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Norris ML, Spettigue W, Obeid N. Pragmatic clinical trials to advance research in children and adolescents with eating disorders. Int J Eat Disord 2024. [PMID: 38578194 DOI: 10.1002/eat.24209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To discuss the utility of pragmatic clinical trials (PCTs) to help advance research in eating disorders (EDs). METHODS We describe challenges associated with traditional explanatory research trials and examine PCTs as an alternative, including a review of the PRECIS-2 tool. RESULTS There are many challenges associated with the design and completion of traditional RCTs within the field of EDs. Pragmatic clinical trials are studies that closely align with conditions available in everyday practice and focus on outcomes that are relevant to patients and clinicians. Results of PCTS maximize applicability and generalizability to clinical settings. DISCUSSION Available therapies established for the treatment of EDs provide remission rates that rarely exceed 50%, implying a need for additional research on new or adjunctive treatments. In addition to a general overview of PCTs, we draw upon published literature and our own experiences involving adjunctive olanzapine for the treatment of children and youth with anorexia nervosa to help highlight challenges associated with randomized controlled trial (RCT) design and implementation, and offer pragmatic suggestions that would allow patients greater choice in treatment trials, while at the same time capturing outcomes that are most likely to advance treatment efforts. CONCLUSIONS Pragmatic clinical trials provide alternatives to RCT design that can help bolster research in EDs that aims to explore real-world effects of interventions. PUBLIC SIGNIFICANCE Available therapies established for the treatment of eating disorders (EDs) in children and adolescents provide remission rates that rarely exceed 50%, implying a need for additional research on new or adjunctive treatments. In this article, we discuss the utility of pragmatic trials to help promote research that can help advance knowledge that is relevant to clinical care settings.
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Affiliation(s)
- Mark L Norris
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicole Obeid
- CHEO Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
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Couturier JL, Kimber M, Ford C, Coelho JS, Dimitropoulos G, Kurji A, Boman J, Isserlin L, Bond J, Soroka C, Dominic A, Boachie A, McVey G, Norris M, Obeid N, Pilon D, Spettigue W, Findlay S, Geller J, Grewal S, Gusella J, Jericho M, Johnson N, Katzman D, Chan N, Grande C, Nicula M, Clause-Walford D, Leclerc A, Loewen R, Loewen T, Steinegger C, Waite E, Webb C, Brouwers M. A study protocol for implementing Canadian Practice Guidelines for Treating Children and Adolescents with Eating Disorders. Implement Sci Commun 2024; 5:5. [PMID: 38183084 PMCID: PMC10768347 DOI: 10.1186/s43058-023-00538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake. METHODS Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8-10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups. DISCUSSION Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies.
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Affiliation(s)
- Jennifer L Couturier
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
| | - Melissa Kimber
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sheri Findlay
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Josie Geller
- University of British Columbia, Vancouver, Canada
| | - Seena Grewal
- University of British Columbia, Vancouver, Canada
| | | | | | - Natasha Johnson
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | | | | | - Maria Nicula
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Drew Clause-Walford
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | | | | | | | | | - Cheryl Webb
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, 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. Can Fam Physician 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
OBJECTIVE To address screening, diagnosis, and treatment of adolescents with anorexia nervosa and atypical anorexia nervosa in primary care. SOURCES OF INFORMATION A literature search was conducted in PubMed using the subject headings anorexia nervosa, adolescents, COVID-19, review, guidelines, and primary care. Applicable articles were reviewed, with key recommendations summarized. Most evidence is level I. MAIN MESSAGE Recent studies suggest that the global COVID-19 pandemic contributed to an increase in the incidence of eating disorders, particularly among teenagers. This has resulted in increasing responsibility for primary care providers regarding the assessment, diagnosis, and management of these disorders. Moreover, primary care providers are in ideal positions to identify adolescents at risk of eating disorders. Early intervention is of utmost importance for avoiding long-term health consequences. High rates of atypical anorexia nervosa indicate a need for providers to have awareness of weight biases and stigmas. Treatment primarily involves a combination of renourishment and psychotherapy, generally through family-based therapy, with pharmacotherapy playing a lesser role. CONCLUSION Anorexia nervosa and atypical anorexia nervosa are serious, potentially life-threatening illnesses that are best addressed through early detection and treatment. Family physicians are in an optimal position to screen for, diagnose, and treat these illnesses.
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Affiliation(s)
| | - Wendy Spettigue
- Associate Professor in the Department of Psychiatry at the University of Ottawa in Ontario and a child and adolescent psychiatrist at the Children's Hospital of Eastern Ontario
| | - Mark L Norris
- Professor of Pediatrics at the University of Ottawa and an adolescent health physician at the Children's Hospital of Eastern Ontario
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Katzman DK, Guimond T, Spettigue W, Agostino H, Couturier J, Norris ML. Classification of Children and Adolescents With Avoidant/Restrictive Food Intake Disorder. Pediatrics 2022; 150:188739. [PMID: 35945342 DOI: 10.1542/peds.2022-057494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence suggests that children and adolescents with avoidant/restrictive food intake disorder (ARFID) have heterogeneous clinical presentations. To use latent class analysis (LCA) and determine the frequency of various classes in pediatric patients with ARFID drawn from a 2-year surveillance study. METHODS Cases were ascertained using the Canadian Pediatric Surveillance Program methodology from January 1, 2016, to December 31, 2017. An exploratory LCA was undertaken with latent class models ranging from 1 to 5 classes. RESULTS Based on fit statistics and class interpretability, a 3-class model had the best fit: Acute Medical (AM), Lack of Appetite (LOA), and Sensory (S). The probability of being classified as AM, LOA, and S was 52%, 40.7%, and 6.9%, respectively. The AM class was distinct for increased likelihood of weight loss (92%), a shorter length of illness (<12 months) (66%), medical hospitalization (56%), and heart rate <60 beats per minute (31%). The LOA class was distinct for failure to gain weight (97%) and faltering growth (68%). The S class was distinct for avoiding certain foods (100%) and refusing to eat because of sensory characteristics of the food (100%). Using posterior probability assignments, a mixed group AM/LOA (n = 30; 14.5%) had characteristics of both AM and LOA classes. CONCLUSIONS This LCA suggests that ARFID is a heterogeneous diagnosis with 3 distinct classes corresponding to the 3 subtypes described in the literature: AM, LOA, and S. The AM/LOA group had a mixed clinical presentation. Clinicians need to be aware of these different ARFID presentations because clinical and treatment needs will vary.
