervosa who require urgent hospitalization: A case control study. Biopsychosoc Med 2011; 5:14. [PMID: 22142436 PMCID: PMC3275451 DOI: 10.1186/1751-0759-5-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 12/05/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevention of serious physical complications in anorexia nervosa (AN) patients is important. The purpose of this study is to clarify which physical and social factors are related to the necessity for urgent hospitalization of anorexia nervosa (AN) patients in a long-term starvation state. We hypothesized that the change of longitudinal BMI, body composition and social background would be useful as an index of the necessity for urgent hospitalization. METHODS AN patients were classified into; urgent hospitalization, due to disturbance of consciousness or difficulty walking(n = 17); planned admission (n = 96); and outpatient treatment only groups (n = 136). The longitudinal BMI pattern and the clinical features of these groups were examined. In the hospitalization groups, comparison was done of body composition variation and the social background, including the educational level and advice from family members. RESULTS After adjusting for age and duration of illness, the BMI of the urgent hospitalization group was lower than that of the other groups at one year before hospitalization (P < 0.01) and decreased more rapidly (P < 0.01). Urgent hospitalization was associated with the fat free mass (FFM) (P < 0.01). Between the groups, no considerable difference in social factors was found. CONCLUSIONS The longitudinal pattern of BMI and FFM may be useful for understanding the severity in AN from the viewpoint of failure of the homeostasis system.
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Affiliation(s)
- Keisuke Kawai
- Department of Psychosomatic Medicine, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan, 3-1-1 Higashi-ku, Fukuoka, Japan 812-8582.
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Larrañaga A, Docet MF, García-Mayor RV. Disordered eating behaviors in type 1 diabetic patients. World J Diabetes 2011; 2:189-95. [PMID: 22087355 PMCID: PMC3215768 DOI: 10.4239/wjd.v2.i11.189] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 10/05/2011] [Accepted: 10/22/2011] [Indexed: 02/05/2023] Open
Abstract
Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially difficult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following components: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight and shape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population.
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Affiliation(s)
- Alejandra Larrañaga
- Alejandra Larrañaga, Ricardo V García-Mayor, Eating Disorders Unit, University Hospital of Vigo, 36204 Vigo, Spain
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Kent D, Haas L, Randal D, Lin E, Thorpe CT, Boren SA, Fisher J, Heins J, Lustman P, Nelson J, Ruggiero L, Wysocki T, Fitzner K, Sherr D, Martin AL. Healthy coping: issues and implications in diabetes education and care. Popul Health Manag 2011; 13:227-33. [PMID: 20879903 DOI: 10.1089/pop.2009.0065] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Psychological, emotional, and social factors not only impact quality of life, but also often play a role in chronic illness outcomes. Diabetes care, in particular, is greatly influenced by psychosocial factors when they hinder a person's ability to manage the disease and achieve metabolic control. Healthy coping, defined as responding to a psychological and physical challenge by recruiting available resources to increase the probability of favorable outcomes in the future, is essential to effective self-management by people with diabetes. In June 2009, the American Association of Diabetes Educators convened a multidisciplinary expert panel to discuss healthy coping in diabetes. The panel included diabetes educators and behavioral science and mental health professionals. Drawing on their knowledge and experiences, as well as information presented at the symposium, the panel probed several aspects of healthy coping including what it entails, common barriers, assessment, population diversity, and clinical applications. A team approach to addressing the patient's coping is critical. Team involvement relieves the diabetes educator of the entire burden of supporting the patient in this regard. The team should be broadly defined and include those who are formally and informally involved. Healthy coping is a complex, qualitative behavior that cannot be easily quantified. Future efforts to address the issue of healthy coping should add to the body of literature regarding diabetes self-management at the individual and population-based levels.
