Psychological characteristics and childhood adversity of adolescents with atypical anorexia nervosa versus anorexia nervosa.

The assessment and diagnosis of atypical anorexia nervosa (AAN) is an ongoing challenge for clinicians. This study aims to examine psychological morbidity and exposure to childhood adversity in adolescents with AAN compared to adolescents with anorexia nervosa, restricting type (AN-R). This registry-based study compared 42 adolescents with AAN to 79 adolescents with AN-R on a variety of psychosocial measures at the time of presentation to a specialized eating disorder program. In contrast to AN-R, adolescents with AAN had more severe drive for thinness (p =.011), body dissatisfaction (p =.038), and lower quality of life (p =.047), but had better global functioning (p =.032). Adolescents who had high Adverse Childhood Experiences (ACE) Questionnaire scores (ACE score ≥ 4) had over 5 times higher odds of having AAN than those who did not have high ACE scores (p =.008). There was no significant difference between groups on measures of low self-esteem and non-accidental self-injury. Adolescents with AAN presented with similar or more severe psychosocial distress compared to their peers with AN-R across a majority of the measures. The findings highlight the need to address trauma, body-related difficulties, and quality of life in the assessment and treatment of adolescents with AAN.

The COVID-19 Pandemic and Canadian Pediatric Tertiary Care Hospitalizations for Anorexia Nervosa.

PURPOSE: Global studies show an increase in hospitalizations for pediatric eating disorders (EDs). No published Canadian studies have confirmed these findings in pediatric ED programs for one-year post onset of the COVID-19 pandemic. The primary objective was to examine health administrative data from two pediatric tertiary care ED programs: Alberta Children's Hospital (ACH) and Hospital for Sick Children (SickKids) to determine the number of pediatric hospitalizations with the most responsible discharge diagnosis of anorexia nervosa (AN). METHODS: This hospital-based design explored monthly pediatric hospitalizations in seven-year-olds to 18-year-olds between March 11, 2014 and March 11, 2021 using the Discharge Abstract databases. The analysis used negative binomial regression with robust standard errors to compare hospitalization counts in the months preceding and following the World Health Organization pandemic declaration (March 11, 2020). RESULTS: Hospitalizations due to pediatric AN increased by 63% and 132% at SickKids (p < .001) and ACH (p < .001), respectively, in the first year of the pandemic compared to the previous six years. The total number of non-ED hospitalizations decreased by 29.3% and 2.4% at SickKids and ACH, respectively. DISCUSSION: This is the first Canadian study to show a rise in pediatric hospitalizations over one year due to AN in two tertiary care hospitals following the onset of the pandemic, confirming the impact that the pandemic has had on children and adolescents with AN in Canada.

Evaluation of the Referral Process and Patterns to a Canadian Specialized Eating Disorders Treatment Program.

OBJECTIVE: To describe the referral process and patterns to the Calgary Eating Disorders Program (CEDP). METHOD: A retrospective chart review for the study period of May 2014 to May 2016 was completed and a descriptive evaluation of the referral process was outlined. RESULTS: The results summarize the steps in the referral process from initiation of referral to booking an assessment. The CEDP received 918 referrals during the study period, yet 60% did not materialize into a patient assessment. Regardless of age, the two most common reasons were patients declined treatment and did not meet program criteria. Physicians who refer to the CEDP are mostly female, family physician specialty and from Calgary. Patients referred to the CEDP are predominantly females, have an average age of 25 years and are mainly referred for 'eating disorder symptoms-diagnosis unclear', regardless of age. The majority of patients are not severely ill at the time of referral. More than 50% of patients have psychiatric comorbidities, with depression, anxiety and substance abuse being the most common. The average wait times to the CEDP are 12 weeks. CONCLUSIONS: This is the first study in Canada to assess referral patterns to a specialized eating disorders program. Results from this study have elucidated the reasons for referral fall-through and highlighted areas of improvement in the referral process. Understanding referral trends is a necessary foundation to advance our knowledge of the factors that contribute to referrals materializing into assessments and ultimately optimizing patient care.

OBJECTIF: Décrire le processus et les modèles d'aiguillage du programme de Calgary sur les troubles alimentaires (PCTA). MÉTHODE: Une revue des dossiers rétrospective a été menée pour la période de l'étude, de mai 2014 à mai 2016, et une évaluation descriptive du processus d'aiguillage a été ébauchée. RÉSULTATS: Les résultats résument les étapes du processus d'aiguillage, du début de l'aiguillage à la réservation d'une évaluation. Le PCTA a reçu 918 aiguillages durant la période de l'étude, et pourtant, 60 % ne se sont pas concrétisés en une évaluation de patient. Peu importe l'âge, les deux raisons les plus communes étaient que les patients refusaient le traitement et ne satisfaisaient pas aux critères du programme. Les médecins qui aiguillent des patients au PCTA sont surtout des femmes, spécialisées en médecine familiale et sont de Calgary. Les patients orientés au PCTA sont principalement des femmes, d'une moyenne d'âge de 25 ans et sont surtout aiguillées pour des « symptômes de troubles alimentaires ­ diagnostic imprécis ¼, peu importe l'âge. La majorité des patients ne sont pas gravement malades au moment de l'aiguillage. Plus de 50 % des patients ont des comorbidités psychiatriques, les plus communes étant la dépression, l'anxiété et l'abus de substances. La moyenne des temps d'attente au PCTA est de 12 semaines. CONCLUSIONS: Cette étude est la première au Canada à évaluer les modèles d'aiguillage à un programme spécialisé de troubles alimentaires. Les résultats de cette étude ont élucidé les raisons des manquements de l'aiguillage et mis en évidence les domaines du processus d'aiguillage à améliorer. Comprendre les tendances de l'aiguillage est un fondement nécessaire pour mieux connaître les facteurs qui contribuent à ce que les aiguillages se concrétisent en évaluations et en fin de compte, en des soins optimaux aux patients.