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Affiliation(s)
- Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Tim Guimond
- Rainbow Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Holly Agostino
- Division of Adolescent Medicine, Department of Pediatrics, Montreal Children's Hospital and McGill University, Montreal, Quebec, Canada
| | - Jennifer Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Mark L Norris
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
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Katzman DK, Spettigue W, Agostino H, Couturier J, Dominic A, Findlay SM, Lam PY, Lane M, Maguire B, Mawjee K, Parikh S, Steinegger C, Vyver E, Norris ML. Incidence and Age- and Sex-Specific Differences in the Clinical Presentation of Children and Adolescents With Avoidant Restrictive Food Intake Disorder. JAMA Pediatr 2021; 175:e213861. [PMID: 34633419 PMCID: PMC8506291 DOI: 10.1001/jamapediatrics.2021.3861] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE To our knowledge, this is the first pediatric surveillance study of children and adolescents with avoidant restrictive food intake disorder (ARFID). OBJECTIVES To examine the incidence and age- and sex-specific differences in the clinical presentation of ARFID in children and adolescents in Canada. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, patients with ARFID were identified through the Canadian Paediatric Surveillance Program by surveying 2700 Canadian pediatricians monthly from January 1, 2016, to December 31, 2017. MAIN OUTCOMES AND MEASURES The incidence of ARFID in Canadian children (5-18 years of age) and age- and sex-specific clinical characteristics at presentation. RESULTS In total, 207 children and adolescents (mean [SD] age, 13.1 [3.2] years; 127 [61.4%] female) were included in this study. The incidence of ARFID in children 5 to 18 years of age was 2.02 (95% CI, 1.76-2.31) per 100 000 patients. Older children and adolescents were more likely to endorse eating too little (5-9 years of age: 76.7%; 95% CI, 58%-88.6; 10-14 years of age: 90.9%; 95% CI, 84.6%-94.8%; 15-18 years of age: 95.6%; 95% CI, 83.6%-98.9%; P = .02), have a loss of appetite (5-9 years of age: 53.3%; 95% CI, 35.4%-70.4%; 10-14 years of age: 74.2%; 95% CI, 66.0%-81.0%; 15-18 years of age: 80.0%; 95% CI, 65.5%-89.4%; P = .03), be medically compromised (mean body mass index z score: 10-14 vs 5-9 years of age: -1.31; 95% CI, -2.0 to -0.6; 15-18 vs 5-9 years of age: -1.35; 95% CI, -2.2 to -0.5; 15-18 vs 10-14 years of age: -0.04; 95% CI, -0.6 to 0.5; P < .001; mean percentage of treatment goal weight: 10-14 vs 5-9 years of age: -8.6; 95% CI, -14.3 to -2.9; 15-18 vs 5-9 years of age: -9.8; 95% CI, -16.3 to -3.3; 15-18 vs 10-14 years of age: -1.2; 95% CI, -5.8 to 3.4; P < .001; mean heart rate (beats per min): 10-14 vs 5-9 years of age: -10; 95% CI, -21.9 to 1.9; 15-18 vs 5-9 years of age: -19.7; 95% CI, -33.1 to -6.2; 15-18 vs 10-14 years of age: -9.7; 95% CI, -18.7 to -0.7; P = .002), have higher rates of anxiety (5-9 years of age: 26.7%; 95% CI, 13.7-45.4; 10-14 years of age: 52.3%; 95% CI, 43.7%-60.7%; 15-18 years of age: 53.3%; 95% CI, 38.6%-67.5%; P = .03) and depression (5-9 years of age: 0%; 10-14 years of age: 6.8%; 95% CI, 3.6%-12.7%; 15-18 years of age: 26.7%; 95% CI, 15.7%-41.6%; P < .001), and be more likely to be hospitalized (5-9 years of age: 13.3%; 95% CI, 5.0%-31.1%; 10-14 years of age: 41.7%; 95% CI, 33.5%-50.3%; 15-18 years of age: 55.6%; 95% CI, 40.7%-69.5%; P = .001). Younger children were more likely to endorse lack of interest in food (5-9 years of age: 56.7%; 95% CI, 38.4%-73.2%; 10-14 years of age: 75.0%; 95% CI, 66.8%-81.7%; 15-18 years of age: 57.8%; 95% CI, 42.8%-71.4%; P = .03), avoidance of certain foods (5-9 years of age: 90.0%; 95% CI, 72.6%-96.8%; 10-14 years of age: 69.7%; 95% CI, 61.3%-77.0%; 15-18 years of age: 62.2%; 95% CI, 47.2%-75.3%; P = .03), and refusal based on sensory characteristics (5-9 years of age: 66.7%; 95% CI, 47.9%-81.3%; 10-14 years of age: 38.6%; 95% CI, 30.7%-47.3%; 15-18 years of age: 22.2%; 95% CI, 12.3%-36.9%; P < .001). Eating but not enough was more common in girls (75.0%; 95% CI, 64.1%-83.4%) vs boys (68.5%; 95% CI, 59.8%-76.1; P = .04), and boys had a higher rate of refusal based on sensory characteristics (51.2%; 95% CI, 40.2%-62.2%) compared with girls (31.5%; 95% CI, 23.9%-40.2%; P = .007). CONCLUSIONS AND RELEVANCE This study suggests that ARFID is a relatively common eating disorder and is associated with important age- and sex- specific clinical characteristics that may help in early recognition and timely treatment of the presenting symptoms.
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Affiliation(s)
- Debra K. Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Wendy Spettigue
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Holly Agostino
- Montreal Children’s Hospital and McGill University Health Center, Montreal, Quebec, Canada
| | - Jennifer Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Anna Dominic
- Janeway Children’s Health & Rehabilitation Centre, Eastern Health, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Sheri M. Findlay
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Pei-Yoong Lam
- BC Children’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Margo Lane
- Winnipeg Health Sciences Centre and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bryan Maguire
- Biostatistics, Design and Analysis, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karizma Mawjee
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada,Now with KPMG LLP (Canada), Toronto, Ontario, Canada
| | - Supriya Parikh
- Biostatistics, Design and Analysis, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cathleen Steinegger
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ellie Vyver
- Alberta Children’s Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Mark L. Norris
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Couturier J, Pellegrini D, Miller C, Bhatnagar N, Boachie A, Bourret K, Brouwers M, Coelho JS, Dimitropoulos G, Findlay S, Ford C, Geller J, Grewal S, Gusella J, Isserlin L, Jericho M, Johnson N, Katzman DK, Kimber M, Lafrance A, Leclerc A, Loewen R, Loewen T, McVey G, Norris M, Pilon D, Preskow W, Spettigue W, Steinegger C, Waite E, Webb C. The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond. J Eat Disord 2021; 9:46. [PMID: 33863388 PMCID: PMC8050997 DOI: 10.1186/s40337-021-00394-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/11/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond. METHODS Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers. RESULTS Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended. CONCLUSIONS Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.
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Affiliation(s)
- Jennifer Couturier
- McMaster University, Hamilton, ON, Canada.