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Affiliation(s)
- Dan Kent
- University of Washington Medical School , Seattle, Washington, USA
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Abstract
BACKGROUND Eating disorders are serious illnesses that often are not detected by health care professionals. The author presents techniques that the oral health care professional (OHCP) can use to screen at-risk patients for eating disorders during routine preventive care appointments. CONCLUSIONS OHCPs often are the first health care professionals to encounter patients with undiagnosed eating disorders. Because early detection of eating disorders is challenging, screening tools can be helpful. Early detection of eating disorders, with appropriate referral, is associated with fewer dental and systemic adverse effects and a more favorable prognosis. CLINICAL IMPLICATIONS OHCPs are in an ideal position to screen patients for eating disorders. They can accomplish this via a valid, reliable, brief questionnaire and careful patient assessment.
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Refeeding syndrome: a literature review. Gastroenterol Res Pract 2010; 2011. [PMID: 20886063 PMCID: PMC2945646 DOI: 10.1155/2011/410971] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/21/2010] [Accepted: 08/03/2010] [Indexed: 12/21/2022] Open
Abstract
Refeeding syndrome (RFS) describes the biochemical changes, clinical manifestations, and complications that can occur as a consequence of feeding a malnourished catabolic individual. RFS has been recognised in the literature for over fifty years and can result in serious harm and death. Crude estimates of incidence, morbidity, and mortality are available for specific populations. RFS can occur in any individual but more commonly occurs in at-risk populations. Increased awareness amongst healthcare professionals is likely to reduce morbidity and mortality. This review examines the physiology of RFS and describes the clinical manifestations. A management strategy is described. The importance of a multidisciplinary approach is emphasized.
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Sim LA, McAlpine DE, Grothe KB, Himes SM, Cockerill RG, Clark MM. Identification and treatment of eating disorders in the primary care setting. Mayo Clin Proc 2010; 85:746-51. [PMID: 20605951 PMCID: PMC2912736 DOI: 10.4065/mcp.2010.0070] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Eating disorders, which are associated with a host of adverse medical morbidities, negative psychological sequelae, and considerable reductions in quality of life, should be diagnosed and treated promptly. However, primary care physicians may find it uniquely challenging to detect eating disorders in their early stages, before obvious physical problems arise and while psychological symptoms are subtle. Although psychological symptoms may dominate the presentation, the physician is an integral member of the treatment team and is in a unique role to diagnose and treat eating disorders. This clinical review surveys the eating disorders literature, identified by searching MEDLINE and PubMed for articles published from January 1, 1983, to September 30, 2009, using the following keywords: anorexia nervosa, bulimia nervosa, eating disorders, eating disorders NOS, binge eating, binge eating disorder, and night eating syndrome. This review also focuses on practical issues faced by primary care physicians in the management of these conditions and other issues central to the care of these complex patients with medical and psychiatric comorbid conditions.
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Affiliation(s)
- Leslie A Sim
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
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Hill LS, Reid F, Morgan JF, Lacey JH. SCOFF, the development of an eating disorder screening questionnaire. Int J Eat Disord 2010; 43:344-51. [PMID: 19343793 DOI: 10.1002/eat.20679] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article describes the three-stage development of the SCOFF, a screening tool for eating disorders. METHOD Study 1 details questionnaire development and testing on cases and controls. Study 2 examines reliability of verbal versus written administration in a student population. Study 3 validates the test as a screening tool in primary care. RESULTS The SCOFF demonstrates good validity compared with DSM-IV diagnosis on clinical interview. In the primary care setting it had a sensitivity of 84.6% and a specificity of 89.6%, detecting all true cases of anorexia nervosa and bulimia nervosa and seven of nine cases of EDNOS. Reliability between written and verbal versions of the SCOFF was high, with a kappa statistic of 0.82. DISCUSSION The SCOFF, which has been adapted for use in diverse languages, appears highly effective as a screening instrument and has been widely adopted to raise the index of suspicion of an eating disorder.
