Eating Disorder Behaviors Research Articles

Workplace health promotion embedded in medical surveillance

Abstract The Total Worker Health© strategy is an advantageous and effective way of integrating prevention and health promotion in the workplace. The main critical points are the correct balance between prevention and promotion efforts and the extension of the projects to small companies. For several years now, in Italy, the Occupational Health Unit of the Catholic University proposed a model named Workplace Health Promotion Embedded in Medical Surveillance (WHPEMS). WHPEMS projects, which are also implemented in small companies, focus each year on a new topic that emerges from the needs of workers. During their regular medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. The design of the project, the development of the investigative tools and the operating procedures are carried out by the University. The doctors in charge of the health surveillance of the workers in the various companies can join and receive the results free of charge. The data analysis is conducted by the University. Despite its apparent simplicity, the strategy required many years to develop, refine and validate the promotion methods. In recent years projects have dealt with: Eating behavior disorders; Post-COVID syndrome; Syncope and presyncope; Headache; Musculoskeletal disorders; Work engagement; Sleep health promotion; Aging and ability to work; Violence at work; Work organization; Indoor air quality; Mediterranean Diet. More than 30,000 workers participated and over 1,000 of them were invited to undergo diagnostic tests or treatments. The participatory character of the projects, their simplicity and cost-effectiveness, the integration between occupational medicine and basic medicine demonstrate that WHPEMS projects are economical, sustainable, and effective. Key messages • Workplace Health Promotion Embedded in Medical Surveillance Projects are economical, sustainable, and effective. • The creation of a network of occupational physicians who are involved in WHPEMS projects respects corporate and professional independence and improves the work culture, health, and safety of workers.

Using machine learning with passive wearable sensors to pilot the detection of eating disorder behaviors in everyday life.

Eating disorders (ED) are serious psychiatric disorders, taking a life every 52 minutes, with high relapse. There are currently no support or effective intervention therapeutics for individuals with an ED in their everyday life. The aim of this study is to build idiographic machine learning (ML) models to evaluate the performance of physiological recordings to detect individual ED behaviors in naturalistic settings. From an ongoing study (Final N = 120), we piloted the ability for ML to detect an individual's ED behavioral episodes (e.g. purging) from physiological data in six individuals diagnosed with an ED, all of whom endorsed purging. Participants wore an ambulatory monitor for 30 days and tapped a button to denote ED behavioral episodes. We built idiographic (N = 1) logistic regression classifiers (LRC) ML trained models to identify onset of episodes (~600 windows) v. baseline (~571 windows) physiology (Heart Rate, Electrodermal Activity, and Temperature). Using physiological data, ML LRC accurately classified on average 91% of cases, with 92% specificity and 90% sensitivity. This evidence suggests the ability to build idiographic ML models that detect ED behaviors from physiological indices within everyday life with a high level of accuracy. The novel use of ML with wearable sensors to detect physiological patterns of ED behavior pre-onset can lead to just-in-time clinical interventions to disrupt problematic behaviors and promote ED recovery.

Strategies for correction of physical and emotional states in adolescent girls with body weight disorders

The article analyzes existing strategies of physical activity aimed at correcting the physical and emotional states in adolescents with body weight disorders. The aim of the study was to investigate the existing approaches to correcting the physical and emotional state in adolescent girls with body weight disorders. Methods. Theoretical analysis of special scientific and methodological literature and documentary materials, comparative analysis, and pedagogical methods were used. Research results. Based on a systematic analysis of specialized literature and documentary materials, the prevalence of body weight disorders among children and adolescents worldwide and in Ukraine was evaluated. Global trends in childhood and adolescent obesity were highlighted. Factors leading to weight disorders were characterized, including decreased physical activity, insufficient sleep, eating behavior disorders, and psychological status. An analysis of program documents aimed at increasing the level of physical activity was carried out, focusing on the implementation of effective strategies and programs for the physical activity of children and adolescents. The development of an effective motivation and incentive system for engaging in physical activity, coordination of multisectoral strategies to promote an active lifestyle, and the improvement of the quality of physical education in educational institutions at all levels were discussed. A systematic analysis of specialized literature allowed summarizing existing approaches to correction strategies for the physical and emotional well-being of adolescent girls with weight disorders. Conclusions. Based on the collected material, recommendations for increasing the involvement of children and adolescents in physical activity programs aimed at correcting the physical and emotional well-being of adolescent girls with weight disorders were summarized.

