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Di Cara M, Rizzo C, Corallo F, Cardile D, Calabrò RS, Quartarone A, Buda M, Cucinotta F. Avoidant Restrictive Food Intake Disorder: A Narrative Review of Types and Characteristics of Therapeutic Interventions. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1297. [PMID: 37628296 PMCID: PMC10453506 DOI: 10.3390/children10081297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
The diagnosis of avoidant/restrictive food intake disorder (ARFID) was added to the diagnostic and statistical manual of mental disorders (DSM-5) just 10 years ago. This disorder consists of the failure to meet one's nutritional and/or energy needs, which may result in significant weight loss, significant nutritional deficit or functioning dependent on enteral nutrition or oral supplements. In children with this disorder, development is often problematic, and there is also marked interference with psychosocial functioning at all ages. The causes leading to food avoidance in these patients may be related to a lack of interest, to the sensory properties of the food or to the possible adverse consequences associated with it. Given the multitude of aspects involved in this disorder and the impact it has especially on younger patients, more and more studies are addressing treatments and related benefits and/or complications. A narrative review of currently published studies was performed for articles published before 5 March 2023 on therapeutic interventions in patients with ARFID. Because of the large number of results obtained, this review was conducted only via PubMed in order to analyze and discuss children and adolescent ARFID treatments reported in literature. The treatments most often referred to in the literature are cognitive behavioral therapy, family-based therapy and pharmacological treatment. All the data on these treatments are promising. However, due to the recent introduction of this disorder and the limited data still available, a multidisciplinary approach seems to be the best option.
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Affiliation(s)
| | | | | | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy; (M.D.C.); (F.C.); (R.S.C.); (A.Q.); (M.B.); (F.C.)
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2
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Protocolized Intervention for Children and Adolescents With Phagophobia. J Pediatr Gastroenterol Nutr 2022; 75:e107-e110. [PMID: 36399174 DOI: 10.1097/mpg.0000000000003628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We aimed to prospectively evaluate the effectiveness of a protocolized shaping intervention in children with phagophobia, which occurs when an aversive oral experience causes fear of swallowing and can result in restricted oral intake and weight loss. Twenty-one children (12 males) diagnosed with phagophobia (mean age 8.5 years) underwent initial medical workup and a pediatric psychologist driven shaping protocol. The outpatient protocol involved graduated food exposure with anxiety reduction strategies to eliminate anxiety and expand participants' diet. The participants completed an average of 6 treatment sessions. Post-treatment, there was a significant increase in weight, total number of foods consumed, and number of foods consumed across food groups and texture. Additionally, self-reported subjective units of distress were low for all participants throughout treatment. We conclude that after appropriate medical workup behavioral treatment is safe and efficacious in children with phagophobia and returns children to premorbid functioning and diet.
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Dolman L, Thornley S, Doxtdator K, Leclerc A, Findlay S, Grant C, Breakey VR, Couturier J. Multimodal therapy for rigid, persistent avoidant/restrictive food intake disorder (ARFID) since infancy: A case report. Clin Child Psychol Psychiatry 2021; 26:451-463. [PMID: 33334145 DOI: 10.1177/1359104520981401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Avoidant/restrictive food intake disorder (ARFID) is a feeding and eating disorder that results in nutritional inadequacies, weight loss, and/or dependence on enteral feeds, and for which three clinical subtypes have been described. We present a unique case of an 11-year-old boy with rigid ARFID since infancy and features of all three ARFID subtypes. The patient presented with a life-long history of sensory aversion, limited intake and phobia of vomiting resulting in restriction to a single food item (yogurt) for more than 5 years. He presented with severe iron-deficiency anaemia, and deficiencies of vitamins A, C, D, E and zinc. We employed a multimodal therapeutic approach that incorporated elements of cognitive-behavioural therapy (CBT), family-based therapy (FBT) and pharmacological management with an antidepressant medication (sertraline) and an atypical antipsychotic agent (olanzapine). Over the course of a 7-week admission, our approach assisted the patient in successful weight restoration and incorporation of at least three new food items into his daily diet. While there are currently no first-line recommendations for ARFID management, our study lends support to the efficacy of CBT, FBT and pharmacological management for ARFID patients, including complex cases with multiple subtype features. Further research is needed to strengthen ARFID clinical guidelines.
