A longitudinal study of autism spectrum disorder characteristics in adolescents with restrictive type anorexia nervosa during and after underweight.

OBJECTIVES: This prospective, longitudinal study aims to compare the prevalence of autism spectrum disorder (ASD) characteristics in adolescents with anorexia nervosa (AN) during and after underweight in order to help unravel the complex link between both conditions. METHODS: 24 adolescents with AN completed the youth self-report, autism spectrum quotient (AQ) or autism spectrum quotient adolescent version (AQ - adolescent) and a questionnaire designed by the researchers during a state of underweight and after weight recovery. RESULTS: AQ total score and several AQ subscale scores at the time of underweight are significantly higher than after weight recovery with medium to large effect sizes. Linear modelling cannot prove a significant effect of weight gain, internalizing problems or medication use on AQ score, but it does show an association between AQ during underweight and AQ after weight recovery. CONCLUSIONS: The results highlight the complexity of the link between AN and ASD characteristics. Although a clear change in AQ score is seen in part of the participants, this effect cannot be generalized and a link with weight change cannot be demonstrated. It seems likely that ASD characteristics in AN are a combination of trait and state: underweight and starvation might exacerbate potentially present traits. Part of our results may indicate the existence of subgroups based on AQ score during underweight. Our study supports the theory that more ASD characteristics at T1 may result in a poorer outcome and a higher need for specified and intensive treatment.

Sociodemographic and clinical characteristics of eating disorder patients treated in the specialized residential settings in Belgium.

INTRODUCTION: Epidemiologic information on sociodemographic and clinical characteristics in eating disorders in Western European countries are scarce. PURPOSE: In this study, we report demographic and clinical characteristics of eating disorder (ED) patients undergoing treatment in five specialized ED centers in Flanders (Belgium). METHOD: Data from 642 ED patients were collected by means of a structured questionnaire. RESULTS: Data show that 93.8% of patients are female, with an average age of 22.6 years. The largest subgroup in our sample suffers from anorexia nervosa, namely 52.8%. Bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS) account for 17.7%, 10.7% and 18.8% of the sample, respectively. Mean age of onset was 17 years. Mean duration of illness was 5.6 years, but 20.2% of patients had their illness for over 8 years. Anorexia nervosa patients of the restricting type (AN-R) have the shortest duration of illness. BED patients stood out because they were older on average, more often in a relationship and more often in ambulatory treatment. 70% of patients over 20 years old completed higher education, but one-third of this group was unemployed and/or disabled. Remarkably, ED patients grow more up in intact families compared to the general population. CONCLUSIONS: Epidemiology of ED patients in treatment in Flanders (Belgium) seems to resemble worldwide findings. The long duration of illness, the common evolution towards chronicity and the early work impairment underline the severe personal and societal impact of ED and call to the need for early detection and treatment of these patients. LEVEL OF EVIDENCE: Level V: cross-sectional descriptive study.

Ferritin and body mass index predict cardiac dysfunction in female adolescents with anorexia of the restrictive type.

BACKGROUND AND AIM: Decreased left ventricular mass index in anorexia nervosa is amply reported. The aim of this study is to identify non-burdensome predictors of reduced left yentricular mass/height (cLVM) in a cohort of adolescent restrictive anorexic girls. METHODS: This is a retrospective study of all anorexic girls of the restrictive type referred to our tertiary eating disorder unit between September 2002 and December 2012, for somatic assessment of weig ht loss. All subjects fulfilled DMS-IV criteria, without a family history of cardiac or cardiovascular diseases. RESULTS: In all, 283 restrictive anorexic girls (age: 14.63 +/- 1.65 y; body mass index: 15.72 +/- 1.81 kg/m2) were included. Ferritin and body mass index were independent, statistically significant predictors of the corrected left ventricular mass (P <0.05). CONCLUSION: Decreased cLVM is very common in anorexia nervosa of the restrictive type. Two factors predicted decreased cLVM in our population: ferritin and BMI.

Erythema ab igne in an adolescent with anorexia nervosa.

OBJECTIVE: A rare skin lesion, erythema ab igne (EAI) is presented, in an adolescent female with anorexia nervosa. METHOD: Clinical records of this patient were compared with a pubmed search about EAI in patients with an eating disorder. RESULTS: The patient presented with localized, spider-like, erythematous and hyperpigmented skin lesions on the lower abdomen and on both thighs. Repetitive exposure to heating pads can induce reticular and macular hyperpigmentation with telangiectases without squamation. Strict avoidance of heat is advised, because there is no effective treatment. DISCUSSION: EAI is described in patients with an eating disorder. Facing an increased pain threshold, prolonged heat exposure to treat a general feeling of cold, can induce this dermatosis.

