Purging using the Heimlich maneuver among children and adolescents with eating disorders.

This case report describes five independent cases of children and adolescents assessed for eating disorders who disclosed using the Heimlich maneuver as a purging technique. The maneuver is meant to be used only in life or death situations, likely once or less in any person's lifetime. A child or adolescent with an eating disorder may be using it to self-induce vomiting on a daily basis, increasing the risk of complications, including potential damage to major organs of the body. Asking patients who purge to elaborate on the methods with which they purge can provide clinicians with fuller information, improving their ability to select appropriate medical tests and interventions. Thorough investigations of physical complaints during the patient assessment may be warranted, including examining patients for possible rib fractures, hemorrhages, perforations of the hollow viscous, and other forms of blunt abdominal traumas.

Factors associated with successful completion in an adolescent-only day hospital program for eating disorders.

The purpose of this study was to examine factors associated with completion of an adolescent-only eating disorder day hospital program. A total of 65 adolescents were included. Completers were compared to non-completers on multiple variables including diagnosis, weight, and medication use. Adolescents who completed the program were more likely to have been prescribed antidepressants and less likely to purge. The two groups did not differ significantly on other variables. Few factors differentiated completers from non-completers of the eating disorder day hospital program. Further research is needed to determine the role medications or purging may play in completing treatment.

A study protocol for implementing Canadian Practice Guidelines for Treating Children and Adolescents with Eating Disorders.

BACKGROUND: Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake. METHODS: Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8-10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups. DISCUSSION: Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies.

'I know I can help you': parental self-efficacy predicts adolescent outcomes in family-based therapy for eating disorders.

Family-based therapy is regarded as best practice for the treatment of eating disorders in adolescents. In family-based therapy, parents play a vital role in bringing their child or adolescent to health; however, little is known about the parent-related mechanisms of change throughout treatment. The present study examines parent and adolescent outcomes of family-based therapy as well as the role of parental self-efficacy in relation to adolescent eating disorder, depressed mood and anxiety symptoms. Forty-nine adolescents and their parents completed a series of measures at assessment, at 3-month post-assessment and at 6-month follow-up. Results indicate that, throughout treatment, parents experienced an increase in self-efficacy and adolescents experienced a reduction in symptoms. Maternal and paternal self-efficacy scores also predicted adolescent outcomes throughout treatment. These results are consistent with the philosophy of the family-based therapy model and add to the literature on possible mechanisms of change in the context of family-based therapy.

Paediatric eating disorders: Exploring virtual family therapy during a global pandemic.

AIM: Explore treatment response and effectiveness of virtual treatment for a paediatric eating disorder sample. METHODS: Twenty patients and their families who received either virtual or in-person family therapy were included in the study. Family therapy was informed by family-based treatment (FBT) principles. Patients' weight restoration at 1, 3, and 6 months after starting treatment was examined. Independent sample t tests assessed group differences and a Fisher exact test was used to evaluate the association between treatment group and weight restoration. RESULTS: Weight restoration did not significantly differ between treatment groups (virtual vs. in-person) at any time point and there was no association between group and remission weight at 6 months. CONCLUSIONS: Study results are considered exploratory. Future research addressing study limitations is needed. Results suggest that paediatric eating disorder patients may benefit from family therapy delivered via a virtual platform.

A qualitative evaluation of team and family perceptions of family-based treatment delivered by videoconferencing (FBT-V) for adolescent Anorexia Nervosa during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, outpatient eating disorder care, including Family-Based Treatment (FBT), rapidly transitioned from in-person to virtual delivery in many programs. This paper reports on the experiences of teams and families with FBT delivered by videoconferencing (FBT-V) who were part of a larger implementation study. METHODS: Four pediatric eating disorder programs in Ontario, Canada, including their therapists (n = 8), medical practitioners (n = 4), administrators (n = 6), and families (n = 5), participated in our study. We provided FBT-V training and delivered clinical consultation. Therapists recorded and submitted their first four FBT-V sessions. Focus groups were conducted with teams and families at each site after the first four FBT-V sessions. Focus group transcripts were transcribed verbatim and key concepts were identified through line-by-line reading and categorizing of the text. All transcripts were double-coded. Focus group data were analyzed using directed and summative qualitative content analysis. RESULTS: Analysis of focus group data from teams and families revealed four overarching categories-pros of FBT-V, cons of FBT-V, FBT-V process, and suggestions for enhancing and improving FBT-V. Pros included being able to treat more patients and developing a better understanding of family dynamics by being virtually invited into the family's home (identified by teams), as well as convenience and comfort (identified by families). Both teams and families recognized technical difficulties as a potential con of FBT-V, yet teams also commented on distractions in family homes as a con, while families expressed difficulties in developing therapeutic rapport. Regarding FBT-V process, teams and families discussed the importance and challenge of patient weighing at home. In terms of suggestions for improvement, teams proposed assessing a family's suitability or motivation for FBT-V to ensure it would be appropriate, while families strongly suggested implementing hybrid models of FBT in the future which would include some in-person and some virtual sessions. CONCLUSION: Team and family perceptions of FBT-V were generally positive, indicating acceptability and feasibility of this treatment. Suggestions for improved FBT-V practices were made by both groups, and require future investigation, such as examining hybrid models of FBT that involve in-person and virtual elements. Trial registration ClinicalTrials.gov NCT04678843 .