Tension and disordered eating behaviors in the daily lives of adolescents and young adults from the general population: Associations and moderating role of trait emotion regulation.

Experiences of tension and difficulties in emotion regulation have been linked to eating pathology in clinical samples and are targeted in respective treatment approaches. The present study aimed to investigate the impact of tension on engagement in disordered eating behaviors (DEBs) and potential moderating effects of trait emotion regulation in young people from the general population. A subsample of 971 adolescents and young adults from an epidemiological cohort study reported on levels of tension and four different DEBs (skipping eating, restrained eating, eating large amounts of food, loss-of-control-eating) via ecological momentary assessment (EMA), as well as on trait emotion regulation via questionnaire. In multilevel models, momentary tension did not predict levels of subsequent DEBs. However, higher average levels of tension across the EMA period predicted higher levels of all DEBs. No interactions with emotion regulation emerged. Individuals experiencing overall higher levels of tension appear to be more prone to engaging in DEBs.

Factors associated with disordered eating behaviors among schizophrenia patients

Recent hypotheses suggest that patients with schizophrenia consume more unhealthy foods, an issue that raises the need for a more meticulous examination of disordered eating behaviors (DEBs) in such patients due to increasing rates of metabolic mortality and morbidity. Therefore, this study aimed to investigate predictors associated with DEBs in schizophrenia. This cross-sectional study was conducted from May 2018 to November 2019. A total of 131 patients with schizophrenia were recruited through convenience sampling among outpatients referring to the Baharan Psychiatric Clinic (Zahedan, Iran). Patients were evaluated using demographic information forms and the eating attitudes test-26 items. In this study, 120 patients (52 males and 68 females) with schizophrenia provided correct answers to the questionnaires. According to regression analysis results, the variables of marital status, employment, classes of medication, and duration of disease could significantly predict DEBs among schizophrenia patients. The results of this study demonstrate the need for a more meticulous examination of DEBs at earlier stages of schizophrenia. Besides, psychosocial interventions and antipsychotic medication switching seem to be associated with a decreased risk of DEBs among schizophrenia patients.

Kesitsel bir ön çalışma: Müzik dinlemenin yeme davranışı üzerinde olumsuz bir etkisi var mıdır?

Objective: Cortical auditory and gustatory centers are considered to interact with each other. Studies have shown that music affects eating behavior. The present study aimed to investigate the effect of the time spent on engaging with music on eating behavior.
 Material and Method: This is a randomized cross-sectional study. It included 40 volunteering undergraduates enrolled in the Department of Music, Fine Arts Faculty, Yuzuncu Yil University, Van, Turkey. All participants were administered a questionnaire to assess the time spent engaging with music, the Eating Attitudes Test (EAT-40), and the State-Trait Anxiety Inventory (STAI). The body mass index (BMI) was calculated for each participant.
 Results: Eating behavior disorder (EBD) was detected in 11 (27.5%) participants. The EAT-40 scores established a positive correlation with the total time spent on music per week (Total-T) (r=0.413, p

Integrating "Lumpers" versus "Splitters" Perspectives: Toward a Hierarchical Dimensional Taxonomy of Eating Disorders from Clinician Ratings.

This study describes a hierarchical dimensional model of eating-disorder (ED) classification based on the Hierarchical Taxonomy of Psychopathology (HiTOP). Participants were community-recruited adults with an ED (N=252; 81.9% female). We used a modified version of Goldberg's (2006) method, which involved sequentially extracting latent factors using exploratory structural equation modeling, resulting in a 10-factor hierarchical-dimensional model. Dimensions predicted 92.4% and 58.7% of the variance in recovery outcomes at six-month and one-year, respectively. Compared to other illness indicators (e.g., DSM diagnoses, dimensional ED impairment scores, weight/shape overvaluation, and DSM ED severity specifiers), hierarchical dimensions predicted .88 to 334 times more variance in ED behaviors at baseline and 1.95 to 80.8 times more variance in psychiatric impairment at one-year follow-up. Results suggest that reducing within-disorder heterogeneity for EDs within the broader context of internalizing symptoms provides a powerful framework from which to predict outcomes and understand symptoms experienced by those with EDs.

