The classification of feeding and eating disorders in the ICD-11: results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines.

BACKGROUND: The World Health Organization (WHO) International Classification of Diseases and Related Health Problems (ICD) is used globally by 194 WHO member nations. It is used for assigning clinical diagnoses, providing the framework for reporting public health data, and to inform the organization and reimbursement of health services. Guided by overarching principles of increasing clinical utility and global applicability, the 11th revision of the ICD proposes major changes that incorporate empirical advances since the previous revision in 1992. To test recommended changes in the Mental, Behavioral, and Neurodevelopmental Disorders chapter, multiple vignette-based case-controlled field studies have been conducted which examine clinicians' ability to accurately and consistently use the new guidelines and assess their overall clinical utility. This manuscript reports on the results from the study of the proposed ICD-11 guidelines for feeding and eating disorders (FEDs). METHOD: Participants were 2288 mental health professionals registered with WHO's Global Clinical Practice Network. The study was conducted in Chinese, English, French, Japanese, and Spanish. Clinicians were randomly assigned to apply either the ICD-11 or ICD-10 diagnostic guidelines for FEDs to a pair of case vignettes designed to test specific clinical questions. Clinicians selected the diagnosis they thought was correct for each vignette, evaluated the presence of each essential feature of the selected diagnosis, and the clinical utility of the diagnostic guidelines. RESULTS: The proposed ICD-11 diagnostic guidelines significantly improved accuracy for all FEDs tested relative to ICD-10 and attained higher clinical utility ratings; similar results were obtained across all five languages. The inclusion of binge eating disorder and avoidant-restrictive food intake disorder reduced the use of residual diagnoses. Areas needing further refinement were identified. CONCLUSIONS: The proposed ICD-11 diagnostic guidelines consistently outperformed ICD-10 in distinguishing cases of eating disorders and showed global applicability and appropriate clinical utility. These results suggest that the proposed ICD-11 guidelines for FEDs will help increase accuracy of public health data, improve clinical diagnosis, and enhance health service organization and provision. This is the first time in the revision of the ICD that data from large-scale, empirical research examining proposed guidelines is completed in time to inform the final diagnostic guidelines.

Neurology in the German training system for psychiatrists - a personal view.

In mid-19th-century Germany the conviction that 'mental disease is brain disease' was accompanied by a call for social reform in psychiatry. During neurology training, future psychiatrists often encounter patients with mental disorders rarely seen in psychiatric departments and learn how to avoid misdiagnosing brain diseases as mental disorders.

The German version of the Anorectic Behavior Observation Scale (ABOS).

OBJECTIVE: To assess the performance of the German version of the Anorectic Behavior Observation Scale (ABOS) as a parent-report screening instrument for eating disorders (ED) in their children. METHODS: Parents of 101 ED female patients (80 with Anorexia Nervosa; 21 with Bulimia Nervosa) and of 121 age- and socioeconomic status (SES)-matched female controls completed the ABOS. RESULTS: Confirmatory factor analysis supported the original three-factor structure model of the ABOS. Cronbach's alpha coefficients indicated good internal consistency for the three factors and the total score in the total sample. The best cut-off point (100% sensitivity and specificity) in the German version was >or=23. CONCLUSION: The ABOS may be a useful additional instrument for assessing ED.

[Parental assessment of children's eating behaviors with a short form of the Anorectic Behavior Observation Scale]. / Einschätzung kindlichen Essverhaltens durch die Eltern mit einer Kurzform der Anorectic Behaviour Observation Scale.

OBJECTIVE: To determine whether the Anorectic Behavior Observation Scale (ABOS) originally developed for clinical purposes can be used in epidemiological studies to assess parents' rating of their child's eating behavior. METHOD: In a study of 1,057 children aged 10-17 years, the children completed the Eating Disorder Inventory, Child Version (EDI-C), while the parents of 922 children completed the ABOS. The ABOS consists of 30 items, divided into three subscales--unusual eating behaviors, bulimia-like behaviors, and hyperactivity. RESULTS: The data revealed a number of psychometric problems of the ABOS, including variance restriction and extreme distributions. This is due to the checklist design of the ABOS, which generates few "yes" responses in nonclinical populations. Using principal components analysis and confirmatory factor analysis, 10 items were selected that had better psychometric characteristics than the 30-item ABOS while maintaining the same level of validity. This resulted in three subscales similar to the original ones, with 4, 2, and 4 items--eating behavior, bulimia-like behavior, and level of activity/fitness. CONCLUSIONS: The short form of the ABOS, called Eating and Activity Questionnaire for Parents (EAQP), is a parsimonious instrument for screening parents' assessments of their child's eating behavior.

