Adolescent Anorexia Nervosa Research Articles

Enhanced Family-Based Treatment for an Adolescent With Binge-Eating Disorder: A Case Report

Family-based treatment (FBT) is considered the treatment standard for adolescent anorexia nervosa and bulimia nervosa—however, the effectiveness of FBT for adolescents with binge-eating disorder (BED) has not been evaluated. This clinical case paper presents the case of BED in an adolescent female treated with FBT. Through the use of FBT, family weight bias was addressed in sessions by the multidisciplinary team. Empirically supported survey measures were analyzed to monitor treatment outcome. After 21 weeks of treatment, eating disorder symptoms were in remission. In addition, the use of FBT allowed for family factors to be addressed in treatment that may have been overlooked in individual treatment. This led to a reduction in weight and food-based shame within the family unit. As indicated by this case, FBT may be an effective treatment for adolescent BED, and as such, an effective treatment approach for adolescents across the eating disorder spectrum. Further research is needed to understand the effectiveness of FBT for BED.

Temporal dynamics of cognitive flexibility in adolescents with anorexia nervosa: A high-density EEG study.

Impairment in cognitive flexibility is a core symptom of anorexia nervosa (AN) and is associated with treatment resistance. Nevertheless, studies on the neural basis of cognitive flexibility in adolescent AN are rare. This study aimed to investigate brain networks underlying cognitive flexibility in adolescents with AN. To address this aim, participants performed a Dimensional Change Card Sorting task during high-density electroencephalography (EEG) recording. Anxiety was measured with the State-Trait Anxiety Inventory. Data were collected on 22 girls with AN and 23 controls. Evoked responses were investigated using global-spatial analysis. Adolescents with AN showed greater overall accuracy, fewer switch trial errors and reduced inverse efficiency switch cost relative to controls, although these effects disappeared after adjusting for trait and state anxiety. EEG results indicated augmented early visual orienting processing (P100) and subsequent impaired attentional mechanisms to task switching (P300b) in subjects with AN. During task switching, diminished activations in subjects with AN were identified in the posterior cingulate, calcarine sulcus and cerebellum, and task repetitions induced diminished activations in a network involving the medial prefrontal cortex, and several posterior regions, compared with controls. No significant associations were found between measures of cognitive flexibility and anxiety in the AN group. Findings of this study suggest atypical neural mechanisms underlying cognitive flexibility in adolescents with AN. More importantly, our findings suggest that different behavioural profiles in AN could relate to differences in anxiety levels. Future research should investigate the efficacy of cognitive training to rebalance brain networks of cognitive flexibility in AN.

When eating disorder attitudes and cognitions persist after weight restoration: An exploratory examination of non-cognitive responders to family-based treatment for adolescent anorexia nervosa.

Family-based treatment (FBT) is a well-established intervention for adolescent anorexia nervosa (AN). Although FBT is efficacious in promoting weight gain and improvements in psychological symptoms, for some adolescents, cognitive/attitudinal recovery lags behind weight gain. This study conducted an exploratory post hoc analysis of outcomes of adolescents who achieved weight gain by the end of FBT but continued to experience elevated psychological symptoms post-treatment. Data were drawn from two randomised controlled trials (RCTs) testing two forms of FBT (conjoint/whole family and parent-focussed). Descriptive statistics and generalised estimating equations were used to examine differences in treatment outcomes between non-cognitive responders (NCRs) (those who regained weight but continued to experience psychological symptoms) and full responders (FRs) (those who achieved both weight and cognitive restoration by the end of treatment) (n=80; 83.7% female, Agemean [SD]=14.66 [1.73]). By 12months post-treatment, there were no differences in weight between NCRs and FRs. However, NCRs had a slower trajectory of weight gain than FRs and continued to have elevated levels of psychological symptoms throughout the follow-up period. A subset of adolescents appear to continue to experience clinically significant levels of eating pathology up to 12months after FBT even when weight restoration is achieved.

