A study protocol for implementing Canadian Practice Guidelines for Treating Children and Adolescents with Eating Disorders.

BACKGROUND: Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake. METHODS: Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8-10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups. DISCUSSION: Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies.

Assessment of Aggressive Behaviour in a Patient with Autism Spectrum Disorder Requiring General Anesthesia.

OBJECTIVE: To consider the utility of general anesthesia in the assessment of aggressive behaviour associated with autism spectrum disorder (ASD). METHODS: We describe the case of an adolescent male exhibiting violent behaviour with a previous diagnosis of ASD and review medical literature relevant to the assessment of aggression in the context of ASD. RESULTS: A 16-year-old male with a prior diagnosis of ASD, who was non-verbal, was admitted to an inpatient psychiatry ward with the presenting issue of violent behaviour. The patient had not received routine medical or dental care for several years due to agitation and aggression when attempts to physically examine him were made. General anesthesia was necessary to assess for medical conditions that may be contributory to his behavioural changes. While under general anesthesia, he was physically examined by several consulting services, received brain imaging, and laboratory specimens were drawn. CONCLUSIONS: Aggressive behaviour is a common issue for patients with ASD. When a patient's behaviour precludes examination and investigations, general anesthesia may be beneficial to facilitate the assessment process. This case illustrates the importance of a multidisciplinary approach in the assessment and management of a minimally verbal patient presenting with behavioural changes. To the knowledge of the authors, this represents the first published case report of a patient with ASD requiring general anesthesia for the assessment of aggressive behaviour.

OBJECTIF: Estimer l'utilité d'une anesthésie générale dans l'évaluation du comportement agressif associé au trouble du spectre de l'autisme (TSA). MÉTHODES: Nous décrivons le cas d'un adolescent masculin présentant un comportement violent avec un diagnostic précédent de TSA, et révisons la littérature médicale traitant de l'évaluation de l'agressivité dans le contexte du TSA. RÉSULTATS: Un jeune homme de 16 ans ayant un diagnostic précédent de TSA, qui était non verbal, a été hospitalité dans une unité d'hospitalisation psychiatrique alors qu'il présentait un problème de comportement violent. Le patient n'avait pas reçu de soins médicaux ou dentaires réguliers depuis plusieurs années en raison de l'agitation et de l'agressivité qu'il manifestait quand on tentait de l'examiner physiquement. L'anesthésie générale était nécessaire pour évaluer les affections médicales qui pouvaient contribuer à ces changements de comportement. Quand il fut sous anesthésie générale, il a été physiquement examiné par plusieurs services de consultation, il a reçu une imagerie cérébrale et des échantillons de laboratoire ont été prélevés. CONCLUSIONS: Le comportement agressif est un problème commun chez les patients souffrant du TSA. Quand le comportement d'un patient empêche l'examen et les investigations, l'anesthésie générale peut être bénéfique pour faciliter le processus d'évaluation. Ce cas illustre l'importance d'une approche multidisciplinaire dans l'évaluation et la prise en charge d'un patient minimalement verbal qui présente des changements de comportement. À la connaissance des auteurs, ceci représente la première étude de cas publiée d'un patient souffrant du TSA nécessitant une anesthésie générale pour évaluer un comportement agressif.

The relationship between child abuse, parental divorce, and lifetime mental disorders and suicidality in a nationally representative adult sample.

OBJECTIVES: To determine how the experiences of child abuse and parental divorce are related to long-term mental health outcomes using a nationally representative adult sample after adjusting for sociodemographic variables and parental psychopathology. METHODS: Data were drawn from the National Comorbidity Survey (NCS, n=5,877; age 15-54 years; response rate 82.4%). Logistic regression models were used to determine the odds of experiencing lifetime psychiatric disorders and suicidal ideation and attempts. RESULTS: Parental divorce alone was associated with some psychiatric disorders after adjusting for sociodemographic variables (AOR ranging from 1.30 to 2.37), while child abuse alone was associated with psychiatric disorders (AOR ranging from 1.39 to 6.07) and suicidal ideation (AOR=2.08; 95% CI=1.57-2.77) and attempts (AOR=1.54; 95% CI=1.02-2.31) after adjusting for sociodemographic variables. However, having experienced both parental divorce and child abuse together resulted in significantly increased odds for lifetime PTSD (AOR=9.87; 95% CI=6.69-14.55), conduct disorder (AOR=4.01; 95% CI=2.92-5.51) and suicide attempts (AOR=2.74; 95% CI=1.84-4.08) compared to having experienced either parental divorce or child abuse alone. These results were attenuated when further adjusting for parental psychopathology. CONCLUSIONS: When the experience of parental divorce is accompanied with child abuse, the associations with some poor mental health outcomes are significantly greater compared to the impact of either parental divorce or child abuse on its own. Therefore, parental divorce is an additional childhood adversity that significantly contributes to poor mental health outcomes especially when in combination with child abuse. Parental psychopathology attenuated these relationships suggesting that it may be one possible mechanism to explain the relationships between child abuse, parental divorce, and psychiatric disorders and suicide attempts.