[Survey of disordered eating and behaviour in children and adolescents]. / Erhebung von Essverhalten und Verhaltensauffälligkeiten bei Kindern und Jugendlichen.

OBJECTIVE: To study in children and adolescents associations between body mass index and psychosocial problems including those typical for eating disorders. METHOD: 1057 pupils aged 10 to 17 years completed the Youth Self-Report (YSR) and the Eating Disorder Inventory for children (EDI-C). Socio-demographic data and information about height and weight were also gathered. RESULTS: Underweight girls reported fewer problems than those with normal weight. Overweight girls had higher scores than normal weight girls on six out of eleven EDI-C-scales (drive for thinness, bulimia, body dissatisfaction, ineffectiveness, interpersonal distrust, interoceptive awareness) as well as on the YSR-scales Anxious/depressed and Social problems. Similarly, overweight boys presented more social problems then those of normal weight and higher scores on the same EDI-C-scales as overweight girls with the exception of interpersonal distrust. Underweight boys differed from normal weight boys on the YSR in reporting more somatic complaints, but on none of the EDI-C scales. CONCLUSIONS: Overweight children and adolescents seem to suffer from psychosocial problems including those typical for eating disorders. Therefore, they require intervention not only for the prevention of medical consequences of overweight and obesity. In the treatment of overweight children and adolescents eating disorder symptoms need to be taken into account.

Gender differences in routine treatment of depressed outpatients with the selective serotonin reuptake inhibitor sertraline.

Gender is known to have an influence on medical treatment and the prescribing and outcome of drug treatment. This has also been suggested for selective serotonin reuptake inhibitors (SSRIs). To examine sex differences in the treatment with the SSRI sertraline in routine treatment of depression, data from a 6-month prospective drug utilization observation study on 3,858 women and 1,594 men were analysed for gender differences. Compared to men, women were more often treated by a general practitioner, were somewhat older, had a later onset of illness, were more likely to suffer from a recurrent rather than a first episode of depression, had been treated for depression before, and showed more anxious and less neurasthenic or retarded syndromes. There was no difference regarding duration of the present episode or severity of illness. The mean prescribed dose of sertraline was marginally lower for females compared to males (45.5 versus 46.5 mg/day) with no difference in the rate of psychoactive concomitant medication (6.76% versus 6.80%). There was no difference in side-effects, treatment termination or treatment response.

Forced treatment of anorexic patients: part 2.

PURPOSE OF REVIEW: The purpose of this review was to update and complement part 1 of this study. Clinical, ethical and legal approaches to forced treatment in patients with anorexia nervosa were considered in the light of recent literature. RECENT FINDINGS: The first comparison of compulsorily detained adolescents and those treated under parental consent shows mainly advantages in the short and medium term of using the Mental Health Act. In a qualitative study, a pathway for advance decisions has been developed. Implications of the Human Rights Act for clinical practice have been elucidated. A case report of a pregnant anorexic woman shows the risk for her foetus. The ethical dilemma of treating a woman with cerebral palsy and chronic anorexia nervosa has been reported and an ethical re-evaluation of treatments for (especially chronic) anorexia nervosa recommended. SUMMARY: The treatment of adolescents with severe anorexia nervosa may be improved by detention under the Mental Health Act. The Human Rights Act has implications for the treatment of anorexia nervosa. Guidelines for treating anorexia nervosa should include recommendations for pregnant sufferers as well as for those with severe physical comorbidity. A shift from cure to care for chronic anorexia nervosa might improve ethical conduct.

Forced treatment of patients with anorexia.

PURPOSE OF REVIEW: To consider clinical, ethical and legal approaches to forced feeding in patients with anorexia nervosa in the light of recent literature. RECENT FINDINGS: An Australian retrospective record analysis compared 27 coercive with 96 informal hospitalizations and found more previous inpatient treatments, comorbidities, and a lower BMI at admission of 13.2 (SD 1.67) kg/m, but no significantly different weight gain [4.96 (SD 6.56) kg]. In a higher proportion of the involuntary group a re-feeding syndrome, treatment in a locked ward, and tube feeding were recorded. In Germany 25 women with anorexia nervosa with an admission BMI of 12.09 (SD 1.51) kg/m gained 12.44 (SD 1.21) kg. Twenty were treated involuntarily and 22 received tube feeding- 20 of whom were fed a via transdermal duodenal tube, four of whom as voluntary patients. SUMMARY: As full recovery is possible in life-threatening anorexia nervosa, detention is sometimes justifiable and may indeed be necessary. Compulsory admission, however, does not necessarily imply a need for forced or tube feeding. Highly skilled nursing seems preferable, and so it may be better to admit the patient before the BMI drops below 13 kg/m. The validity of this proposal should be examined using a prospective research design with a follow-up period.