The Treatment Experience of Anorexia Nervosa in Adolescents from Healthcare Professionals’ Perspective: A Qualitative Study

Anorexia nervosa (AN) is a serious psychiatric illness with a high mortality rate and a poor outcome. AN in adolescents can be difficult to treat. The prognosis of patients with AN depends highly on how early specialized AN treatment starts. Therefore, the purpose of this study was to explore the experiences of healthcare professionals in treating adolescents with AN. A qualitative study approach was conducted. Through semi-structured interviews, 16 healthcare professionals, including 10 nurses, 3 dieticians and 3 physicians from the paediatric ward at a university-affiliated medical centre in central Taiwan, shared their experiences. Recorded interviews were transcribed and analyzed by content analysis. Five themes and ten subthemes were identified: 1. Building a trusting relationship first: (a) spending time to build trust with the client and (b) establishing a relationship with the client's parents; 2. The key to treatment success: (a) Clients' awareness of the illness and (b) parents' support for clients; 3. Consistency of team treatment goals: (a) maintaining stable vital signs and (b) achieving caloric intake; 4. Empowerment with knowledge about anorexia: (a) continuing education for healthcare professionals and (b) interdisciplinary collaborative care; and 5. Using different interaction strategies: (a) the hard approach and (b) the soft approach. In conclusion, the findings will provide important information for healthcare professionals to apply in monitoring the psychological and emotional states of adolescents with AN. The findings indicate that healthcare professionals should invite parents to participate in the treatment, support and guide them in their adolescent care, develop scales of family stress and support for AN in adolescents, develop interventions, and establish an early therapeutic alliance.

Dieting: An Early Predictor of Anorexia Nervosa in Adolescents?

Dieting: An Early Predictor of Anorexia Nervosa in Adolescents?

Personality Disorder in Adolescent Patients with Anorexia Nervosa

Objective: Anorexia nervosa (AN) is a highly debilitating disease which frequently results in chronification and often originates in adolescence. Personality traits have been associated with the onset and maintenance of AN; moreover, study results indicated a worse treatment outcome in patients with AN and comorbid personality disorder (PD). However, research on PD in adolescent AN is scarce. Methods: The sample consists of 73 female adolescent patients with AN. We investigated comorbid PD and AN symptom severity performing the International Personality Disorder Examination (IPDE) and the Eating Disorder Inventory 2 (EDI-2). Results: Almost a third (27.4%) of all participants were diagnosed with comorbid PD. They had significantly higher EDI-2 total scores reflecting overall stronger symptom severity, as well as significantly higher scores in the subscales “ineffectiveness,” “interpersonal distrust,” “interoceptive awareness,” “asceticism,” “impulse regulation,” and “social insecurity.” Conclusion: PD is an important and frequent comorbid condition in adolescent AN and should be addressed in diagnostic and treatment planning. Early diagnosis of comorbidity could have an impact on choosing specialized treatment for adolescents with AN and PD in order to enhance the outcome.

A case of anorexia nervosa whose body image deteriorated after being weighed with classmates at school

Anorexia nervosa is an eating disorder characterized by a heightened desire to have a lean body structure that leads to an extreme fear of becoming fat. The patients with this disorder have a severely impaired perception of their bodies. Negative behaviors and attitudes in peer communication may hugely impact the affected individual at every stage of this disorder. The level of peer communication quality could be shaped by the conditions prevalent in the school, particularly the approaches undertaken by the educators and the staff at school. However, it would be incorrect to state that wrong communication styles adopted by the friends of an individual or unsuitable conditions in the school environment alone would be sufficient for the development of anorexia nervosa in adolescents. A 16-year-old girl with anorexia nervosa was followed up for 1.5 years after the diagnosis of the disorder, a period during which she had begun exhibiting improvement in her condition. However, her symptoms reappeared after she underwent height and weight measurements at school during the physical education and sports class to determine her physical health. This case is presented (1) to remind that anthropometric measurements are personal data and (2) to emphasize that it would be appropriate to provide privacy in this respect at schools.

Multidisciplinary implementation of family-based treatment delivered by videoconferencing (FBT-V) for adolescent anorexia nervosa during the COVID-19 pandemic.

Family-Based Treatment (FBT)-the most widely supported treatment for pediatric eating disorders-transitioned to virtual delivery in many programs due to COVID-19. Using a blended implementation approach, we systematically examined therapist adherence to key components of FBT and fidelity to FBT by videoconferencing (FBT-V), preliminary patient outcomes, and team experiences with our FBT-V implementation approach as well as familial perceptions of FBT-V effectiveness. We examined our implementation approach across four pediatric eating disorder programs in Ontario, Canada, using mixed methods. Participants included therapists (n = 8), medical practitioners (n = 4), administrators (n = 6), and families (n = 5; 21 family members in total). We developed implementation teams at each site, provided FBT-V training, and offered clinical and implementation consultation. Therapists submitted video recordings of their first four FBT-V sessions for fidelity rating, and patient outcomes. Therapists self-reported readiness, attitudes, confidence, and adherence to FBT-V. Focus groups were conducted with each team and family after the first four sessions of FBT-V. Quantitative data were analyzed using repeated measures ANOVA. Qualitative data were analyzed using directed and summative content analysis. Therapists adhered to key FBT components and maintained FBT-V fidelity. Changes in therapists' readiness, attitudes, and confidence in FBT-V over time were not significant. All patients gained weight. Focus groups revealed implementation facilitators/barriers, positives/negatives surrounding FBT-V training and consultation, suggestions for improvement, and effectiveness attributed to FBT-V. Our implementation approach appeared to be feasible and acceptable. Future research with a larger sample is required, furthering our understanding of this approach and exploring how organizational factors influence treatment fidelity.

