Attentional Bias Modification Training Based on Virtual Reality and Eye Tracking in Anorexia Nervosa Patients

Anorexia nervosa (AN) patients exhibit attentional bias (AB) related to the body, which is the tendency to pay greater attention to weight-related body areas compared to non-weight-related ones. This phenomenon has been linked to elevated levels of body dissatisfaction (BD) and may potentially reduce the effectiveness of body exposure therapy. The purpose of this pilot study is to assess the efficacy of a single session of a new body-related AB modification task (ABMT) that combines virtual reality with eye tracking in patients with AN. The goals of the ABMT are to reduce body-related AB by balancing attention between weight and non-weight-related body areas and to reduce BD levels. Twenty-three adolescent patients with AN were embodied in a virtual avatar and immersed in a virtual environment where they completed the ABMT. Body-related AB measures and BD levels were assessed before and after the training. A paired samples t-test showed statistically significant differences between pre-assessment and post-assessment; the complete fixation time on weight-related body parts was reduced and BD levels decreased. The initial evidence of the efficacy of this ABMT has important clinical implications, since AB and BD are considered risk factors for developing and maintaining eating disorder symptomatology among patients with AN.

Modification of Body-Related Attentional Bias through Virtual Reality and Eye-Tracking in Healthy Participants: Implications for Anorexia Nervosa Treatments

Cognitive biases have a significant impact on the etiology and treatment of eating disorders (EDs). These biases, including selective attentional bias (AB) to disliked body parts, may reinforce concerns about body shape, fear of gaining weight and body image disturbances and may contribute to dietary restriction and restraint. Decreasing AB could reduce core symptoms in anorexia nervosa (AN). This study represents a preliminary exploration aiming to assess whether AB towards weight-related (WR) and non-weight-related (NW) body parts could be reduced through an AB modification task in a virtual reality (VR) environment in healthy participants. A total of 54 female participants, aged 22.98 ± 1.89, were recruited. The task consisted of directing the participants' attention towards all body parts equally in a VR setting. Eye-tracking (ET) measurements (complete fixation time [CFT] and number of fixations [NF]) were made before and after the task. The results showed a significant reduction of the AB in the two groups with an initial AB towards WR body parts or towards NW body parts. Participants showed a tendency to more balanced (non-biased) attention after the intervention. This study provides evidence of the usefulness of AB modification tasks in a non-clinical sample.

An Attentional Bias Modification Task, through Virtual Reality and Eye-Tracking Technologies, to Enhance the Treatment of Anorexia Nervosa

Mirror exposure therapies (METs) have been shown to be effective in reducing body image disturbances through the habituation process. Virtual reality (VR) combined with eye-tracking techniques can provide innovative solutions to some of METs’ limitations reported with patients with anorexia nervosa (AN), especially the negative influence of body-related attentional bias (AB). This pilot study aimed to assess the preliminary efficacy of a new VR-based AB modification task (ABMT) among healthy women and the procedure’s user experience. AB levels towards weight- and non-weight-related body parts, using complete fixation time (CFT) and number of fixations (NF), were assessed throughout the ABMT procedure (300 trials). The user experience was evaluated at the end of the procedure. The results showed that VR-based ABMT was effective in reducing AB significantly after 150 trials for both CFT- and NF-based measures, although 225 trials were necessary to get the same result for women with an NF initially more oriented towards weight-related body parts. Overall, the software received a “C-rating” on a scale from “A” (most usable) to “F” (least usable). These results provide evidence of the opportunity to use a VR-based ABMT procedure to reduce AB and improve existing treatments for AN.

