Eating Disorder Patients Research Articles

Evaluation of Psychological and Nutritional Interventions for Eating Disorders in Nigeria: A Scoping Review

The objective of this scoping review is to map and analyze literature which utilized any kind of psychological or nutritional intervention in treating patients with eating disorders (ED) in Nigeria as well as to assess the effectiveness of such interventions in helping ED patients. This study follows the methodology provided by the Joanna Briggs Institute (JBI) for scoping reviews. A database search of Google Scholar, PubMed, PsychINFO and Cochrane, from where 68 articles were selected using carefully developed search terms. Six studies were finally selected after two reviewers read the full text to ensure they ticked all the boxes stipulated in the inclusion criteria, while other papers were excluded. Findings revealed that psychological and nutritional interventions were used in treating eating disorders in Nigeria, and the interventions proved effective. Findings indicate that anorexia nervosa is the most frequently diagnosed and treated ED in Nigeria. This is because the majority of studies reviewed focused on anorexia nervosa, only two of the studies analysed eating disorders in general, and none of the studies focused on bulimia nervosa. This finding showed that psychological and nutritional interventions have been used to treat various patients in Nigeria, including adolescents, pupils and undergraduates. Findings from this study build on existing research to assert that psychological and nutritional interventions have proven highly effective in treating eating disorders. This is because the majority of eating disorder cases were treated using either or both of these interventions and, in the end, succeeded in helping patients overcome the disorder.

Factors associated with later suicide attempt in a large cohort of eating disorder patients. Prospective follow-up study

Factors associated with later suicide attempt in a large cohort of eating disorder patients. Prospective follow-up study

QUALITY OF LIFE IN PATIENTS WITH DIFFERENT PSYCHIATRIC DISORDERS

Abstract: Background: Quality of life should be a very important issue for doctors, especially in chronic diseases. Currently, the most important matters in the therapeutic process are not only bringing about the relief of certain symptoms of the disease itself, but also improving the patients functioning with respect to such areas as social, physical and self-perception through the disease. The study researched the quality of life in relation to demographic and clinic factors in patients with different psychiatric disorders. Materials and Methods: The Medical Outcomes Study Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), socio-demographic data questionnaire were delivered to a group of 186 subjects (110 females, 76 males) during outpatient visits or hospitalizations in the Psychiatry Ward of the Hager Multispecialty District Hospital in Tarnowskie Gry. There were 5 groups of patients, who had been diagnosed with different psychiatricdiseases: schizophrenia (22 females and 28 males in mean age 33,410,06), recurrent major depressive disorder (28 females and 18 men, age was 40,6110,64), bipolar disorders (8 woman and 12 men, average age was 41,0910,45), anxiety disorders (26 women and 18 men the age was 33,5810,21) and eating disorders (women only mean age was 26,4342.50). Results: Schizophrenic patients showed significantly better results in health-related quality of life in most domains of SF-36 score and summary scales The Physical Component Summary Scale (PCS) and Mental Component Summary Scale (MCS) than patients with other psychiatric disorders. The lowest results in SF-36 scale were obtained by recurrent major depressive disorder and eating disorders patients. Importantly, symptoms of depression and anxiety influenced the quality of life in all examined groups. Age, marital status as well as duration of illness were negatively associated with the MCS. The BMI was negatively associated with PCS in schizophrenic patients. In anxiety patients, MCS was negatively influenced by BMI.Conclusions: Active treatment for depressive and anxiety symptoms is recommended to improve quality of life in patients with different psychiatric disorders. Schizophrenic andanxiety patients must not forget that high body weight may be a risk factor of the low quality of life.

Battles over 'unruly bodies': Practitioners' interpretations of eating disorders and the utility of psychiatric labelling.

Our article offers a critical appraisal of psychiatric medical constructions of eating disorders (EDs) by highlighting the complexity of professional discourses, power plays, claims and counterclaims in ongoing struggles over 'unruly bodies.' Inductive thematic analysis of data from five studies was undertaken, covering thirty semi-structured interviews with UK health-care professionals working in the ED field. Professionals engaged in various struggles over eating disorders, which were compounded by the labelling process itself. Although person-centredness was valued, encounters with ED patients were frequently framed as outstandingly problematic in terms of treatment resistance, with clients' unruliness spurred on by ED competitiveness on social media and in-hospital rivalries. Paradoxically, the labelling of eating disorders created further expectations in terms of achieving specific weight levels and diagnostic labels, reportedly resulting in lay competition over who was sickest, which was mirrored by treatment priorities within an overstretched public health system. Narratives also highlighted interesting tensions between professionals rationalising their work with patients and acknowledging themselves as potentially vulnerable to societal pressures promoting EDs. Arguably, while lay narratives around EDs continue to be framed by authorities as unruly behaviours in deviant individuals, the gap between officially sanctioned and illicit ED discourses will only grow.