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.
| | | | - Catherine Miller
- Canadian Mental Health Association - Waterloo Wellington, Waterloo, ON, Canada
| | | | | | - Kerry Bourret
- St. Joseph's Care Group - Thunder Bay, Thunder Bay, ON, Canada
| | | | | | | | - Sheri Findlay
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Catherine Ford
- Ontario Ministry of Health and Long-Term Care, Toronto, ON, Canada
| | - Josie Geller
- The University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Natasha Johnson
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | | | | | | | - Anick Leclerc
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | | | | | - Gail McVey
- University of Toronto, Toronto, ON, Canada
| | | | | | - Wendy Preskow
- National Initiative for Eating Disorders, Toronto, ON, Canada
| | | | | | | | - Cheryl Webb
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
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Chubbs-Payne A, Lee J, Isserlin L, Norris ML, Spettigue W, Spence K, Longmuir PE. Attitudes toward physical activity as a treatment component for adolescents with anorexia nervosa: An exploratory qualitative study of patient perceptions. Int J Eat Disord 2021; 54:336-345. [PMID: 33185901 DOI: 10.1002/eat.23411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/15/2020] [Accepted: 10/31/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) with compulsive exercise is associated with poor treatment outcomes. This study sought to understand the attitudes of adolescents with AN from various stages of treatment, toward physical activity research practices and physical activity as a component of treatment. METHOD Seventeen adolescents 12-18 years old (15 female) with AN (10 with acknowledged history of compulsive exercise) were recruited from a Canadian Tertiary Care Hospital's Eating Disorder Program. Six inpatients, 5-day program patients, and six outpatients treated by either the inpatient and/or day treatment program in the past 2 years completed individual, semi-structured interviews that were audio-recorded and transcribed. Results were analyzed deductively using qualitative techniques. RESULTS Participants recognized both benefits (psychological, sociological, and physiological) and risks (trigger negative thoughts, increase competitive behavior) of implementing physical activity into acute AN treatment. Patient characteristics, such as stage of treatment and exercise history, had an impact on participants' perceptions toward physical activity in AN. Participants suggested that the ideal physical activity program would be focused on fun, individualized and progressively integrated, group-based, and directly supported by staff. Although the majority of participants stated that they would wear an activity monitor for research purposes, concerns were voiced regarding compliance and the potential impact on eating disorder symptomatology. DISCUSSION Participants overwhelmingly supported the careful implementation of structured physical activity and physical activity psychoeducation into the acute treatment of adolescents with AN. This study allows for the inclusion of patient voices in the conversation surrounding the role of physical activity in AN treatment.
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Affiliation(s)
- Adam Chubbs-Payne
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Paediatrics, University of Ottawa's Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jacqueline Lee
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Leanna Isserlin
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Mark L Norris
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Kelly Spence
- Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Paediatrics, University of Ottawa's Faculty of Medicine, Ottawa, Ontario, Canada
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Obeid N, Valois DD, Bedford S, Norris ML, Hammond NG, Spettigue W. Asceticism, perfectionism and overcontrol in youth with eating disorders. Eat Weight Disord 2021; 26:219-225. [PMID: 31916047 DOI: 10.1007/s40519-019-00837-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Personality traits such as perfectionism and asceticism, and combinations of these traits (i.e., overcontrol) have been related to eating disorder (ED) diagnosis, symptoms, and chronicity in adult patients with EDs. However, as limited evidence exists in adolescents, the aim of the present study was to examine these links in a clinical sample of adolescents with EDs. METHOD A retrospective chart review was conducted on 178 adolescents (91% females; Mage = 15.73 years, SD = 1.31) receiving services at a tertiary care pediatric ED program. An examination of variability in mean levels of perfectionism, asceticism, and overcontrol across ED symptom groups (restrictive and binge/purge ED subtypes) was conducted to learn of diagnostic differences, while correlations were used to explore the association of these personality traits with comorbid anxiety and depressive symptoms. Hierarchical linear regression was used to assess whether overcontrol was related to length of stay (LOS) in an inpatient program. RESULTS Results indicated that adolescents with binge-purge symptoms had higher levels of perfectionism, asceticism and overcontrol compared to those with restrictive symptoms, and that greater levels of perfectionism, asceticism and overcontrol were associated with elevated depression and anxiety symptoms. Additionally, overcontrol predicted greater LOS in the inpatient ED program. CONCLUSION Results suggest the importance of assessing, monitoring and targeting overcontrol in treatment for adolescents with EDs given its impact on comorbid symptoms and LOS. LEVEL OF EVIDENCE Level III, evidence obtained from case-control analytic studies.
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Affiliation(s)
- Nicole Obeid
- Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. .,Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Darcie D Valois
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | | | - Mark L Norris
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.,Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, K1H 8L, Canada
| | - Nicole G Hammond
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, K1H 8L1, Canada
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10
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Norris ML, Obeid N, Santos A, Valois DD, Isserlin L, Feder S, Spettigue W. Treatment Needs and Rates of Mental Health Comorbidity in Adolescent Patients With ARFID. Front Psychiatry 2021; 12:680298. [PMID: 34349680 PMCID: PMC8327955 DOI: 10.3389/fpsyt.2021.680298] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022] Open
Abstract
The purpose of this paper is to provide a descriptive overview of a single-center ARFID-specific pilot clinic that sought to better understand the specific needs of patients with ARFID including rates of comorbidities, and to gain insight into treatment requirements. A retrospective cohort study was completed on patients meeting criteria for ARFID admitted to a specialized pilot clinic within a tertiary care hospital. Over an 18 month period, a total of 26 patients were assessed and had follow-up data for a 12 month period. Patients presented with heterogeneous manifestations of ARFID and high rates of comorbid mood and anxiety disorders were noted. Treatment plans were tailored to meet individual needs at assessment and over the treatment period. A multidisciplinary approach was most often administered, including a combination of individual therapy, family therapy, medical monitoring, and prescribed medications. Only 30% of patients were treated exclusively by therapists on the eating disorder team. The experiences gained from this pilot study highlight the need for specialized resources for assessment and treatment of patients with ARFID, the importance of a multidisciplinary approach to treatment, and the necessity of utilization of ARFID-specific measures for program evaluation purposes.
