Medication management of pediatric eating disorders

Psychotropic medications in adult and adolescent eating disorders: clinical practice versus evidence-based recommendations

AIM

The current study examined the frequency of psychotropic prescriptions in a clinical sample of eating disorder (ED) patients confirming earlier research indicating their use is very common but inconsistent with evidence-based recommendations.

METHODS

The sample consisted of 501 ED patients admitted to an adult partial hospitalization or adolescent residential program. Patients were divided into two diagnostic groups: anorexia nervosa (AN = 287) and bulimia nervosa (BN = 214), as well as two age groups: adults (age ≥18; N = 318) and adolescents (age <18; N = 183).

RESULTS

Forty-one different psychotropic medications (891 prescriptions in all) were prescribed for 429 patients. Overall, 85.6 % of the total sample reported using one or more psychotropic medications. Of 429 patients using any medications, 46.9 % were on two or more, 25.3 % on three or more, and 11.0 % four or more. Antidepressants were most commonly prescribed (89.5 % of those on medication) with no significant differences in usage patterns based on diagnosis. However, there was greater medication use among adults (89.6 %) compared to adolescents (78.7 %). Results indicate psychotropic medication prescription is more widespread in a clinical sample than in an earlier report screening for osteoporosis in AN women.

DISCUSSION

Treatment recommendations suggest medication should not be the primary treatment for EDs and empirical evidence demonstrates their ineffectiveness in AN. Nevertheless, there were no differences in frequency found between diagnostic groups, confirming little relationship between evidence-based recommendations and actual clinical use for those referred to a specialized ED treatment facility. This study adds new evidence regarding age-based comparisons of psychotropic prescription frequency in clinical EDs and comparison between AN and BN which has not been examined in earlier studies.

The psychopharmacological management of eating disorders in children and adolescents

In this review we synthesised current literature on the psychopharmacological management of eating disorders (EDs) in children and adolescents (C&As). We focus specifically on anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). The treatment of EDs is determined by physical and psycho-social factors and needs. Pharmacological management should therefore be viewed and incorporated as one component of a multi-disciplinary comprehensive treatment plan for specific requirements of a patient depending on the stage of the disorder. As there is a dearth of studies evaluating the use of psychopharmacology for EDs in C&As we first review the findings from studies performed in adults and then discuss specific studies performed in C&As. We include information from reviews and treatment guidelines to assist the clinician with an approach to the use of psychopharmacological agents in the treatment of EDs in C&As.

Alexithymia in anorexia nervosa: the mediating role of depression

The role of depression in the expression of alexithymia in anorexia nervosa (AN) has been controversially explained and several variables that may mask or increase the presence of emotional difficulties have scant examination in previous studies. This study aims to analyze the associations between alexithymia and state variables, such as age, BMI, illness duration, treatment duration, and medication status in AN participants, and to test the mediating role of depression in emotional difficulties. The Toronto Alexithymia Scale (TAS-20) and the Zung Self-Rating Depression Scale were administrated to 160 females: 80 participants with AN and 80 healthy controls. High levels of alexithymia were not a function of state variables. The mediating role of depression differed by the alexithymia dimension, with total mediation found for the TAS-DDF and partial mediation found for the TAS-DIF. Alexithymia is a relevant feature throughout the spectrum of AN and does not seem to be related to developmental maturation and some clinical features. Depression is probably the variable that best accounts for the variance in alexithymia, but is not a complete explanation for the known cognitive-affective disturbances in AN. Specific emotional competencies require scrutiny during psychiatric treatment.

Psychotropic medication treatment of adolescents: results from the National Comorbidity Survey-Adolescent Supplement

OBJECTIVE

To examine the 12-month prevalence of psychotropic medication use among adolescents, and the match between mental disorder diagnoses and past-year antidepressant and stimulant use.

METHOD

Data are from the National Comorbidity Survey-Adolescent Supplement (2002-2004), a nationally representative survey of 10,123 adolescents aged 13 to 18 years that assesses DSM-IV disorders using a fully structured diagnostic interview, a modified version of the World Health Organization Composite International Diagnostic Interview (CIDI). Rates of 12-month psychotropic medication use are stratified by respondent socio-demographic characteristics, and the distribution of 12-month DSM-IV CIDI disorders is estimated among past-12-month use of antidepressants and stimulants.

RESULTS

During a 1-year period, 7.0% of adolescents used at least one psychotropic medication; these medications were most commonly antidepressants (3.9%), followed by stimulants (2.8%), anxiolytics (0.8%), antipsychotics (0.5%), and mood stabilizers (0.4%). Nearly three-quarters (74.1%) of adolescents with any past-year psychotropic medication use had at least one CIDI mental disorder, and many had disorders for which the specific medication class is clinically indicated. Among adolescents using antidepressants, 48.8% had a past-12-month depressive or anxiety disorder, and an additional 20.3% had a lifetime depressive or anxiety disorder. Nearly one-half (49.1%) of adolescents using stimulants met past-12-month attention-deficit/hyperactivity disorder (ADHD) criteria, and an additional 13.1% met lifetime criteria for ADHD.

CONCLUSIONS

Most adolescents who are treated with psychotropic medications have one or more psychiatric disorders and many, albeit far from all, have mental disorders for which the specific medications are clinically indicated.

Disordered eating and unhealthy weight loss practices: which adolescents are at highest risk?

Early diagnosis of unhealthy weight loss practices (UWLP) among adolescents improves treatment outcomes. Analysis of population-based school survey data in Oregon demonstrated that the 11.6% reporting UWLP were more likely to perceive themselves as overweight, depressed, and to have abused substances. Targeted screening of adolescents can help identify those with UWLP.