Day hospital program for anorexia nervosa in children and adolescents: Assessment, management and specific focus on early onset anorexia nervosa

IntroductionThe French day hospital program specialized in eating disorders (ED) opened in January 2018. Our study presents preliminary data on clinical profiles of patients with anorexia nervosa (AN). We describe more specifically clinical characteristics of patients with early onset AN and according to their therapeutics orientations. Then, we compare the weight gain of patients managed only in day-patient (DP) treatment with those managed initially inpatient (IP) treatment and relays in DP. MethodsNinety-two patients with AN, aged between 8 and 18 years, were evaluated with several questionnaires (EDI-2, EDE-Q, BSQ, EDS-R, CDI, STAI-Y, VSP-A, EPN-13). ResultsPatients with early onset AN, n = 23 (25.3%), presented more restrictive behaviors, less marked dietary symptomatology, a lower degree of clinical perfectionism and a less marked feeling of ineffectiveness than adolescent patients with AN. Regarding the choice of hospitalization modality (DP alone or IP-DP), the only difference highlighted was the severity of patient undernutrition. Among the patients who were treated (IP-DP n = 27 vs DP alone n = 25), the weight evolution after one month and at discharge was favorable for both groups. ConclusionThese preliminary data suggest the effectiveness of DP in the care of AN in children and adolescents.

Disease Characteristics and Psychiatric Comorbidities in Adolescents with Anorexia Nervosa Hospitalized During COVID-19 Pandemic

Since the beginning of COVID-19 pandemic, an increase in new diagnoses and pediatric hospital admission for anorexia nervosa (AN) or atypical AN in adolescents have been reported, suggesting an adverse effect of COVID-19 on youth mental health. We hypothesized possible differences in prevalence of hospitalization and/or disease severity, related to socio-economic status and/or ethnicity. Retrospectively, patients were divided into two subgroups and compared according to the date of first hospital admission: "pre SARS-COV2 era" group (n. 45, 8th March 2016-8th March 2020) and "SARS-COV2 era" group (n. 43, 9th March 2020-8th March 2022). During the two years of the SARS-COV2 era, we reported an increase in hospital admission incidence more than doubled respect to the "pre-SARS-COV2 era". The "SARS-COV2 era group" showed a more rapid weight loss (p = 0.005), a minor duration of weight loss from lifetime maximum to admission (p = 0.019) and needed most frequently treatments with intravenous fluids (p < 0.0001), oral dietetic supplements (p <0.001) and enteral nutrition by nasogastric tube (p = 0.002). The same group presented higher prevalence of psychiatric comorbidities (63% vs. 22%, p < 0.0001) and required most frequently treatments with psychotropic drugs (56% vs. 24%, p = 0.002). We found higher family socioeconomic status (SES) in our patients with AN in both the periods and we did not find a shift in social class distribution over time. Our study confirms a significant increase in incidence of hospitalization and of psychiatric comorbidity in the pediatric population with AN during the second year of COVID-19 pandemic, regardless of SES or ethnic background. Further studies are needed to understand potential mechanisms that during COVID-19 pandemic trigger eating disorder symptoms.

A machine learning investigation into the temporal dynamics of physical activity-mediated emotional regulation in adolescents with anorexia nervosa and healthy controls.