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Affiliation(s)
- Mark L Norris
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Alexandre Santos
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Darcie D Valois
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Leanna Isserlin
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Stephen Feder
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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11
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Obeid N, Norris ML, Valois DD, Buchholz A, Goldfield GS, Hadjiyannakis S, Henderson KA, Flament M, Hammond NG, Dunn J, Spettigue W. Bingeing, Purging, and Suicidal Ideation in Clinical and Non-Clinical Samples of Youth. Eat Disord 2020; 28:289-307. [PMID: 31314685 DOI: 10.1080/10640266.2019.1642033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Suicidal ideation is a serious mental health concern reported by adolescents. Despite understanding of increased suicidal ideation in patients with eating disorders (EDs) and obesity, few studies have compared how disordered eating (bingeing, vomiting and over exercising) is associated with suicidal ideation in clinical and non-clinical samples of youth across the ED and weight spectrum. The present study aimed to 1) comparatively examine rates of suicidal ideation and disordered eating behaviors in clinical samples of youth with EDs, complex obesity, or from the community, and 2) examine whether disordered eating was associated with suicidal ideation above and beyond age, body mass index, diagnosis, treatment-seeking status, and depressive symptoms in large samples of males vs. females in an attempt to understand whether these behaviors should lead to concern regarding suicidal ideation. Data from charts on treatment-seeking adolescents diagnosed with either an ED (N = 315), severe complex obesity (N = 212), and from the community (N = 3036) were pooled together for comparative purposes. Results showed that suicidal ideation was higher in youth seeking treatment for an ED (50.2%) and obesity (23.7%) as compared to youth from the community (13%). Binary logistic regression analyses revealed that vomiting (OR = 1.73 for females, 8.17 for males) and over-exercising (OR = 1.47 for females, 1.68 for males) was significantly associated with suicidal ideation in both males and females. Findings underscore the importance of screening for suicidal ideation in youth who report vomiting or over-exercising despite diagnostic presentation, age, weight, or treatment setting.
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Affiliation(s)
- Nicole Obeid
- Eating Disorders program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Mark L Norris
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Darcie D Valois
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Annick Buchholz
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Gary S Goldfield
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Stasia Hadjiyannakis
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Martine Flament
- Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Nicole G Hammond
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jessica Dunn
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Wendy Spettigue
- Eating Disorders program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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12
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Spettigue W, Aldaqqaq Z, Isserlin L, Bishop B, Norris ML, Valois D, Obeid N. A Brief Modified Family-Based Treatment Intervention for Youth With Mild Eating Disorders: A Case Series. Front Psychiatry 2020; 11:105. [PMID: 32210848 PMCID: PMC7066491 DOI: 10.3389/fpsyt.2020.00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family-based treatment (FBT), an outpatient treatment which is typically offered for 6-12 months by specially trained therapists, is currently the first line treatment for adolescent anorexia nervosa and bulimia nervosa. The success of FBT for adolescents with moderate to severe eating disorders indicates a potential use for a short course of modified FBT which could be offered as an early intervention by nonspecialized community mental health counselors to adolescents with mild or subsyndromal eating disorders. METHODS In 2016, seven adolescents with mild eating disorders underwent a brief intervention in the form of five FBT-inspired therapy sessions (called 'DREAMS' sessions). The DREAMS sessions consisted of five replicable family sessions given over 6 weeks, each with a specific area of focus for treatment, such as nutrition and eating disorder symptoms, mood, relationships and anxiety. Charts of these seven patients were reviewed in 2019 to determine whether this treatment might be worthy of further study. RESULTS Based on a review of the progress notes, all seven patients reported an improvement in intake, a decrease in ED symptoms and an improvement in mood by the end of the sessions. All seven families reported that the sessions had been beneficial. CONCLUSION Early intervention is recommended for adolescents who present in the early stages of an eating disorder, yet there are no guidelines to recommend which treatment should be offered to this population. Further research is required to determine whether a short course of modified FBT, such as these five FBT-inspired 'DREAMS' sessions, may be an effective intervention to offer to youth who present with mild eating disorders.
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Affiliation(s)
- Wendy Spettigue
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Zizo Aldaqqaq
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Leanna Isserlin
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Brittany Bishop
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Mark L Norris
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Darcie Valois
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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13
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Isserlin L, Spettigue W, Norris M, Couturier J. Outcomes of inpatient psychological treatments for children and adolescents with eating disorders at time of discharge: a systematic review. J Eat Disord 2020; 8:32. [PMID: 32637099 PMCID: PMC7333407 DOI: 10.1186/s40337-020-00307-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/28/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Recommended first line treatment for children and adolescent eating disorders is outpatient therapy. However, a significant number of children and adolescents with eating disorders continue to require inpatient treatment during the course of their illness. The effect of psychological treatments in an inpatient setting on outcomes at the time of discharge remains unclear. This paper presents the results of a review of the literature on outcomes at the time of discharge following inpatient psychological treatment for children and adolescents with eating disorders. MAIN BODY The majority of studies found were observational and of low quality. The most consistently reported positive outcome of inpatient treatment is weight gain. Results related to symptom change and motivation vary between studies. Within the inpatient setting, there is considerable heterogeneity in the types of treatments offered, goals of treatment, length of stay and outcomes measured. CONCLUSION There remains a paucity of high-quality studies examining the effect of psychological treatments provided to children and adolescents in an inpatient setting. The significant heterogeneity between studies makes it not possible to compare across studies. Future research should aim to resolve these deficiencies in order to better determine the specific factors that contribute to positive outcomes of inpatient treatment for children and adolescents with eating disorders.
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Affiliation(s)
- Leanna Isserlin
- Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H 8L1 Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1 Canada
| | - Wendy Spettigue
- Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H 8L1 Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1 Canada
| | - Mark Norris
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1 Canada.,Division of Adolescent Health, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H 8L1 Canada
| | - Jennifer Couturier
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8N3Z5 Canada
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Norris ML, Santos A, Obeid N, Hammond NG, Valois DD, Isserlin L, Spettigue W. Characteristics and clinical trajectories of patients meeting criteria for avoidant/restrictive food intake disorder that are subsequently reclassified as anorexia nervosa. Eur Eat Disord Rev 2019; 28:26-33. [PMID: 31833147 DOI: 10.1002/erv.2710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/10/2019] [Accepted: 09/28/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the initial assessment profiles and early treatment trajectories of youth meeting the criteria for avoidant/restrictive food intake disorder (ARFID) that were subsequently reclassified as anorexia nervosa (AN). METHOD A retrospective cohort study of patients assessed and treated in a tertiary care eating disorders (ED) program was completed. RESULTS Of the 77 included patients initially meeting criteria for ARFID, six were reclassified as having AN (7.8%) at a median rate of 71 days after the first assessment. Patients in this cohort presented at very low % treatment goal weight (median 71.6%), self-reported abbreviated length of illness (median 6 months), and exhibited low resting heart rates (median 46 beats per minute). Nutrition and feeding focused worries related more to general health as opposed to specific weight and shape concerns or fears at assessment in half of those reclassified with AN. Treatment at the 6-month mark varied among patients, but comprised family and individual therapy, as well as prescription of psychotropic medication. CONCLUSION Prospective longitudinal research that utilizes ARFID-specific as well as traditional eating disorder diagnostic measures is required to better understand how patients with restrictive eating disorders that deny fear of weight gain can be differentiated and best treated.
