Assessment and treatment of eating disorders in adolescents

Pediatric health care providers understand that eating disorders are not lifestyle choices but lifethreatening mental health conditions Among patients of all ages, anorexia nervosa (AN) has the second-highest mortality rate of all mental health conditions, after substance abuse.1 Both suicide and the physical effects of nutritional deficit are implicated. Prevalence Analyses of prevalence vary widely in their findings.2 One meta-analysis found lifetime prevalence of AN from 1.7% to 3.6% for female patients and 0.1% for male patients;lifetime prevalence of BN for female patients was about 2.1%.3 BED, with reported prevalence rates of approximately 2% to 4%, is almost as common among male as female patients.2 4 Among adolescents aged 13 to 18 years, one study found prevalence rates of 0.3% for AN, 0.9% for BN, and 1.6% for BED.5 Long characterized as affecting primarily affluent White adolescent girls, eating disorders now affect people from lower socioeconomic groups, members of non-White ethnic groups, preteen children, and boys.2 LGBTQIA+ young people may be at particular risk.6 During the early months of the COVID-19 pandemic, hospitalizations for eating disorders doubled,7 and patients reported significant increases in unhealthy behaviors.8 Screening Caregiver reports about a child's weight or eating habits or clinical observation of unexpected weight changes are likely to alert the pediatrician to the possibility of an eating disorder. Presence of any one of the following symptoms indicates the need for immediate medical hospitalization for refeeding2'14: O Heart rate less than 50 beats per minute (bpm) while awake;less than 45 bpm while asleep O Systolic pressure less than 90/45 mm Hg O Orthostatic changes: decrease in blood pressure of more than 20 mm Hg systolic or 10 mm Hg diastolic;heart rate increase of more than 20 bpm O ECG abnormalities: Prolonged corrected QT interval or other arrhythmia O Syncope O Temperature less than 96 °F (35.6 °C) O Electrolyte abnormalities O Uncontrollable binge eating and purging Dehydration Suicide risk O Less than 75% of expected body weight O Failed outpatient management O Acute weight loss and food refusal Communication Today's young people typically know what anorexia and bulimia are.

The impact of COVID-19 on emotional, social, and behavioral health in adolescents with preexisting mental health concerns: A qualitative study

Objective: The COVID-19 pandemic has caused a decline in well-being for many adolescents. However, the impact of COVID-19 on mental health outcomes among adolescents remains understudied. The current study qualitatively examined the impact of COVID-19 restrictions on adolescents with mental health concerns prior to the pandemic. Methods: We enrolled 20 adolescents who were engaged in care through an Adolescent Health Specialty Clinic prior to COVID-19. Participants were 12- to 19 years old who experienced mental health concerns prior to COVID-19 and experienced declining mental health (e.g., new mental health diagnosis or increased severity of previous mental health diagnosis reported during clinical visit or documented in medical chart) during the pandemic. In-depth interviews were conducted, and inductive coding was applied to transcripts to identify emergent themes. Results: Five key themes were identified: manifestations of declining mental health, loss of motivation, changes to social relationships, use of social media, and coping mechanisms. Adverse mental health outcomes were provoked by experiences of loneliness and social isolation, especially due to school closures which disrupted routines, access to educational and social support, and key cultural milestones. The increased uses of social media and illicit substances were notable coping strategies. Conclusions: Findings from this study strengthen our understanding of the key factors influencing the psychosocial well-being of adolescents during the pandemic. Our results may help inform researchers, clinicians, and policymakers to develop guidelines and community-based strategies for mitigating the potentially negative effects of future pandemic-related disruptions to mental health among adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement The current study examined the impact of COVID-19 restrictions on adolescents with mental health concerns prior to the pandemic. Results emphasize the importance of obtaining first-hand perspectives from adolescents to optimize their care. Providers should prioritize mental health and substance use screening given the impact of the pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Association Between Co-Occurring Anxiety and Depression With Drug Overdose Encounters in the Emergency Department Among Adolescents and Young Adults in the Era of COVID-19.

PURPOSE: COVID-19 risk mitigation efforts could have negatively impacted anxiety, depression, and substance use among adolescents and young adults. METHODS: We analyzed 45,223 emergency department visits from April 2018 to March 2022 of patients aged 12-21 in Pinellas County, Florida. RESULTS: Frequency of overdose, anxiety, and depression significantly increased from the pre-COVID-19 to the COVID-19 period. Anxiety (adjusted odds ratio: 1.49, 95% confidence interval: 1.11, 1.98) and depression (adjusted odds ratio: 2.89, 95% confidence interval: 2.15, 3.88) were associated with significantly higher odds of overdose during COVID-19. DISCUSSION: Mental health and overdose among adolescents and young adults worsened during COVID-19, necessitating greater screening and treatment in primary care.