Assessing motivation for treatment in eating disorders: psychometric validation of the Italian version of the Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ-ITA).

PURPOSE: Treatment resistance is a significant challenge in addressing eating disorders (EDs). The Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ) has been previously validated in ED populations to assess patients' motivation for treatment. This study aimed to validate the ACMTQ in the Italian language (ACMTQ-ITA) and evaluate its psychometric properties. METHODS: We recruited a clinical sample of adults aged 18 or older, diagnosed with EDs, proficient in the Italian language, and providing written informed consent. Participants with psychiatric comorbidities such as schizophrenia, bipolar disorder, and substance use disorder were excluded from the study. Validity of the ACMTQ-ITA was assessed using reliability analysis with Cronbach's α and McDonald's ω estimates, and Confirmatory Factor Analysis (CFA). RESULTS: Results from the reliability analysis confirmed the internal consistency of the Autonomous Motivation (AM) factor (α = 0.82, ω = 0.82), the Controlled Motivation (CM) factor (α = 0.76, ω = 0.77), and the ACMTQ-ITA overall score (α = 0.79). The CFA confirmed the two-factor solution (i.e., AM and CM) identified in the original validation of the ACMTQ (Comparative Fit Index = 0.92, Akaike Information Criterion = 3427.26, Bayesian Information Criterion = 3486.82; Root Mean Square Error of Approximation = 0.08, Standardized Root Mean Square Residual = 0.09). CONCLUSION: The ACMTQ-ITA emerged as a valid and reliable tool for measuring motivation for treatment in individuals with EDs. Its implementation may facilitate the comprehension of treatment motivation, offering valuable clinical insights and implications for health management practices. LEVEL OF EVIDENCE: Level V, descriptive studies.

A Perspective on Chronic and Long-Lasting Anorexia Nervosa.

Anorexia Nervosa (AN) is a severe eating disorder which typically develops in younger females. Many studies focus on this specific population, a majority of which will eventually partially or fully recover. A minority will become chronic despite extensive treatment. These patients are treatment-resistant and may not necessarily benefit from usual treatment. In this article we will reflect on possible mechanisms which may explain the maintenance of disease, and especially on the possible role of affective and anxiety disturbances. We will use, due to the lack of large-scale studies, data from risk and prognostic factors, treatment options and neurobiological correlates in chronic AN patients. Lastly, we will propose how these elements may advise further research and treatments.

Compulsory treatments in eating disorders: a systematic review and meta-analysis.

INTRODUCTION: The aims of this systematic review and meta-analysis are to provide a summary of the current literature concerning compulsory treatments in patients with eating disorders (ED) and to understand whether compulsorily and involuntarily treated patients differ in terms of baseline characteristics and treatment outcomes. METHODS: Relevant articles were identified following the PRISMA guidelines by searching the following terms: "treatment refusal", "forced feeding", "compulsory/coercive/involuntary/forced treatment/admission", "eating disorders", "feeding and eating disorders", "anorexia nervosa", "bulimia nervosa". Research was restricted to articles concerning humans and published between 1975 and 2020 in English. RESULTS: Out of 905 articles retrieved, nine were included for the analyses allowing the comparisons between 242 compulsorily and 738 voluntarily treated patients. Mean body mass index (BMI) was slightly lower in patients compelled to treatments. Mean illness duration, BMI at discharge and BMI variation showed no significant differences between the two groups. Average length of hospitalization was 3 weeks longer among compulsory-treated patients, but this did not result in a higher increase in BMI. No significant risk difference on mortality was estimated (three studies). CONCLUSIONS: Compulsory treatments are usually intended for patients having worse baseline conditions than voluntary ones. Those patients are unlikely to engage in treatments without being compelled but, after the treatments, albeit with longer hospitalisations, they do achieve similar outcomes. Therefore, we can conclude that forcing patients to treatment is a conceivable option. LEVEL OF EVIDENCE: Level I, systematic review and meta-analysis.

How Does SARS-CoV-2 Affect the Central Nervous System? A Working Hypothesis.

