ABSTRACT
Abstract Avoidant/restrictive food intake disorder (ARFID) has a complex clinical presentation. Since its recognition in the DSM-5, investigations have provided data of this condition, however, its treatment has mostly been reported in case studies. Therefore, the objective of the present study was analyzed clinical characteristics and clinical interventions reported in case reports and case series studies of ARFID, from a literature review according to the PRISMA and CARE guidelines. In total, 41 articles were examined, most of the reported cases were males (53.85%) with ages between 10 to 13 (29.23%), although, 15.38% of the cases had an age range of 20 to 56. Regarding their symptoms, the most frequent was underweight (66.15%), however, 3.08% of these patients were overweight linked to carbohydrate consumption. The most frequent psychiatric comorbidities were anxiety disorders (38.46%). Lastly, the most widely used was hospital treatment (46.34%), with a multidisciplinary approach (65.85%) and as for the most used psychological intervention was Cognitive Behavioral Therapy (21.95%).
Resumen El Trastorno de evitación/restricción de la ingesta de alimentos (TERIA) tiene una presentación clínica compleja. Desde su reconocimiento en el DSM-5 se han realizado investigaciones que aportan datos de esta condición, sin embargo, su tratamiento se ha reportado mayormente en estudios de casos. Por tanto, el objetivo del presente estudio fue analizar las características e intervenciones clínicas de estudios y series de casos del TERIA, a partir de una revisión de la literatura con base a los lineamientos PRISMA y CARE. En total se examinaron 41 artículos, la mayoría de los casos reportados fueron en hombres (53.85%) con edades entre 10 a 13 (29.23%), aunque, 15.38% de los casos tenían un rango de edad de 20 a 56 años. En cuanto a sus síntomas, el más frecuente fue el bajo peso (66.15%), sin embargo, 3.08% de estos pacientes presentaba sobrepeso ligado al consumo de carbohidratos. Las comorbilidades psiquiátricas más frecuentes fueron los trastornos de ansiedad (38.46%). Por último, el tratamiento más utilizado fue el hospitalario (46.34%), con abordaje multidisciplinar (65.85%) y en cuanto a la intervención psicológica más utilizada fue la Terapia Cognitivo Conductual (21.95%).
ABSTRACT
@#Eating disorder (ED) referrals of school age children and adolescents, by their parents and school teachers, have become more common. Also, they are now presenting at an earlier age to the primary health care and school systems, with physical, medical and psychological symptoms. Nevertheless, there is an average of six months to two years between the onset of symptoms to formal assessment and treatment by specialist team. There are also more cases presenting to ED specialist clinic services, especially pre-pubertal children, with early onset and presentation before 14 years old. Mid and late adolescent presentations (after 14 years old) continue to make up more than two third of the cases. More than 60 percent of cases seen in specialist clinics are of the restrictive type anorexia nervosa, and often associated with persistent and excessive exercise. Thirty percent of cases presented are Bulimia nervosa, which tend to be episodic. Majority of single episode bulimia cases do not present themselves early to medical services but take on open source self-directed management. For patients with bulimia who comply to treatment program and recover after 6-12 months of therapy, they can also experience high relapse rate as they often discontinue their follow up. Avoidant-restrictive food intake disorder is more closely related to pre-pubertal onset eating disorder with arrested sexual maturity and growth failure, if left untreated. Psychiatric co-morbidities arising from body image disturbance, overdrive high achievement needs, prior exposure to adverse childhood experiences (ACE), dysfunctional family or peer relationships, include anxiety, avoidance behavior, obsessive rumination, depression, suicidal ideation and attempt. Death can arise from acute presentation and chronic state of ED, when associated with medical complications from refeeding syndrome, severe malnourishment, accidents and suicide. Early identification and assessment by family physicians would significantly improve the prognosis and mitigate against long term chronicity when share care with ED specialist services.
ABSTRACT
@#Eating disorder (ED) referrals of school age children and adolescents, by their parents and school teachers, have become more common. Also, they are now presenting at an earlier age to the primary health care and school systems, with physical, medical and psychological symptoms. Nevertheless, there is an average of six months to two years between the onset of symptoms to formal assessment and treatment by specialist team. There are also more cases presenting to ED specialist clinic services, especially pre-pubertal children, with early onset and presentation before 14 years old. Mid and late adolescent presentations (after 14 years old) continue to make up more than two third of the cases. More than 60 percent of cases seen in specialist clinics are of the restrictive type anorexia nervosa, and often associated with persistent and excessive exercise. Thirty percent of cases presented are Bulimia nervosa, which tend to be episodic. Majority of single episode bulimia cases do not present themselves early to medical services but take on open source self-directed management. For patients with bulimia who comply to treatment program and recover after 6-12 months of therapy, they can also experience high relapse rate as they often discontinue their follow up. Avoidant-restrictive food intake disorder is more closely related to pre-pubertal onset eating disorder with arrested sexual maturity and growth failure, if left untreated. Psychiatric co-morbidities arising from body image disturbance, overdrive high achievement needs, prior exposure to adverse childhood experiences (ACE), dysfunctional family or peer relationships, include anxiety, avoidance behavior, obsessive rumination, depression, suicidal ideation and attempt. Death can arise from acute presentation and chronic state of ED, when associated with medical complications from refeeding syndrome, severe malnourishment, accidents and suicide. Early identification and assessment by family physicians would significantly improve the prognosis and mitigate against long term chronicity when share care with ED specialist services.