Are lifetime affective disorders predictive of long-term outcome in severe adolescent anorexia nervosa?

Depression and anxiety are commonly associated with anorexia nervosa (AN) and contribute to difficulties in social integration, a negative factor for outcome in AN. The link between those disorders and AN has been poorly studied. Thus, our objective was to investigate (1) the link between outcome nine years after hospitalisation for AN and the occurrence of lifetime anxious or depressive comorbidities; (2) the prognostic value of these comorbidities on patient outcome; 181 female patients were hospitalised for AN (between 13 and 22 years old), and were re-evaluated for their psychological, dietary, physical and social outcomes, from 6 to 12 years after their hospitalisation. The link between anxious and depressive disorders (premorbid to AN and lifetime) and the outcome assessment criteria were tested through multivariate analyses; 63% of the participants had good or intermediate outcome, 83% had presented at least one anxiety or depression disorder in the course of their lives, half of them before the onset of AN. Premorbid obsessive compulsive disorders (OCD), BMI at admission, and premenarchal AN all contribute to poor prognosis. Social phobia and agoraphobia affect the subjects' quality of life and increase eating disorder symptoms. These results encourage a systematic assessment of, and care for, anxiety and depression comorbidities among female adolescent patients with a particular focus on premorbid OCD.

[Evaluation of excessive daytime sleepiness in child and adolescent psychopathology]. / Évaluation d'une somnolence diurne excessive en psychopathologie de l'enfant et de l'adolescent.

Childhood and adolescence are characterized by major changes in physiological, social and psychological domains. Some learning, behavior, mood or sleep disorders occurring during these ever-changing periods may lead children and teenagers to search for psychiatric care. It is then crucial to accurately determine which symptoms pertain to sleep and alertness disorders. Otherwise, some sleepy children and adolescents may be incorrectly considered as lazy, hyperactive or depressed. The evaluation of sleepiness requires a thorough physical examination (including the otorhinolaryngologic aspect), the completion of scales and brief questionnaires suited for pediatric patients, a fully completed sleep diary and in some cases biological or electrophysiological exams such as polysomnography (suited for the diagnosis of sleep apnea, narcolepsy, and periodic limb movement disorder). These investigations will help recognize excessive sleepiness, evaluate the often bi-directional links with the associated psychopathology and, should the case arise, diagnose primary sleep disorders (mostly sleep apnea in children and insufficient sleep in adolescents) and guide the adequate treatment.