91. Choosing Wisely: Refeeding Hypophosphatemia And The Value of Daily Laboratory Monitoring In Hospitalized Adolescents With Restrictive Eating Disorders

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations.Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review.Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047;p=0.039). No statistical significance was found between electrolytes and calories provided during refeeding.Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

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The Association of Malnutrition, illness duration, and pre-morbid weight status with anxiety and depression symptoms in adolescents and young adults with restrictive eating disorders: a cross-sectional study

Journal of Eating Disorders ◽

10.1186/s40337-021-00415-7 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Jessica A. Lin ◽

Grace Jhe ◽

Julia A. Vitagliano ◽

Carly E. Milliren ◽

Rebecca Spigel ◽

...

Keyword(s):

Eating Disorders ◽

Young Adults ◽

Weight Status ◽

Severe Disease ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Comprehensive Treatment ◽

Psychiatric Medication ◽

Illness Duration ◽

Restrictive Eating

Abstract Background Restrictive eating disorders (EDs) are often comorbid with anxiety and depression symptoms, placing patients at risk for more severe disease, worse treatment outcomes, and higher rates of mortality. To identify risks for developing such co-morbidities, we assessed the association of malnutrition, ED illness duration, and pre-morbid weight status with symptoms of anxiety and depression in adolescents/young adults (AYAs) with EDs. Methods 145 participants with restrictive EDs (anorexia nervosa [AN], other specified feeding and eating disorders [OSFED], avoidant restrictive food intake disorder [ARFID]) were included from the RECOVERY study, a longitudinal web-based registry of AYAs with EDs. We measured malnutrition as percent of expected body mass index (%eBMI), based on participants’ pre-morbid growth trajectory. Outcomes were anxiety and depression scores from the Generalized Anxiety Disorder 7-item (GAD-7) and Center for Epidemiologic Studies Depression (CES-D) scales. We used multiple linear regression to examine the association of malnutrition, ED duration, and pre-morbid weight status with symptoms of anxiety and depression. Results Mean (SD) age was 16.4(3.0) years; 87% were female; 89% white; 85% had AN, 6% OSFED, 10% ARFID. Of these, 2/3 had ED symptoms ≥1 year, 1/3 had previous higher level of ED care (HLOC), and half were taking psychiatric medications. Mean %eBMI was 90% (range 57–112%). Mean GAD-7 was 9.4(5.9) and CES-D was 24(13.8), indicating most participants had clinically significant anxiety and/or depression. Degree of malnutrition was not significantly associated with anxiety or depression adjusting for age, sex, sexual orientation, ED diagnosis, and use of psychiatric medication. Those with longer duration of ED symptoms had higher depression scores after adjusting for malnutrition, HLOC, length of ED symptoms, and time in our care (p = 0.038). Patients with pre-morbid BMIs ≥75th percentile had lower depression scores than those with pre-morbid BMIs <75th percentile (p = 0.014). Conclusions We find high degree of clinically relevant anxiety and depression symptoms in a population of AYAs with EDs. Our findings suggest that factors beyond malnutrition play a role in the co-morbid mood and anxiety disorders in this population. Overall, rapid ED diagnosis and comprehensive treatment for patients with EDs across the weight spectrum—and especially those with psychiatric co-morbidities—will likely aid in recovery.

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94. Embedding Treatment For Adolescent Restrictive Eating Disorders In Primary Care To Improve Early Detection And Treatment: Results From 3 Case Studies

Journal of Adolescent Health ◽

10.1016/j.jadohealth.2018.10.110 ◽

2019 ◽

Vol 64 (2) ◽

pp. S50

Author(s):

Jocelyn Lebow ◽

Angela Mattke ◽

Janna Gewirtz O'Brien ◽

Cassandra Narr ◽

Marcie Billings ◽

...

Keyword(s):

Primary Care ◽

Eating Disorders ◽

Early Detection ◽

Case Studies ◽

Treatment Results ◽

Restrictive Eating

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Restrictive eating disorders in children and adolescents: a comparison between clinical and psychopathological profiles

Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity ◽

10.1007/s40519-020-00962-z ◽

2020 ◽

Author(s):

Valeria Zanna ◽

Michela Criscuolo ◽

Alberta Mereu ◽

Giulia Cinelli ◽

Chiara Marchetto ◽

...