Attachment, body appreciation, and body image quality of life in adolescents with eating disorders

The aim of the current study was to determine the link between parental attachment style and body appreciation in adolescents with and without eating disorders, and to explore the association between attachment, positive aspects of body image and body image quality of life. The sample comprised 260 adolescents (M age = 15.35, SD age = 1.461): 129 non-clinical participants and 131 adolescents with eating disorders who received treatment in five Eating Disorders Units located in different regions in Spain. They were assessed via the Inventory of Parent and Peer Attachment (IPPA), Body Appreciation Scale (BAS), and Body Image Quality of Life Inventory (BIQLI). There was a significant relation between secure attachment and body appreciation in both groups, and body appreciation was positively related to body image quality of life. Patients with eating disorders had higher body image quality of life when they perceived better communication and trust with their father, which was mediated by the body appreciation they showed. Adolescents without eating disorders showed this same relationship form with their mother. This study aims to highlight the influence of parental attachment on a positive body image in adolescence.

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study

Background. The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. Aims. (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. Methods. The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). Results. Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. Conclusions. The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.

The impact of duration of illness on treatment nonresponse and drop-out: Exploring the relevance of enduring eating disorder concept

OBJECTIVE

There are no generally accepted definitions or markers of treatment nonresponse in eating disorders (EDs). The aim of this paper was to examine how the duration of illness and other potential prognostic markers impacted on nonresponse and drop-out from treatment across different EDs subtypes.

METHODS

A total sample of 1199 consecutively treated patients with EDs, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, participated in this study. Kaplan-Meier curves were calculated for each ED diagnosis in which the probability of recovery was plotted against the duration of illness.

RESULTS

Full remission was more likely for people with binge eating disorder (BED; 47.4%) and anorexia nervosa (AN; 43.9%) compared to bulimia nervosa (BN; 25.2%) and other specified feeding and EDs (OSFED; 23.2%). The cut-off points for the duration of the illness related with high likelihoods of poor response was 6-8 years among OSFED, 12-14 years among AN and BN and 20-21 years among BED. Other variables predicting nonresponse included dysfunctional personality traits.

CONCLUSIONS

Nonresponse to treatment is associated with duration of illness which is in turn associated with poor response to previous treatment. However, there was no evidence for staging the illness using specific duration of illness criteria. Nevertheless, the shorter temporal trajectory for OSFED suggests that early interventions may be of importance for this group.

Attachment to parents and friends and body dissatisfaction in adolescents with eating disorders

The study of attachment is a valuable theoretical framework to understand the influence of parents and friends on the evolution and development of adolescents. This study aimed to determine parents' and peers' attachment style, the relationship between parents' and peers' attachment and body dissatisfaction in adolescents with eating disorders (ED), and to compare it with a control group. The sample consisted of 260 adolescents (M_age = 15.35, SD_age = 1.461): a control group consisting of 129 non-clinical subjects and an ED group composed by 131 adolescents diagnosed with ED who attended five ED units located in different regions of Spain. They completed the Body Shape Questionnaire (BSQ-34) and the Inventory of Parent and Peer Attachment (IPPA). Adolescents with ED have less trust with their parents, worse communication with their parents and peers, and greater alienation with fathers and peers. The results showed a statistically significant relationship between parents' attachment and body dissatisfaction in both groups. In ED group, peers' alienation was positively correlated to body dissatisfaction. Parental attachment and alienation feelings with peers could influence body dissatisfaction in ED adolescents.

Avoidant/restrictive food intake disorder: Psychopathological similarities and differences in comparison to anorexia nervosa and the general population

INTRODUCTION

Avoidant/restrictive food intake disorder (ARFID) categorises patients with selective and/or restrictive eating patterns in the absence of distorted cognition concerning weight, food, and body image.

OBJECTIVE

To examine the sociodemographic and clinical profile of patients with ARFID in comparison to those with anorexia nervosa (AN) and to a non-clinical group (NCG).

METHOD

A descriptive, observational, comparative study made up of three groups (ARFID, AN and NCG). Ninety-nine children and adolescents were analyzed by means of a semi-structured diagnostic interview and questionnaires on depression, anxiety, clinical fears and general psychopathology.

