Diagnosis and treatment of eating disorders in children and adolescents

Abstract Objectives To provide a narrative review of the main eating disorders (ED), specifically focusing on children and adolescents. This review also aims to help the pediatrician identify, diagnose, and refer children and adolescents affected by this medical condition and inform them about the multidisciplinary treatment applied to these disorders. Data source The research was conducted in the Scientific Electronic Library Online (SciELO), Medical Literature Analysis and Retrieval System Online (Medline) databases via PubMed and Embase. Consolidated Guidelines and Guidebooks in the area were also included in the review to support the discussion of ED treatment in childhood and adolescence. Data synthesis ED are psychiatric condition that usually begins in adolescence or young adulthood but can occur at any time of life, including in childhood, which has been increasingly frequent. Pediatricians are the first professionals to deal with the problem and, therefore, must be well trained in identifying and managing these disorders, which can be severe, and determine physical complications and quality of life of patients and their families. Conclusion ED has shown an increase in prevalence, as well as a reduction in the age of diagnosed patients, requiring adequate detection and referral by pediatricians. The treatment requires a specialized multidisciplinary team and is generally long-lasting for adequate recovery of affected individuals.

Avoidant restrictive eating disorder and panic attacks in an adult man: A case report / Trastorno evitativo restrictivo de la ingesta alimentaria y ataques de pánico en un hombre adulto: Reporte de caso

Abstract Avoidant or Restrictive Food Intake Disorder (ARFID) is an eating disorder (ED) not common in adults. In this article we present a clinical case of ARFID in a 37-year-old male patient treated in an ED center in Medellin, Colombia; displaying anxious symptoms that began a year earlier and concomitant weight loss, following a traumatic event causing an overall impairment with that patient. Several medical evaluations/examinations looking for organic causes, were excluded. Interventions were implemented by a psychiatry, a psychotherapist using cognitive-behavior therapy (CBT), and a nutritionist, all in face-to-face modality, which were carried out weekly for the first three months, then biweekly and subsequently quarterly. each lasting approximately 40-60 minutes. After the set of pharmacological interventions and psychotherapy, a great improvement in the functionality of the patient was observed. Improvement was found with respect to eating in public, food variation and panic attacks. In the absence of guidelines, it is important to use standardized and replicable treatments in this population.

Resumen El trastorno evitativo restrictivo de la ingesta (TERIA) es un trastorno alimentario (TCA) raro en adultos. Se presenta el caso de un hombre de 37 años con TERIA y trastorno de pánico atendido en un centro para TCA en Medellín, Colombia, quien presentó un año de síntomas ansiosos y pérdida de peso después de evento traumático, generando disfuncionalidad. Fue evaluada y excluida organicidad. Se realizaron intervenciones por parte de psiquiatría, psicoterapia con enfoque cognitivo conductual y nutrición, todas en modalidad presencial, las cuales se realizaron semanalmente los primeros tres meses, luego quincenalmente y posteriormente trimestralmente. Cada una con una duración de 40-60 minutos aproximadamente por sesión. Posterior al conjunto de intervenciones farmacológicas y psicoterapia, se observó una gran mejoría la funcionalidad del paciente, se encontró mejoría con respecto a comer en público, variación en los alimentos y ataques de panico. Ante la ausencia de guías de manejo de TERIA en adultos es relevante realizar tratamientos estandarizados que puedan ser replicados.

Therapeutic assessment as a brief and intensive intervention for avoidant restrictive food intake disorder, belching, and histrionic personality disorder: A case report

A 26-year-old female was hospitalized with complaints of repeated vomiting and weight loss (18 kg in 8 months); and incessant belching and nausea/regurgitation for 30 days subsequent to her COVID-19 treatment. After all the normal medical radiological reports, appropriate psychological and psychiatric evaluations were done. Incessant belching warranted a simple and flexible cognitive psychotherapy for histrionic personality with a therapeutic assessment technique. A total of 6 h of psychotherapy was delivered in three sessions. The belching and vomiting came down by 75% after the first extensive session, and almost 100% after the second session. However, mild belching reappeared, and after the termination-cum-booster session belching subsided till discharge and the first follow-up after 2 weeks