Transgender and other gender diverse adolescents with eating disorders requiring medical stabilization

BackgroundDespite the high prevalence of eating disorders in gender diverse adolescents, little is known about the characteristics of gender diverse youth with eating disorders who require inpatient medical stabilization. The primary objective of this study was to describe the medical, anthropometric, and psychiatric characteristics of gender diverse adolescents hospitalized for eating disorders and compare these characteristics to cisgender peers hospitalized for eating disorders. The secondary objective was to evaluate percent median body mass index as one marker of malnutrition and treatment goal body mass index as a recovery metric between patients’ birth-assigned sex and affirmed gender using standardized clinical growth charts.MethodsA retrospective chart review was conducted of 463 patients admitted to an inpatient eating disorders medical unit between 2012 and 2020. To compare medical, anthropometric, and psychiatric data between gender diverse and cisgender patients, chi-square/Fisher’s exact and t-tests were used. Clinical growth charts matching the patients’ birth-assigned sex and affirmed gender identity were used to assess percent of median body mass index and treatment goal body mass index.ResultsTen patients (2.2%) identified as gender diverse and were younger than cisgender patients [13.6 (1.5) years vs. 15.6 (2.7) years, p = 0.017]. Gender diverse patients were hospitalized with a higher percent median body mass index compared to cisgender peers [97.1% (14.8) vs. 87.9% (13.7), p = 0.037], yet demonstrated equally severe vital sign instability such as bradycardia [44 (8.8) beats per minute vs. 46 (10.6) beats per minute, p = 0.501], systolic hypotension [84 (7.1) mmHg vs. 84 (9.7) mmHg, p = 0.995], and diastolic hypotension [46 (5.8) mmHg vs. 45 (7.3) mmHg, p = 0.884]. Gender diverse patients had a higher prevalence of reported anxiety symptoms compared to cisgender patients (60% vs. 28%, p = 0.037).ConclusionsGender diverse patients demonstrated complications of malnutrition including vital sign instability despite presenting with a higher weight. This is consistent with a greater proportion of gender diverse patients diagnosed with atypical anorexia nervosa compared to cisgender peers. Additionally, psychiatric comorbidities were present among both groups, with a larger percentage of gender diverse patients endorsing anxiety compared to cisgender patients.

Emergency Department Visits and Hospitalizations for Eating Disorders During the COVID-19 Pandemic.

Recent studies have reported increasing eating disorder incidence and severity following the coronavirus disease 2019 (COVID-19) pandemic. In a diverse cohort of pediatric hospitals, we examined trends in the volume of emergency visits and inpatient admissions for eating disorders before and during the pandemic. We examined monthly trends in volume of patients with eating disorders (identified by principal International Classification of Diseases, 10th Revision, diagnosis codes) across 38 hospitals in the Pediatric Health Information System pre- (January 2018-March 2020) and post-COVID-19 onset (April 2020-June 2022). Using interrupted time series analysis, we examined the pre- and post monthly trends in eating disorder emergency and inpatient volume. Before the pandemic, eating disorder emergency visit volume was increasing by 1.50 visits per month (P = .006), whereas in the first year postonset, visits increased by 12.9 per month (P < .001), followed by a 6.3 per month decrease in the second year postonset (P < .001). Pre-COVID-19, eating disorder inpatient volume was increasing by 1.70 admissions per month (P = .01). In the first year postonset, inpatient volume increased by 11.9 per month (P < .001), followed by a 7.6 per month decrease in the second year postonset (P < .001). The volume of patients seeking emergency and inpatient eating disorder care at pediatric hospitals has increased dramatically since the pandemic onset and has not returned to prepandemic levels despite a decline in the second year postonset, with important implications for hospital capacity.