Interstitial pneumonia was the first manifestation to be recognized as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, in just a few weeks, it became clear that the coronavirus disease-2019 (COVID-19) overrun tissues and more body organs than just the lungs, so much so that it could be considered a systemic pathology. Several studies reported the involvement of the conjunctiva, the gut, the heart and its pace, and vascular injuries such as thromboembolic complications and Kawasaki disease in children and toddlers were also described. More recently, it was reported that in a sample of 214 SARS-CoV-2 positive patients, 36.4% complained of neurological symptoms ranging from non-specific manifestations (dizziness, headache, and seizures), to more specific symptoms such hyposmia or hypogeusia, and stroke. Older individuals, especially males with comorbidities, appear to be at the highest risk of developing such severe complications related to the Central Nervous System (CNS) involvement. Neuropsychiatric manifestations in COVID-19 appear to develop in patients with and without pre-existing neurological disorders. Growing evidence suggests that SARS-CoV-2 binds to the human Angiotensin-Converting Enzyme 2 (ACE2) for the attachment and entrance inside host cells. By describing ACE2 and the whole Renin Angiotensin Aldosterone System (RAAS) we may better understand whether specific cell types may be affected by SARS-CoV-2 and whether their functioning can be disrupted in case of an infection. Since clear evidences of neurological interest have already been shown, by clarifying the topographical distribution and density of ACE2, we will be able to speculate how SARS-CoV-2 may affect the CNS and what is the pathogenetic mechanism by which it contributes to the specific clinical manifestations of the disease. Based on such evidences, we finally hypothesize the process of SARS-CoV-2 invasion of the CNS and provide a possible explanation for the onset or the exacerbation of some common neuropsychiatric disorders in the elderly including cognitive impairment and Alzheimer disease.

Fast thoracic MRI as an alternative to chest x-ray: A retrospective evaluation of 287 patients.

PURPOSE: To compare half-Fourier acquisition single-shot turbo spin-echo thoracic MRI (HASTE-MRI) with chest x-ray (CXR). METHODS: A total of 287 patients (median age 53 years) undergoing both axial HASTE-MRI and CXR (<7 days apart) were retrospectively analyzed. Pulmonary nodules and consolidations, pleural effusion, and cardiac or aortic enlargement were considered. Detection rate (DR) and intra- and inter-technique agreement for both HASTE-MRI and CXR, were assessed. RESULTS: Pulmonary nodule DR was 1.7% (5/287) at both techniques (perfect inter-technique agreement); inter-reader agreement was perfect for HASTE-MRI (κ = 1.000) and modest for CXR (κ = 0.393). Pleural effusion DR at HASTE-MRI (19.1%, 55/287) was higher (p < 0.001) than at CXR (13.9%, 40/287), but their agreement was almost perfect (κ = 0.812); inter-reader agreement was almost perfect for HASTE-MRI (κ = 0.902) and substantial for CXR (κ = 0.773). Pulmonary consolidation DR at HASTE-MRI (8.4%, 24/287) was similar (p = 0.625) to that at CXR (7.7%, 22/287), with an almost perfect inter-technique agreement (κ = 0.905); inter-reader agreement was moderate for both HASTE-MRI (κ = 0.639) and CXR (κ = 0.554). Cardiac enlargement DR at HASTE-MRI (45.3%, 130/287) was borderline significantly lower (p = 0.057) than that at CXR (48.1%, 138/287), with an almost perfect inter-technique agreement (κ = 0.902); inter-reader agreement was substantial for both HASTE-MRI (κ = 0.798) and CXR (κ = 0.744). Aortic dilation DR at HASTE-MRI (17.7%, 51/287) was significantly higher (p < 0.001) than that at CXR (9.7%, 28/287), with a substantial inter-technique agreement (κ = 0.648); inter-reader agreement was moderate for both HASTE-MRI (κ = 0.724) and CXR (κ = 0.346). CONCLUSION: HASTE-MRI and CXR showed at least a comparable DR for thoracic cardiac and non-cardiac findings.