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Affiliation(s)
- Mark L Norris
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Alexandre Santos
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicole G Hammond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Darcie D Valois
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Leanna Isserlin
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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16
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Spettigue W, Norris ML, Douziech I, Henderson K, Buchholz A, Valois DD, Hammond NG, Obeid N. Feasibility of Implementing a Family-Based Inpatient Program for Adolescents With Anorexia Nervosa: A Retrospective Cohort Study. Front Psychiatry 2019; 10:887. [PMID: 31849732 PMCID: PMC6901823 DOI: 10.3389/fpsyt.2019.00887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Manualized Family Based Therapy (FBT) is the treatment of choice for adolescent anorexia nervosa, but it is an outpatient treatment. Very little research has examined whether or how the principles of FBT might be successfully adapted to an inpatient setting, and there is little other evidence in the literature to guide us on how to best treat children and adolescents with eating disorders (EDs) while in hospital. This paper describes and provides treatment outcomes for an intensive inpatient program that was designed for the treatment of adolescents less than 18 years of age with severe anorexia nervosa, based on the principles of FBT. Each patient's family was provided with FBT adapted for an inpatient setting for the duration of the admission. Parents were encouraged to provide support for all meals in hospital and to plan meal passes out of hospital. Methods: A retrospective cohort study was conducted that examined the outcomes of 153 female patients admitted over a 5-year period. Outcome data focused primarily on weight change as well as psychological indicators of health (i.e., depression, anxiety, ED psychopathology). Results: Paired t-tests with Bonferroni corrections showed significant weight gain associated with a large effect size. In addition, patients showed improvements in scores of mood, anxiety, and ED psychopathology (associated with small to medium effect sizes), though they continued to display high rates of body dissatisfaction and some ongoing suicidality at the time of discharge. Conclusion: This study shows that a specialized inpatient program for adolescents with severe EDs that was created using the principles of FBT results in positive short-term medical and psychological improvements as evidenced by improved weight gain and decreased markers of psychological distress.
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Affiliation(s)
- Wendy Spettigue
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Mark L. Norris
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Ingrid Douziech
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | | | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Darcie D. Valois
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicole G. Hammond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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17
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Obeid N, Norris ML, Buchholz A, Hadjiyannakis S, Spettigue W, Flament MF, Henderson KA, Goldfield GS. Development of the Ottawa Disordered Eating Screen for Youth: The ODES-Y. J Pediatr 2019; 215:209-215. [PMID: 31610932 DOI: 10.1016/j.jpeds.2019.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To develop a concise screening tool that allows for early identification of disordered eating in youth. STUDY DESIGN In this 2-step classification accuracy study, questions for the Ottawa Disordered Eating Screen-Youth, a 2-question screening tool (index test), were conceptualized by clinician-scientists from tertiary care pediatric eating disorder and weight-related clinics, and was validated using retrospective data (2004-2010) from a community-based study, the Research on Eating and Adolescent Lifestyles (REAL) study. RESULTS Analyses of contrast between the index test and the reference standard using data from 2892 (1714 females) students between grade 7 and grade 12 revealed classification statistics of 67.1% for sensitivity, 85.9% for specificity, 4.7 for positive likelihood ratio, 0.38 for negative likelihood ratio, 50.6% for positive predictive value, and 92.4% for negative predictive value for females and 61.1% for sensitivity, 93.9% for specificity, and 9.9 for positive likelihood ratio, 0.41 for negative likelihood ratio, 32.3% for positive predictive value, and 98.0% for negative predictive value for males. CONCLUSIONS Our findings suggest that the index test has utility as a short and accurate screening tool for earlier detection of disordered eating thoughts and behaviors in youth. Additional research is needed to best determine how the index test can be administered to youth across various health care, school, public health, and surveillance settings in clinically sensitive pragmatic ways.
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Affiliation(s)
- Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
| | - Mark L Norris
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Psychology, Carleton University, Ottawa, Ontario, Canada; Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Stasia Hadjiyannakis
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Martine F Flament
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Gary S Goldfield
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Department of Psychology, Carleton University, Ottawa, Ontario, Canada
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18
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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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19
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Harrison ME, Norris ML, Robinson A, Spettigue W, Morrissey M, Isserlin L. Use of cyproheptadine to stimulate appetite and body weight gain: A systematic review. Appetite 2019; 137:62-72. [DOI: 10.1016/j.appet.2019.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 02/05/2023]
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20
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Dupuis LL, Flank J, Schechter T, Dvorak CC, Sung L, Spettigue W. Comment on: Olanzapine for chemotherapy-induced nausea: Lessons learned from child and adolescent psychiatry. Pediatr Blood Cancer 2019; 66:e27456. [PMID: 30207056 DOI: 10.1002/pbc.27456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022]
Affiliation(s)
- L Lee Dupuis
- Research Institute and Department of Pharmacy, The Hospital for Sick Children and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Jacqueline Flank
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada
| | - Tal Schechter
- Department of Medicine, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Christopher C Dvorak
- Department of Medicine, Division of Pediatric Allergy, Immunology & Bone Marrow Transplantation, Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Lillian Sung
- Department of Medicine, Division of Haematology/Oncology and Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Wendy Spettigue
- Department of Medicine, Hospital-based Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Spettigue W, Norris ML, Santos A, Obeid N. Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments. J Eat Disord 2018; 6:20. [PMID: 30123505 PMCID: PMC6091012 DOI: 10.1186/s40337-018-0205-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To date, little research has examined the effectiveness of either modified Family-Based Therapy or psychopharmacological treatments for patients diagnosed with avoidant/restrictive food intake disorder (ARFID), and there is little evidence to guide clinicians treating children and adolescents with ARFID. This case series describes the clinical presentations, treatments and outcomes of six patient diagnosed with ARFID who were treated sequentially by a child psychiatrist and adolescent medicine physician in a hospital-based eating disorder program. CASE PRESENTATIONS Five out of six cases were female and median age of patients at assessment was 12.9 (SD = 1.13) years. On average, patients' percentage of treatment goal weight was 80.5% at initial assessment (SD = 8.56) and 81.9% (SD = 7.08) when family therapy began. Cases 1, 2 and 3 were admitted to a specialized inpatient unit at assessment due to medical instability (2) or failed outpatient treatment (1), and all six cases presented with severe co-morbid anxiety. All patients were treated using a combination of medical monitoring, family therapy, medication (including olanzapine, fluoxetine and in two cases cyproheptadine), and cognitive behavioural therapy. At treatment termination, all six patients had achieved their goal weight. CONCLUSION These cases illustrate the complex ways in which young patients with ARFID can present, the illness' effect on development and mental health, and the positive outcomes associated with weight gain and concurrent treatment for co-morbid anxiety disorders.