Anorexia nervosa (AN) is commonly experienced alongside difficulties of emotion regulation (ER). Previous works identified physical activity (PA) as a mechanism for AN sufferers to achieve desired affective states, with evidence towards mitigation of negative affect. However, temporal associations of PA with specific emotional state outcomes are unknown. Using lag-ensemble machine learning and feature importance analyses, 888 affect-based ecological momentary assessments across N = 75 adolescents with AN (N = 44) and healthy controls (N = 31) were analysed to explore significance of past PA, measured through passively collected wrist-worn actigraphy, with subsequent self-report momentary affect change across 9 affect constructs. Among AN adolescents, later lags (≥2.5h) were important in predicting change across negative emotions (hostility, sadness, fear, guilt). AN-specific model performance on held-out test data revealed the holistic "negative affect" construct as significantly predictable. Only joviality and self-assurance, both positively-valenced constructs, were significantly predictable among healthy-control-specific models. Results recapitulated previous findings regarding the importance of PA in negative ER for AN individuals. Moreover, PA was found to play a uniquely prominent role in predicting negative affect 4.5-6h later among AN adolescents. Future research into the PA-ER dynamic will benefit from targeting specific negative emotions across greater temporal scales.

Study protocol for training providers in private practice in family-based treatment for adolescents with anorexia nervosa: A randomized controlled feasibility trial

BackgroundPrivate practice clinicians make up approximately 50% of US mental health outpatient providers and treat a high number of eating disorder patients. While family-based treatment (FBT) is a first-line treatment for adolescent anorexia nervosa (AN), private practice clinicians experience difficulties receiving training in evidence-based treatments such as FBT. This report outlines the study protocol for a randomized control trial (RCT) training private practice clinicians in FBT for adolescent AN (NCT04428580). MethodsIn this study, we intend to recruit 140 private practice mental health practitioners and randomize them to complete either a standard webinar-based online training or an enhanced online training that incorporates additional modules related to the putative mechanisms of treatment effect in FBT (i.e., use of externalization and agnosticism). Following the training, participants will begin expert case consultation for an adolescent with AN using FBT from their private practice. ConclusionBased on preliminary studies suggesting the importance of enhanced skills related to agnosticism and externalization, we hypothesize that feasibility data will support a larger randomized clinical trial (RCT) and that the enhanced training arm will significantly improve FBT knowledge and skills compared to the standard webinar training arm. We also expect that patient weight gain early in treatment will be associated with clinician fidelity to the inventions used in FBT regardless of training type.

The efficacy of family treatments for adolescent anorexia nervosa in specialist versus non-specialist settings: protocol for a systematic review and meta-analysis

BackgroundAnorexia nervosa (AN) is often diagnosed in adolescence, and most evidence-based treatments for AN in young people involve the family. Family therapies for AN are intensive, outpatient treatments that utilise the parents as the primary resource in the young person’s recovery. Research regarding family treatment for AN is often conducted in specialist settings—with relatively little data reporting the translation of this specialised treatment into real-world, non-specialist settings. This systematic review and meta-analysis aims to determine the efficacy of family treatments for adolescents with AN in specialist settings versus non-specialist settings.MethodsThis systematic review and meta-analysis will be conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Retrospective cohort studies, pilot studies, case series, randomised controlled trials and qualitative investigations that present original data and investigated the efficacy of family treatments for adolescents with AN in either a specialist or non-specialist setting will be included in the review. Data will be extracted by two reviewers and study quality will be assessed. The primary outcome, change in weight, will be used to determine via meta-analysis and, depending on study heterogeneity, subgroup analysis or meta-regression whether there is a statistically significant subgroup difference between specialist and non-specialist treatment settings. The review will also consider changes in eating disorder symptomology and related constructs.DiscussionResults from this review will help determine if there is a difference in the efficacy of family treatments for adolescent AN in specialist versus non-specialist treatment settings, primarily in relation to weight recovery. This, in turn, will inform the translation of evidence-based interventions that are generally studied and implemented within specialist centres into the non-specialist health care system.

Evidence Based Update on Psychosocial Treatments for Eating Disorders in Children and Adolescents

ABSTRACT Eating disorders (EDs) are life-threatening psychiatric illnesses that occur in adolescents. Unfortunately, limited randomized controlled trials exist to address EDs in this vulnerable population. The current review updates a prior Journal of Clinical Child and Adolescent Psychology review from 2015. The recommendations in this review build upon those that were previously published. This update was completed through a systematic search of three major scientific databases (PsychInfo, Pubmed, and Cochrane) from 2015 to 2022 (inclusively) from three databases, employing relevant medial subject headings. Additionally, expert colleagues were asked for additional literature to include. Thirty-one new studies were added to this review. Psychosocial treatments included family therapies, individual therapy, cognitive-behavioral therapy, interpersonal psychotherapy, cognitive training, dialectical behavioral therapy, and more recently, virtual or telehealth-based practices and guided self-help modalities for carers of youth with EDs. Using the Journal of Clinical Child and Adolescent Psychology’s methodological review criteria, this update found behavioral family-based treatment modalities (FBT) for both adolescent anorexia nervosa and bulimia nervosa met well-established treatment criteria. To date, there were no well-established treatments found for child and adolescent avoidant-restrictive food intake disorder, or binge eating disorder. Internet facilitated cognitive-behavioral therapy and family-based therapy were found to be possibly efficacious for binge eating disorder. Family-based treatment was found to be possibly efficacious for avoidant restrictive food intake disorder, with other clinical trials for cognitive treatment modalities under way. Ongoing research examining treatments for eating disorders in children and adolescents broadly is needed.