Characteristics, course and condition of patients presenting to an adolescent medicine eating disorder program: A three-year study

PurposeEvaluate clinical characteristics at initiation, during, and at discontinuation of care for patients with eating disorders regardless of reason for discontinuation of care. MethodsA chart review of 279 patients who presented to the Division of Adolescent Medicine of Cohen Children's Medical Center (Northwell Health, New York) between May 1, 2014 and April 30, 2015. Demographics and clinical information including anthropometry, last menstrual period (LMP), caloric intake, eating disorder behaviors, length of illness, DSM-5 eating disorder diagnosis was collected from 2734 visits. Results45% of patients had Anorexia Nervosa (AN), 24% had Atypical Anorexia Nervosa (AAN), 15% had Bulimia Nervosa/Purging Disorder (BN/PD), and 17% had Avoidant Restrictive Food Intake Disorder (ARFID). Patients on average were sick for 18 months and lost 20 pounds prior to presentation. Physicians indicated they wanted patients to remain in active treatment in approximately 40% of cases where care was discontinued. The factors, used to predict which patients would have an unsuccessful vs successful outcome (defined as needing vs not requiring frequent care), were analyzed. A history of diet-pill use, purging, and exercise predicted an “unsuccessful outcome” (p = 0.02, p = 0.005, p=0.03, respectively). 32% of the 202 menarchal females lost their menses prior to treatment, and 54% had resumption of menses during treatment. ConclusionsPrevious studies report high dropout rates in treatment of eating disorders across various treatment modalities and focus on those who remain in care. Here outcomes for all patients evaluated and treatment in an adolescent medicine care model are presented and show that a sizable portion, 37%, of those who drop out are recommended to stay in active treatment and only approximately 30% complete treatment. This finding supports an adolescent care model for eating disorder treatment and highlights that most adolescent patients go on to do well after leaving treatment, even if they left care earlier than recommended.

Traditional versus virtual partial hospital programme for eating disorders: Feasibility and preliminary comparison of effects.

Minimal research has examined teletherapy for group or intensive eating disorder (ED) treatment, particularly partial hospital programme (PHP). This study compared treatment outcomes for individuals treated before and after a pandemic-driven implementation of virtual PHP. Patients received care at ED treatment centres using the Renfrew Unified Treatment for Eating Disorders and Comorbidity. Patients treated with virtual PHP were compared to patients treated with traditional PHP. Measures of ED symptomology and behaviours, depressive symptoms, anxiety severity, anxiety sensitivity, experiential avoidance, mindfulness, and body mass index (BMI; reported for anorexia nervosa [AN] patients only) were collected at intake and discharge. Multiple regression analyses were conducted to examine the effect of treatment group on outcomes, controlling for intake score, comorbidity, discharge status, AN diagnosis, and step-down status. Differences in treatment type were only found for binge eating frequency, with those in virtual PHP reporting significantly lower binge eating episodes at discharge than those in traditional PHP. Body mass index showed significantly less improvement in virtual PHP than in traditional PHP. Preliminary results suggest virtual PHP is feasible and effective, potentially increasing access to evidence-based, intensive ED treatment. However, additional research is needed to establish efficacious support for weight gain among individuals with AN in virtual programs.

