Journal of the Canadian Academy of Child and Adolescent Psychiatry最新文献

Atypical anorexia nervosa (AAN) has historically been underrecognized by clinicians due to traditional markers of low weight as indicative of malnutrition. Inadequate case identification can lead to treatment delays while placing children and adolescents with AAN at further risk of medical and psychiatric sequalae. The accompanying article in this journal issue examines the challenges of determining weight-based treatment goals for this population. In this commentary, we elaborate on this discussion and question the validity of weight stabilization as a treatment target in child and adolescent AAN. Furthermore, we address: (1) the role of weight and historical, variable, and stable growth curves in shaping treatment goals; (2) future growth targets, including numeric and remission targets; and; (3) the impact of weight stigma and implicit weight bias in clinical decision-making. We argue that target weights must take a secondary role in the treatment of AAN, shifting the focus to the mental, behavioural, and nutritional aspects of this disorder. In addition, we recommend that clinicians acknowledge and mitigate fears around weight gain and weight-based social rejection for young people and families in treatment.

Background: Although over one-third of adolescents presenting with restrictive eating disorders have a history of being overweight, there is no evidence-based treatment for atypical anorexia nervosa (AAN). Family-Based Treatment (FBT) is a feasible treatment and is routinely applied to treat atypical anorexia nervosa in adolescents; however, identifying a treatment target weight within FBT for these patients is a challenge.

Objective: This study aimed to 1) increase understanding regarding recommendations for weight gain versus weight stabilization in FBT for adolescents with AAN and 2) examine treatment outcomes in FBT for adolescents with AAN.

Method: Using a retrospective design, we reviewed the files of 41 patients with AAN who were referred for FBT at a pediatric eating disorder program located within a tertiary care health centre.

Results: We found variability in recommendations for weight gain, with 56% of the sample recommended to gain weight and 44% recommended to stabilize weight. Baseline BMI for age appeared to be a key factor in establishing recommendations for weight gain. AAN patients in our sample gained a significant amount of weight across treatment, with those recommended to gain weight showing more weight gain during treatment. Forty-nine percent of the sample completed FBT; those patients displayed a mean of 10kg of weight gain during treatment.

Conclusions: Findings suggest that many patients gained weight during the course of FBT for AAN. Further study on weight changes during FBT for adolescents with AAN and increased diagnostic consistency for AAN will be important for this field.

Psychiatric disorders are common co-existing conditions in children with epilepsy and can precede or follow epilepsy onset. Therefore, when selecting anti-seizure medications (ASMs) for children with epilepsy, in addition to seizure control, careful consideration of behavioral and psychotropic effects (BPEs) is critical, as they can have a negative impact on ASM adherence and quality of life. The goal in supporting children with epilepsy is an individualized approach to maximize seizure control and minimize negative BPEs. A previous history of a psychiatric disorder is the most significant risk factor for negative BPEs. Therefore, systematic screening for psychiatric symptoms can guide ASM selection and prompt intervention as needed. Besides familiarity with different ASM profiles, awareness of risk factors for negative BPEs including rapid dose titrations and weaning schedules, polypharmacy, high ASM doses, and drug interactions are important. In children with co-existing psychiatric disorders, ASMs with mood stabilizing, behavior regulating or anxiolytic properties may be preferred choices. Overall, a comprehensive and coordinated approach, with family psychoeducation and a mutual understanding of clinical aspects between the disciplines of neurology and psychiatry will enable better outcomes in children with epilepsy. Further pediatric "real-world" studies will expand knowledge of BPEs and potential risk factors. For some children, timely epilepsy surgery or precision therapies targeting a pathological defect may reduce the ASM burden in a child's life and subsequent BPEs. The ability to predict an individual child's susceptibility to negative BPEs with valid biomarkers may become available in the near future with advances in pharmacogenomics and technology.