Hyperthyroidism during refeeding in anorexia nervosa.

OBJECTIVE: We report the second case of hyperthyroidism emerging during refeeding of a severely malnourished patient with Anorexia Nervosa (AN). METHOD: Available patient records and biochemical data were evaluated. Previous case reports of hyperthyroidism in eating disorders were reviewed. DISCUSSION: Refeeding can be associated with the onset of hyperthyroidism in patients with AN. AN and hyperthyroidism share a number of symptoms which can make identification of hyperthyroidism difficult. Lack of weight gain because of hyperthyroidism may be interpreted as noncompliance with refeeding treatment. The report shows that not taking antithyroid treatment can be employed as a method of weight control, highlighting the importance of extra consideration regarding treatment regimen and adequate support with medication compliance.

What patients with anorexia nervosa should wear when they are being weighed: report of two pilot surveys.

AIM: Weighing patients with anorexia nervosa tends to be an integral part of their treatment, yet there is variability in the detail of how this is conducted. The aim of this study was to carry out preliminary exploration of one aspect of this, namely what patients wear when being weighed. METHOD: Two Web-based surveys were conducted accessing the views of ex-patients (20 respondents) and professionals (98 respondents). RESULTS: Responses confirmed the variability in arrangements for weighing patients. Both patients and professionals were more concerned with accuracy than with privacy, and the patients stated a preference for being weighed in underwear. Between 30 and 57% of patients reported having falsified their weight during treatment. DISCUSSION: These surveys provide a reminder of the high frequency of falsification of weight and some support for a policy of weighing in underwear. The strength of the findings is limited by the methodology with small number of ex-patients all of whom had been through the same treatment programme. Given the paucity of literature on this clinically relevant topic, this does seem to be an area that warrants further investigation.

The inpatient management of physical activity in young people with anorexia nervosa.

This study investigates the management of physical activity in young inpatients with anorexia nervosa. Through telephone interviews and postal surveys inpatient units across the UK were asked about written documents regarding physical activity management, how they viewed healthy exercise, how they assessed physical fitness to engage in activity, the management approaches taken, provision of education and support around this issue and range of activities provided. Results indicated that a variety of approaches were taken, with little consensus between units, although the majority of approaches did involve some form of restriction, frequently determined by weight criteria. There were few substantial written documents to guide practice and a range of interpretations of healthy exercise. The findings are discussed and suggestions made for research to explore this area further and to inform the development of effective interventions.

Three cases illustrating the potential of dental treatment as a precipitant for weight loss leading to anorexia nervosa.

OBJECTIVE: This is the first published report to illustrate the potential for dental treatment to precipitate weight loss leading to anorexia nervosa. METHOD: Documentation of history and clinical findings on three adolescents referred to a specialist eating disorder service are presented. RESULTS: These cases illustrate that dental treatment may be precipitants of weight loss leading to anorexia nervosa. CONCLUSION: There is a need for increased awareness of this area amongst parents of children and adolescents vulnerable to eating disorders and also their dentists.

Eating disorders in children and adolescents: an update.

PURPOSE OF REVIEW: Children and adolescents with eating disorders frequently present to child mental health and paediatric services and have significant morbidity, psychosocial impairment and mortality. Efforts to treat these individuals have been hampered by a poor evidence base for effective interventions. This article reviews research published during 2004 with a primary focus on this challenging clinical area. RECENT FINDINGS: Research published during 2004 has replicated past epidemiological findings and expanded our understanding of the relationship of family meal structure and disordered eating. Research has provided assistance in the well known clinical conundrums of excessive exercising in anorexia nervosa and predicting when return of menses will occur. There has also been clarification of adolescent bingeing. Potential advances include a new, noninvasive method of measuring body composition and investigations in adolescents on leptin, neuro and gastrointestinal peptides. Importantly, further evidence of the effectiveness of family therapy for anorexia nervosa and short-term benefits from intervention programs have been published. SUMMARY: The research base that will influence clinical practice in child and adolescent eating disorders is increasing. More research is required in all areas of intervention.

