Impact of COVID-19 lockdown in eating disorders: a multicentre collaborative international study

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 patientsFondo Investigación Sanitario-FIS, Grant/Award Numbers: FIS, INT19/00046, PI17/01167; Ministerio de Economía y Competitividad, Grant/Award Number: PSI2015-68701-R; Portuguese Foundation for Science and Technology grant, Grant/Award Number: POCI-01-0145-FEDER-028145; Consejo Nacional de Ciencia y Tecnología; Generalitat de Catalunya; European Regional Development Fun

Examining associations between obesity and mental health disorders from childhood to adolescence: A case-control prospective study

Childhood obesity and mental disorders often co-exist. To date, most of the studies are cross-sectional, involve the assessment of a specific disorder, and rely on self-report questionnaires. This study aimed to provide a comprehensive psychological assessment to examine the concurrent and prospective association between childhood obesity and mental health problems. We compared 34 children with obesity with 37 children with normal weight at baseline, and at a five-year follow-up, to examine the development of mental health disorders from childhood (8–12 years) to adolescence (13–18 years). Both assessments included a clinical interview and self-reported measures of psychosocial and family markers. Findings showed that the obesity group had a higher prevalence of mental disorders, and psychological comorbidity increased in five years. Prospectively, childhood obesity was associated with a psychological diagnosis in adolescence. Moreover, the obesity group displayed higher severity of symptoms at both times. Finally, body esteem contributed to predicting mental health disorders in adolescence regardless of weight status, while eating symptomatology was a specific marker for the obesity group. Therefore, in the management of childhood obesity is suggested to address also psychosocial variables such as weight-related teasing and body esteem, to prevent the onset or development of mental health problem

Childhood obesity and adolescent follow-up depressive symptoms: Exploring a moderated mediation model of body esteem and gender

Obesity is a well-recognized risk factor for adolescent depressive symptoms, but mediating mechanisms of this association have scarcely been studied. This study is unique in examining an indirect pathway of this link via body esteem (BE) prospectively from childhood (8–12 years) to adolescence (13–18 years). In addition, potential gender moderation was examined. This study utilized data from a case–control study comparing 100 children with and without obesity matched on important confounders (age, gender, and socioeconomic status). Our findings provide support for the mediating role of BE in the link between childhood weight status and adolescent depressive symptoms at a 5-year follow-up. This mediation effect did not differ between boys and girls. The findings suggest the relevance of specifically targeting children’s BE in preventive intervention programs among children with obesity to prevent future mental health problem

Hypercapnia in hospitalized children and adolescents with anorexia nervosa as a predictive marker for readmission: a prospective study

To determine whether hypercapnia is associated with risk of hospital readmission related to anorexia nervosa (AN) in children and adolescents. Methods We performed a prospective study of patients≤18 years old admitted due to AN decompensation from November 2018 to October 2019. Both subtypes of AN, restricting subtype (AN-R) and binge-eating/purging subtype (AN-BP), were included. Study participants were evaluated upon admission, at discharge and six months after discharge. T-tests or Mann–Whitney U tests was used to compare means values. Pearson or Spearman correlations were used to measure the association between two variables. Logistic regression models were developed to evaluate the relationship between scoring methods and readmission. Results Of the 154 persons admitted during the study period, 131 met the inclusion criteria. Median age was 15.1 years. At admission, 71% of participants were malnourished and 33 (25%) had been previously admitted. We observed a marked decrease in venous pH and stable pCO2 elevation during follow-up period. Hypercapnia at discharge was associated with a twofold increased likelihood of readmission and the odds of readmission increased as discharge pCO2 rose. These fndings did not depend on AN subtype or participant sex. Electrolytes persisted within the normal range. Conclusion Hypercapnia and respiratory acidosis are common alterations in children and adolescents hospitalized due to AN decompensation. Hypercapnia persists for at least 6 months after discharge despite clinical improvement and is associated with higher odds of readmission. This is the frst study to identify an abnormal laboratory fnding as a potential predictor of readmission in AN. Level of evidence IV: Multiple time series without interventio

Family‐reported barriers and predictors of short‐term attendance in a multidisciplinary intervention for managing childhood obesity: A psycho‐family‐system based randomised controlled trial (ENTREN‐F)

Objective: This study was aimed to examine patient enrolment in the pre‐ intervention stage, family‐reported barriers, attendance rates and underlying predictors of short‐term attendance in a family‐system‐based randomised controlled trial for managing childhood obesity in children aged 8–12‐years‐ old (ENTREN‐F). Method: Psychosocial and anthropometric measures were collected through primary health referral. The data were used for descriptive analyses of sample characteristics and linear regression analyses. Results: Low enrolment rates and several family‐reported barriers were observed in the pre‐intervention stage. Logistical barriers were the most frequent family‐reported reason for attrition in the different stages of the study. Having a first face‐to‐face orientation session with the families and the use of motivational interviewing helped to improve adherence in the initial phases of the study. After 6 months of intervention, family based treatments (FBTs) under consideration achieve greater adherence compared with the standard intervention. Moreover, family involvement was a predictor of success for better treatment adherence rates. By contrast, participants who attended a brief standard intervention, mothers with primary education,greater body mass index, higher levels of depressive symptomatology and more critical comments towards their children, children with higher weight status and lower levels of self‐reported depressive symptoms at baseline attended interventions less frequently. Conclusions: In future programmes a comprehensive screening of modifiable factors related to family and their setting characteristics is paramount prior to intervention, identifying key barriers related to drop‐out, especially in the case of less‐advantaged familiesFUAM; Auchan Foundation for Youth; Ministerio de Ciencia e Innovació