RESULTS

The ARFID group was significantly younger (10.8 vs. 14.1 years of age), with a greater proportion of males (60.6% vs. 6.1%), an earlier onset of illness (6.2 vs. 13.4 years of age), and a longer period of evolution of the illness (61.2 vs. 8.4 months) compared to the AN group. Clinically, patients with ARFID showed greater medical (42.4% vs. 12.1%) and psychiatric (81.8% vs. 33.3%) comorbidity-assessed with a semi-structured diagnostic interview-greater clinical fear (p < 0.005), more attention problems (p < 0.005) and fewer symptoms of anxiety and depression (p < 0.005)-measured with self-report questionnaires.

CONCLUSIONS

ARFID is a serious disorder with a significant impact on the physical and mental health of the pediatric population. Likewise, some of these physical and mental conditions may be a risk factor in developing ARFID. Attention problems and clinical fears in ARFID, and the greater presence of internalised symptoms in AN, were the main differences found in the psychopathological profiles.

Validity of Virtual Reality Body Exposure to Elicit Fear of Gaining Weight, Body Anxiety and Body-Related Attentional Bias in Patients with Anorexia Nervosa

Fear of gaining weight (FGW), body image disturbances, associated anxiety and body-related attentional bias are the core symptoms of anorexia nervosa (AN) and play critical roles in its development and maintenance. The aim of the current study is to evaluate the usefulness of virtual reality-based body exposure software for the assessment of important body-related cognitive and emotional responses in AN. Thirty female patients with AN, one of them subclinical, and 43 healthy college women, 25 with low body dissatisfaction (BD) and 18 with high BD, owned a virtual body that had their silhouette and body mass index. Full-body illusion (FBI) over the virtual body was induced using both visuo-motor and visuo-tactile stimulation. Once the FBI was induced, the FBI itself, FGW, body anxiety and body-related attentional bias toward weight-related and non-weight-related body areas were assessed. One-way analyses of covariance (ANCOVA), controlling for age, showed that AN patients reported higher FGW, body anxiety and body-related attentional bias than healthy controls. Unexpectedly, patients with AN reported significantly lower FBI levels than healthy participants. Finally, Pearson correlations showed significant relationships between visual analog scales and body-related attentional bias measures, compared to other eating disorder measures. These results provide evidence about the usefulness of virtual reality-based body exposure to elicit FGW and other body-related disturbances in AN patients. Thus, it may be a suitable intervention for reducing these emotional responses and for easing weight recovery.

COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study

Confinement during the COVID‐19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational‐theoretical structure of the CIES. Adequate goodness‐of‐fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face‐to‐face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.

Virtual Reality Body Exposure Therapy for Anorexia Nervosa. A Case Report With Follow-Up Results

Objective

Exposure-based therapies such as mirror exposure may help to improve the results of classic cognitive behavioral therapy in anorexia nervosa (AN). Virtual reality (VR)-based procedures provide interesting novelties for targeting body-related concerns. This study aimed to provide preliminary evidence of the usefulness of a VR body exposure therapy in a patient diagnosed with AN.

Method

Fear of gaining weight (FGW), body anxiety, drive for thinness, body image disturbances, body mass index and body-related attentional bias were assessed before and after the intervention, as well as 5 months later. Five sessions of VR body exposure therapy were included within the standard course of cognitive behavioral therapy. The sessions involved a systematic and hierarchical exposure of the patient to a virtual representation of her own silhouette, with the body mass index of the avatar progressively increasing in subsequent sessions.

Results

After the intervention, there was a clear reduction in AN symptoms such as the FGW, drive for thinness, body-related anxiety and dissatisfaction. Body mass index values rose continuously during the intervention and reached healthy levels. Finally, there was a notable change in the dysfunctional body-related attentional bias. Almost all these improvements were maintained after 5 months, except for the FGW.

Conclusion

To the best of our knowledge, this study is the first to focus on treating the FGW and body-related concerns in AN using a VR-based paradigm. To pursue this study further and assess the effectiveness of this new VR software, larger controlled clinical trials are needed.