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Affiliation(s)
- Wendy Spettigue
- Department of Psychiatry, Children’s Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
- Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 5B2 Canada
| | - Mark L. Norris
- Division of Adolescent Health, Department of Pediatrics, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
- Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 5B2 Canada
| | - Alexandre Santos
- Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 5B2 Canada
| | - Nicole Obeid
- Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 5B2 Canada
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Spettigue W, Norris ML, Maras D, Obeid N, Feder S, Harrison ME, Gomez R, Fu MC, Henderson K, Buchholz A. Evaluation of the Effectiveness and Safety of Olanzapine as an Adjunctive Treatment for Anorexia Nervosa in Adolescents: An Open-Label Trial. J Can Acad Child Adolesc Psychiatry 2018; 27:197-208. [PMID: 30038658 PMCID: PMC6054282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the effectiveness and safety of adjunctive olanzapine treatment for low weight adolescents with anorexia nervosa (AN). METHODS A non-randomized open-label trial was conducted between 2010 and 2014. Participants received standard treatment and were invited to take olanzapine at study enrollment. Participants could accept, continue, or discontinue olanzapine as treatment progressed. Weight and psychological outcomes were monitored. RESULTS Of 239 adolescents assessed, 65 met inclusion criteria, 38 enrolled in the study, and 32 were retained for analysis. Twenty-two participants took olanzapine (medication group) and ten participants did not (comparison group). Participants in the medication group demonstrated a higher rate of weight gain compared to those who did not receive olanzapine (p = .012). No serious adverse events were noted, although seven participants (31.8%) discontinued olanzapine due to a side effect. CONCLUSION Preliminary results suggest that olanzapine may help facilitate weight gain in adolescents with AN. The importance of medical monitoring over the course of treatment is discussed. Evaluation of the Efficacy and Safety of Olanzapine for Anorexia Nervosa in Children and Adolescents; http://clinicaltrials.gov; NCT01184443.
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Affiliation(s)
- Wendy Spettigue
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario
- Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Mark L Norris
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario
| | | | - Nicole Obeid
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Stephen Feder
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario
| | - Megan E Harrison
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario
| | - Rebecca Gomez
- Department of Psychiatry, University of Ottawa, Ontario
| | | | | | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Centre for Health Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario
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Norris ML, Spettigue W, Hammond NG, Katzman DK, Zucker N, Yelle K, Santos A, Gray M, Obeid N. Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder. Int J Eat Disord 2018; 51:170-173. [PMID: 29215749 DOI: 10.1002/eat.22814] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine characteristics of patients with Avoidant/Restrictive Food Intake Disorder (ARFID) in an effort to identify and describe subtypes of the disorder. METHOD A retrospective chart review was completed for patients aged 8-17 years assessed over a 17-year period. RESULTS Seventy-seven patients were included in the study, the majority of whom were female (n = 56, 73%). The average age of patients was 13.7 years (SD = 2.4 years). Three specific subtypes of ARFID (aligning with example presentations outlined in the DSM-5) were identified: (a) those with weight loss and/or medical compromise as a consequence of apparent lack of interest in eating (n = 30, 39%); (b) restriction arising as a result of sensory sensitivity (n = 14, 18%); and (c) restriction based upon food avoidance and/or fear of aversive consequences of eating (n = 33, 43%). Clinical characteristics of patients varied depending on the assigned subtype. DISCUSSION Our findings highlight the need for further research into the relative merit of subtype-assignment in patients with ARFID and whether such practice would aid in the recommended treatment. Further research is required to understand whether these categories are generalizable and applicable to other samples such as young children or adults with ARFID, and how treatment options might differ according to subtype.
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Affiliation(s)
- Mark L Norris
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario K1H 8L1, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario K1H 8L1, Canada
| | - Nicole G Hammond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario M5G 1X8, Canada
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina 27705
| | - Katie Yelle
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Alexandre Santos
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Madeline Gray
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
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Spettigue W, Norris M, Gomez R, Isserlin L. Working with youth with eating disorders: what every trainee needs to know. MedEdPublish 2017. [DOI: 10.15694/mep.2017.000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was not marked as recommended. Introduction: Eating Disorders (EDs) are severe mental illnesses with significant medical complications. With the broader diagnostic criteria as defined in the Diagnostic and Statistical Manual, 5th version (DSM-V), and the upcoming International Classification of Diseases, 11th version (ICD-11), prevalence rates are expected to increase and it will become even more important for trainees in pediatrics and psychiatry to know how to manage EDs. For trainees, working with these patients can be daunting given the nature of the illness and potential for serious medical complications. Purpose: To provide medical trainees with an understanding of how to conceptualize and work with pediatric patients with eating disorders, including general principles of management. Methods: Both experiential recommendations by Psychiatric and Pediatric physicians as well as evidence-based practices make up the advice and information presented in this paper. Learning points: Assessment and treatment of EDs can be difficult and daunting for trainees due to the severity of medical comorbidities and nature of the illness, but experience and knowledge have helped to inform important practice points: EDs are not a lifestyle choice, assessment requires modifications to the standard psychiatric interview, families do not cause EDs and are an essential part of the treatment team.
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Spettigue W, Maras D, Obeid N, Henderson KA, Buchholz A, Gomez R, Norris ML. A psycho-education intervention for parents of adolescents with eating disorders: a randomized controlled trial. Eat Disord 2015; 23:60-75. [PMID: 25090010 DOI: 10.1080/10640266.2014.940790] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study evaluated the efficacy of a 2-hour psycho-education session combined with bi-weekly telephone support in increasing parent/caregiver knowledge about eating disorders, increasing self-efficacy by empowering parents to support their child's recovery, and decreasing the impact of eating disorder symptoms on the family. The intervention was targeted at parents/caregivers whose child was waiting to be assessed for an eating disorder. Participants included 51 parents/caregivers and 36 youths. The brief intervention successfully increased parent/caregiver knowledge of the illness, feelings of self-efficacy, and help-seeking behaviors. These findings are clinically useful as waiting lists are common in Canada.
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Affiliation(s)
- Wendy Spettigue
- a Department of Psychiatry, Children's Hospital of Eastern Ontario , University of Ottawa , Ottawa , Ontario , Canada
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Norris ML, Robinson A, Obeid N, Harrison M, Spettigue W, Henderson K. Exploring avoidant/restrictive food intake disorder in eating disordered patients: a descriptive study. Int J Eat Disord 2014; 47:495-9. [PMID: 24343807 DOI: 10.1002/eat.22217] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 10/02/2013] [Accepted: 10/05/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess and compare clinical characteristics of patients with avoidant/restrictive food intake disorder (ARFID) to those with anorexia nervosa (AN). METHOD A retrospective review of adolescent eating disorder (ED) patients assessed between 2000 and 2011 that qualified for a diagnosis of ARFID was completed. A matched AN sample was used to compare characteristics between groups. RESULTS Two hundred and five patients met inclusion criteria and were reviewed in detail. Of these, 34 (5%) patients met criteria for ARFID. A matched sample of 36 patients with AN was used to draw comparisons. Patients with ARFID were younger than those with AN, more likely to present before age 12, and more likely to be male. Patients in both groups presented at low weights. Common eating-specific behaviors and symptoms in the ARFID group included food avoidance, loss of appetite, abdominal pain, and fear of vomiting. Rates of comorbid psychiatric diagnoses and medical morbidity were high in both groups. Almost 80% of AN patients and one-third of ARFID patients required hospital admission as a result of medical instability. Symptom profiles in 4/34 ARFID patients resulted in eventual reclassification to AN. DISCUSSION This study supports the notion that a small percentage of adolescent patients presenting with restrictive eating disorders meet criteria for ARFID. Patients are younger than average, more likely to be male compared to adolescent AN samples, and have high rates of psychiatric and medical morbidity. The study also suggests that a proportion of patients evolve into AN as treatment progresses.
