[Questionnaire on Treatment Satisfaction in Inpatient Child and Adolescent Psychiatry (FBZ-KJP) - Results of a Swiss Pilot Study]. / Fragebogen zur Behandlungszufriedenheit in der stationären Kinder- und Jugendpsychiatrie (FBZ-KJP).

Questionnaire on Treatment Satisfaction in Inpatient Child and Adolescent Psychiatry (FBZ-KJP) - Results of a Swiss Pilot Study Abstract: Objectives: Patient satisfaction is an established indicator for medical interventions. Existing questionnaires for the assessment of patient satisfaction in child and adolescent psychiatry are too global to target quality improvement in child and adolescent psychiatric hospitals. The assessment of patient satisfaction in child and adolescent psychiatry is very challenging because specific demands (development status, role of parents in treatment) have been taken into account. Therefore, an expert team leaded by the Swiss Society of Child and Adolescent Psychiatry developed a targeted instrument to assess patient satisfaction in both language regions (i. e., German and French). Methods: The article reviews the development of a new child and adolescent psychiatric questionnaire for the assessment of patient satisfaction as well as the findings of a survey conducted in a representative sample of 174 patients and 145 parents in six hospitals. Results: The internal consistency (Cronbach's α = .93) is excellent. The questionnaire has high levels of both convergence and face validity, and the correlation with the Client Satisfaction Questionnaire (CSQ-8) is ρ = .80 (patient-report) and .83 (parent-report). Furthermore, this questionnaire reveals the relative strengths and weaknesses of individual hospitals. The correlation between patient and parent assessment is, as expected, moderate (ρ = .29, for the total score and ρ = .39 for the CSQ-8). Conclusions: The Patient Satisfaction Questionnaire can be recommended to professionals as a standard for collecting data on client satisfaction within child and adolescent psychiatry.

Anxious depression as a clinically relevant subtype of pediatric major depressive disorder.

In adults, anxious depression has been identified as a more severe form of major depressive disorder (MDD), associated with higher depression severity, more suicidal ideation and worse treatment outcome. Research in pediatric depression, however, has been sparse. 126 children and adolescents aged 8-18 years with a primary diagnosis of MDD were categorized into a MDD-only group and an anxious depression group based on clinically elevated scores on the Beck Anxiety Inventory. One-third of the sample was classified as having anxious depression with females being overrepresented in the anxious depressed compared to the MDD-only group. 42.2% of the anxious depressed youth met diagnostic criteria for a comorbid anxiety disorder. Anxious depressed youth were more likely to suffer recurrent depressive episodes, showed higher depression severity and a unique pattern of depressive symptoms characterized by more severe sleep problems, more somatic complaints, more severely depressed mood and more frequent suicidal ideations. Scores on a suicidal ideation scale were increased even when controlling for overall depression severity. However, when comparing depressed patients with and without comorbid anxiety disorders, no differences in depression severity, symptom patterns or suicidal ideations were observed. The results indicate that high anxiety levels in depressed youth are clinically relevant, and given the increase in suicidal ideation, anxiety symptoms during depressive episodes should routinely be screened in clinical practice even in the absence of a fully formed comorbid anxiety disorder.

[Lino Castle - An interior design concept to improve inpatient treatment in child and adolescent psychiatry]. / Burg Lino ­ Ein innenarchitektonisches Konzept zur Verbesserung der stationären Behandlung in der Kinder- und Jugendpsychiatrie.

Lino Castle - An interior design concept to improve inpatient treatment in child and adolescent psychiatry Abstract. Only very few data exist concerning hospital architecture in psychiatry/child and adolescent psychiatry. Previous data suggest that architectural improvements do reduce the application of coercive measures as well as reducing aggressive behavior, endangerment of self and others, and provoking changes in the kind and frequency of medication. In order to improve the overall hospital environment of inpatient treatment, the Center for Child and Adolescent Psychiatry and Psychotherapy of Clienia Littenheid AG developed a spatial and communication concept named "Lino Castle." In cooperation with patients, their parents as well as members of the multidisciplinary team, we implemented a concept that serves to ameliorate the recovery process of the children and adolescents. "Lino Castle" is deeply rooted in the history of the local village and aims to allow patients to feel at ease for the duration of their stay. It hosts seven characters that serve as guardians and protectors of the individual wards and represent various types of disorders and emotional states. The respective architectural concept grew out of the storyline of "Lino Castle" and combines colors, forms, materials, graphics, and furniture to ensure an environment conducive to healing and reduced anxiety. With the implementation of "Lino Castle," we observed that the number of admissions and hospital occupancy increased significantly, whereas the length of stay and the ratio of involuntary admissions in closed wards decreased. We presume that this turn of events is due to higher commitment, acceptance, and less aggressive behavior in the patients, and to higher motivation and work satisfaction in the staff.