Pericardial effusions in adolescent girls with anorexia nervosa: clinical course and risk factors.

The aim of this study was to evaluate cardiac, biochemical and endocrine differences between female adolescents with anorexia nervosa (AN) with and without pericardial effusions. We studied 128 female adolescents (9.8-17.7 years) with anorexia nervosa (AN) diagnosed according to DSM-IV (American Psychiatric Association, 1994) criteria. They all underwent an echocardiographic evaluation. In 29 patients (22.2 %) a pericardial effusion (ranging between >or= 0.35-2.5 cm) was noted. None of the patients were clinically symptomatic. After 3 months of refeeding, the effusions disappeared in 18/29 patients while in 7/29 patients a pericardial effusion > 0.3 cm persisted. Risk factors for development of effusions were a BMI or= 25% and IGF-1-level

Do parents of children with metabolic diseases benefit from the Triple P - Positive Parenting Program? A pilot study.

Background Parents of children with metabolic diseases report more parenting stress, anxiety, depression and dysfunctional parenting styles than parents of children without metabolic diseases. In addition, their children have more behavioral problems. Beside the fact that metabolic diseases are rare, they form a relatively large proportion in the morbidity and mortality of chronically ill children. Methods In this pilot study 14 parents of children with metabolic diseases, aged between 2.5 and 13 years, participated in a quasi-experimental pre-post-follow-up study. Results After participating in the Level 4 Group Triple P-program there were small effects in decreasing child behavioral problems and large effects in decreasing dysfunctional parenting styles. There was a moderate to large reduction of parental stress and a large reduction of parental anxiety. Only the effects on the behavioral problems and the parenting style 'laxness' were no longer significant at 6 months follow-up. Conclusions In summary it can be said that the existing Triple P-program has good effects, with a great degree of satisfaction, for parents of children with metabolic diseases in reducing dysfunctional parenting styles, parenting stress and behavioral problems of their children. One should not wait for a specialized program to reach these parents, but further research is necessary as a greater effect can be expected when this program is adapted to these parents.

Intermittent Brugada syndrome in an anorexic adolescent girl.

We report an anorexic adolescent girl with an intermittent Brugada syndrome. A 14-year-old anorexic girl with a body mass index (BMI) of 13.15 kg/m2 was admitted in the acute state of the disease with an ST elevation in V1 and V2, suggestive of Brugada syndrome. After 1 month of re-feeding, a control electrograph (ECG) was normal, but after an 8-month follow-up control with a nearly normal BMI, the ECG was again suggestive of Brugada syndrome. A genetic analysis of the gene SNC5A established a genetic change (p Leu 1582 pro), which provides the final explanation for the Brugada syndrome. Every rhythm problem in the acute state or during the re-feeding procedure deserves a strict follow-up to distinguish iatrogenic from heritable rhythm problems. .

Girl With Tyrosinemia Type 1 and Executive Dysfunctions Treated With Methylphenidate: A Case Report

Abstract Hereditary tyrosinemia type 1 (HT1; OMIM 27670) is an inborn error of tyrosine metabolism, caused by a deficiency of the enzyme fumarylacetoacetate hydrolase. This defect leads to accumulation of toxic products, which cause liver and kidney dysfunction. In patients with HT1, IQ, executive functioning, and social cognition are also affected. We report here a case report of a Belgian 11-year-old girl of Moroccan ethnicity with HT1. She had attention problems, which had a significant impact on her school functioning. Neuropsychological tests showed very low scores for processing speed and executive functioning. Therapies such as adaptations in the school and private tutoring were not sufficient to improve this. Treatment with methylphenidate showed a significant improvement in the neuropsychological test and school functioning. This case shows the importance of being alert for problems with executive functions in patients with HT1 and to consider psychopharmacological treatment.

Cognitive functioning and psychiatric disorders in children with a metabolic disease.

OBJECTIVE: To report on the intelligence scores and the psychiatric pathology of distinct groups of children with metabolic diseases. METHODS: The study population consists of 53 children between 0 and 18 years of age. Diagnostic assessment included a semi-structured interview, self-report questionnaires and a standard intelligence test. RESULTS: In 40% of the children older than 5 years, a child psychiatric diagnosis was made. While CBCL total and internalizing scores did not differ between metabolic disease groups, the CBCL externalizing scores for some groups did. Two fifths of the children showed a below normal intelligence, while a performal-verbal IQ discrepancy was found in half of the children. Of the school aged children almost one third attended a special needs school. CONCLUSION: In spite of the small sample size, the results suggest substantial psychiatric problems in children with a metabolic disease. Further study on larger groups is warranted, which should enable further comparison of patients affected by specific metabolic diseases.