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Affiliation(s)
- Mark L Norris
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada; Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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Henderson K, Buchholz A, Obeid N, Mossiere A, Maras D, Norris M, Harrison M, Feder S, Spettigue W. A family-based eating disorder day treatment program for youth: examining the clinical and statistical significance of short-term treatment outcomes. Eat Disord 2014; 22:1-18. [PMID: 24365524 DOI: 10.1080/10640266.2014.857512] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes an innovative family-based day treatment program (DTP) for youth with moderate to severe eating disorders. A sample of 65 youth completed a battery of psychological measures pre- and post-treatment and 6 months after program completion. Treatment outcomes were assessed in three main domains: (a) medical stabilization, (b) normalization of eating behavior, and (c) improved psychological functioning. Overall, patients demonstrated statistically significant and clinically meaningful improvements on all outcome measures. Findings indicate that a comprehensive DTP can successfully facilitate positive outcomes in youth with eating disorders and that these improvements can be maintained 6 months post-treatment.
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Affiliation(s)
- Katherine Henderson
- a Department of Psychology , Carleton University , Ottawa , Ontario , Canada
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Obeid N, Henderson KA, Tasca GA, Lyons JS, Norris ML, Spettigue W. Growth trajectories of maintenance variables related to refractory eating disorders in youth. Psychother Res 2013; 23:265-76. [DOI: 10.1080/10503307.2013.775529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Norris ML, Spettigue W. How much do we really know about the effectiveness of olanzapine use in patients with anorexia nervosa? ACTA ACUST UNITED AC 2012. [DOI: 10.2217/npy.12.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Norris ML, Apsimon M, Harrison M, Obeid N, Buchholz A, Henderson KA, Spettigue W. An examination of medical and psychological morbidity in adolescent males with eating disorders. Eat Disord 2012; 20:405-15. [PMID: 22985237 DOI: 10.1080/10640266.2012.715520] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of this study was to examine the clinical profile of adolescent male patients presenting for eating disorder (ED) assessment over a 17-year period. A retrospective cohort study was completed. A total of 52 patients (8% of the total sample) were included in the study. The average age of patients was 14.7 years and the most common diagnosis observed was Eating Disorder Not Otherwise Specified (EDNOS). Rates of concurrent depression and anxiety were very high, as were rates of medical co-morbidity, including osteoporosis. Our study supports findings documented in previously published reports of males with eating disorders and adds to the limited knowledge base which targets adolescents specifically. Multi-center controlled trials are required to further investigate male-specific ED symptomatology, treatment courses, and outcomes.
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Affiliation(s)
- Mark L Norris
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Norris ML, Spettigue W, Buchholz A, Henderson KA, Gomez R, Maras D, Gaboury I, Ni A. Olanzapine use for the adjunctive treatment of adolescents with anorexia nervosa. J Child Adolesc Psychopharmacol 2011; 21:213-20. [PMID: 21510781 PMCID: PMC3111870 DOI: 10.1089/cap.2010.0131] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine assessment and treatment profiles of adolescent patients with anorexia nervosa and eating disorder not otherwise specified who received olanzapine as compared with an untreated matched sample. METHOD A retrospective, matched-groups comparison study was completed. Medical files of 86 female patients treated in the eating disorder program at the Children's Hospital of Eastern Ontario were examined. Patients treated with olanzapine were initially identified through chart review and then matched to a diagnosis, age, and, when possible, treatment group that served as the active comparator. Weight gain was examined in a sample of 22 inpatients. RESULTS Patients treated with olanzapine displayed greater evidence of psychopathology and medical compromise at the time of first assessment compared with those not treated. Rate of weight gain was not statistically different between groups when olanzapine was started during inpatient admissions. Medication effect on eating disorder cognitions could not be assessed given the presence of multiple confounders relating to treatment. Notable side effects included sedation and dyslipidemia in 56% of patients. CONCLUSIONS Despite our best attempts at matching olanzapine-treated subjects with a control sample, analysis revealed significant differences between groups, suggesting greater illness severity in those augmented with olanzapine. Given these inherent differences, we were unable to draw any firm conclusions regarding the potential efficacy of olanzapine. Factors associated with the prescription of adjunctive pharmacotherapy in this cohort appear to be linked to illness severity, acuity, and associated comorbidity. The observed side-effect profile indicates the need for more consistent predrug screening and for closer monitoring during treatment.
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Affiliation(s)
- Mark L Norris
- Department of Paediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
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Abstract
This study describes the development and validation of the clinician-rated Eating Disorder Symptom Severity Scale (EDS(3)), created to address a gap in measurement options for youth with eating disorders. The EDS(3) is modeled on the Childhood Severity and Acuity of Psychiatric Illness Scales (Lyons, J. S, 1998). Factor analysis revealed a 5-factor solution and accounted for 78% of the variance, and internal consistency within the subscales was good (Cronbach alphas: 0.69 to 0.93). The EDS(3) is a valid and reliable measure designed for clinicians to help assess the severity of a youth's eating disorder and to facilitate outcomes research.
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Affiliation(s)
- Katherine A Henderson
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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Abstract
This study examined factors that contributed to patient's eligibility and participation in a randomized controlled trial involving olanzapine for the adjunctive treatment of anorexia nervosa (AN). Factors involving patient eligibility and willingness to participate were systematically recorded for all patients approached to participate. Of the 92 patients that were assessed and treated over the study timeframe, only 27 patients (29%) met full criteria for inclusion, of which just 7 enrolled (26%). The most common reasons for study refusal related to fears associated with medication effects and refusal to consider medication as a treatment option (70%). Factors affecting recruitment in psychopharmacological studies involving AN in youth are discussed.