Body-related attentional bias as mediator of the relationship between body mass index and body dissatisfaction

Body image disturbance, consisting of an affective (body dissatisfaction) and perceptual (body distortion) component, is not only found in eating disorders, but is also present in healthy individuals, affecting their psychological well-being and everyday life. A higher body mass index is associated with higher body dissatisfaction, whereas results in relation to body distortion are mixed. Furthermore, body dissatisfaction is associated with a weight-related attentional bias. This study aimed to investigate the mediating role of a weight-related attentional bias in the relationship between body mass index and body image disturbance. Forty-one college women took part in a virtual reality and eye tracking procedure, in which the illusion of owning a virtual avatar with their body measurements was induced. During this procedure, body-related attentional bias was measured and afterwards body image disturbance was assessed. Mediation analysis revealed that weight-related attentional bias mediated the relationship between body mass index and body dissatisfaction (but not distortion). These findings suggest that modifying weight-related attentional bias would be a useful treatment target for improving body dissatisfaction. In addition, virtual reality technology could serve as an innovative method for modifying attentional bias in an ecologically valid way. HIGHLIGHTS: This Virtual Reality and Eye-Tracking study expands our knowledge about the relation between body mass index, body-related attention and body image disturbances. The results suggest that attentional bias towards weight-related body parts mediates the relation between BMI and body dissatisfaction. On the contrary, the relation between BMI and body distortion was not significant.

Alternatives to inpatient treatment in adolescents with anorexia nervosa: Effectiveness and characteristics of a new intensive model of day patient treatment

INTRODUCTION

Inpatient Treatment (IT) is the treatment of choice for moderate or severely ill adolescents with Anorexia Nervosa (AN). Nevertheless, it is expensive, and the risk for relapse or readmissions is high. A less costly alternative to IT is Day Patient Treatment (DP), which may also help to avoid relapses and readmissions because facilitates transition from hospital to community treatment.

AIM

To assess the effectiveness of the 11-hour DP program for Eating Disorders (DP-ED-11h), a new intensive DP treatment for adolescents with AN, with respect to weight recovery, avoidance of hospital admission and decrease of Length of Stay (LoS).

METHOD

A longitudinal, naturalistic study was carried out analysing clinical and sociodemographic variables from 77 patients with AN who were consecutively discharged from DP-ED-11h, during years 2015-2016.

RESULTS

There were 77 discharges. The average age was 14.4 years old (SD: 1.62). The LoS at DP-ED-11h was 28.9 days (SD: 18.5). The mean body mass index increased significantly at discharge (17.2 vs. 17.9, p<0.001) and at 12 months follow- up (17.9 vs. 19.3, p<0.001). Twenty nine (70.8%) of the patients treated at DP-ED-11h, who came from a less intensive setting, avoided an admission. Fourteen (18.2%) required readmission at DP-ED-11h within two years. The LoS at IT was significantly reduced (from 33 to 24 days, p<0.043).

CONCLUSION

DP-ED-11h has shown to be an effective resource as an alternative to IT for adolescents with moderate to severe AN. This new model has cost-effectiveness implications as it is a safe resource and is less costly than IT.

The influence of gender and body dissatisfaction on body-related attentional bias: An eye-tracking and virtual reality study

OBJECTIVE

In the attentional bias (AB) phenomenon, eating disorder (ED) patients show a tendency to pay more attention to self-attributed unattractive body parts than to other body parts. However, little research has focused on gender differences in body-related attention, controlling for body dissatisfaction (BD). This study aimed to assess gender differences in AB toward specific weight- or nonweight-related body parts using a virtual reality (VR)-based embodiment technique and an eye-tracking AB assessment.

METHOD

Forty-five women (23 with high BD and 22 with low BD) and 40 men (20 with high BD and 20 with low BD) were subsequently embodied in three virtual avatars, the first based on the participant's actual measurements, the second being larger than the participant, and the third being the same as the first avatar. The number of fixations and complete fixation time on weight-related areas of interest (W-AOIs) and nonweight-related areas of interest (NW-AOIs) were recorded for the three assessment time/avatars.