Substance use associated with eating attitudes and behaviors, neglected health issues among Palestinian refugees

ABSTRACT Objective We aimed to investigate substance use and its association with eating attitudes and behaviors among male Palestinian refugees. Methods In a cross-sectional study, male Palestinian refugees(N = 566) were recruited to fill out self-administrated questionnaire on eating attitudes and behaviors (EAT-26) and to give urine samples to test current illicit drug use. Results The response rate was 47.7%. Substance use was highly prevalent among participants (28.9%). The percentage of participants with eating disorders (ED) among substance users was as follows: Any illicit drug (30.8%), benzodiazepine (32.6%), methamphetamines(40.7%), amphetamine (39.3%), tetrahydrocannabinol (25.8%), barbiturates (20%),and alcohol (12.50%). Obese participants were at higher risk of having ED(OR = 2.344, p < .05) than underweight participants. Binge eaters were more likely to be tetrahydrocannabinol users (OR = 2.745, p < .05). Increased riskof self-induced vomiting behavior was associated with binge behavior (OR = 5.97, p < .05, laxative use (OR = 26.38, p < .01), barbiturates use (OR = 59.36, p < .05), waterpipe smoking (OR = 8.62, p < .05), vape smoking (OR = 10.37, p < .05), and inversely associated with age (OR = 0.832, p < .001). Conclusion Findings from this study demonstrated a substantially increased frequency of substance use among Palestinian refugees with ED and unhealthy weight control behaviors. This study highlighted new challenge for the health system to deal with new emerging health conditions among male refugees.

The Dynamics of Eating Behavior Disorders and the Level of General Psychological Adaptation in Bodybuilding and Fitness Athletes

Knowing the psychological traits and clinically relevant symptoms for the development and maintenance of Eating Behavior Disorders (EDD) in bodybuilding and fitness athletes is a necessity for early intervention and the elimination of stressors that contribute to improving sports performance and quality of life. The aim of the study: To know the dynamics of EDD and the level of general psychological adaptation in athletes who practice bodybuilding and fitness according to sports gender and age. By applying the Inventory of Eating Disorders, EDI-III on 30 participants, bodybuilding and fitness practitioners, aged between 19 and 53, of which 21 are male and 9 are female, psychological traits were investigated relevant (low self-esteem, perfectionism, asceticism, fear of maturity, interpersonal, emotional problems, exaggerated control, and others) in order to know the level of distress and the presence of clinically relevant symptoms for the development and maintenance of EDD (the desire to being thin, bulimia, body dissatisfaction) We concluded that most of the athletes fall within the limits of the threshold values ​​established for the evaluated scales, 30% of the athletes (3 female athletes and 6 male athletes), obtained scores rated above the threshold on at least one of the clinical scales, which means that the risk of EDD is present in some athletes. The average of the investigated psychological scales calculated for the rated scores to establish the level of general psychological adaptation does not exceed the specified threshold for each investigated dimension separately, except for the asceticism, interpersonal problems, and exaggerated control scales. Female athletes have greater psychological balance than male athletes and lower risk of ED than male athletes, important aspects of personality and mental health in psychological training as a screening tool in the process of optimizing the effectiveness of bodybuilding and fitness training.

Comparing self-harming intentions underlying eating disordered behaviors and nonsuicidal self-injury: Replication and extension in adolescents.

Eating disorder (ED) behaviors are often characterized as indirect forms of self-harm. However, recent research has found less clear demarcations between direct self-harming behaviors (e.g., nonsuicidal self-injury [NSSI], suicidal behaviors) than previously assumed. The aim of this study was to replicate findings of this prior research on adult populations in adolescents with a history of restrictive eating. A total of 117 adolescents between ages 12-14 were included in the study. Participants reported the presence and frequency of binge eating, compensatory, restrictive eating, and NSSI. Participants also reported thoughts of and intentions to hurt and kill themselves when engaging in each behavior on average. The t-tests and linear effects models were conducted to compare self-harming thoughts and intentions across behaviors. Participants reported at least some intent to hurt themselves physically in the moment and in the long-term when engaging in all ED behaviors and NSSI, and reported engaging in these behaviors while thinking about suicide. Direct self-harming knowledge and intentions were most frequently reported with NSSI and longer-term knowledge and intentions via NSSI and restrictive eating. Additionally, participants reported some suicidal thoughts and intentions across behaviors. This study replicates prior research, suggesting that adolescents engage in ED behaviors and NSSI with non-zero self-harming and suicidal thoughts and intentions. ED behaviors and NSSI may better be explained on a continuum. Implications include the recommendation of safety planning during ED treatment. This study highlights the overlap between eating disorder (ED) behaviors, nonsuicidal self-injury (NSSI), and suicide. Though clear distinctions typically exist for motives of self-harming behavior between ED behaviors (i.e., indirect, in the long run) and NSSI (i.e., direct, in the moment), this research suggests that intentions for self-harming and suicide may exist on a continuum. Clinical ED treatment should consider safety planning as part of routine interventions.