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Mitchell JE, Myers T, Crosby R, O'Neill G, Carlisle J, Gerlach S. Health care utilization in patients with eating disorders. Int J Eat Disord 2009; 42:571-4. [PMID: 19172600 PMCID: PMC4205564 DOI: 10.1002/eat.20651] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine health care costs among patients with eating disorders (EDs) using the Blue Cross Blue Shield of North Dakota claims database system. METHOD Four groups of individuals enrolled between 1999 and 2005 were identified: (1) a group diagnosed with EDs at the beginning of the study period, in 2000 or 2001; (2) a group diagnosed with EDs later in the study period, in 2004 or 2005; (3) a comparison group with depression; and (4) a non-eating disordered comparison group. RESULTS Health care costs were high for patients diagnosed with an ED during the period when the diagnosis was made but remained elevated in the years following. Such costs were consistently higher than those for the non-eating disordered comparison group, but similar to the depression comparison group. DISCUSSION Health care costs remained elevated after a diagnosis of an ED for an extended period of time.
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Affiliation(s)
- James E Mitchell
- Neuropsychiatric Research Institute, 120 South 8th Street, Fargo, North Dakota 58107, USA.
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Bosi MLM, Uchimura KY, Luiz RR. Eating behavior and body image among psychology students. JORNAL BRASILEIRO DE PSIQUIATRIA 2009. [DOI: 10.1590/s0047-20852009000300002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To characterize eating habits and possible risk factors associated with eating disorders among psychology students, a segment at risk for eating disorders. METHOD: This is a cross-sectional study. The questionnaires Bulimic Investigatory Test Edinburgh (BITE), Eating Attitudes Test (EAT-26), Body Shape Questionnaire (BSQ) and a variety that considers related issues were applied. Statistical Package for the Social Sciences (SPSS) 11.0 was utilized in analysis. The study population was composed of 175 female students, with a mean age of 21.2 (DP ± 3.6 years). RESULTS: A positive result was detected on the EAT-26 for 6.9% of the cases (CI95%: 3.6-11.7%). The prevalence of increased symptoms and intense gravity, according to the BITE questionnaire was 5% (CI95%: 2.4-9.5%) and 2.5% (CI95%: 0.7-6.3%), respectively. According to the findings, 26.29% of the students presented abnormal eating behavior. The population with moderate/severe BSQ scores presented dissatisfaction with corporal weight. CONCLUSION: The results indicate that attention must be given to eating behavior risks within this group. A differentiated gaze is justified with respect to these future professionals, whose practice is jeopardized in cases in which they are themselves the bearers of installed symptoms or precursory behavior.
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Dinas K, Daniilidis A, Sikou K, Tantanasis T, Kasmas S, Tzafettas J. Anorexia nervosa in pregnancy: a case report and review of the literature. Obstet Med 2008; 1:97-8. [PMID: 27582794 PMCID: PMC4989718 DOI: 10.1258/om.2008.080026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2008] [Indexed: 11/18/2022] Open
Abstract
Anorexia nervosa is a complex illness rarely encountered in pregnant women. It is a disorder characterized by markedly decreased food intake accompanied by a distorted body image, resulting in an inability to maintain the body weight within 85% of ideal body weight. We describe a case of a pregnant woman diagnosed with anorexia nervosa at 28 weeks of gestation. Her body mass index was 17 kg/m(2). A live male infant weighing 2,08 kg was delivered prematurely via vaginal delivery at 35 weeks of gestation. Pregnant women with anorexia nervosa may have a higher risk of hypertension, miscarriage, difficult labour, premature delivery and intrauterine growth restriction. Management of pregnancy complicated with anorexia nervosa requires involvement of a multidisciplinary team and hospitalization in severe cases.
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Affiliation(s)
| | - A Daniilidis
- Department of Obstetrics-Gynaecology, Hippokratio University Hospital, Thessaloniki, Greece
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Tierney S, Deaton C, Whitehead J. Caring for people with type 1 diabetes mellitus engaging in disturbed eating or weight control: a qualitative study of practitioners’ attitudes and practices. J Clin Nurs 2008; 18:384-90. [DOI: 10.1111/j.1365-2702.2008.02434.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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