RESULTS

The results showed a statistically significant interaction between gender and time for total fixation time and number of fixations (p < .05). BD levels did not significantly affect the results. Overall, women paid more attention to the W-AOIs than men, who in turn paid more attention to the NW-AOIs. Furthermore, preliminary evidence was found for an AB toward muscular-related AOIs among men.

CONCLUSIONS

This study provides new information about gender differences and BD in gaze pattern behaviors. Future psychological ED assessments and treatments could take advantage of the possibilities of VR while real-time AB is objectively measured.

Mobile Health Adoption in Mental Health: User Experience of a Mobile Health App for Patients With an Eating Disorder

Background

Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the overall adoption levels of mHealth tools by health professionals remain relatively low.

Objective

This study aimed (1) to investigate attitudes of health care providers and mHealth experts toward mHealth tools in the health context in general, and this study aimed (2) to test the acceptability and feasibility of a specific mHealth tool for patients with an eating disorder (ED), called TCApp, among patients and ED specialists.

Methods

To this purpose, we conducted an explorative qualitative study with 4 in-depth group discussions with several groups of stakeholders: our first focus group was conducted with 11 experts on mHealth from the Catalan Association of Health Entities; the second focus group included 10 health care professionals from the Spanish College of Doctors of Barcelona; the third focus group involved 9 patients with an ED who had used the TCApp over a 12-week period, and the fourth and last focus group involved 8 ED specialists who had monitored such ED patients on the Web.

Results

The focus groups showed that health care providers and mHealth experts reported barriers for mHealth adoption more often than facilitators, indicating that mHealth techniques are difficult to obtain and use. Most barriers were attributed to external factors relating to the human or organizational environment (ie, lack of time because of workload, lack of direct interest on a legislative or political level) rather than being attributed to internal factors relating to individual obstacles. The results of the mHealth intervention study indicate that the TCApp was considered as easy to use and useful, although patients and the ED specialists monitoring them on the Web reported different adoption problems, such as the inability to personalize the app, a lack of motivational and interactive components, or difficulties in adhering to the study protocol.

Conclusions

In general, this paper indicates that both health professionals and patients foresee difficulties that need to be addressed before comprehensive adoption and usage of mHealth techniques can be effectively implemented. Such findings are in line with previous studies, suggesting that although they acknowledge their possible benefits and cost-effectiveness, health care providers are quite resistant and conservative about integrating mHealth technologies in their daily practice.

Validation of the Caregiver Skills (CASK) scale in Catalonia: Concordance between caregivers in attitudes and behaviours

OBJECTIVE

The aim of this study was to validate a Spanish version of the Caregiver Skills scale (CASK) in a sample of eating disorder (ED) caregivers. A further aim was to examine the concordance/discrepancy between them (namely, between the mothers and fathers of ED patients).

METHOD

Two hundred sixty-five ED caregivers were recruited from ED centers in Catalonia, Spain. Confirmatory factor analyses was used to test the factorial structure of the CASK scale. Cronbach's α was used to measure internal consistency of the CASK scales. A comparison of the CASK measures between respondents (mothers and fathers) was conducted using generalized estimating equations.

RESULTS

Confirmatory factor analysis of the Spanish version of the CASK corroborated the strong factorial validity of the 6 factors of the original CASK questionnaire. Mothers and fathers did not differ significantly on CASK overall and subscale scores. There was however less concordance between parents on the bigger picture (ICC = 0.28) and biting your tongue (ICC = 0.08) subscales.

CONCLUSIONS

The CASK is a valid tool to assess ED-related attitudes in Spanish-speaking caregivers. Furthermore, caregivers and patients alike could stand to benefit from interventions focused on improving areas such as ED beliefs, effective communication, quality of life, and emotional distancing.

