Clinical features of adolescents diagnosed with eating disorders and at risk for psychosis.

Martina Maria Mensi,Renata Nacinovich,Matteo Chiappedi,Anna Riva,Umberto Balottin,Livio Provenzi,Chiara Rogantini,Renato Borgatti

doi:10.1192/j.eurpsy.2020.80

Abstract

The presence of subthreshold psychotic symptoms in adolescents with eating disorders is poorly described. This study provides a detailed characterization of adolescents affected by eating disorders in the absence or presence of subthreshold psychotic symptoms, taking into account a wide set of sociodemographic, psychological, and clinical variables. Ninety-four adolescents diagnosed with eating disorders were interviewed, focusing on clinical anamnesis and sociodemographic data collection. The Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to assess the presence (HR+) or absence (HR-) of subthreshold psychosis. The clinicians completed a questionnaire on eating disorders severity, whereas patients provided self-report measures of global social functioning and psychological symptoms associated with eating disorders. Attenuated psychotic symptoms were highly frequent (84% of subjects). HR+ patients experienced more frequently purging behaviors and dysmorphophobia and received a greater amount of antipsychotic drugs. Compared to HR- counterparts, HR+ patients reported higher eating disorders severity and psychological symptoms (i.e., ineffectiveness, interpersonal and affective problems) associated with eating disorders. Finally, a significant correlation between global social functioning and eating disorders severity emerged only for HR- subjects. These descriptive data are warranted to identify a potential psychotic core in eating disorders, mainly concerning body image and weight as well as specific psychological features. The availability of reliable and valid markers of risk can further increase our capacity to detect the early emergence of psychosis in adolescents with eating disorders, whose outcome might be worsened by the presence of psychotic symptoms.

Highlights

Eating disorders are a heterogeneous group of potentially severe and often chronic pathologies, accompanied by an important impairment of global, social, and labor functioning [1]
This finding is consistent with previous research suggesting that the comorbidity between psychosis and eating disorders may be at least partially due to overlapping common psychological processes distorting reality perceptions that are common of anorexia nervosa and psychotic symptoms [4]
The present study described a multidimensional psychotic core that can have relevant implications for clinical practice with adolescents with eating disorders who are at risk for psychosis

Summary

Introduction

Eating disorders are a heterogeneous group of potentially severe and often chronic pathologies, accompanied by an important impairment of global, social, and labor functioning [1]. This study provides a detailed characterization of adolescents affected by eating disorders in the absence or presence of subthreshold psychotic symptoms, taking into account a wide set of sociodemographic, psychological, and clinical variables. The clinicians completed a questionnaire on eating disorders severity, whereas patients provided self-report measures of global social functioning and psychological symptoms associated with eating disorders. The availability of reliable and valid markers of risk can further increase our capacity to detect the early emergence of psychosis in adolescents with eating disorders, whose outcome might be worsened by the presence of psychotic symptoms

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Methods

Results

Discussion

Conclusion