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Affiliation(s)
- Lena Dolman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Sheri Findlay
- Division of Adolescent Medicine, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Christina Grant
- Division of Adolescent Medicine, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Vicky R Breakey
- Division of Hematology/Oncology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Jennifer Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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4
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Begotka AM, Silverman AH, Goday P. A multidisciplinary approach to the management of phagophobia. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2020.1870117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Andrea M. Begotka
- Division of Pediatrics, Psychiatry Department, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alan H. Silverman
- Division of Pediatrics, Gastroenterology Department, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Praveen Goday
- Division of Pediatrics, Gastroenterology Department, Medical College of Wisconsin, Milwaukee, WI, USA
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Couturier J, Isserlin L, Norris M, Spettigue W, Brouwers M, Kimber M, McVey G, Webb C, Findlay S, Bhatnagar N, Snelgrove N, Ritsma A, Preskow W, Miller C, Coelho J, Boachie A, Steinegger C, Loewen R, Loewen T, Waite E, Ford C, Bourret K, Gusella J, Geller J, LaFrance A, LeClerc A, Scarborough J, Grewal S, Jericho M, Dimitropoulos G, Pilon D. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord 2020; 8:4. [PMID: 32021688 PMCID: PMC6995106 DOI: 10.1186/s40337-020-0277-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline. METHODS Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders. RESULTS Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed. CONCLUSIONS Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Wendy Preskow
- National Initiative for Eating Disorders, Toronto, Canada
| | - Catherine Miller
- Canadian Mental Health Association - Waterloo, Wellington, Dufferin, Kitchener, Canada
| | | | | | | | | | | | | | - Catherine Ford
- 9Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Kerry Bourret
- 10St. Joseph's Care Group - Thunder Bay, Thunder Bay, Canada
| | | | - Josie Geller
- 6The Univeristy of British Columbia, Vancouver, Canada
| | | | | | - Jennifer Scarborough
- Canadian Mental Health Association - Waterloo, Wellington, Dufferin, Kitchener, Canada
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6
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Couturier J, Isserlin L, Spettigue W, Norris M. Psychotropic Medication for Children and Adolescents with Eating Disorders. Child Adolesc Psychiatr Clin N Am 2019; 28:583-592. [PMID: 31443877 DOI: 10.1016/j.chc.2019.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Psychotropic medications are commonly used in the treatment of eating disorders in children and adolescents. This article reviews the evidence base on psychotropic medications, including all randomized trials, uncontrolled trials, and case reports for the treatment of anorexia nervosa, bulimia nervosa, other specified feeding and eating disorders, binge-eating disorder, and avoidant/restrictive food intake disorder. Despite advances in the number of medication-based studies completed in young patients with eating disorders over the last 2 decades, significantly more work needs to be done in terms of identifying what role, if any, psychotropic medications can have on treatment outcomes.
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Affiliation(s)
- Jennifer Couturier
- McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
| | - Leanna Isserlin
- University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
| | - Wendy Spettigue
- University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
| | - Mark Norris
- University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
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Harada M, Amariglio N, Wills H, Koolwijk I. Feeding Issues in Young Children. Adv Pediatr 2019; 66:123-145. [PMID: 31230689 DOI: 10.1016/j.yapd.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Melissa Harada
- Department of Pediatrics, UCLA David Geffen School of Medicine, 300 UCLA Medical Plaza, Suite 3300, Los Angeles, CA 90095, USA
| | - Nelly Amariglio
- Department of General Pediatrics, Children's Hospital of Los Angeles, 4650 Sunset Boulevard, MS #53, Los Angeles, CA 90027, USA
| | - Hope Wills
- Department of Clinical Nutrition Services, Children's Hospital of Los Angeles, 4650 Sunset Boulevard, MS #53, Los Angeles, CA 90027, USA
| | - Irene Koolwijk
- Department of Pediatrics, UCLA David Geffen School of Medicine, 300 UCLA Medical Plaza, Suite 3300, Los Angeles, CA 90095, USA.