Neurocognitive predictors of food memory in healthy adults – A preregistered analysis

Memory processes have long been known to determine food choices (Rozin & Zellner, 1985) but recognition memory of food and its cognitive, homeostatic and neuroanatomical predictors are still largely understudied.60 healthy, overweight, non-restrictive eating adults (20 females) took part in a food wanting and subsequent food recognition and lure discrimination task at four time points after a standardized breakfast shake. With advanced tractography of 3 T diffusion-weighted imaging data, we investigated the influence of the uncinate fasciculus’ (UF) brain microstructure on the interplay of food wanting and memory processes. The analysis was preregistered in detail and conducted with Bayesian multilevel regression modeling.Target recognition (d’) and lure discrimination (LDI) performance of food tended to be higher than of art images while single image food memory accuracy evidently dominated art memory. On this single item level, wanting enhanced recognition accuracy and caloric content enhanced food memory accuracy. The enhancement by reward anticipation was most pronounced during memory encoding. Subjective hunger level did not predict performance on the memory task. The microstructure of the UF did neither evidently affect memory performance outcomes nor moderate the wanting enhancement of the recognition accuracy. Interestingly, female participants outperformed males on the memory task, and individuals with stronger neuroticism showed poorer memory performance.We shed light on to date understudied processes in food decision-making: reward anticipation influenced recognition accuracy and food memory was enhanced by higher caloric content, both effects might shape food decisions. Our findings indicate that brain microstructure does not affect food decision processes in adult populations with overweight. We suggest extending investigation of this interplay to brain activity as well as to populations with eating behaviour disorders.

Eating Disorders in Youth with Chronic Health Conditions: Clinical Strategies for Early Recognition and Prevention.

Youth with chronic health conditions face an elevated risk of eating disorders and disordered eating behaviors. Contributors to this phenomenon may include the unique threats faced by this vulnerable population to their body image, their relationships with food and eating, and their mental health and self-esteem. However, youth with chronic health conditions may also experience more severe medical complications and mortality from eating disorder behaviors because of the additional risks conveyed by their underlying conditions. In this review, clinical strategies are provided to support youth with chronic health conditions through early recognition of eating disorder behaviors and prompt referral to treatment, which is important for a better prognosis. Suggestions are also given to mitigate their risk of developing eating disorders by proactively addressing risk factors and offering thoughtful anticipatory guidance that promotes a positive relationship with food and eating.

Back to the future: Progressing memory research in eating disorders.

Human behaviors, thoughts, and emotions are guided by memories of the past. Thus, there can be little doubt that memory plays a fundamental role in the behaviors (e.g., binging), thoughts (e.g., body-image concerns), and emotions (e.g., guilt) that characterize eating disorders (EDs). Although a growing body of research has begun to investigate the role of memory in EDs, this literature is limited in numerous ways and has yet to be integrated into an overarching framework. In the present article, we provide an operational framework for characterizing different domains of memory, briefly review existing ED memory research within this framework, and highlight crucial gaps in the literature. We distinguish between three domains of memory-episodic, procedural, and working-which differ based on functional attributes and underlying neural systems. Most recent ED memory research has focused on procedural memory broadly defined (e.g., reinforcement learning), and findings within all three memory domains are highly mixed. Further, few studies have attempted to assess these different domains simultaneously, though most behavior is achieved through coordination and competition between memory systems. We, therefore, offer recommendations for how to move ED research forward within each domain of memory and how to study the interactions between memory systems, using illustrative examples from other areas of basic and clinical research. A stronger and more integrated understanding of the mechanisms that connect memory of past experiences to present ED behavior may yield more comprehensive theoretical models of EDs that guide novel treatment approaches. Memories of previous eating-related experiences may contribute to the onset and maintenance of eating disorders (EDs). However, research on the role of memory in EDs is limited, and distinct domains of ED memory research are rarely connected. We, therefore, offer a framework for organizing, progressing, and integrating ED memory research, to provide a better foundation for improving ED treatment and intervention going forward.