Sleep disturbance, but not depression severity, is associated with inflammation in children and adolescents.

STUDY OBJECTIVES: We aimed to examine the association between self-rated and clinician-rated sleep disturbances and C-reactive protein (CRP), an objective marker of inflammation, in pediatric depression. METHODS: Two hundred fifty-six children and adolescents (15.2 ± 1.6 y, 72.3% female) with moderate to severe symptoms of depression participated in the study. Sleep disturbances were assessed by self-reports (Insomnia Severity Index) and clinician ratings (Kiddie-Schedule for Affective Disorder and Schizophrenia), inflammation by plasma CRP levels. RESULTS: Higher levels of CRP correlated positively with clinician-rated middle insomnia and hypersomnia. After adjusting for control variables (body mass index, tobacco, alcohol, stress, age, sex, antidepressants, sleep medication, depression severity), regression models confirmed the significant association of clinician-rated hypersomnia and middle insomnia symptoms with elevated CRP levels. In the adjusted regression models, other clinician-rated manifestations of sleep disturbance (eg, initial insomnia) and insomnia self-ratings were not significantly associated with CRP. Body mass index correlated positively with CRP, but body mass index had no mediating effect on the associations between sleep disturbances and CRP. We did not find an association between depression severity, assessed by the Children's Depression Rating Scale-Revised, and CRP. CONCLUSIONS: Results of the present study indicate a significant association of hypersomnia and middle insomnia symptoms with CRP in pediatric depression, not linked to alterations in the body mass index. CITATION: Strumberger MA, Häberling I, Emery S, et al. Sleep disturbance, but not depression severity, is associated with inflammation in children and adolescents. J Clin Sleep Med. 2023;19(10):1775-1784.

Executive functions and borderline personality features in adolescents with major depressive disorder.

Background: Executive functions (EF) consolidate during adolescence and are impaired in various emerging psychiatric disorders, such as pediatric Major Depressive Disorder (pMDD) and Borderline Personality Disorder. Previous studies point to a marked heterogeneity of deficits in EF in pMDD. We examined the hypothesis that deficits in EF in adolescents with pMDD might be related to comorbid Borderline Personality features (BPF). Methods: We examined a sample of 144 adolescents (15.86 ± 1.32) diagnosed with pMDD. Parents rated their child's EF in everyday life with the Behavior Rating Inventory of Executive Function (BRIEF) and BPF with the Impulsivity and Emotion Dysregulation Scale (IED-27). The adolescents completed equivalent self-rating measures. Self- and parent-ratings of the BRIEF scores were compared with paired t-Tests. Correlation and parallel mediation analyses, ICC, and multiple regression analyses were used to assess symptom overlap, parent-child agreement, and the influence of depression severity. Results: Over the whole sample, none of the self- or parent-rated BRIEF scales reached a mean score above T > 65, which would indicate clinically impaired functioning. Adolescents tended to report higher impairment in EF than their parents. Depression severity was the strongest predictor for BPF scores, with Emotional Control predicting parent-rated BPF and Inhibit predicting self-rated BPF. Furthermore, the Behavioral Regulation Index, which includes EF closely related to behavioral control, significantly mediated the relationship between depression severity and IED-27 factors emotional dysregulation and relationship difficulties but not non-suicidal self-injuries. Conclusion: On average, adolescents with depression show only subtle deficits in executive functioning. However, increased EF deficits are associated with the occurrence of comorbid borderline personality features, contributing to a more severe overall psychopathology. Therefore, training of executive functioning might have a positive effect on psychosocial functioning in severely depressed adolescents, as it might also improve comorbid BPF. Clinical trial registration: www.ClinicalTrials.gov, identifier NCT03167307.

Differences in serum zn levels in acutely ill and recovered adolescents and young adults with anorexia nervosa--a pilot study.