Eating disorders and non-suicidal self-injury: Cluster analysis considering eating pathology, emotion dysregulation, and negative urgency

Research on the interplay between eating pathology, emotion dysregulation and negative urgency is needed to inform intervention approaches for patients with eating disorders and non-suicidal self-injury. This study aimed to investigate the characterization of patients with eating disorders and non-suicidal self-injury considering eating pathology, emotion dysregulation and negative urgency. This cross-sectional study evaluated 73 outpatients with eating disorders and non-suicidal self-injury (14-55 years; 68 women). A cluster analysis was performed using eating pathology, emotion dysregulation and negative urgency. Differences between clusters were explored on sociodemographic/psychological variables, eating disorder diagnostics and past/current non-suicidal self-injuryengagement. Three clusters were identified. Cluster 1 (n=29) (moderate severity) was characterized by high levels of eating pathology, but moderate emotion dysregulation and negative urgency. Cluster 2 (n=29) (high severity) was characterized by the highest scores in eating pathology, emotion dysregulation and negative urgency, and included more patients with current non-suicidal self-injury. Cluster 3 (n=15) (low severity) was characterized by the lowest levels of eating pathology, emotion dysregulation and negative urgency, and included more patients with past non-suicidal self-injury. These profiles highlight the importance of emotion dysregulation and negative urgency as treatment targets for eating disorders patients with current non-suicidal self-injury.

COVID-19 related familial economic disruptions and eating disorder patients’ mental health concerns and motivation to recover

BackgroundFamily support has been shown to be important for adolescents and young adults (AYA) in eating disorder (ED) treatment. Many families were impacted by the pandemic, potentially altering their ability to support individuals in ED treatment. This study examined the association of COVID-19 related familial economic change with self-reported mental health (MH) and ED concerns in AYA seeking treatment for ED.MethodsAYA patients with EDs aged 10–27 years enrolled in the Registry of Eating Disorders and their Co-morbidities OVER time in Youth (RECOVERY) completed an additional COVID-19-specific survey (n = 89) that assessed their perception of the effects of the pandemic on their lives and their ED. Participants self-reported on familial economic disruptions, measured through a composite score of four markers: (1) family member’s work hours cut, (2) family member was required to stop working, (3) family member lost job permanently, and (4) family lost health insurance/benefits. In bivariate analyses, we examined the association between self-reporting any familial economic disruption and self-reported changes in intrusive ED thoughts, feelings of anxiety, feelings of depression, feelings of isolation, and motivation to recover from their ED. Logistic regression models were used to examine the association between familial economic disruptions on self-reported changes in ED/MH affect and motivation to recover adjusting for age and ED diagnosis.ResultsForty-six percent of participants self-reported that the pandemic had resulted in at least one economic familial disruption. Of patients reporting any familial economic disruption, 29% reported decreased motivation for ED recovery, and over 75% reported worsening feelings of depression, anxiety, isolation, and/or intrusive eating disorder thoughts. Reporting any COVID-19 familial economic disruption was marginally associated with feelings of isolation (p = 0.05). Though the findings were only marginally significant, the odds of reporting worsening feelings of depression, anxiety, intrusive ED thoughts or motivation to recover were nearly twice in those who reported a COVID-19-related familial economic disruption compared to those who did not report such a disruption.ConclusionsFamily-related economic disruptions are associated with ED/MH-related concerns and motivation to recover from an ED during the COVID-19 pandemic in AYA patients.

The Influences of COVID-19 Pandemic on Patient with Eating Disorders - A Literature Review

Introduction: Physical consequences have garnered the greatest attention during the coronavirus pandemic lockdowns, and few studies have studied the link between the COVID-19 lockdown and pre-existing mental health difficulties such as eating disorders (ED). Our main goal was to assess the impact of the COVID-19 pandemic on individuals suffering from ED.&#x0D; Methods: We searched the online databases PubMed, ScienceDirect, and Springer for scientific articles published after September 2022 that studied the impact of coronavirus lockdowns on patients with ED. The authors analyzed 40 out of 76 publications that had the qualifying criteria. Most of these studies underline an increase in eating disorders prevalence and a list of associated behaviors related to the COVID-19 pandemic impact.&#x0D; Results: Young adults are more prone to eating disorders during the COVID-19 pandemic, and the individuals in hospital are suffered more from disordered eating behaviors. Disruption of lifestyle routine, social isolation, restricted access to customary support networks, limited or no access to healthcare and mental health services, and social anxiety were all related to symptomatic worsening in ED patients during COVID-19 lockdowns. We identified a large increase in hospitalizations during the pandemic, as well as an increase in EDs symptoms and mental health concerns among ED patients.&#x0D; Conclusion: This study identifies children and adolescents, as well as adults with a history of an eating disorder, as particularly sensitive populations to the COVID-19 pandemic's effects. More research in understudied and minority populations is needed, as well as an examination of the long-term effects of the COVID-19 pandemic on eating behaviors.