The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond.

OBJECTIVE: The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond. METHODS: Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers. RESULTS: Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended. CONCLUSIONS: Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.

Canadian practice guidelines for the treatment of children and adolescents with eating disorders.

OBJECTIVES: Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline. METHODS: Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders. RESULTS: Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed. CONCLUSIONS: Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.

Assessment and treatment of pediatric eating disorders: a survey of physicians and psychologists.

OBJECTIVE: Studies show that primary care clinicians struggle with the assessment and treatment of eating disorders in adults. There are no known studies examining current practices of clinicians with respect to eating disorders in children and adolescents. The following study describes the key practices of primary care clinicians in Ontario, Canada, around the screening, assessment, and treatment of eating disorders in children and adolescents. METHOD: A 24-item survey was developed to obtain information from family physicians and psychologists about presenting complaints and current practices related to the assessment and treatment of eating disorders. RESULTS: Findings of this study suggest that despite discipline-specific differences, a large proportion of clinicians do not routinely screen for eating disorders, and when eating disorders are assessed and treatment is initiated, family members are not routinely involved in the process. CONCLUSION: In Ontario, primary care clinicians may benefit from more training and support to better identify and treat children and adolescents with eating disorders. In particular, clinicians may require additional training around screening, multi-informant assessment methods, as well as appropriate therapy techniques.

Delivery of family therapy in the treatment of anorexia nervosa using telehealth.

Family therapy plays an important role in the comprehensive treatment of adolescents with anorexia nervosa (AN). However, most comprehensive hospital-based treatment facilities for eating disorders are situated in large urban centers, thus not accessible to individuals living in underserviced rural communities. Telehealth is now being used to provide psychiatric services to individuals who do not have access to urban-based treatment centers. We report the therapeutic outcome and patient satisfaction of using telehealth to provide family therapy as an adjunctive treatment for AN to an adolescent female admitted to a large urban-based hospital treatment program. Family therapy was delivered via telehealth in a therapeutic environment within a hospital setting, and was received in a telehealth facility in the rural community. Family therapy was effectively delivered and contributed to patient recovery, as measured by objective criteria (weight gain, improved medical condition) and subjective clinical observations. In addition, all family members reported high satisfaction with telehealth without any concern regarding confidentiality. The advantages of telehealth are discussed in the context of legal and ethical issues relating to the use of this technology to deliver psychiatric care.

Olanzapine use as an adjunctive treatment for hospitalized children with anorexia nervosa: case reports.

OBJECTIVE: A recent case report suggested that olanzapine resulted in improved weight gain and maintenance, as well as decreased anxiety and agitation, for two hospitalized inpatients with anorexia nervosa (AN). However, a subsequent larger case study did not show a relationship between the use of olanzapine and rate of weight gain among a primarily adult population. The aim of this case report was to clinically examine the therapeutic benefit and tolerability of olanzapine as an adjunctive treatment for four children with AN in a pediatric inpatient setting. RESULTS: Olanzapine use was associated with considerable weight gain and maintenance, with an average rate of weight gain during hospitalization of 0.99 kg per week. In addition to weight gain, olanzapine was associated with a clinically notable decrease in levels of agitation and premeal anxiety and almost immediate improvement in sleep, general functioning, and overall compliance with treatment. Olanzapine was also well tolerated in these young patients. DISCUSSION: These case report findings warrant more controlled research, including randomized controlled studies, to better determine the therapeutic benefits and safety of olanzapine use in children with AN.