The Staffing of Inpatient Child and Adolescent Mental Health Services.

BACKGROUND: There is a need for more accurate information regarding the staffing of Child and Adolescent Psychiatric inpatient units. This is both to facilitate clinical governance and to allow planning and focused further development of these services. METHOD: Postal surveys were sent to all units in England and Wales. RESULTS: Seventy-three percent (n = 1060) of the 1460 staff employed by the units were nurses; 43% of nurses were unqualified. On average there was one consultant psychiatrist for every 25 patients. Only 12% of nurses working on a 'census' day held a specialist qualification in nursing children. The use of agency and bank staff was higher in independent sector units than in NHS units (37% vs 10% of all nurses who worked a shift on the census day). CONCLUSIONS: Some child and adolescent inpatient units are not staffed by a multi-disciplinary team. There is evidence of problems of recruitment and retention of nurses.

Characteristics of the Detained and Informal Child and Adolescent Psychiatric In-Patient Populations.

BACKGROUND: This project surveyed the use of the Children Act and the Mental Health Act in in-patient child and adolescent mental health services in England and Wales. METHODS: Data were collected as a day census from child and adolescent psychiatric inpatient units, questionnaire forms completed by consultant psychiatrists or key-workers. Returns were received from 71 of the 80 units. RESULTS: One hundred and twenty-seven of the 663 patients had been admitted formally, the great majority under a section of the Mental Health Act. Compared with those admitted informally, those admitted formally were older, contained a higher proportion of males and had 'adult-type diagnoses', mainly schizophrenia, mood disorders and personality disorder. The clinical and psychosocial characteristics of formal and informal patients were consistent with these differences. CONCLUSIONS: This study provides a timely and useful snapshot of the use of the Acts in this population.

Do girls with anorexia nervosa have elevated autistic traits?

BACKGROUND: Patients with anorexia may have elevated autistic traits. In this study, we tested test whether patients with anorexia nervosa (anorexia) have an elevated score on a dimensional measure of autistic traits, the Autism Spectrum Quotient (AQ), as well as on trait measures relevant to the autism spectrum: the Empathy Quotient (EQ), and the Systemizing Quotient (SQ). METHODS: Two groups were tested: (1) female adolescents with anorexia: n = 66, aged 12 to 18 years; and (2) female adolescents without anorexia: n =1,609, aged 12 to 18 years. Both groups were tested using the AQ, EQ, and SQ, via the parent-report adolescent versions for patients aged 12 to 15 years old, and the self-report adult versions for patients aged over 16 years. RESULTS: As predicted, the patients with anorexia had a higher AQ and SQ. Their EQ score was reduced, but only for the parent-report version in the younger age group. Using EQ-SQ scores to calculate 'cognitive types', patients with anorexia were more likely to show the Type S profile (systemizing (S) better than empathy (E)), compared with typical females. CONCLUSIONS: Females with anorexia have elevated autistic traits. Clinicians should consider if a focus on autistic traits might be helpful in the assessment and treatment of anorexia. Future research needs to establish if these results reflect traits or states associated with anorexia.

Distribution and characteristics of in-patient child and adolescent mental health services in England and Wales.

BACKGROUND: Little is known about the current state of provision of child and adolescent mental health service in-patient units in the UK. AIMS: To describe the full number, distribution and key characteristics of child and adolescent psychiatric in-patient units in England and Wales. METHOD: Following identification of units, data were collected by a postal general survey with telephone follow-up. RESULTS: Eighty units were identified; these provided 900 beds, of which 244 (27%) were managed by the independent sector. Units are unevenly distributed, with a concentration of beds in London and the south-east of England. The independent sector, which manages a high proportion of specialist services and eating disorder units in particular, accentuates this uneven distribution. Nearly two-thirds of units reported that they would not accept emergency admissions. CONCLUSIONS: A national approach is needed to the planning and commissioning of this specialist service.