Preliminary evidence suggests that changes in zinc (Zn) metabolism are associated with anorexia nervosa (AN). However, data are scarce regarding potential differences in serum Zn concentrations in adolescent and young adult patients with AN. It was the aim of the present pilot study to compare serum Zn concentrations between acutely ill and remitted adolescent and young adult female patients with AN and female controls. Zn concentrations were higher in remitted compared with acutely ill patients. Zn concentrations were also higher in remitted patients compared with controls, but there was no significant difference in Zn concentrations between acutely ill patients and controls. The present study provides preliminary evidence for differences in serum Zn status in recovered patients with AN. These differences are likely influenced by reported food preferences, in particular as regards Ca²âº and phosphorus-containing foods. However, because of limited statistical power, future research involving larger samples is necessary.

Body-Related Attitudes, Personality, and Identity in Female Adolescents with Anorexia Nervosa or Other Mental Disorders.

The psychological integration of body-related attitudes (BodyRA) is a critical developmental task in adolescence. Adolescents must adapt to their changing body image and body satisfaction. For young people, BodyRA (body dissatisfaction, bulimia, and drive for thinness) are connected to insecurities, which can disturb identity integration and personality development. Our goal was to evaluate the importance of BodyRA also for other mental disorders other than anorexia nervosa (AN), and the association between BodyRA with temperament and personality traits and identity diffusion. Data for the period of 2012 to 2019 were retrospectively analyzed from a convenience sample of patients in a child and adolescent psychiatric hospital (n = 114). The patients were 13 to 17 years of age and had a BMI of 11.9−36.1 kg/m2. As expected, BodyRA were found to be more pronounced in AN, as well as in borderline personality disorder (BPD), depression (DD), and attention deficit hyperactivity disorder (ADHD). BodyRA correlated significantly with internalizing problems in patients with DD (r = 0.428−0.565, p < 0.01) and BPD (r = 0.680, p < 0.01) as well as with BMI (r = 0.404, p < 0.01) in patients with DD. Moreover, we detected significant correlations with impaired identity development in patients with DD (r = 0.482−0.565, p < 0.01) and BPD (r = 0.681−0.703, p < 0.01). BodyRA also correlated significantly with the personality traits of harm avoidance (r = 0.377−0.541, p < 0.01) and self-directedness (r = −0.537−−0.635, p < 0.01) in DD. These personality traits and bulimia were used as predictors for identity diffusion in the investigated disorders of this study. We conclude that BodyRA, harm avoidance and self-directedness are associated with identity development in adolescent females with mental disorders.

Serotonergic neurotransmission and lapses of attention in children and adolescents with attention deficit hyperactivity disorder: availability of tryptophan influences attentional performance.

Deficiencies in serotonergic (5-HT) neurotransmission have frequently been linked to altered attention and memory processes. With attention deficit hyperactivity disorder (ADHD) being associated with impaired attention and working memory, this study investigated the effects of a diminished 5-HT turnover achieved by rapid tryptophan depletion (RTD) on attentional performance in children and adolescents with ADHD. Twenty-two male patients with ADHD (aged 9-15 yr) received the RTD procedure Moja-De and a tryptophan (Trp)-balanced placebo (Pla) in a randomized, double-blind, within-subject crossover design on two separate study days. Lapses of attention (LA) and phasic alertness (PA) were assessed within the test battery for attentional performance under depleted and sham-depleted conditions 120 (T1), 220 (T2) and 300 (T3) min after intake of RTD/Pla. At T1 there was a significant main effect for RTD, indicating more LA under intake of a Trp-balanced Pla compared to diminished 5-HT neurotransmission. For T2/T3 there were no such effects. PA was not affected by the factors RTD/Pla and time. Interactions of 5-HT with other neurotransmitters as possible underlying neurochemical processes could be subject to further investigations involving healthy controls as regards altered attentional performance in children and adolescents.

[Psychopharmacotherapy in adolescents with borderline personality disorder in inpatient and outpatient psychiatric treatment]. / Psychopharmakotherapie einer ambulanten und stationären Inanspruchnahmepopulation adoleszenter Patienten mit Borderline-Persönlichkeitsstörung.