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Affiliation(s)
- Mark L Norris
- Department of Paediatrics, Children's Hospital of Eastern Ontario/University of Ottawa, Ottawa, Ontario, Canada
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Norris ML, Spettigue W, Buchholz A, Henderson K, Gomez R, Harrison M. Dyslipidemia Independent of Body Mass in Antipsychotic Treated Patients with Anorexia Nervosa. Paediatr Child Health 2009. [DOI: 10.1093/pch/14.suppl_a.15ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Spettigue W, Buchholz A, Henderson K, Feder S, Moher D, Kourad K, Gaboury I, Norris M, Ledoux S. Evaluation of the efficacy and safety of olanzapine as an adjunctive treatment for anorexia nervosa in adolescent females: a randomized, double-blind, placebo-controlled trial. BMC Pediatr 2008; 8:4. [PMID: 18234120 PMCID: PMC2258294 DOI: 10.1186/1471-2431-8-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 01/31/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a serious, debilitating condition that causes significant physical, emotional, and functional impairment. The condition is characterized by destructive weight loss behaviours and a refusal to maintain body weight at or above a minimally normal weight for age and height. AN often develops in adolescence and is a predominantly female disorder. Treatment for AN typically involves medical, nutritional and psychological interventions. Pharmacotherapy is also often used; however, the literature on the effectiveness of these drugs in a pediatric population is very limited. Olanzapine, which is an 'atypical' antipsychotic, is becoming more widespread in the treatment of AN. Olanzapine is hypothesized to facilitate weight gain, while decreasing levels of agitation and decreasing resistance to treatment in young women with AN. This randomized, double-blind placebo-controlled trial seeks to examine the effectiveness and safety of olanzapine in female youth with AN. METHODS/DESIGN Adolescent females between the ages of 12 and 17 diagnosed with AN (either restricting or binge/purge type) or Eating Disorder Not Otherwise Specified with a Body Mass Index of less than or equal to 17.5, will be offered inclusion in the study. Patients will be randomly assigned to receive either olanzapine or placebo. Patients assigned to receive olanzapine will start at a low dose of 1.25 mg/day for three days, followed by 2.5 mg/day for four days, 5 mg/day for one week, then 7.5 mg/day (the target dose chosen) for 10 weeks. After 10 weeks at 7.5 mg the medication will be tapered and discontinued over a period of two weeks. The effectiveness of olanzapine versus placebo will be determined by investigating the change from baseline on measures of eating attitudes and behaviors, depression and anxiety, and change in Body Mass Index at week 12, and after a follow-up period at week 40. It is anticipated that 67 participants will be recruited over two years to complete enrollment. DISCUSSION Randomized controlled trials designed to measure the safety and effectiveness of olanzapine in comparison to placebo are desperately needed, particularly in the adolescent population. TRIAL REGISTRATION Current Controlled Trials ISRCTN23032339.
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Affiliation(s)
- Wendy Spettigue
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Psychiatry, University of Ottawa, 550 Cumberland, Ottawa, ON, K1N 6N5, Canada
| | - Annick Buchholz
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Katherine Henderson
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Stephen Feder
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - David Moher
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Chalmers Research Group, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, 550 Cumberland, Ottawa, ON, K1N 6N5, Canada
| | - Kader Kourad
- Chalmers Research Group, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Isabelle Gaboury
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Mark Norris
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Sheila Ledoux
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
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Buchholz A, Henderson KA, Hounsell A, Wagner A, Norris M, Spettigue W. Self-silencing in a clinical sample of female adolescents with eating disorders. J Can Acad Child Adolesc Psychiatry 2007; 16:158-163. [PMID: 18392167 PMCID: PMC2247456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Accepted: 10/29/2007] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The present study was designed to assess the relationship between self-silencing behaviours and eating disorder symptoms in a female adolescent population with eating disorders. METHOD One hundred and forty-nine adolescent girls between the ages of 13 and 18 completed a comprehensive assessment at a tertiary care children's hospital. Each participant completed the Eating Disorder Inventory-2 (EDI-2; Garner, 1991), the Multidimensional Anxiety Scale for Children (MASC; March et al, 1997), and an adapted version of the Silencing the Self Scale for adolescents (STSS; Sippola & Bukowski, 1996). RESULTS Self-silencing behaviours correlated strongly with eating disorder symptomatology. Social anxiety was found to predict body dissatisfaction, while externalized self-perception was found to contribute uniquely to body dissatisfaction and drive for thinness, two risk factors closely associated with eating disorders. CONCLUSION These results suggest the importance of including relational and emotional development in comprehensive models of disordered eating.
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Affiliation(s)
- Annick Buchholz
- Regional Eating Disorders Program for Youth, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario.
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Norris ML, Spettigue W, Buchholz A, Henderson KA. Challenges associated with controlled psychopharmacological research trials in adolescents with eating disorders. J Can Acad Child Adolesc Psychiatry 2007; 16:167-172. [PMID: 18392169 PMCID: PMC2247458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Accepted: 10/07/2007] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Eating disordered populations present many unique challenges both to clinicians and researchers. Adolescents with eating disorders can be difficult to treat, and the challenges associated with research in this area can be significant. OBJECTIVES This paper was written with three main objectives in mind: to comment on some of the barriers impeding mental health research in general, to highlight challenges faced in the design and implementation of ED-specific studies, and to integrate personal insight into some of the many challenges that we have encountered during our experience with a randomized clinical trial examining the efficacy of olanzapine for the adjunctive treatment of youth with Anorexia Nervosa. DISCUSSION It is hoped that providing information in this context will allow researchers greater insight into some of the many challenges that accompany study of this cohort.
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Affiliation(s)
- Mark L Norris
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario.
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Spettigue W, Henderson KA. Eating disorders and the role of the media. Can Child Adolesc Psychiatr Rev 2004; 13:16-19. [PMID: 19030149 PMCID: PMC2533817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION This paper provides a review of the role of the media in the development, maintenance, prevention, and treatment of eating disorders. METHOD The literature on gambling in youth on the internet was reviewed. It explores: (1) the role of the media in providing a social context for the development of eating disorders, (2) the role of the media in the etiology of eating disorder pathology, (3) the ways in which the media is used by patients suffering from eating disorders, and (4) the role that awareness of the media can have in the treatment and prevention of eating disorders. RESULTS This review demonstrates that the media does contribute to the development of eating disorders. CONCLUSION This review highlights the need for media literacy and media activism to help change the current normative body discontent of women in the Western world.
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Affiliation(s)
- Wendy Spettigue
- Regional Eating Disorders Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1
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Abstract
OBJECTIVE A recent case report suggested that olanzapine resulted in improved weight gain and maintenance, as well as decreased anxiety and agitation, for two hospitalized inpatients with anorexia nervosa (AN). However, a subsequent larger case study did not show a relationship between the use of olanzapine and rate of weight gain among a primarily adult population. The aim of this case report was to clinically examine the therapeutic benefit and tolerability of olanzapine as an adjunctive treatment for four children with AN in a pediatric inpatient setting. RESULTS Olanzapine use was associated with considerable weight gain and maintenance, with an average rate of weight gain during hospitalization of 0.99 kg per week. In addition to weight gain, olanzapine was associated with a clinically notable decrease in levels of agitation and premeal anxiety and almost immediate improvement in sleep, general functioning, and overall compliance with treatment. Olanzapine was also well tolerated in these young patients. DISCUSSION These case report findings warrant more controlled research, including randomized controlled studies, to better determine the therapeutic benefits and safety of olanzapine use in children with AN.
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Affiliation(s)
- Ahmed Boachie
- Department of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Canada
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