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Zielinski-Gussen IM, Herpertz-Dahlmann B, Dahmen B. Involuntary Treatment for Child and Adolescent Anorexia Nervosa-A Narrative Review and Possible Advances to Move Away from Coercion. Healthcare (Basel) 2023; 11:3149. [PMID: 38132039 PMCID: PMC10742854 DOI: 10.3390/healthcare11243149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Children and adolescents with psychiatric disorders frequently experience hospital treatment as coercive. In particular, for patients with severe anorexia nervosa (AN), clinical and ethical challenges often arise if they do not voluntarily agree to hospital admission, often due to the ego-syntonic nature of the disorder. In these cases, involuntary treatment (IVT) might be life-saving. However, coercion can cause patients to experience excruciating feelings of pressure and guilt and might have long-term consequences. METHODS This narrative review aimed to summarize the current empirical findings regarding IVT for child and adolescent AN. Furthermore, it aimed to present alternative treatment programs to find a collaborative method of treatment for young AN patients and their families. RESULTS Empirical data on IVT show that even though no inferiority of IVT has been reported regarding treatment outcomes, involuntary hospital treatment takes longer, and IVT patients seem to struggle significantly more with weight restoration. We argue that more patient- and family-oriented treatment options, such as home treatment, might offer a promising approach to shorten or even avoid involuntary hospital admissions and further IVT. Different home treatment approaches, either aiming at preventing hospitalization or at shortening hospital stays, and the results of pilot studies are summarized in this article.
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Affiliation(s)
- Ingar M. Zielinski-Gussen
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, 52074 Aachen, Germany
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Joffe AR, Elliott A. Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response. SAGE Open Med 2023; 11:20503121231194400. [PMID: 37655303 PMCID: PMC10467233 DOI: 10.1177/20503121231194400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
This review proposes a model of Long-COVID where the constellation of symptoms are in fact genuinely experienced persistent physical symptoms that are usually functional in nature and therefore potentially reversible, that is, Long-COVID is a somatic symptom disorder. First, we describe what is currently known about Long-COVID in children and adults. Second, we examine reported "Long-Pandemic" effects that create a risk for similar somatic symptoms to develop in non-COVID-19 patients. Third, we describe what was known about somatization and somatic symptom disorder before the COVID-19 pandemic, and suggest that by analogy, Long-COVID may best be conceptualized as one of these disorders, with similar symptoms and predisposing, precipitating, and perpetuating factors. Fourth, we review the phenomenon of mass sociogenic (functional) illness, and the concept of nocebo effects, and suggest that by analogy, Long-COVID is compatible with these descriptions. Fifth, we describe the current theoretical model of the mechanism underlying functional disorders, the Bayesian predictive coding model for perception. This model accounts for moderators that can make symptom inferences functionally inaccurate and therefore can explain how to understand common predisposing, precipitating, and perpetuating factors. Finally, we discuss the implications of this framework for improved public health messaging during a pandemic, with recommendations for the management of Long-COVID symptoms in healthcare systems. We argue that the current public health approach has induced fear of Long-COVID in the population, including from constant messaging about disabling symptoms of Long-COVID and theorizing irreversible tissue damage as the cause of Long-COVID. This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term "Pandemic-Response Syndrome" to describe what previously was labeled Long-COVID. This alternative perspective aims to stimulate research and serve as a lesson learned to avoid a repeat performance in the future.
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Affiliation(s)
- Ari R Joffe
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - April Elliott
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Parpia R, Spettigue W, Norris ML. Approche de l’anorexie mentale et de l’anorexie mentale atypique chez l’adolescent. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:393-398. [PMID: 37315980 PMCID: PMC10266404 DOI: 10.46747/cfp.6906393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objectif Aborder le dépistage, le diagnostic et le traitement de l’anorexie mentale et de l’anorexie mentale atypique chez les adolescents en soins primaires. Sources de l’information Une recherche documentaire a été effectuée dans PubMed à l’aide des rubriques thématiques en anglais anorexia nervosa, adolescents, COVID-19, review, guidelines et primary care . Les articles pertinents ont été passés en revue et les principales recommandations ont été résumées. La plupart des données probantes sont de niveau I. Message principal De récentes études font valoir que la pandémie mondiale de la COVID-19 a contribué à une augmentation de l’incidence des troubles du comportement alimentaire, en particulier chez les adolescents. Il s’ensuit de plus grandes responsabilités pour les professionnels des soins primaires concernant l’évaluation, le diagnostic et la prise en charge de ces troubles. En outre, les professionnels des soins primaires sont bien placés pour identifier les adolescents à risque de troubles du comportement alimentaire. Une intervention précoce revêt une importance capitale pour éviter les conséquences à long terme pour la santé. Des taux élevés d’anorexie mentale atypique indiquent la nécessité que les professionnels soient sensibilisés aux préjudices et à la stigmatisation entourant le poids. Le traitement comporte principalement une combinaison de renutrition et de psychothérapie, généralement au moyen d’une thérapie familiale, et la pharmacothérapie joue un rôle secondaire. Conclusion L’anorexie mentale et l’anorexie mentale atypique sont des maladies graves et potentiellement mortelles, et leur prise en charge optimale comprend la détection et le traitement précoces. Les médecins de famille sont très bien placés pour dépister, diagnostiquer et traiter ces maladies.