Evaluating differences in setting expected body weight for children and adolescents in eating disorder treatment.

Weight restoration or weight gain is a common goal in eating disorder treatment. However, approaches to determine expected body weight (EBW) vary. A standardized approach based on normative data for a patient's age and gender uses weight associated with median BMI (mBMI). An individualized approach predicts EBW based on a patient's individual growth trajectory. Little research has examined differences in these approaches. Weight and clinical data were collected from patients ages 6-20 enrolled in virtual eating disorder treatment. EBW associated with mBMI was compared with EBW using the individualized approach. Linear mixed effects models examined differences in weight, eating disorder symptoms, depression, and anxiety, and whether EBW approach varied by patient characteristics. Patients (N=609) were on average age 15.6 (2.29), 85% were cisgender female, and predominantly diagnosed with anorexia nervosa (83.1%). The individualized approach led to significantly higher EBW on average (mean difference=8.4lbs [SE: .75]; p < .001) compared to mBMI; 70% of patients had a higher EBW using the individualized approach. Notably, EBW varied based on gender and diagnosis and it took longer on average to achieve individualized EBW. Time was the strongest predictor of changes in psychosocial outcomes and there were no significant differences by EBW approach. Results from this study indicate that an individualized approach led to significantly higher EBWs compared with using mBMI. As underestimation of EBW may lead to higher risk of relapse, eating disorder professionals should consider using an individualized approach for setting EBW. For eating disorder patients who need to gain weight, accurately estimating target body weight for eating disorder treatment is critical to recovery and preventing relapse. An individualized, patient-centered approach to estimating target body weight more accurately estimated target body weight than the standardized, median body mass index approach. Using an individualized approach to treatment may improve a patient's likelihood of full recovery.

A Multicenter Network Analysis Examining the Psychological Effects of the COVID-19 Pandemic on Patients with Eating Disorders versus Their Healthy Siblings.

(1) Background: The impact of the COVID-19 pandemic on individuals with eating disorders (EDs) has been recorded all over the world; the traumatic effects of COVID-19 have exacerbated specific and general psychopathologies in those with EDs. Comparing patients' and their healthy siblings' responses might help one evaluate whether there are significant differences between healthy individuals and those struggling with EDs in regard to posttraumatic psychological symptoms. (2) Methods: A sample of 141 ED patients and 99 healthy siblings were enrolled in this study in two different centers specializing in ED treatment. All participants completed the posttraumatic stress disorder (PTSD) checklist and an eating and general psychopathological self-report questionnaire. Network analysis was then applied to evaluate the differences between the populations. (3) Results: No significant differences emerged between the network structures despite the significant differences between patients and their healthy siblings in regard to posttraumatic symptoms, eating, and general psychopathology. (4) Conclusion: The complex nature of the interaction between environmental and personal factors should be evaluated further in individuals with EDs due to how they respond to traumatic events, which exacerbate patients' psychopathology.

Treating eating disorders in patients with autism: Should treatment standards be implemented on a spectrum?

Treating eating disorders in patients with autism: Should treatment standards be implemented on a spectrum?

Electrocardiographic QTc as a Surrogate Measure of Cardiac Risk in Children, Adolescents, and Young Adults With Eating Disorders.