Stress, Depression and Coping in Tuberculosis Patients- A Hospital Based Study

Context/Background: Tuberculosis (TB) often leaves its impact physically, socially and mentally on pa-tients. Coping strategies refer to the specific efforts, both behavioural and psychological, that people employ to master, tolerate, reduce or minimize stressful events. The study was started to find out the prevalence of Depression in Tuberculosis patients, to find out the effect of Stress and Depression on Cop-ing strategies in patients diagnosed with Tuberculosis. Methodology: The study was a Cross sectional study carried out for period of two years at District tu-berculosis centre, SNR Hospital, Kolar. Sample size calculated was 288. All data entered in Microsoft of-fice excel sheet, analyzed using SPSS v 22. Descriptive statistics applied where ever needed and to com-pare between groups t-test, ANOVA was used. To check for association between factors, Chi-square was applied. Results: Out of 302 Tuberculosis patients, 29.1% belonged to 41-50 years, 72.2%were male, 77.5% re-sided in rural area, 24.5% were unemployed, 4% had HIV comorbidity, 46.4% had Diabetes Mellitus. 138(45.7%) patients had Severe Depression. Age, Gender, HIV status, Diabetes status, Tb Patients who Perceived TB stigma, BMI, Perceived Family Support, type of family and occupation were few Clinico-social factors which were statistically significant for Perceived stress scores. Conclusions: Better management of psychiatric morbidities should be educated by the treating primary health care doctors and DOTS providers in chronic infectious diseases like Tuberculosis can have direct or indirect impact on improving treatment adherence, illness perception and patient coping skills.

Change In Risk Perception and Behavior of the People of India during the COVID-19 Pandemic

Background: On 25th March 2020 the COVID-19 pandemic had affected more than 600 individuals across India and a nationwide lockdown was imposed. Although the number of active cases kept on increasing the government had to keep relaxing the lockdown as the months passed expecting people to continue practicing the COVID-19 mitigating behaviours. Various dynamic factors like risk perception are shown to determine the degree to which people practice the mitigating behaviours. We aimed to study the degree to which the practice of COVID-19 related mitigating behaviours has changed amongst people of India over a period of 5 months from lockdown to Unlock and the factors associated with it. The aim of the study was to study and compare the change in behaviour among different groups of people towards the COVID-19 pandemic from the period of the lockdown 1.0 (25th March 2020 to 31st May 2020) to 1st September 2020 onwards in terms of precautions adopted by them. Methodology: The nature of this study is cross-sectional, and it is an online-based survey. We conducted a cross-sectional observational study using an anonymous online questionnaire (which was divided into 3 sections) about demography, change in adoption of protective measures against the COVID-19 infection, change in avoidant behaviour towards the potential sources of infection, change in their perception of risk of the infection, and the probable reasons for this change. In all question participants were asked to choose the answer that best reflects the change in their behaviour that might have occurred from the time of strict nationwide lockdown (25th March – 31st May 2020) to Unlock 4.0 (1st September 2020 onwards). The data was entered and tabulated using EXCEL 2020 and was analysed using SPSS Version 22.0. Comparisons were done using Chi-Square test. Results of analysis have been expressed as percentages. Results: The total number of participants in our survey after applying the inclusion and exclusion criteria was 1030. Subjects demonstrated decreased practice of most COVID-19 mitigating behaviours as the pandemic progressed with the exception of use of sanitises and wearing of masks. The mitigating behaviour which decreased the most was social distancing as almost two third participants went out for non-essential activities more than before. Risk perception of the illness seems to be the most important predictor of health- related protective behaviour. Perceived susceptibility of self and loved ones was not associated with change of behaviours, however, decrease in perceived severity of illness for themselves and family members is associated with significant decrease in practicing COVID-19 behaviours. Conclusion: Our results have implications on our understanding of how mitigating behaviours and risk perception can target public education and health policies.