Cost-effectiveness of the mobile application TCApp combined with face-to-face CBT treatment compared to face-to-face CBT treatment alone for patients with an eating disorder: study protocol of a multi-centre randomised controlled trial

BACKGROUND

The clinical utility of the existing apps for people with eating disorders (EDs) is not clear. The TCApp has been specifically developed for people with EDs, is based on the principles of Cognitive Behavioural Treatment (CBT) and allows a bidirectional link between the patient and the therapist. The objectives of the study are, first, to assess the clinical efficacy of a combined intervention for Eating Disorders (EDs) that includes an online intervention through the TCApp plus standard face-to-face CBT in comparison to standard face-to-face CBT alone, and second, to examine the cost-effectiveness of the TCApp and identify potential predicting, moderating and mediating variables that promote or hinder the implementation of the TCApp in ED units in Spain.

METHODS

The study methodology is that of a randomised controlled trial combining qualitative and quantitative methods, with a 6-month follow-up. Approximately 250 patients over 12 years old with a diagnosis of an ED from several ED units in Spain will be randomised to one of two different conditions. Participants, their caregivers, healthcare professionals and technical staff involved in the development and maintenance of the application will be assessed at baseline (T0), post-intervention (T1) and at 6 months follow-up (T2). Primary outcome measures will include ED symptomatology while secondary measures will include general psychopathology and quality of life for patients, quality of life and caregiving experience for family caregivers and adoption-related variables for all participants involved, such as perceived usability, user's satisfaction and technology acceptance. For the cost-effectiveness analysis, we will assess quality-adjusted life years (QALYs); total societal cost will be estimated using costs to patients and the health plan, and other related costs.

DISCUSSION

The study will provide an important advance in the treatment of EDs; in the long term, it is expected to improve the quality of patient care and the treatment efficacy and to reduce waiting lists as well as direct and indirect costs associated with the treatment of EDs in Spain.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03197519 ; registration date: June 23, 2017.

Suicidal ideation and self-injurious behavior in adolescents with eating disorders

INTRODUCTION

The presence of suicidal thoughts and self-injurious behaviors in patients with eating disorders (ED) is well-known; however, this association is currently not defined empirically. The aim of the study is to determine the prevalence of suicidal ideation and self-harm in adolescents with eating disorders. A second objective is to study the association between self-injurious behavior and suicidal ideation, severity of eating disorder symptoms and symptoms of depression and anxiety, motivation to change and perfectionism.

METHODOLOGY

We evaluated 109 patients (mean age, 14.74 years (SD: 1.53); 87.2% female) using the Eating Disorder Inventory (EDI-2), the Beck Depression Inventory (BDI-II), the State-Trait Anxiety Inventory (STAI), the Child and Adolescent Perfectionism Scale (CAPS) and the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ).

RESULTS

Forty-seven patients (43.1%) had suicidal ideation and 34 (31.2%), self-injurious behavior. The presence of suicidal ideation did not discriminate between patients with or without self-injurious behavior. Patients who self-harm had significantly higher scores on all scales of the EDI-2, except for &#8220;maturity fears&#8221;, in the total scores of BDI-II, STAI and CAPS. An association between selfinjurious behavior and motivation to change was found.

CONCLUSIONS

A significant percentage of adolescents with eating disorders present suicidal ideation and selfinjurious behavior, making the psychopathological profile of these patients more severe. The presence of suicidal ideation in adolescents with eating disorders does not necessarily imply that they have self-injurious behavior; rather, such behavior could be a result of the need to regulate intense negative emotions.

Diagnostic Distribution of eating disorders: Comparison between DSMIV- TR and DSM-5

INTRODUCTION

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a significant revision of Eating Disorders (ED). The objective of this study is to compare the distribution of diagnosis of ED in adolescents according to DSM-VI-TR and DSM-5 criteria. A second objective is to study the psychopathological differences between patients with ED (based on DSM-IV-TR) and those whose diagnosis changed by applying DSM-5 criteria.