The study goal was to investigate electrocardiographic findings, including corrected QT interval (QTc), in patients aged 8 to 23 with eating disorders (EDs) at presentation, compared with an age-and sex-matched control population. We retrospectively reviewed 200 ED patients, and 200 controls. Blinded electrocardiograms (ECGs) were interpreted by an expert reader, and QT intervals corrected using the Bazett formula. Eating disorder patients were 89.5% female, with mean age 16.4 years and median percent median body mass index (BMI)-for-age (%mBMI)a of 91.1%. In ED patients, QTc was significantly shorter than controls (399.6 vs 415.0msec, P < .001). After adjusting for height, %mBMI, sex, magnesium level, and bradycardia, mean QTc duration in patients with anorexia nervosa-restricting subtype (AN-R) was significantly shorter than other ED patients (P = .010). Higher %mBMI was associated with shorter QTc duration (P = .041) after adjusting for height, magnesium, bradycardia, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis. Within the ED group, no significant association was identified between QTc and medications, electrolytes, or inpatient status.

Perspectives of underweight people with eating disorders on receiving Imagery Rescripting trauma treatment: a qualitative study of their experiences

BackgroundThe prognosis for underweight individuals with an eating disorder (ED) and posttraumatic stress disorder (PTSD) is worse than for their peers without these comorbid symptoms. This qualitative study explores the experiences of trauma-focused Imagery Rescripting (ImRs) therapy of underweight inpatients being treated for an ED.ObjectiveTo test the feasibility and to improve ImRs by understanding the experiences and perspectives of people with an ED and PTSD who, when underweight, received ImRs as an adjunct to their inpatient ED treatment.MethodTo explore how underweight people with an ED experience and perceive ImRs, we used a qualitative study design involving semi-structured interviews with 12 participants. After analysis, the data were summarized and classified within a thematic framework that focused on experiences and improving the ImRs method.ResultsThe thematic analysis resulted in the following 6 main themes; (1) Expectations of ImRs; (2) Ability to participate in ImRs; (3) Effect of ImRs; (4) Experience of ImRs technique; (5) Conditions under which ImRs is given; (6) In depth-analysis. The results show that despite the fear of disappointment the participants appreciate addressing the PTSD and ED symptoms simultaneously. Further, results showed that it had been possible for them to attend ImRs but that the effects of ImRs were not uniformly perceived. Also, participants indicated that a caring context is important and that ImRs should not be scheduled immediately before a meal. Finally, the treatment generated hope.ConclusionsThe findings of this study demonstrated the feasibility of the integration of ImRs trauma treatment for individuals who are being treated in an ED inpatient treatment setting, and are in contrast to standard practice where the focus of inpatient treatment has been ED-symptom improvement without comprehensively addressing past traumatic experiences during an underweight phase.Trial registration International Clinical Trials Registry Platform (ICTRP) (NTR6094). Date of registration 09/23/2016. https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6094

Impact of Impulsivity and Therapy Response in Eating Disorders from a Neurophysiological, Personality and Cognitive Perspective

Impulsivity, as a multidimensional construct, has been linked to eating disorders (EDs) and may negatively impact treatment response. The study aimed to identify the dimensions of impulsivity predicting poor remission of ED symptoms. A total of 37 ED patients underwent a baseline assessment of impulsive personality traits and inhibitory control, including the Stroop task and the emotional go/no-go task with event-related potentials (ERPs) analysis. The remission of EDs symptomatology was evaluated after 3 months of cognitive-behavioral therapy (CBT) and at a 2-year follow-up. Poor remission after CBT was predicted by poor inhibitory control, as measured by the Stroop task. At 2 years, the risk of poor remission was higher in patients with higher novelty seeking, lower inhibitory control in the Stroop and in ERPs indices (N2 amplitudes) during the emotional go/no-go task. The present results highlight inhibitory control negatively impacting both short- and long-term symptomatology remission in ED patients. On the other hand, high novelty seeking and ERPs indices of poor inhibition seem to be more specifically related to long-term remission. Therefore, a comprehensive assessment of the impulsivity dimension in patients with ED is recommended to tailor treatments and improve their efficacy.

Mental health and health behaviours among patients with eating disorders: a case–control study in France