OBJECTIVE: The majority of adult patients with borderline personality disorder (BPD) are treated with psychotropic drugs. However, there are no data on psychotropic therapy in adolescents. This study examines the prevalence of BPD in an adolescent population undergoing either inpatient or outpatient psychiatric treatment and assesses psychotropic prescription patterns in adolescent in- and outpatients with BPD. METHODS: Out of a population of adolescents undergoing psychiatric treatment over a seven-year observation period, 58 adolescent patients with BPD (16.7 +/- 2.5 years) were investigated retrospectively with regard to their first episode of treatment, type of medication, and different risk variables. RESULTS: Out of the investigated population, 37 inpatients and 21 outpatients received treatment. Inpatients were shown to have higher rates of risk variables (approx. 68% with co-morbid disorders and approx. 49% with self-harmful behaviour, significantly (p < .001) more attempted suicides in their patient history) and higher rates of psychotropic treatment (p < .001). Antidepressants (SSRI and NaSSA) were most commonly prescribed, followed by neuroleptics. More than 50% of the medicated patients were treated with multiple psychotropic drugs administered simultaneously. CONCLUSIONS: Pharmacotherapy in BPD has a high and increasing therapeutic value, with the prescription of psychotropic drugs being primarily symptom-orientated. Pharmacotherapy of co-morbid disorders should be accorded equal treatment priority. In line with this, psychotropic treatment of BPD in adolescents is increasingly important. Inpatient adolescents are more burdened in terms of psychiatric risk variables, and also receive medication more often.

[Psychopharmacotherapy improves psychosocial functioning in adolescents with borderline personality disorder]. / Psychopharmakotherapie verbessert das psychosoziale Funktionsniveau bei adoleszenten Patienten mit Borderline-Persönlichkeitsstörung.

Treatment of patients with borderline personality disorder (BPD) has undergone significant changes within the last decades. Although there is no specific pharmacological treatment approach for BPD per se, there is evidence for a beneficial effect of psychopharmacological treatment in adults. As there is a significant lack of data regarding such treatment in adolescents we aim to investigate the effects of psychopharmacological treatment retrospectively focusing on the first period of treatment. The study sample comprised 2,778 subjects (inpatients and outpatients) from a population on demand of psychiatric services referred to our department, with 39 patients (aged 16,2 +/- 1,7 yrs.) having a diagnosis of BPD. Psychosocial functioning as indexed on axis VI was assessed within the BADO documentation algorithm before and after treatment. Effects of treatment in terms of improved psychosocial functioning under different medications as well as different risk variables were assessed. Moreover, medicated and un-medicated patients were compared as regards effects of treatment. Upon admission inpatients showed a significantly higher impairment in their psychosocial functioning compared with outpatients. There was no significant difference between medicated and un-medicated patients with respect to the different risk variables assessed. Psychosocial functioning improved under pharmacological treatment, with this effect being unrelated to in- or outpatient status. About 80% of the prescribed medications were antidepressants and neuroleptics, with a combination of two drugs being the most frequent treatment approach to be observed. The data of the present study indicate that psychopharmacological treatment of adolescents with BPD can improve psychosocial functioning.

When parents and children disagree: Informant discrepancies in reports of depressive symptoms in clinical interviews.

BACKGROUND: Parents and their children often disagree on the existence and severity of psychopathological symptoms, especially in major depressive disorder (MDD). Discrepant estimations pose a problem for the validity of diagnoses and illness severity with major implications for treatment evaluation. METHODS: 118 adolescents aged 13-18 years and their parents were interviewed and their reports were compared regarding the presence of a MDD diagnosis. In addition, severity ratings of depression symptoms reported in the Children's Depression Rating Scale-Revised (CDRS-R) were compared between parents and their offspring using multivariate analyses and polynomial regressions. The association between borderline features, functional impairment, and treatment history variables with parent-child agreement was assessed. RESULTS: In 38% of the cases, parents and adolescents agreed on DSM-IV diagnostic MDD criteria, while in 53%, only the adolescent endorsed criteria for a MDD. A MDD that was endorsed by parents and adolescents was characterized by higher depression severity, higher number of previous treatments, and higher functional impairment. Using a polynomial approach, neither age nor borderline tendencies were associated with agreement. LIMITATIONS: We did not differentiate between mother's versus father's reports and borderline features were assessed by self-report only. CONCLUSIONS: Adolescents and their parents gave differing reports of the existence and severity of depressive symptoms. The high discrepancy levels combined with the uncertainty of previously published findings due to methodological challenges are concerning. Clinicians and researchers need to consider discrepancies in agreement in relation to diagnosis and illness severity in the context of their clinical and research decisions.

Verbal Memory Performance in Depressed Children and Adolescents: Associations with EPA but Not DHA and Depression Severity.