Keyword(s):

Eating Disorders ◽

Children And Adolescents ◽

Restrictive Eating

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Making the most of an admission: the safety and efficacy of higher caloric refeeding in hospitalised adolescents with restrictive eating disorders

Journal of Eating Disorders ◽

10.1186/2050-2974-3-s1-o66 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

Elizabeth Parker ◽

Sonia Faruquie ◽

Gail Anderson ◽

Linette Gomes ◽

Danielle Hewitt ◽

...

Keyword(s):

Eating Disorders ◽

Safety And Efficacy ◽

Restrictive Eating

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Use of atomoxetine in eating disorders. A case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.792 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S554-S555

Author(s):

R. Landera Rodríguez ◽

M. Juncal Ruiz ◽

L. Sánchez Blanco ◽

G. Pardo de Santayana Jenaro ◽

O. Porta Olivares ◽

...

Keyword(s):

Eating Disorders ◽

Positive Impact ◽

Public Health Problem ◽

Behavioural Therapy ◽

Eating Behaviours ◽

Important Public Health Problem ◽

Restrictive Eating ◽

Cognitive Behavioural ◽

Competing Interest ◽

Comorbid Adhd

IntroductionEating disorders (EDs) are an important public health problem and not all patients respond adequately to psychotherapy. In the last decade, researchers report a significant comorbidity of EDs and attention-deficit/hyperactivity disorder (ADHD), especially binge eating disorder and bulimia nervosa. Some studies postulate the hypothesis of a common neurobiological substrate, such as noradrenergic pathways among others.ObjectivesTo revise the possible use of atomoxetine, a highly selective noradrenergic reuptake inhibitor, for the treatment of EDs.MethodsWe describe the effect of atomoxetine in a young woman with purging disorder and history of ADHD in childhood added to cognitive behavioural therapy (CBT).Resultspatient had selective/restrictive eating behaviours, daily purges and occasional binges for last five years. At age 14 she was diagnosed with ADHD by impulsivity/aggressiveness and poor school performance, but she did not take drugs and left medical consultations. She came to our specific unit of EDs in november-2015. Her BMI was 24.88 kg/m2. We initiated CBT and atomoxetine (80 mg/day). In this first year of treatment binges and purges have disappeared and exposure to new foods and body image have improved partially. We found clear improvement in mood, motivation and attention/concentration in relation with introduction of atomoxetine. These facts have positive impact on the clinical evolution. Her current BMI is 26.90 kg/m2.ConclusionsIdentify comorbid ADHD to assess the use of specific drugs for this disorder could be beneficial in the treatment and prognosis of EDs. However, more studies are needed to determine effectivenes, particularly of non-stimulant drugs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Anorexia Nervosa and Pregnancy: A Case Report

European Psychiatry ◽

10.1016/s0924-9338(09)70975-7 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

L.C. Castro ◽

S. Moreira ◽

A. Lopes ◽

M. Branco

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Pregnancy Complications ◽

Eating Behaviour ◽

Perinatal Outcomes ◽

Obstetric Care ◽

Future Research ◽

Restrictive Eating ◽

Risk Pregnancy ◽

The Impact

Background:Several studies report that women with a history of eating disorders are at higher risk of pregnancy complications and major adverse perinatal outcomes.Aim:To report a case of anorexia nervosa during pregnancy, in order to underline the impact of eating disorders on pregnancy.Methods:Case study and review of the literature.Results:A 32 year old woman was hospitalized in an obstetric service of a general hospital for high risk pregnancy complications. She maintained a disturbed eating behaviour, with periods of restrictive eating and bulimic-purging episodes. She was underweight, did not reach the recommended weight gain during pregnancy and showed intrauterine growth restriction. The Psychiatry Liasion Unit was asked to follow the case during the obstetric hospitalization.Discussion:Pregnant women with eating disorders have higher risk of pregnancy and neonatal complications. Pregnancy is a privileged opportunity to maximize intervention in eating disorders, since women show higher levels of motivation for therapy. Some cases of anorexia nervosa may warrant special obstetric care to ensure adequate prenatal nutrition and fetal development. Since there are few studies on this topic and they report conflicting results, it is a relevant area for future research.

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