METHODOLOGY

One hundred and one adolescents diagnosed with ED (mean: 14.68 years; SD: 1.46) were evaluated with clinical interviews and scales for eating psychopathology, perfectionism, anxiety, and depression.

RESULTS

Applying the DSM-5 criteria led to a significant decrease in the diagnosed cases of Eating Disorders Not Otherwise Specified (EDNOS) (from 34.7% to 23.8%; p<0.001) and to a significant increase in those of anorexia nervosa (AN) (from 58.4% to 66.3%; p<0.001) and of bulimia nervosa (BN) (from 6.9% to 8.9%; p<0.001). No significant psychopathological differences were found between patients diagnosed with AN and BN based on DSM-IV-TR criteria and those newly diagnosed with AN and BN based on DSM-5 criteria.

DISCUSSION

Using DSM-5 criteria for adolescents with ED leads to a significant decrease in the frequency of an EDNOS diagnosis. As similar psychopathological characteristics were observed between ED patients diagnosed based on DSM-IV-TR and those who were switched from EDNOS to AN or BN based on DSM-5, we conclude that the new criteria for ED in DSM-5 are valid for an adolescent population.

Attention-deficit hyperactivity disorder: agreement between clinical impression and the SNAP-IV screening tool

INTRODUCTION

The CONCOR study aimed to determine the predictive value of the SNAP-IV screening tool for ADHD relative to the pediatricians' clinical global impression of the presence of ADHD in children attending their practice.

METHODS

In this multicentre, cross-sectional, case-control study participated pediatricians from all over Spain and each pediatrician enrolled at least six children over the age of 6 years who had no previous diagnosis of ADHD, three whom they considered to have symptoms characteristic of ADHD (DSM-IV criteria) and three children who did not. Screening with the SNAP-IV tool was completed by parents in the waiting room prior to a consultation (for any reason) and results were compared with the pediatrician's clinical global impression.

RESULTS

Results for 7263 Spanish children (>6 years of age) showed 'good' concordance between the SNAP-IV screening tool and the pediatricians' clinical impression of ADHD (kappa concordance index 0.6471; 95% confidence intervals: 0.6296-0.6646), with acceptable sensitivity and specificity (82.3% and 82.4%, respectively). Based on an estimated ADHD prevalence of 3-10%, the negative predictive values of SNAP-IV were 97.7%-99.3% and positive predictive values were 12.6-34.2%.

CONCLUSIONS

SNAP-IV is a useful screening tool that identifies children who are unlikely to have ADHD, and brings those in whom there is a high possibility of ADHD to the attention of the pediatrician for clinical evaluation.

Is psychological treatment efficacious for attention deficit hyperactivity disorder (ADHD)? Review of non-pharmacological treatments in children and adolescents with ADHD

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is the most prevalent psychiatric disorder in children and adolescents, and has a great impact on the psychological development of affected patients. Even though its efficacy is proven, the use of medication for ADHD has several limitations, and non-pharmacological interventions are considered a necessary component of treatment.

METHODOLOGY

This work is a review of evidence-based non-pharmacological treatments with demonstrated efficacy for ADHD in children and adolescents, analyzed by age groups.

RESULTS

Non-pharmacological treatments that have shown scientific evidence of efficacy are psychological and psychoeducational interventions. Psychological interventions include behavioral therapy, parent training (PT) and social skills training. Psychoeducational interventions include a set of practices to improve learning and are carried out in the school setting. Scientific evidence of efficacy in preschool children is limited to PT, while different psychological and psychoeducational interventions have been shown to be beneficial in school-age children. The available evidence for non-pharmacological treatment in adolescence is so far insufficient.

CONCLUSIONS

Though more randomized controlled trials are necessary for non-pharmacological interventions to become established practices, there are clear indications of their efficacy. For more severe cases of ADHD, a combination of non-pharmacological and pharmacological treatment is recommended.