Considering a risk profile based on emergency department utilization in young people with eating disorders: Implications for early detection.

OBJECTIVE: While screening tools are available for the early identification of eating disorders, it may not be feasible to employ them in an emergency department (ED). Establishing a risk profile may improve the screening process. The purpose of this study was to investigate ED service utilization among patients with eating disorders and create a risk profile to help detect eating disorders at an earlier and more treatable stage. METHOD: We applied a concurrent mixed methods research design, however, only the quantitative findings will be presented. Our study involved a retrospective cohort analysis of administrative ED health data for patients (n = 243) aged 12-24 years in an eating disorders program. Two control groups: (1) all-cause (n = 716), (2) and mental health (n = 679) were included. RESULTS: 68.7% of eating disorder patients were discharged from the ED without follow-up being arranged. Comorbidities were recorded as the primary or secondary diagnosis, and patients presented with suicidality more frequently than controls (χ = 31.2, p < .001). Patients accessed ED services five times more often than controls. DISCUSSION: Despite eating disorder patients accessing the ED more frequently than controls, eating disorder diagnoses were not always assigned or documented. Our findings highlight the importance of enhanced eating disorder training for ED health care staff to better understand the risk profile, and the consideration of comorbidities and suicide risk when assessing patients to ensure early detection. CONCLUSION: As eating disorders are often undetected, more comprehensive training and access to screening tools may help improve detection, mitigate symptom progression, and enhance patient safety.

Emotional functioning in pediatric epilepsy: Evidence of greater externalizing behavior with left hemisphere onset.

Though it is wellknown that psychiatric concerns are common in children with epilepsy, factors predicting such problems are not well understood. The present investigation studied rates of parent-reported psychological concerns in clinically referred children with epilepsy. Further, it investigated differences in psychological distress across epilepsy subtypes (i.e., focal, generalized, mixed), relationships with epilepsy severity variables, gender, and lateralization of seizure foci. The parents of 170 children and adolescents (ages 6-18 years, 78 girls, 92 boys) completed the Child Behavior Checklist (CBCL). Scale elevation frequencies (T-scores ≥ 65) were calculated and Chi square analyses examined rates of elevations between epilepsy groups. Internalizing problems (32.4%) were more common than externalizing problems (17.1%) for the sample, with attention problems being the most common concern across all epilepsy types (48.8%). While there were no significant relationships between epilepsy severity variables and CBCL broadband scales, the Total Problems scale was inversely related to intellectual functioning (r = -0.174, p = 0.023). Rates of anxiety and depression did not differ across epilepsy subtypes and no gender differences were found. Those with left-sided epilepsy had higher rates of externalizing problems (33.2%) than those with right (14.0%; χ2[1, 88] = 4.55, p = 0.03), with rule-breaking behaviors (15.4%) being more common in left-hemisphere epilepsy (15.4% versus 2.3%; χ2[1,88] = 4.66, p = 0.03). In summary, while no significant differences were found across epilepsy groups, the current study adds to the literature regarding lateralization effects and mood/behavior, with more externalizing problems in those with left hemisphere epilepsy.