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Hoşoğlu E, Akça ÖF. Escitalopram in the Treatment of a 3-Year-Old Child with Posttraumatic Feeding Disorder. J Child Adolesc Psychopharmacol 2018; 28:153-154. [PMID: 29315010 DOI: 10.1089/cap.2017.0162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Esra Hoşoğlu
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University , Konya, Turkey
| | - Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University , Konya, Turkey
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9
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Sudden Onset of Refusal to Eat on Waking After a Nightmare in a 6-Year-Old Girl. J Dev Behav Pediatr 2017; 38 Suppl 1:S53-S55. [PMID: 28141722 DOI: 10.1097/dbp.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bridgette is a 6-year-old girl, who presented with sudden onset of refusal to eat or drink. The only precipitating event was a nightmare the previous night. She described a dream in which her mother and maternal aunt, dressed as witches, and father and maternal uncle, appearing as bats, wanted to kill her by making her eat and drink from a cauldron. Bridgette stated, "I can't eat anymore, I'm afraid of dying." Bridgette's eating pattern and behavior were described as previously normal. Motor, social, and language milestones were also normal. Her parents reported that she occasionally refused nonpreferred foods, and they believed that her food intake had decreased at age 4 years. She was a full-term infant without perinatal problems and breast fed until 8 months. Her medical history was significant for strabismus surgery, before 6 months. Her mental health history revealed mildly depressed mood and irritability related to teasing at school after her strabismus surgery. Her parents described her as "always looking for attention." Her teachers reported that she had normal intelligenceand described her behavior as shy, slightly withdrawn, and distrustful. Social history revealed an only child of married parents without marital or work-related problems. Bridgette went to her maternal grandmother's home after school and during school holidays.Her parents pleaded with her to eat, but she refused. She was evaluated at urgent care where her physical examination was described as normal. Her body mass index was above the 97th percentile (3 SD above the mean). The parents were described as fearful and despairing. Laboratory tests included a complete blood count with differential, an electroencephalogram, and a computed tomography scan, all of which were normal. Intravenous fluids were administered on the day of presentation and the following day. She continued to refuse to eat or drink, and after 2 days, she was hospitalized for nasogastric tube feeding.
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10
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Kim Y, Kim J, Cohen A, Backus M, Arnovitz M, Rice T, Luber MJ, Coffey BJ. Medication Nonadherence Secondary to Choking Phobia (Phagophobia) in an Adolescent with Significant Trauma History: Addressing the Issue of Mental Contamination. J Child Adolesc Psychopharmacol 2017. [PMID: 28930500 DOI: 10.1089/cap.2017.29138.bjc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Youngjung Kim
- 1 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Jungjin Kim
- 2 Department of Psychiatry, Emory University School of Medicine , Atlanta, Georgia
| | - Abigail Cohen
- 1 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Melissa Backus
- 1 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Mitchell Arnovitz
- 3 State University of New York Upstate Medical University , Syracuse, New York
| | - Timothy Rice
- 1 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Maxwell J Luber
- 1 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Barbara J Coffey
- 1 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
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11
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Dömötör S, Cserép M. Treatment methods of avoidant/restrictive food intake disorder: Review with therapeutic implications. PSIHIJATRIJA DANAS 2017. [DOI: 10.5937/psihdan1701005d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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12
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13
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Tanıdır C, Hergüner S. Mirtazapine for Choking Phobia: Report of a Pediatric Case. J Child Adolesc Psychopharmacol 2015; 25:659-60. [PMID: 26485089 DOI: 10.1089/cap.2015.0145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Canan Tanıdır
- 1 Child and Adolescent Psychiatry Clinic, Bakirkoy State Hospital for Mental Health and Neurological Disorders , Istanbul, Turkey
| | - Sabri Hergüner
- 2 Department of Child and Adolescent Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University , Konya, Turkey
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14
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Seiverling L, Burns J, Rodriguez J, Yamazaki H, Fernandez A, Yusupova S. The Effects of a Brief Behavioral Intervention on Food Refusal in a Child With a Fear of Choking. Clin Case Stud 2015. [DOI: 10.1177/1534650115602065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the effects of an exposure-based behavioral treatment on food refusal in a 4-year-old girl who developed a fear of choking after an acute choking episode. Prior to treatment, the child had stopped eating almost all solid foods for 3 months and was primarily consuming a chocolate-flavored pediatric formula. Treatment occurred across the span of 2 weeks and took place at a pediatric feeding program. At the end of treatment, the child accepted over 30 new foods and was no longer dependent on a pediatric formula to meet her nutritional needs.
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Affiliation(s)
| | - Justine Burns
- Early Bird Developmental Services, Charlotte, NC, USA
| | | | - Hiro Yamazaki
- St. Mary’s Healthcare System for Children, Bayside, NY, USA
| | - Ana Fernandez
- Helping Hands Children Services, Huntington, NY, USA
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15
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Kerzner B, Milano K, MacLean WC, Berall G, Stuart S, Chatoor I. A practical approach to classifying and managing feeding difficulties. Pediatrics 2015; 135:344-53. [PMID: 25560449 DOI: 10.1542/peds.2014-1630] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The objective is to allow the physician to efficiently sort out the wide variety of conditions, categorize them for therapy, and where necessary refer to specialists in the field.
