Association of executive function problems and disordered eating behaviours in teens with type 1 diabetes.

AIM: To explore cross-sectional associations between executive function problems and disordered eating behaviours in teens with type 1 diabetes. METHODS: Executive function was assessed by the Behavior Rating Inventory of Executive Function (BRIEF), self-report and parent proxy-report versions. Scores ≥60 (on Global Executive Composite, Behavioral Regulation Index, Metacognition Index or clinical scales) indicated problems with executive function. Disordered eating behaviour was assessed by the Diabetes Eating Problem Survey Revised (DEPS-R) and categorized as follows: <10 low, 10-19 moderate and ≥20 high. RESULTS: In the 169 teens (46% girls, median age 16.0 years [range 13.7-18.7], median diabetes duration 8.9 years [range 1.4-16.6]), 29% had moderate and 12% had high level of disordered eating behaviours. Executive function problems were present in 9% by self report and 26% by parent proxy-report. Among teens with moderate/high level of disordered eating behaviours, 19% had executive function problems by self report (vs. 2% of teens with low level of disordered eating behaviours, p < 0.001) and 33% had executive function problems by parent proxy-report (vs. 20% of teens with low level of disordered eating behaviours, p = 0.056). A greater level of disordered eating behaviours was associated with executive function problems by teen self report on the General Executive Composite (p < 0.001), Behavioral Regulation Index (p < 0.001), emotional control clinical scale (p < 0.001), shift clinical scale (p < 0.001) and by parent proxy-report on the task initiation clinical scale (p = 0.008). CONCLUSIONS: Assessing executive function and screening for disordered eating behaviours in teens with type 1 diabetes could help identify a subset of teens at high risk for adverse outcomes and need for intervention.

Avoidant/restrictive food intake disorder: Psychopathological similarities and differences in comparison to anorexia nervosa and the general population.

INTRODUCTION: Avoidant/restrictive food intake disorder (ARFID) categorises patients with selective and/or restrictive eating patterns in the absence of distorted cognition concerning weight, food, and body image. OBJECTIVE: To examine the sociodemographic and clinical profile of patients with ARFID in comparison to those with anorexia nervosa (AN) and to a non-clinical group (NCG). METHOD: A descriptive, observational, comparative study made up of three groups (ARFID, AN and NCG). Ninety-nine children and adolescents were analyzed by means of a semi-structured diagnostic interview and questionnaires on depression, anxiety, clinical fears and general psychopathology. RESULTS: The ARFID group was significantly younger (10.8 vs. 14.1 years of age), with a greater proportion of males (60.6% vs. 6.1%), an earlier onset of illness (6.2 vs. 13.4 years of age), and a longer period of evolution of the illness (61.2 vs. 8.4 months) compared to the AN group. Clinically, patients with ARFID showed greater medical (42.4% vs. 12.1%) and psychiatric (81.8% vs. 33.3%) comorbidity-assessed with a semi-structured diagnostic interview-greater clinical fear (p < 0.005), more attention problems (p < 0.005) and fewer symptoms of anxiety and depression (p < 0.005)-measured with self-report questionnaires. CONCLUSIONS: ARFID is a serious disorder with a significant impact on the physical and mental health of the pediatric population. Likewise, some of these physical and mental conditions may be a risk factor in developing ARFID. Attention problems and clinical fears in ARFID, and the greater presence of internalised symptoms in AN, were the main differences found in the psychopathological profiles.

Alternatives to inpatient treatment in adolescents with anorexia nervosa: Effectiveness and characteristics of a new intensive model of day patient treatment.