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

BackgroundDuring 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.MethodsFour 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.ResultsAnalysis 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.ConclusionTeam 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.

Increase in admission rates and symptom severity of childhood and adolescent anorexia nervosa in Europe during the COVID-19 pandemic: data from specialized eating disorder units in different European countries

BackgroundThe COVID-19 pandemic, associated with confinement and social isolation, seems to have impacted the course of many mental disorders in children and adolescents. An increase in hospital admission rates for juvenile anorexia nervosa (AN) has been documented in many regions of the world. However, data from Europe are scarce.MethodsWe asked clinicians in specialized eating disorder units in hospitals of maximum care in France, Germany, Italy, Spain, Sweden, and the Netherlands to report on (i) overall (inpatient and outpatient) and (ii) inpatient admission rates for adolescents with AN during 2019 and 2020. Additionally, a modified version of the COVID Isolation Eating Scale (CIES) was used to assess the child and adolescent psychiatrists’ estimations of a possible increase in symptom severity in children and adolescents with AN during the COVID-19 pandemic and to (iii) inquire about the contributing factors perceived by the caring professionals.ResultsFour out of six representatives of European hospitals described a higher rate of overall admissions during the pandemic. Three hospitals out of six reported an increase in inpatient admissions, and two centres had constant high numbers of admissions of both outpatients and inpatients. The clinicians perceived a higher symptom severity in 2020 than in 2019, especially involving more frequent use of social media, longer duration of exercising, and more restrictive eating. They supposed an increase in social media consumption, a perceived “loss of control”, and a lack of in-person assessments and weight controls as the main contributing factors for the deterioration in AN numbers and symptomatology.ConclusionsThe COVID-19 pandemic seems to have had a deep impact on symptom severity in AN, which is mirrored by a large increase in admission rates across Europe. An increase in exercise, social media consumption, a perceived “loss of control”, and a lack of face-to-face health care seem to have contributed to this development. Further investigation is required to identify which factors may lead to the increase in incidence and deterioration of childhood and adolescent AN. Possible preventive means for the future could include educating paediatricians and health care workers about AN, regular weight assessment, and home-based treatments.

Promising effect of multi-family therapy on BMI, eating disorders and perceived family functioning in adolescent anorexia nervosa: an uncontrolled longitudinal study

ABSTRACT This contribution reports on the results of an uncontrolled longitudinal study investigating the effects of a Multi-Family Therapy (MFT) as treatment for adolescent Anorexia Nervosa (AN) and the role played by perceived family functioning in these effects. 150 patients (144 females) and their families took part in an MFT and were assessed at the beginning, middle, end of the therapy, as well as 6 and 12 months after the end of therapy. BMI, eating disorders symptomatology (EDI-II) and perceived family functioning (FAD) all improved over the time of MFT, and these benefits remained at both times of follow-up. Ultimately, we found that the improvement of some dimensions of family functioning (i.e., roles, communication, and general family functioning) mediated the improvement of several dimensions of symptomatology (i.e., ineffectiveness, impulsivity, social insecurity, interpersonal distrust). These observations provide further support for MFT as useful for improving mental health, weight restoration, and perceived family functioning of adolescents with AN.