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Affiliation(s)
- Benny Kerzner
- Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, and
| | - Kim Milano
- Pediatric Nutritional Consultant, Geneva, Illinois
| | - William C MacLean
- FAAP Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, College of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Glenn Berall
- Department of Paediatrics, North York General Hospital, Department of Paediatrics and Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sheela Stuart
- Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, and
| | - Irene Chatoor
- Psychiatry, Children's National Medical Center, The George Washington School of Medicine and Health Sciences, Washington, District of Columbia
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16
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Kardas M, Cermik BB, Ekmekci S, Uzuner S, Gökçe S. Lorazepam in the treatment of posttraumatic feeding disorder. J Child Adolesc Psychopharmacol 2014; 24:296-7. [PMID: 24813692 DOI: 10.1089/cap.2013.0149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Murat Kardas
- 1 Department of Pediatrics; Department of Pediatric Gastroenterology, Hepatology and Nutrition; and Department of Child and Adolescent Psychiatry, Bezmialem Vakif University , Istanbul, Turkey
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17
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A case of choking phobia: towards a conceptual approach. Eat Weight Disord 2014; 19:125-31. [PMID: 23888402 DOI: 10.1007/s40519-013-0048-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022] Open
Abstract
Choking phobia, also known as phagophobia or swallowing phobia is an uncommon clinical entity that has been underappreciated and is included in the new DSM-5 and upcoming ICD-11 diagnostic category of avoidant/restrictive food intake disorder. Phenomenologically distinct from other eating disorders, it is characterized by the phobic stimulus of swallowing that results in the avoidance of food or drinks, and ultimately to low weight, social withdrawal, anxiety and depression states. Its prevalence and long-term course on the general population still needs to be determined, probably reflecting years of indefiniteness regarding its nosology and by the absence of a clear set of diagnostic criteria. We present a clinical case of choking phobia in a 32-year-old male patient after an episode of choke when eating chicken. An early diagnosis and distinction from other eating disorders is important for proper treatment and fundamental for prognosis. We also make a thorough revision on literature in clinical features, differential diagnosis and treatment approaches, suggesting a conceptual approach for choking phobia as a clinical spectrum settled by different degrees of phobic subtypes, which may depend on a varied number of clinical variables.
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Abstract
This article describes the case of a 69-year-old man with a long history of swallowing difficulties and a past diagnosis of obsessive-compulsive disorder. He was seen for treatment by a speech-language pathologist and a clinical psychologist. Prior to treatment, he ate only one type of sweet dessert and some pureed foods, at restricted times of the day, and without others present. Treatment focused on increasing variety in his diet, increasing bolus size, reducing ritualistic and safety behaviors, and eating in social situations. Treatment methods included surface electromyographic biofeedback and systematic desensitization. After 19 months of treatment (49 sessions), the patient was able to eat a variety of soft/ground foods. He gained weight and was able to eat in social situations. At post-treatment, 8-month and 48-month follow-up, he reported being satisfied with his progress and did not wish to pursue further goals involving eating solid foods or increasing bolus size of liquids.
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Affiliation(s)
- Colleen Millikin
- University of Manitoba, Winnipeg, Canada
- Deer Lodge Centre, Winnipeg Regional Health Authority, Winnipeg, Canada
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19
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Sudden onset of refusal to eat on waking after a nightmare in a 6-year-old girl. J Dev Behav Pediatr 2012; 33:184-6. [PMID: 22227797 DOI: 10.1097/dbp.0b013e318244eb2f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bridgette is a 6-year-old girl, who presented with sudden onset of refusal to eat or drink. The only precipitating event was a nightmare the previous night. She described a dream in which her mother and maternal aunt, dressed as witches, and father and maternal uncle, appearing as bats, wanted to kill her by making her eat and drink from a cauldron. Bridgette stated, "I can't eat anymore, I'm afraid of dying." Bridgette's eating pattern and behavior were described as previously normal. Motor, social, and language milestones were also normal. Her parents reported that she occasionally refused nonpreferred foods, and they believed that her food intake had decreased at age 4 years. She was a full-term infant without perinatal problems and breast fed until 8 months. Her medical history was significant for strabismus surgery, before 6 months. Her mental health history revealed mildly depressed mood and irritability related to teasing at school after her strabismus surgery. Her parents described her as "always looking for attention." Her teachers reported that she had normal intelligence and described her behavior as shy, slightly withdrawn, and distrustful. Social history revealed an only child of married parents without marital or work-related problems. Bridgette went to her maternal grandmother's home after school and during school holidays.Her parents pleaded with her to eat, but she refused. She was evaluated at urgent care where her physical examination was described as normal. Her body mass index was above the 97th percentile (3 SD above the mean). The parents were described as fearful and despairing. Laboratory tests included a complete blood count with differential, an electroencephalogram, and a computed tomography scan, all of which were normal. Intravenous fluids were administered on the day of presentation and the following day. She continued to refuse to eat or drink, and after 2 days, she was hospitalized for nasogastric tube feeding.