INTRODUCTION: Inpatient Treatment (IT) is the treatment of choice for moderate or severely ill adolescents with Anorexia Nervosa (AN). Nevertheless, it is expensive, and the risk for relapse or readmissions is high. A less costly alternative to IT is Day Patient Treatment (DP), which may also help to avoid relapses and readmissions because facilitates transition from hospital to community treatment. AIM: To assess the effectiveness of the 11-hour DP program for Eating Disorders (DP-ED-11h), a new intensive DP treatment for adolescents with AN, with respect to weight recovery, avoidance of hospital admission and decrease of Length of Stay (LoS). METHOD: A longitudinal, naturalistic study was carried out analysing clinical and sociodemographic variables from 77 patients with AN who were consecutively discharged from DP-ED-11h, during years 2015-2016. RESULTS: There were 77 discharges. The average age was 14.4 years old (SD: 1.62). The LoS at DP-ED-11h was 28.9 days (SD: 18.5). The mean body mass index increased significantly at discharge (17.2 vs. 17.9, p<0.001) and at 12 months follow- up (17.9 vs. 19.3, p<0.001). Twenty nine (70.8%) of the patients treated at DP-ED-11h, who came from a less intensive setting, avoided an admission. Fourteen (18.2%) required readmission at DP-ED-11h within two years. The LoS at IT was significantly reduced (from 33 to 24 days, p<0.043). CONCLUSION: DP-ED-11h has shown to be an effective resource as an alternative to IT for adolescents with moderate to severe AN. This new model has cost-effectiveness implications as it is a safe resource and is less costly than IT.

Suicidal ideation and self-injurious behavior in adolescents with eating disorders.

INTRODUCTION: The presence of suicidal thoughts and self-injurious behaviors in patients with eating disorders (ED) is well-known; however, this association is currently not defined empirically. The aim of the study is to determine the prevalence of suicidal ideation and self-harm in adolescents with eating disorders. A second objective is to study the association between self-injurious behavior and suicidal ideation, severity of eating disorder symptoms and symptoms of depression and anxiety, motivation to change and perfectionism. METHODOLOGY: We evaluated 109 patients (mean age, 14.74 years (SD: 1.53); 87.2% female) using the Eating Disorder Inventory (EDI-2), the Beck Depression Inventory (BDI-II), the State-Trait Anxiety Inventory (STAI), the Child and Adolescent Perfectionism Scale (CAPS) and the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ). RESULTS: Forty-seven patients (43.1%) had suicidal ideation and 34 (31.2%), self-injurious behavior. The presence of suicidal ideation did not discriminate between patients with or without self-injurious behavior. Patients who self-harm had significantly higher scores on all scales of the EDI-2, except for “maturity fears”, in the total scores of BDI-II, STAI and CAPS. An association between selfinjurious behavior and motivation to change was found. CONCLUSIONS: A significant percentage of adolescents with eating disorders present suicidal ideation and selfinjurious behavior, making the psychopathological profile of these patients more severe. The presence of suicidal ideation in adolescents with eating disorders does not necessarily imply that they have self-injurious behavior; rather, such behavior could be a result of the need to regulate intense negative emotions.

[Cardiovascular risk factors, cardiovascular risk and quality of life in patients with a severe mental disorder]. / Factores de riesgo cardiovascular, riesgo cardiovascular y calidad de vida en pacientes con trastorno mental severo.

AIM: To determine the cardiovascular risk factors (CVRF), level of cardiovascular risk (CVR) and to analyse the relationship between CVR and quality of life in patients with severe mental illness (SMI). DESIGN OF STUDY: Cross sectional study. SETTING: Mental Health Service, Consorci Hospitalari de Vic (Barcelona). SUBJECTS: Patients over 18 years diagnosed with SMI. MAIN MEASUREMENTS: Data was collected on, socio-demographic variables, toxic habits, previous pathologies, family history of premature cardiovascular disease, psychiatric diagnoses, physical parameters and laboratory findings. The CVR was determined by the SCORE and REGICOR scales. Quality of life was measured by Euro-QoL and Seville Questionnaires. RESULTS: A total of 137 patients with SMI were included; 64.9% female, and a mean age 51.1 years (SD 12.9). Major CVRF distribution: 40.1% smoking, 37.9% hypertension, 56.2% dyslipidemia, and 11.1% diabetes. The criteria for obesity and metabolic syndrome were met by 37.9% and 48.4% of the patients, respectively. The average major CVRF was 1.5 factors. The CVR was high in 4.6% of the sample by SCORE and in 5.4% by REGICOR. Neither the patients who accumulated more CVRF or those with high CVR scores showed a worse quality of life. CONCLUSIONS: The most prevalent CVRF in patients with SMI are smoking and dyslipidemia, with a prevalence that exceeded population-based studies. The subgroup of depressive disorders showed a higher CVR and worse quality of life. No relationships were found between the CVR and the quality of life.

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study.

BACKGROUND: The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. AIMS: (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. METHODS: The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). RESULTS: Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. CONCLUSIONS: The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.