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been described as positively associated with cognitive functioning. Current meta-analyses have identified eicosapentaenoic acid (EPA) as potentially more effective than docosahexaenoic acid (DHA). An especially vulnerable subgroup that might benefit from these beneficial effects are depressed youths. In this study, we examined associations between red blood cell (RBC) DHA and EPA levels and depression severity and verbal memory performance in a sample of 107 moderately (n = 63) and severely (n = 44) depressed youths. The findings showed that youths with high RBC EPA levels had steeper learning curves compared to those with moderate or low RBC EPA levels (Pillai's Trace = 0.195, p = 0.027, ηp2 = 0.097). No associations between RBC DHA levels or depression severity and verbal memory performance were observed. Our results further confirm previous findings indicating a more important role of EPA compared to DHA in relation to cognitive functioning. Future research should further investigate the differential role of EPA and DHA concerning cognitive functioning in depressed youths. Evidence supporting beneficial supplementation effects could potentially establish a recommendation for a natural and easily accessible intervention for cognitive improvement or remission.

Diminished central nervous 5-HT neurotransmission and mood self-ratings in children and adolescents with ADHD: no clear effect of rapid tryptophan depletion.

INTRODUCTION: Research on 5-HT-functioning in adult patients and healthy subjects using rapid tryptophan depletion (RTD) has indicated weak but stable effects on mood ratings. Altered mood in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) can confound the differential diagnosis between severe ADHD and mood disorders such as pediatric bipolar disorder. The present study investigated the effects of RTD induced lowered central nervous 5-HT-levels on mood self-ratings in children with ADHD. METHODS: Seventeen boys with ADHD participated in the study in a double-blind within-subject crossover-design. They were administered RTD within an amino acid drink lacking tryptophan, thus lowering central nervous 5-HT-synthesis. On another day they received a placebo. Self-rated mood was assessed on both days at baseline conditions and at three different post-drink time-points. RESULTS: RTD had no clear effect on mood within the whole sample. Low scorers on venturesomeness were more strongly affected by RTD in terms of feelings of inactivity and negative feelings compared to high venture patients. CONCLUSIONS: Our data did not show a significant effect of RTD on mood self-ratings. However, the findings must be considered as preliminary and require further replication, in particular as they could be due to sampling bias.

Dietary tryptophan depletion according to body weight - a new treatment option in acute mania?

Decreased neurotransmission of serotonin (5-HT) was shown to be related to the development of depressive symptoms, whereas recent preliminary evidence suggests that acute mania may be related to a hyperserotonergic state. The reduction of central nervous 5-HT synthesis achieved by a new modification of the dietary rapid tryptophan depletion technique, with the relevant amino acids dosed according to body weight, is hypothesized by the authors to be a further option of treatment during acute mania, in particular in view of a decrease in adverse reactions, a reduced amount of amino acids needed for sufficient depletion, but also improved tolerability. However, ethical issues may limit such studies investigating this relationship in acutely manic patients, in particular in view of informed consent.

[Withdrawal syndrome after abuse of GHB (Gamma-Hydroxybutyrate) and its physiological precursors - its relevance for child and adolescent psychiatrists]. / Entzugsdelir nach Missbrauch von GHB-(Gamma-Hydroxybutyrat) und seiner Vorstufen: Grundlagen und Bedeutung für die Kinder- und Jugendpsychiatrie.

BACKGROUND: The chronic abuse of Gamma-Hydroxybutyrate (GHB) as a designer drug as well as it's physiological precursors Gamma-Butyrolactone (GBL) and 1,4-Butandiole (1,4-BD) confronts child and adolescent psychiatrists with new challenges. The acute withdrawal of GHB with its cardiovascular and delirant symptoms is of particular importance for child and adolescent psychiatrists. METHODS: In the present paper theoretical and biological aspects of acute GHB-/GBL-/1,4-BD-withdrawal syndrome are presented, and selected cases are discussed as regards potential treatment. RESULTS: High dose treatment with benzodiazepines was successful in some cases of acute GHB-/GBL-/1,4-BD-withdrawal syndrome. Complications were severe dystonia under neuroleptic treatment, and also side-effects of treatment with benzodiazepines. Further problems were vegetative symptoms, electrocardiographic changes, rhabdomyolysis, acute renal failure, and death. CONCLUSION: Acute GHB-withdrawal syndrome is a life-threatening condition which requires immediate intensive care treatment along with continuous monitoring of vital parameters. As acute GHB-withdrawal syndrome can present with symptoms close to psychotic episodes or acute alcohol withdrawal this condition is relevant for child and adolescent psychiatrists.