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20
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León LA, Landeira-Fernandez J, Cardenas FP. Effects of chronic intracerebroventricular 3,4-methylenedioxy-N-methamphetamine (MDMA) or fluoxetine on the active avoidance test in rats with or without exposure to mild chronic stress. Behav Brain Res 2009; 205:259-64. [PMID: 19589359 DOI: 10.1016/j.bbr.2009.06.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 06/24/2009] [Accepted: 06/26/2009] [Indexed: 10/20/2022]
Abstract
In despite the similarity of mechanisms of action between both selective serotonin reuptake inhibitors (SSRI) and MDMA (main compound of "Ecstasy") there are relatively few reports on the effects of the later on animal models of depression. There are many animal models designed to create or to assess depression. Mild chronic stress (MCS) is a procedure designed to create depression. MCS includes the chronic exposure of the animal to several stressors. After that, rats show behavioural changes associated to depression. In the other hand, the active avoidance task (AAT) is an experimental situation in which an animal has to accomplish a particular behaviour in order to avoid the application of a stressor. Animals exhibiting depression fail to acquire avoidance responses as rapidly as normal animals do. In order to assess the effect of MDMA on the acquisition of an active avoidance response, forty-five rats were divided in two groups exposed or not exposed to MCS. Rats also received chronic intracerebroventricular MDMA (0.2microg/microl; 1microl), fluoxetine (2.0microg/microl; 1microl) or saline solution (0.9%; 1microl). Our results showed that the effect of MDMA depends upon the level of stress. MDMA treated animals showed better acquisition (F([2,37])=7.046; P=0.003) and retention (F([2,37])=3.900; P=0.029) of the avoidance response than fluoxetine or saline treated animals when exposed to MCS. This finding suggests that MDMA (and no fluoxetine) was able to change the aversive valence of the stressors maybe enhancing coping strategies. This effect could serve as a protective factor against helplessness and maybe post-traumatic stress.
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Affiliation(s)
- Laura A León
- Laboratory of Neuroscience and Behaviour, Department of Psychology, Universidad de los Andes, Cra 1 #18A-12, Bogotá, Colombia
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21
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Celik G, Diler RS, Tahiroglu AY, Avci A. Fluoxetine in posttraumatic eating disorder in two-year-old twins. J Child Adolesc Psychopharmacol 2007; 17:233-6. [PMID: 17489718 DOI: 10.1089/cap.2006.0057] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Feeding disorders of infancy or early childhood are relatively uncommon in the pediatric population. In posttraumatic eating disorder, the infant demonstrates food refusal after a traumatic event or repeated traumatic events to the oropharynx or esophagus. We present case reports of 24-month-old twin girls, A and B, who presented to our clinic with food refusal and fear of feeding. Several invasive gastrointestinal procedures were performed when they were 3 months old, and they started to refuse all solid food and some liquids soon after hospitalization. Fluoxetine 0.3 mg/kg per day (5 mg/day) was started to target their anxiety and fear about feeding. In the second month of weekly follow up, the children began to be fed without a nasogastric catheter. A significant decrease in anxiety and fear was observed during feeding. Although the use of serotonin-selective reuptake inhibitors (SSRIs) in preschool children is controversial due to the lack of empirical data in this age group, we observed clinical improvements in anxiety in these two cases. Furthermore, fluoxetine was well tolerated and no side effects were observed.
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Affiliation(s)
- Gonca Celik
- Department of Child and Adolescent Psychiatry, Cukurova University, Adana, Turkey 01330
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