Cuidados enfermeros que modifican conductas alimentarias en adolescentes, etapa inicial de anorexia / Nursing cares that modify eating behaviors in adolescents, first stage of anorexia / Cuidados de enfermagem que mudam comportamentos alimentares em adolescentes, etapa inicial da anorexia

Introducción: La anorexia nerviosa es un trastorno de la conducta alimentaria que afecta al individuo fisiológica y psicológicamente. El profesional de enfermería y equipo multidisciplinar debe promocionar, prevenir y rehabilitar para modificar estas conductas y reducir su progresión. Metodología: Revisión integrativa de la literatura. Palabras clave utilizadas Atención de Enfermería, Jóvenes, Anorexia, Conducta alimentaria trastorno de la Ingesta Alimentaria Evitativa/Restrictiva, Tratamiento multimodal y Habilidades de afrontamiento. Se incluyeron artículos en español, inglés y portugués de cualquier nacionalidad y diseño metodológico publicados entre 2014 y 2019 indexados en bases de datos ClinicalKey, Scielo, CINAHL y metabuscador Google académico. Se filtraron por lectura de título, resumen y texto completo, se clasificaron según el nivel de evidencia y grado de recomendación; finalmente se ejecutó lectura crítica mediante las escalas Amstar, Consort y Strobe.. Resultados: Se incluyeron 34 artículos y se construyeron cuatro temáticas: cuidados de enfermería que modifican la conducta alimentaria, factores que influyen en el cambio de la conducta alimentaria, impacto de los cuidados de enfermería y consecuencias de la no aplicación de los cuidados de enfermería. Conclusión: Las intervenciones de enfermería son fundamentales para la recuperación de los adolescentes en etapa inicial de anorexia ya que reducen la progresión de la enfermedad y favorece la expresión de sentimientos.

Introduction: Anorexia nervosa is an eating disorder that affects the individual physiologically and psychologically. The nursing professional, along with a multidisciplinary team must promote, prevent and rehabilitate the individual, to modify these behaviors and reduce its progression. Methodology: Integrative review of the literature. Keywords used: nursing care, young people, anorexia, eating behavior, avoidant/restrictive food intake disorders, multimodal treatment and methodological design. Articles in English, Spanish and Portuguese were included, from any nationality and methodological design. The articles selected were published between 2014 and 2019 and were indexed to the databases ClinicalKey, Scielo, CINAHL, and Google Scholar. These were filtered by reading the title, abstract and complete text; and were classified according to their level of evidence and grades of recommendation. Finally, a critical reading was made using the tools, AMSTAR, CONSORT and STROBE. Results: 34 articles were included, and four themes were built: nursing care to modify eating habits, factors that include change in eating behaviors, nursing care impact and consequences of not applying nursing care. Conclusion: The nursing interventions are fundamental for the recovery of adolescents in the first stage of anorexia since these reduce the progression of the disease and support expressing their feelings.

Introdução: A anorexia nervosa é um transtorno do comportamento alimentar que afeta ao sujeito fisiologica e psicologicamente. O profissional de enfermagem junto com a equipe multiprofissional deve promover, prever e reabilitar para mudar essas condutas e reduzir o progresso. Métodos: Revisão integrativa da literatura. Palavras-chave empregadas: cuidados de enfermagem, adolescente, anorexia, comportamento alimentar, transtorno da evitação ou restrição da ingestão de alimentos, terapia combinada, adaptação psicológica. Incluíram-se artigos publicados em espanhol, inglês e português com qualquer nacionalidade ou metodologia. Foram selecionadas as publicações entre 2014-2019 disponíveis na ClinicalKey, Scielo, CINAHL e no Google Scholar. Foram filtrados pela leitura do título, o resumo e o texto completo; classificaram-se segundo o nível de evidência e o grau de recomendação. Finalmente, efetivou-se uma leitura crítica empregando as escalas Amstar, Consort e Strobe. Resultados: Incluíram-se 34 artigos e construíram-se quatro temas: cuidados de enfermagem que mudam os comportamentos alimentares; fatores que influenciam a mudança de comportamento alimentar; impacto nos cuidados de enfermagem; e, consequências da ausência de cuidados de enfermagem. Conclusão: As intervenções de enfermagem são fundamentais para a recuperação dos adolescentes na etapa inicial da anorexia, devido à redução do progresso do transtorno, além de favorecer a expressão dos seus sentimentos.