[Mental disorders among relatives of patients with anorexia nervosa and bulimia nervosa]. / Psychiatrische Erkrankungen bei Verwandten von Patienten mit Anorexia nervosa und Bulimia nervosa.

BACKGROUND: Family studies of anorexia (AN) and bulimia (BN) nervosa in relatives of patients with eating disorders compared to control subjects are rare in German-speaking countries. METHODS: A German multicenter study compared first-, second- and third-degree relatives of 65 adolescent AN subjects (n = 746), 21 adolescent BN subjects (n = 265) and relatives of 11 adolescent depressive control subjects (n = 157), as well as those of 37 adolescent healthy control subjects (n = 480). Assessments included the Diagnostic Interview for Genetic Studies (DIGS), the short form of the Family Interview of Genetic Studies (FIGS), and the Eating Disorder Family History Interview. RESULTS: Rates of anorexia nervosa and major depressive disorder (trend) were significantly (p < .01) higher among the first- and second-degree relatives of anorexic and bulimic subjects than among the relatives of healthy controls. Most results were more prominent among relatives of bulimic index patients. Nevertheless, the frequencies were lower in this sample than in comparable US-American samples. CONCLUSIONS: The data confirm the hypothesis of familial vulnerability to anorexia and bulimia nervosa. The observed differences in comorbidity patterns among eating-disordered relatives may be due to an age effect of the index patients.

[Changed taste perception in patients with eating disorders]. / Veränderte Schmeckwahrnehmung bei Patientinnen mit Essstörungen.

OBJECTIVE: Taste is a hereditary trait and affects eating and dietary behavior. The tongue's papillae represent the first line of the gustatory apparatus to provide information about taste. The aim of the present investigation was to evaluate the number of fungiform papillae (fPap) in relationship with 6-n-propylthiouracil (PROP) sensitivity and body mass index (BMI) in patients with eating disorders. METHODS: 18 female patients with eating disorders (anorexia or bulimia nervosa; age 14-20 yrs.) and 15 age-matched female controls were included. The number of fPap was quantified. Bitter taste was probed with PROP. Different BMIs (e.g. minimal BMI, maximal BMI) were calculated. RESULTS: As regards non-tasters (PROP negative), anorectic patients showed a significant reduction in the number of fPap compared to both PROP negative healthy controls and also bulimic patients. The number of fPap did not differ significantly between tasters and non-tasters within controls and eating disorder groups. There was a trend of higher BMI's in bulimic and healthy non-tasters. CONCLUSIONS: In anorectic patients a reduced number of fPap was associated with a decreased PROP sensitivity, which is a new finding. The data of the present study support the notion that the variation of fPap number and PROP sensitivity influences the pathophysiology of eating behavior and taste perception, and following this are involved in the development of eating disorders.

Differences in serum zinc levels in acutely ill and remitted adolescents and young adults with bulimia nervosa in comparison with healthy controls - a cross-sectional pilot study.

BACKGROUND: Research has implicated that changes in zinc (Zn) metabolism may be associated with the biological underpinnings of eating disorders, in particular anorexia nervosa. However, to date research on the role of Zn in patients with bulimia nervosa (BN) is scarce. OBJECTIVE: We aimed to explore serum Zn concentrations in young patients with BN, with a focus on the stage of the disorder, comparing acutely ill and recovered patients with BN with healthy controls. METHODS: Serum Zn concentrations were obtained from healthy controls and from acutely ill and remitted young patients with BN. Mean duration of remission was 4.0±3.5 years. RESULTS: Remitted patients showed elevated serum Zn concentrations when compared to controls (Cohen's d=2.022), but concentrations were still in the normal range. Acutely ill patients also had higher serum Zn levels when compared to controls (all values still being within the reference range, Cohen's d=0.882). There was no difference between acutely ill and remitted patients with BN in serum Zn concentrations. Of note, remitted patients had a significantly higher body weight when compared to the other two groups. Overall, there were no significant differences in dietary preferences with regard to Zn containing foods between the groups. CONCLUSION: The present study provides preliminary evidence that the underlying factors for changes in Zn serum concentrations in young patients with BN do not vary with regard to the stage of illness (acute versus remitted BN). Further prospective research is needed in order to disentangle the possible interplay between serum Zn status and bulimic eating behaviors.