Improving programme-led and focused interventions for eating disorders: An experts' consensus statement-A UK perspective.

OBJECTIVE: Eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Greater use of programme-led and focused interventions that are less resource-intensive might be part of the solution to this demand-capacity mismatch. METHOD: In October 2022, a group of predominantly UK-based clinical and academic researchers, charity representatives and people with lived experience convened to consider ways to improve access to, and efficacy of, programme-led and focused interventions for eating disorders in an attempt to bridge the demand-capacity gap. RESULTS: Several key recommendations were made across areas of research, policy, and practice. Of particular importance is the view that programme-led and focused interventions are suitable for a range of different eating disorder presentations across all ages, providing medical and psychiatric risk are closely monitored. The terminology used for these interventions should be carefully considered, so as not to imply that the treatment is suboptimal. CONCLUSIONS: Programme-led and focused interventions are a viable option to close the demand-capacity gap for eating disorder treatment and are particularly needed for children and young people. Work is urgently needed across sectors to evaluate and implement such interventions as a clinical and research priority.

Cognitive assessment using ERP in child and adolescent psychiatry: Difficulties and opportunities.

Event related potentials (ERPs) represent powerful tools to investigate cognitive functioning in child and adolescent psychiatry. So far, the available body of research has largely focused on advancements in analysis methods, with little attention given to the perspective of assessment. The aim of this brief report is to provide recommendations for cognitive ERPs assessment that can be applied across diagnostic categories in child and adolescent psychiatry research. First, we discuss major issues for ERPs testing using examples from common psychiatric disorders. We conclude by summing up our recommendations for methodological standards and highlighting the potential role of ERPs in the field.

[Role of the psychiatrist-psychotherapist in the assessment and treatment of gender dysphoria]. / Rôle du psychiatre-psychothérapeute dans la prise en charge de la dysphorie de genre.

This article is the result of the joint work of psychiatrists-psychotherapists working with patients with gender dysphoria (children, adolescents and adults) in Lausanne and Geneva university hospitals. It emphasizes the importance of their clinical interventions when hormone therapy and sex reassignment surgery are requested.

Cet article est issu d'une collaboration entre les psychiatres-psychothérapeutes et les pédopsychiatres-psychothérapeutes intervenant dans les deux consultations universitaires spécialisées pour la dysphorie de genre en Suisse romande et illustre l'importance de leur intervention dans la prise en charge des personnes qui sollicitent des traitements médicochirurgicaux de réassignation sexuelle.

The influence of school on whether girls develop eating disorders.

BACKGROUND: Clinical anecdote suggests that rates of eating disorders (ED) vary between schools. Given their high prevalence and mortality, understanding risk factors is important. We hypothesised that rates of ED would vary between schools, and that school proportion of female students and proportion of parents with post-high school education would be associated with ED, after accounting for individual characteristics. METHOD: Multilevel analysis of register-based, record-linkage data on 55 059 females born in Stockholm County, Sweden, from 1983, finishing high school in 2002-10. Outcome was clinical diagnosis of an ED, or attendance at a specialist ED clinic, aged 16-20 years. RESULTS: The 5-year cumulative incidence of ED diagnosis aged 16-20 years was 2.4%. Accounting for individual risk factors, with each 10% increase in the proportion of girls at a school, the odds ratio for ED was 1.07 (1.01 to 1.13), P = 0.018. With each 10% increase in the proportion of children with at least one parent with post-high school education, the odds ratio for ED was 1.14 (1.09 to 1.19), P < 0.0001. Predicted probability of an average girl developing an ED was 1.3% at a school with 25% girls where 25% of parents have post-high school education, and 3.3% at a school with 75% girls where 75% of parents have post-high school education. CONCLUSIONS: Rates of ED vary between schools; this is not explained by individual characteristics. Girls at schools with high proportions of female students, and students with highly educated parents, have higher odds of ED regardless of individual risk factors.

Assessment Measures for Child and Adolescent Eating Disorders: A Review.

BACKGROUND: Several diagnostic and screening instruments are available for child and adolescent eating disorders. However, limitations have been identified in many of these. METHOD: We review the most frequently used assessment measures for eating disorders in children and adolescents. RESULTS: Several of the available instruments have significant limitations, although relevant strengths are identified. CONCLUSIONS: Limitations in the current available instruments for child and adolescent eating disorders should be addressed in order to improve recognition and treatment.

Diagnosing eating disorders in adolescents: a comparison of the eating disorder examination and the development and well-being assessment.

OBJECTIVE: To compare the diagnostic properties of the Eating Disorder Examination (EDE) and the online version of the Development and Well-Being Assessment (DAWBA). METHOD: Fifty-Seven adolescents (mean age 15.7 years) who attended consecutive assessments at a specialist eating disorders clinic completed the DAWBA, the EDE, and a standard clinical assessment with a multidisciplinary team. Cohen's Kappas were used to make pairwise comparisons between the diagnoses generated by the three assessments. RESULTS: Participants had anorexia nervosa (n = 30), eating disorders NOS (n = 21) or no eating disorder (n = 6) according to the clinical diagnosis. Agreement between the clinical and DAWBA diagnoses was moderate (kappa = 0.59), agreement between the DAWBA and EDE diagnoses was fair (kappa = 0.21), and agreement between the clinical and EDE diagnoses was poor (kappa = 0.10). The EDE did not identify an eating disorder in 20 participants (35% of the sample) who were clinically assessed as cases. CONCLUSION: Computerized measures using multiple informants may be more suitable for assessing clinical samples of adolescents with anorexia nervosa or eating disorders NOS than individual interviews with young people.