Adult avoidant/restrictive food intake disorder: a case report / Transtorno alimentar evitativo/restritivo em uma adulta: um relato de caso

ABSTRACT The aim this report is to present an adult case of avoidant/restrictive food intake disorder (ARFID) in a patient with atypical development. To emphasize the diagnostic and behavioral characteristics of this new nosological category included in the Feeding and Eating Disorders (FED) section of DSM-5. A woman with Down Syndrome in early adulthood who developed restriction and avoidance symptoms of food until the total eating refusal with weight loss, malnutrition and dependence exclusively on enteral feeding by gastrostomy tube. This case exemplified how ARFID may remain a hidden diagnosis and even be misdiagnosed as other eating disorders, such as anorexia nervosa. The increase in diagnostic suspicion for this nosological entity with neurobiological/behavioral mechanisms involved in its clinical presentations in mind, might increase knowledge about this serious eating disorder, aiming the development of evidence-based interventions.

RESUMO O objetivo deste relato é apresentar um caso de transtorno alimentar evitativo/restritivo (TARE) em uma paciente adulta com desenvolvimento atípico e salientar as características diagnósticas e comportamentais dessa nova categoria nosológica incluída na seção de Transtornos Alimentares da DSM-5. Mulher com síndrome de Down que, no início da vida adulta, evoluiu com sintomas de restrição e evitação alimentar até a recusa total da alimentação, com perda de peso, desnutrição e dependência total de alimentação enteral por gastrostomia. Este caso elucida como o diagnóstico de TARE pode permanecer oculto e ser confundindo com outras condições patológicas alimentares, como a anorexia nervosa. O aumento da suspeição diagnóstica para essa entidade nosológica, tendo em mente os mecanismos neurobiológicos/comportamentais envolvidos em suas apresentações clínicas, possibilitará o aumento do conhecimento sobre esse grave transtorno alimentar, visando ao desenvolvimento de intervenções eficazes baseadas em evidências.

The Differential Profile of Social Anxiety Disorder (SAD) and Avoidant Personality Disorder (APD) on the Basis of Criterion B of the DSM-5-AMPD in a College Sample

@#Background: The present study was conducted to determine the differential profile of social anxiety disorder (SAD) and avoidant personality disorder (APD) based on dimensional diagnosis in criterion B of the DSM-5 Alternative Model for Personality Disorders (DSM-5-AMPD) in a college sample. Methods: Samples of this cross-sectional study included 320 (23.08 ± 2.66 years; 57% female) college students in western Iran during February 2015 to December 2017. Liebowitz-social anxiety scale, PID-5, SCID-II, SCID-II-SQ and diagnostic interview for SAD were the tools. The data were analysed using Pearson correlation and multiple linear regression analysis. Results: Forty-three and 38 participants met criteria for SAD alone and APD, respectively. Five main domains of PID-5 could explain 29% and 54% of the variance of SAD and APD, respectively. Facets of negative affect, detachment, antagonism, disinhibition, and psychoticism could explain 25% versus 43%, 26% versus 54%, 7% versus 27%, 21% versus 41%, 13% versus 30% of the variance of SAD and APD, respectively. Conclusion: SAD and APD probably refer to two distinct mental states having prominent anxiety, emotional instability, and interpersonal pattern of avoidance and detachment of challenge. SAD is a simple form of mental disturbances with anxiety in its core features; although, APD is possibly referring to more complicated psychopathology.