BackgroundEating disorders (ED) are a public health concern due to their increasing prevalence and severe associated comorbidities. The aim of this study was to identify mental health and health behaviours associated with each form of EDs.MethodsA case–control study was performed: cases were patients with EDs managed for the first time in a specialized nutrition department and controls without EDs were matched on age and gender with cases. Participants of this study filled self-administered paper questionnaire (EDs group) or online questionnaire (non-ED group). Collected data explored socio-demographics, mental health including anxiety and depression, body image, life satisfaction, substances and internet use and presence of IBS (Irritable Bowel Syndrome).Results248 ED patients (broad categories: 66 Restrictive, 22 Bulimic and 160 Compulsive) and 208 non-ED subjects were included in this study. Mean age was 36.0 (SD 13.0) and 34.8 (SD 11.6) in ED and non-ED groups, respectively. Among patients and non-ED subjects, 86.7% and 83.6% were female, respectively. Body Shape Questionnaire mean score was between 103.8 (SD 46.1) and 125.0 (SD 36.2) for EDs and non-ED group, respectively (p < 0.0001). ED patients had a higher risk of unsatisfactory friendly life, anxiety, depression and IBS than non-ED s (all p < 0.0001) Higher risk of anxiety, depression and IBS was found for the three categories of EDs. Higher risk of smoking was associated only with restrictive ED, while or assault history and alcohol abuse problems were associated only with bulimic ED. The risk of binge drinking was lower in all EDs categories than in non-ED.ConclusionThis study highlights the common comorbidities shared by all EDs patients and also identifies some specific features related to ED categories. These results should contribute to the conception of future screening and prevention programs in at risk young population as well as holistic care pathways for ED patients.Plain English summaryThis case–control study evaluated mental health and health behaviours associated with the main categories of Eating Disorders (EDs). Cases were patients with EDs initiating care in a specialized nutrition department and controls without ED were matched on age and gender with cases. Self-administered paper questionnaires were filled by ED 248 patients (66 Restrictive, 22 Bulimic and 160 Compulsive) and online questionnaire by 241 non-ED controls. Body image satisfaction was significantly worse in ED patients than in controls. (p < 0.0001). Dissatisfactory life, anxiety, depression and irritable bowel syndrome were more found in patients with all EDs categories than in non-ED (p < 0.0001). Smoking risk was increased only in restrictive patients while and assault history and alcohol abuse was increased only in bulimic patients. These results highlight the global burden of ED and related comorbidities and provide useful information for future screening, prevention and care programs.

Association of the COVID-19 Pandemic With Adolescent and Young Adult Eating Disorder Care Volume

The COVID-19 pandemic has affected youth mental health. Increases in site-specific eating disorder (ED) care have been documented; however, multisite studies demonstrating national trends are lacking. To compare the number of adolescent/young adult patients seeking inpatient and outpatient ED care before and after onset of the COVID-19 pandemic. Using an observational case series design, changes in volume in inpatient and outpatient ED-related care across 15 member sites (14 geographically diverse hospital-based adolescent medicine programs and 1 nonhospital-based ED program) of the US National Eating Disorder Quality Improvement Collaborative was examined. Sites reported monthly volumes of patients seeking inpatient and outpatient ED care between January 2018 and December 2021. Patient volumes pre- and postpandemic onset were compared separately for inpatient and outpatient settings. Demographic data such as race and ethnicity were not collected because this study used monthly summary data. Onset of the COVID-19 pandemic. Monthly number of patients seeking inpatient/outpatient ED-related care. Aggregate total inpatient ED admissions were 81 in January 2018 and 109 in February 2020. Aggregate total new outpatient assessments were 195 in January 2018 and 254 in February 2020. Before the COVID-19 pandemic, the relative number of pooled inpatient ED admissions were increasing over time by 0.7% per month (95% CI, 0.2%-1.3%). After onset of the pandemic, there was a significant increase in admissions over time of 7.2% per month (95% CI, 4.8%-9.7%) through April 2021, then a decrease of 3.6% per month (95% CI, -6.0% to -1.1%) through December 2021. Prepandemic, pooled data showed relative outpatient ED assessment volume was stable over time, with an immediate 39.7% decline (95% CI, -50.4% to -26.7%) in April 2020. Subsequently, new assessments increased by 8.1% (95% CI, 5.3%-11.1%) per month through April 2021, then decreased by 1.5% per month (95% CI, -3.6% to 0.7%) through December 2021. The nonhospital-based ED program did not demonstrate a significant increase in the absolute number of admissions after onset of the pandemic but did see a significant increase of 8.2 (95% CI, 6.2-10.2) additional inquiries for care per month in the first year after onset of the pandemic. In this study, there was a significant COVID-19 pandemic-related increase in both inpatient and outpatient volume of patients with EDs across sites, particularly in the first year of the pandemic. Given inadequate ED care availability prior to the pandemic, the increased postpandemic demand will likely outstrip available resources. Results highlight the need to address ED workforce and program capacity issues as well as improve ED prevention strategies.