Prevalence and Associated Factors of Eating Disorders Among Female Students at Jazan University, Kingdom of Saudi Arabia: A Survey Study.

Concerns about the incidence of eating disorders (EDs) among university students are spreading throughout the world. In Saudi Arabia, little is known about the prevalence and associated factors of EDs among female university students. Thus, this study investigated the prevalence, common types, and potential associated factors of EDs among female students of Jazan University. Methods:A cross-sectional survey was conducted between August 31, 2020, and November 2, 2020. The snowball technique was used to recruit female students via anelectronic surveydistributed in Arabic. The survey collected information about demographic characteristics, and SCOFF (Sick, Control, One, Fat, Food) and Eating Attitudes Test (EAT-26) scales. Cronbach's alpha for the SCOFF and EAT-26 scales was calculated to be 0.78 and 0.58, respectively, in this study. A total of 566 female students participated in the survey, with a mean age of 22.12 ± 2.93 years. The results showed that 47.9% of participants were at risk for EDs based onSCOFF scores, while 26.5% were at risk based on EAT-26 scores. The most common types of EDs werebulimia nervosaand binge eating disorder. Furthermore, the study identified severalsociodemographic characteristics, including year of study (p = 0.042),college type (p = 0.004), body weight (p = 0.001), and BMI (p = 0.001), that are significantly associated with EDs. However, no significant relationships were observed betweenmarital status (p = 0.103), age (p = 0.147), and height (p = 0.509) with SCOFF scores. Some students reported frequent binge eating, purging, or laxative/diet pill misuse. The study revealed a moderate to high prevalence of risk for EDs amongfemale university studentsinJazan, Saudi Arabia, associated with higher study years, college majors, and body weight and BMI. Dangerous ED behaviors reported by some students signal an urgent need for resources to identify and support those suffering from these disorders. Targeted interventions and services may help address this critical issue on campuses and support vulnerable students in need. Continued research and public health action are needed to curb the spread of these disorders.

Reduction in eating disorder symptoms among adults in different weight loss interventions

Restriction of food intake and counting calories as part of weight loss programs are thought to trigger eating behaviors and attitudes which can lead to eating disorders. We have developed a treatment model, Regulation of Cues (ROC), that targets appetitive traits, including food responsiveness and satiety responsiveness, which could address overeating at an implicit level and reduce risk of detrimental behaviors and attitudes. This manuscript evaluates eating disorder symptoms, attitudes, and behaviors among adults with overweight or obesity randomized to ROC, behavioral weight loss (BWL), a combination of ROC + BWL (ROC+) and an active comparator (AC). Participants included 271 adults with a body mass index of 25 to 45, age 18 to 65 years, and a lack of comorbidities that could interfere with participation. Assessments occurred at baseline, mid-treatment (6 months), post-treatment (12-months) and 6- and 12-month follow-up. During treatment, participants in all four arms showed decreases in Eating, Weight, and Shape concerns on the Eating Disorder Examination-Questionnaire and binge eating symptoms on the Binge Eating Scale which were maintained at 6-month follow-up but increased at the 12-month follow-up. Both the ROC+ and BWL arms showed increases in Restraint during treatment which dissipated after treatment ended. This study contributes to a growing body of literature demonstrating that weight loss programs are not associated with increases in eating disorder symptoms. Future studies should evaluate interventions to maintain improvements in eating disorder symptoms following weight loss programs.