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Affiliation(s)
| | - Wendy Spettigue
- Professeure agrégée au Département de psychiatrie de l'Université d'Ottawa (Ontario) et psychiatre pour les enfants et les adolescents au Centre hospitalier pour enfants de l'est de l'Ontario
| | - Mark L Norris
- Professeur de pédiatrie à l'Université d'Ottawa et médecin spécialisé en santé des adolescents au Centre hospitalier pour enfants de l'est de l'Ontario
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Tsiandoulas K, McSheffrey G, Fleming L, Rawal V, Fadel MP, Katzman DK, McCradden MD. Ethical tensions in the treatment of youth with severe anorexia nervosa. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:69-76. [PMID: 36206789 DOI: 10.1016/s2352-4642(22)00236-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022]
Abstract
Treatment of anorexia nervosa poses a moral quandary for clinicians, particularly in paediatrics. The challenges of appropriately individualising treatment while balancing prospective benefits against concomitant harms are best highlighted through exploration and discussion of the ethical issues. The purpose of this Viewpoint is to explore the ethical tensions in treating young patients (around ages 10-18 years) with severe anorexia nervosa who are not capable of making treatment-based decisions and describe how harm reduction can reasonably be applied. We propose the term AN-PLUS to refer to the subset of patients with a particularly concerning clinical presentation-poor quality of life, lack of treatment response, medically severe and unstable, and severe symptomatology-who might benefit from a harm reduction approach. From ethics literature, qualitative studies, and our clinical experience, we identify three core ethical themes in making treatment decisions for young people with AN-PLUS: capacity and autonomy, best interests, and person-centred care. Finally, we consider how a harm reduction approach can provide direction for developing a personalised treatment plan that retains a focus on best interests while attempting to mitigate the harms of involuntary treatment. We conclude with recommendations to operationalise a harm reduction approach in young people with AN-PLUS.
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Affiliation(s)
- Kate Tsiandoulas
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Health Science Research Program, University of Toronto, Toronto, ON, Canada
| | - Gordon McSheffrey
- Department of Pediatrics, Scarborough Health Network, Toronto, ON, Canada; Child, Youth, Family Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lindsay Fleming
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Vandana Rawal
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Marc P Fadel
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Division of Child and Youth Mental Health, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Genetics & Genome Biology, Peter Gilgan Centre for Research & Learning, Toronto, ON, Canada.
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Brasseler M, Schönecker A, Steindor M, Della Marina A, Bruns N, Dogan B, Felderhoff-Müser U, Hebebrand J, Dohna-Schwake C, Goretzki SC. Development of restrictive eating disorders in children and adolescents with long-COVID-associated smell and taste dysfunction. Front Pediatr 2022; 10:1022669. [PMID: 36518782 PMCID: PMC9743173 DOI: 10.3389/fped.2022.1022669] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Absent or abnormal senses of smell and taste have been frequently reported during both acute and long COVID in adult patients. In contrast, pediatric patients who test positive for SARS-CoV-2 are often asymptomatic and the loss of smell and/or taste has been infrequently reported. After observing several young patients with COVID-associated anosmia and ageusia at our clinic, we decided to investigate the incidence of subsequent eating disorders in these patients and in SARS-CoV-2 positive patients who did not experience anosmia and ageusia during the same period. MATERIAL AND METHODS A single-site retrospective cohort study of 84 pediatric patients with suspected long COVID who were treated in the Pediatric Infectious Diseases Outpatient Clinic at the University Hospital Essen were evaluated for persistent symptoms of COVID-19. Smell and taste dysfunction as well as eating behaviors were among the signs and symptoms analyzed in this study. RESULTS 24 out of 84 children and adolescents described smell and taste dysfunction after confirmed or suspected SARS-CoV-2 infections. A large number of these patients (6 out of 24) demonstrated increased fixation on their eating behavior post-COVID and over time these patients developed anorexia nervosa. DISCUSSION/CONCLUSION In this study we saw a possible association of long-lasting post-COVID smell and taste dysfunction with subsequent development of eating disorders. This observation is worrisome and merits further investigation by healthcare providers at multiple clinical sites.
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Affiliation(s)
- Maire Brasseler
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany.,West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Anne Schönecker
- Department of Pediatrics III, Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Essen, Germany
| | - Mathis Steindor
- Department of Pediatrics III, Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Essen, Germany
| | - Adela Della Marina
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany
| | - Burcin Dogan
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany.,West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany
| | - Johannes Hebebrand
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany.,Department for Psychiatry, Psychosomatic Medicine and Psychotherapy of Children and Adolescents, LVR, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany.,West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sarah C Goretzki
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany.,West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, Essen, Germany
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