Anorexia Nervosa as a Metabo-Psychiatric Disorder: Consequences for Assessment and Treatment in Childhood and Adolescence

Anorexia Nervosa (AN) has the highest mortality of all psychiatric disorders. Patients who experience the onset of AN in their teens suffer on average 10 years from an eating or other mental disorder. Recently many clinicians in the US and Europe have addressed the inadequacy of treatment for this disabling disease which – at least in adult patients - is mainly based on individual psychotherapeutic interventions. Against the background of a recent GWAS and genetic correlations with other mental disorders, but also inverse correlations with important metabolic parameters such as fasting insulin and leptin new treatment strategies must be developed. This presentation wants to elucidate two different interventions, a biological strategy, and a more pragmatic treatment setting in the “real world”. The biological strategy refers to the gut-brain axis which has been shown to be severely affected in AN. Patients show a deep perturbation of the gut microbiome with no significant improvement with weight rehabilitation. Thus, additional ways must be found such as nutritional strategies (e.g., administration of pre- or probiotics, stool transfer) to probably improve the outcome of this disorder. In addition, inpatient treatment which is still the gold standard for treatment of AN in Europe, has not been proven to alter the long-term prognosis of AN. Consequently, other interventions such as home treatment which involve the family and interrupt eating disorder associated habits as disease preserving factors will be introduced and the results of a pilot study in adolescent AN be presented.DisclosureEuropean Commission/ERA NET Research Grant Ministry of Labour, Health and Social Policies of Research Grant North-Rhine-Westfalia, Germany Joint Federal Committee (GBA) Rese

The impact of nasogastric tube feeding on Drive for Thinness and Body Dissatisfaction in children and adolescents with Anorexia Nervosa

IntroductionThe use of nasogastric-tube feeding (NGT) in the treatment of Anorexia Nervosa (AN) in children and adolescents is recommended by current guidelines. Nonetheless, the literature lacks studies assessing prognostic factors for modifications of AN-specific psychopathology treated with NGT.ObjectivesTo assess potential prognostic affecting improvement in AN-specific psychopathology in children and adolescents hospitalized for AN, treated with NGT.MethodsRetrospective study assessing young inpatients with AN, treated with NGT. Considered outcomes (admission vs discharge) were AN-specific psychopathology (Eating Disorder Inventory-3 (EDI-3): Drive for Thinness (DT); Body Dissatisfaction (BD); Eating-Disorders Risk (EDRC)) and body-mass index (BMI). Considered potential predictors were demographics, duration of untreated illness (DUI), severity (admission BMI), diagnoses, early vs late (0-7 vs 8+ days after admission) start of NGT, drugs). Models for specific contributions of predictors related to outcomes were assessed with analysis of covariance (ANCOVA).ResultsFifty-three inpatients (F=53, mean age 15.1±2.0 years) were enrolled. Both higher DT (F(1,22)=15.07, p&lt;0.001) and BD improvement (F(1,22)=7.73, p=0.011) were predicted by lower admission BMI. Higher BMI improvement was predicted by lower admission BMI (F(1,47)=10.39, p&lt;0.001) and age (F(1.47)=6.12, p=0.011. AN subtypes, comorbidities, antidepressants, and different antipsychotics did not predict any outcome.ConclusionsIn this study, greater improvement in AN-specific psychopathology (DT and BD) and weight in patients treated with NGT was predicted by lower admission BMI. These results suggest that young patients with greater severity may highly benefit from NGT. These findings, if confirmed in wider and controlled samples, could help in optimizing the treatment with NGT in young inpatients with AN.DisclosureNo significant relationships.

Clinical profile of children and adolescents diagnosed with anorexia nervosa in Indian context.

This study was conducted to assess the trends observed in the prevalence pattern, clinical presentation, psychosocial profile and treatment profile of anorexia nervosa in children and adolescents who presented to a tertiary care child and adolescent psychiatry centre over a period of ten years. Case records of children and adolescents diagnosed with anorexia nervosa at the department of child and adolescent psychiatry from 1st April 2009-31st March 2019 were obtained from the medical records department of the National Institute of Mental Health and Neurosciences (NIMHANS). Standardized data abstraction forms were developed and used for the purpose of this study. Pseudo-anonymization was done to ensure confidentiality and clinical characteristics of the sample were studied using frequency analysis and central tendencies. Prevalence of anorexia nervosa in a clinic-based population is estimated to be 0.07% over the 10-year period. The mean age at presentation was 13.96 years (SD-2.3) and the male to female ratio was 1:12. The majority (80.8%) were admitted and only one patient (3.8%) received treatment on an outpatient basis. Two or more psychosocial stressors were associated with the onset of illness in 88.5% (n=23) of the patients and dysfunctional family dynamics was noted to be a significant issue in the majority of cases. All the patients received pharmacotherapy and CBT-based individual therapy. The overall outcome was favourable based on the CGI-I scores. Prevalence of anorexia nervosa in the clinic-based setting is rising in the Indian context. Sample characteristics are similar to those seen in the west. There is a huge demand-supply gap that calls for creating a service provider network to ensure community-based care.