Diabetes distress and disordered eating behaviors in youth with type 1 diabetes: the mediating role of self-regulatory fatigue and the moderating role of resilience

BackgroundDespite previous research on the association between diabetes distress and disordered eating behaviors (DEBs) among youth with type 1 diabetes (T1D), there is a lack of understanding regarding the underlying mechanisms. This study aimed to investigate the relationships between diabetes distress and DEBs, specifically examining whether self-regulatory fatigue mediated the relationship and whether resilience moderated this mediation.MethodsA cross-sectional study was performed among youth with T1D recruited from two diabetes centers in Nanjing, China. Measurement instruments included the problem areas in the diabetes-5 scale, the diabetes strengths and resilience measure for adolescents, the self-regulatory fatigue scale, and the Chinese version of diabetes eating problem survey-revised. Mediation and moderated mediation analyses were conducted.ResultsA total of 185 youths with T1D were involved in the current study. The results indicated that diabetes distress positively predicted DEBs. Self-regulatory fatigue partially mediated the association between diabetes distress and DEBs, accounting for 50.88% of the overall effect. Additionally, the pathway from self-regulatory fatigue to DEBs was moderated by resilience.ConclusionThe current study examined whether self-regulatory fatigue mediated the relationship between diabetes distress and DEBs and whether resilience moderated the connection between self-regulatory fatigue and DEBs. These findings add to the theoretical basis of how diabetes distress influences DEBs and help guide the incorporation of diabetes distress, self-regulatory fatigue, and resilience into DEBs reduction programs for youth with T1D.

A multidimensional approach for differentiating the clinical needs of young people presenting for primary mental health care

ObjectivesThere is an ongoing necessity to match clinical interventions with the multidimensional needs of young people. A key step toward better service planning and the design of optimal models of care is to use multidimensional assessment to understand the clinical needs of those presenting to primary mental health care. Methods1284 people aged 12–25 years presenting to primary youth mental health services completed an online assessment at service entry. Latent class analysis was conducted for seven scales assessing anxiety, depression, psychosis, mania, functioning (indexed by Work and Social Adjustment Scale), and suicidality. ResultsA three-class solution was identified as the optimal solution. Class 1 (n = 305, 23.75%), an early illness stage group, had low and mixed symptomatology with limited functional impairment, class 2 (n = 353, 27.49%) was made up of older persons with established depression and functional impairment, and class 3 (n = 626, 48.75%) had very high and complex needs, with functional impairment, suicidality, and at-risk mental states (psychosis or mania). Additional differentiating characteristics included psychological distress, circadian disturbances, social support, mental health history, eating disorder behaviours, and symptoms of post-traumatic stress disorder. ConclusionsA large proportion of help-seeking young people present with symptoms and functional impairment that may exceed the levels of care available from basic primary care or brief intervention services. These subgroups highlight the importance of multidimensional assessments to determine appropriate service pathways and care options.

Potential biomarker of brain response to opioid antagonism in adolescents with eating disorders: a pilot study.

Eating Disorders (ED) affect up to 5% of youth and are associated with reward system alterations and compulsive behaviors. Naltrexone, an opioid antagonist, is used to treat ED behaviors such as binge eating and/or purging. The presumed mechanism of action is blockade of reward activation; however, not all patients respond, and the optimal dose is unknown. Developing a tool to detect objective drug response in the brain will facilitate drug development and therapeutic optimization. This pilot study evaluated neuroimaging as a pharmacodynamic biomarker of opioid antagonism in adolescents with ED. Youth aged 13-21 with binge/purge ED completed functional magnetic resonance imaging (fMRI) pre- and post-oral naltrexone. fMRI detected blood oxygenation-level dependent (BOLD) signal at rest and during two reward probes (monetary incentive delay, MID, and passive food view, PFV) in predefined regions of interest associated with reward and inhibitory control. Effect sizes for Δ%BOLD (post-naltrexone vs. baseline) were estimated using linear mixed effects modeling. In 12 youth (16-21 years, 92% female), BOLD signal changes were detected following naltrexone in the nucleus accumbens during PFV (Δ%BOLD -0.08 ± 0.03; Cohen's d -1.06, p = 0.048) and anterior cingulate cortex during MID (Δ%BOLD 0.06 ± 0.03; Cohen's d 1.25, p = 0.086). fMRI detected acute reward pathway modulation in this small sample of adolescents with binge/purge ED. If validated in future, larger trials, task-based Δ%BOLD detected by fMRI may serve as a pharmacodynamic biomarker of opioid antagonism to facilitate the development of novel therapeutics targeting the reward pathway, enable quantitative pharmacology trials, and inform drug dosing. https://clinicaltrials.gov/ct2/show/NCT04935931, NCT#04935931.