Mediating effects of positive mental characters on the relationship between avoidant personality dis-order and trait coping style in recruits / 中华行为医学与脑科学杂志

Objective To explore the relationship between avoidant personality disorder and trait coping style,especially the mediating effect of positive mental characters. Methods A sample of 8 500 male recruits was assessed with personality diagnostic questionnaire?4+( PDQ?4+) , positive mental characters scale for recruits(PMCS?R) and trait coping style questionnaire(TCSQ). Results The scores of avoidant personality disorder group were lower than control group on wisdom((3.41±0.77) vs (3.76±0.74)),courage ((3.62±0.76) vs (4.05±0.78)),humanity((3.59±0.75) vs (3.98±0.72)),justice((3.64±0.75) vs (4.02 ±0.76)),temperance((3.58±0.85) vs (4.01±0.83)),transcendence((3.77±0.72) vs (4.13±0.71)),posi?tive mental characters((3.60±0.66) vs (3.99±0.62)) and trait coping style((32.74±6.71) vs (36.61± 6.23)),while negative coping style score was higher than control group((30.87±6.91) vs (22.79±6.96)) respectively,with statistical significance( all P<0.01) . Avoidant personality disorder had significantly negative correlation with positive mental characters and trait coping style( r=-0.323,-0.320,all P<0.01) ,and signif?icantly positive correlation with negative coping style ( r=0.579, P<0.01). Positive mental characters had significantly positive correlation with trait coping style( r=0.548, P<0.01) ,and significantly negative corre? lation with negative coping style( r=-0.289, P<0.01). Hierarchy regression analysis showed that positive mental characters mediate the relationship between trait coping style ( positive coping style,negative coping style) and avoidant personality disorder ( the value of mediating effect was 50.07%,6.36%) . Conclusion ?Recruits’ avoidant personality disorder affects trait coping style not only directly,but also indirectly through positive mental characters.

The Mediating Effects of Loneliness on the Relationship between Smartphone Addiction and Dependent Personality Trait in Adults

BACKGROUND: As the number of smartphone users is increasing, smartphone addiction is a recent concern. The purpose of the present study was to examine the mediating effect of loneliness on the relationship between smartphone addiction and dependent/ avoidant personality trait in Adults. METHODS: A total of 550 adults (male 116, female 434) were selected and rated smartphone addiction scale, dependent and avoidant personality trait scales, and loneliness scale. Pearson correlation coefficients, Structural Equation Model Analysis and Sobel test using SPSS version 21.0 (IBM, New York, NY, USA) and AMOS version 21.0 (IBM, New York, NY, USA) were conducted. RESULTS: Dependent and avoidant personality significantly were related smartphone addiction and loneliness. Finding in structural equation modeling indicated that the loneliness partially mediated the relationship between dependent personality and smartphone addiction, but did not mediated the relationship between avoidant personality and smartphone addiction. CONCLUSIONS: This study confirmed partial mediation effect of loneliness on the relationship between smartphone addiction and dependent personality. This finding suggests that future intervention for smartphone addiction should focus on reducing of loneliness and proper coping with loneliness.

Obsessive-compulsive (anankastic) personality disorder: toward the ICD-11 classification

Obsessive-compulsive personality disorder (OCPD) is an early-onset disorder characterized by perfectionism, need for control, and cognitive rigidity. Its nosological status is currently under review. Historically, OCPD has been conceptualized as bearing a close relationship with obsessive-compulsive disorder (OCD). In this article, we discuss the diagnosis of OCPD in anticipation of its review for the ICD-11, from the perspective of clinical utility, global applicability, and research planning. Considering the recent establishment of an obsessive-compulsive and related disorders (OCRD) category in DSM-5, we focus on the relationship between OCPD and the disorders that are currently thought to bear a close relationship with OCD, including DSM-5 OCRD, and other compulsive disorders such as eating disorder and autistic spectrum disorder (that were not included in the DSM-5 OCRD category), as well as with the personality disorders, focusing on nosological determinants such as phenomenology, course of illness, heritability, environmental risk factors, comorbidity, neurocognitive endophenotypes, and treatment response. Based on this analysis, we attempt to draw conclusions as to its optimal placement in diagnostic systems and draw attention to key research questions that could be explored in field trials.