Anthropometric changes in adolescents with anorexia nervosa in response to resistance training

The follow-up of anthropometric percentiles such as triceps and mid-thigh skinfold thickness (TSF, MTSF), mid-upper arm and mid-thigh circumferences (MUAC, MTC), and arm and mid-thigh muscle areas (AMA, MTMA) after a resistance training might allow for detecting nutritional progress of fat and muscular tissue during the treatment of anorexia nervosa restricting (AN-R) type patients. A total of 44 AN-R patients were randomized for control (CG 13.0 ± 0.6 years) and intervention (IG 12.7 ± 0.7 years) groups after hospitalization. The intervention group underwent a resistance training program of 8 weeks following the guidelines for healthy adolescents (3 days/week; 70 % of 6 RM). All measurements were obtained prior to starting the program (PRE) and after 8 weeks of training (POST) in both groups. TSF, MTSF, MUAC, and MTC were measured, and AMA and MTMA were calculated. Data were matched with percentile tables for general population. Changes were assessed using statistical tests for categorical data. The distribution of percentile categories within the groups did not differ statistically after 8 weeks (p > 0.05). After training, 73 % of the patients were at the same percentile interval of MUAC, 18 % higher and 9 % lower, while 30 % of CG was at lower percentile categories. Further, 54 % of the IG patients remained at the same percentile interval of MTC after training, and 36 % higher, while 20 % were at lower categories in the CG. The AMA increased (32 %) after training or remained at the same interval (59 %) in the IG, while the IG showed greater frequency of percentile decreases (45 %). Anthropometric measurements could be useful for assessing muscle status in AN-R patients during the treatment process. However, exact standard deviation scores should be used instead of percentile categories to increase the sensitivity to changes in TSF, MTSF, MUAC, MTC or AMA.Sin financiación1.254 JCR (2015) Q4, 106/140 PsychiatryUE

Experimental treatment of self-assertion curtails eating disorders (ED) symptoms

Sin financiación4.464 JCR (2019) Q1, 28/155 Psychiatry1.551 SJR (2019) Q1, 70/554 Psychiatry and Mental HealthNo data IDR 2019UE

Improved parental expressed emotion in a family-based intervention for adolescents with eating disorders

Sin financiación4.464 JCR (2019) Q1, 28/155 Psychistry1.551 SJR (2019) Q1, 70/554 Psychiatry and Mental HealthNo data IDR 2019UE

A family-based intervention of adolescents with eating disorders: The role of assertiveness

Introduction One of the key profile features of adolescents with Eating Disorders (ED) is a difficulty with assertiveness. Indeed, current research points to the importance of these patients’ perception of excessive control exerted by their families. Because these adolescents generally live with their families of origin, family-based variables may impact the development and evolution of psychosocial risk factors associated with this psychiatric disorder. Objective To investigate whether adolescents with ED improve on assertive communication as a result of parental assertiveness training. Methods The sample was comprised of 50 female adolescents with ED receiving group therapy treatment at Niño Jesús hospital in Madrid. Out of the 77 parents participating in the study, 36 were part of the experimental group and subjected to training in assertive skills (8-week sessions for about 2 hours). In addition, 41 parents formed the control group (with no assertiveness training). Before and after this training (or the same amount of time for the control group), adolescents were administered the psychometric test known as the Rathus Assertiveness Schedule (RAS). Results A significant increase in RAS scores was found in adolescents whose parents were subjected to the assertiveness training. Moreover, there was a significant decrease in self-restriction scores in patients with ED after their parental assertiveness intervention. No significant changes were observed, however, in the control group. Conclusions Our results indicate that providing families with educational tools that aim at developing assertive communication may boost the level of assertiveness in adolescents and, thereby, presumably help in the prognosis of ED.Sin financiación3.941 JCR (2017) Q1, 29/142 PsychiatryUE

A case-control study to differentiate parents’ personality traits on anorexia nervosa and affective disorders

Eating disorders (ED) and affective disorders (AD) in adolescent population and several investigations have pointed out that specific family dynamics play a major role in the onset, course, and maintenance of both dis-orders. The aim of this study was to extend the literature of this topic by exploring differences between parents' personality traits, coping strategies, and expressed emo-tion comparing groups of adolescents with different men-tal conditions (anorexia nervosa vs. affective disorder vs. control group) with a case–control study design. A total of 50 mothers and 50 fathers of 50 girls with anorexia ner-vosa (AN), 40 mothers and 40 fathers of 40 girls with af-fective disorder (AD), and 50 mothers and 50 fathers of 50 girls with no pathology that conformed the control group (CG) were measured with the Temperament and Character Inventory (TCI), the COPE Inventory, the Family Questionnaire (FQ), and psychopathology vari-ables, anxiety, and depression. Both parents of girls with AN showed a significant difference in personality, cop-ing strategies, and expressed emotion compared to both parents in the CG, while they presented more similarities to parents of girls in the AD group. Identifying personal-ity traits, expressed emotion, coping strategies, and psy-chopathology of parents and their daughters will allow improvements in the interventions with the adolescents, parents, and familiesPSI2011-2312