4 The Impact of the COVID-19 Pandemic on Number and Severity of New Diagnoses of Restrictive Eating Disorders During Prolonged Lockdown in Ontario, Canada

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has had a disproportionate impact on the well-being of adolescents and young adults. Worldwide, eating disorder (ED) experts have observed worsening symptoms in youth with pre-existing EDs and an escalation in the number of new cases compared to prior years. Disruption of routine, work and school closures, as well as social isolation are potential contributing factors. The Canadian province of Ontario (specifically the most highly populated cities) experienced one of the most prolonged lock downs worldwide with approximately 20 weeks of face-to-face school closure and/or restriction to virtual learning. Objectives We sought to better understand the impact of COVID-19 on new pediatric ED presentations, patient characteristics and hospital admissions in a tertiary care Children’s Hospital. Design/Methods We completed a retrospective chart review of patients presenting for new ED assessments at a single centre pediatric ED program within a tertiary care children’s hospital between January 1st, 2015 and June 1st 2021. Patients aged 9-18 years old with a new diagnosis of Anorexia Nervosa (AN) restrictive type or binge/purge type or Other Specified Feeding and Eating Disorder (OSFED) - Atypical Anorexia Nervosa (AAN) were included. Demographic and clinical variables for pre and post pandemic were analyzed using Chi-Square and T-Tests. Interrupted time series regression was used to examine pre-pandemic and post-pandemic monthly summary data over time. Results Overall, 425 youth were newly diagnosed with AN or AAN (N=329 pre-pandemic, N=96 pandemic) during the study period (Jan 1 2015 – December 31 2020). Average age was 14.7 years (SD 1.8, range 8.1 – 17.9). Most youth were diagnosed with DSM-5 AN-restrictive type (65.6%). The number of new diagnoses of AN and AAN during the pandemic more than doubled when compared to pre-pandemic years. In the 5-year period preceding the pandemic, mean number of newly diagnosed cases was 5.1/month (ßcoeff=0.043, p=0.33), increasing to 10.6/month (p=&amp;lt;0.001) during the pandemic and demonstrating an upward trend coinciding with onset of lockdown measures (ßcoeff=5.95, p&amp;lt;0.001). At the time of initial assessment, more youth presented with medical instability and increased illness severity. Hospitalization increased from an average of 2.2/month to 6.3/month (ßcoeff -0.008 vs. 3.23, p&amp;lt;0.0001). Average heart rate also decreased from 58.6 bpm (SD 16.6) pre-pandemic to 53.3 bpm (SD 16.3), p&amp;lt;0.008. Conclusion With this study, we found a significant increase in both new diagnoses and admissions for medical instability for AN and AAN among youth at our institution during the COVID-19 pandemic. Our study contributes to the growing body of global evidence tracking the unanticipated surge of eating disorder diagnoses and severity in already under-resourced health systems. It is unclear how long the effects of the pandemic may last. Further research is required to better understand the illness trajectory and treatment outcomes of pandemic-triggered EDs in adolescents.

Barriers and Facilitators to the Implementation of an Eating Disorders Knowledge Exchange Program for Non-specialist Professionals.

Despite availability of evidence-based treatments for eating disorders (EDs), individuals with EDs often do not receive informed treatment. Training of non-specialized clinicians by experienced professionals through knowledge exchange (KE) programs is an effective way to enhance accessibility to evidence-based treatments for EDs. The authors conducted a qualitative analysis of factors that facilitated or impeded the uptake of an ED-focused KE program. Semi-structured interviews were conducted with mental health professionals (n = 43) and managers (n = 11) at 13 community mental-health sites at which the KE program was offered. Data were analyzed using a qualitative content analysis. Key facilitators identified were management support for the program and building competence through ongoing supervision of clinicians. Main barriers were limited access to ED patients to treat and having insufficient time to apply ED interventions in front-line settings. The results provide insights into the practical imperatives involved in implementing a KE initiative for ED treatment.

Executive dysfunction in eating disorders: Relationship with clinical features

Eating disorders (ED) are severe mental disorders that may result in significant functional impairment and disability. Neuropsychological studies have consistently found impaired executive function (EF) among ED patients. EF is particularly involved in fundamental skills of daily living and in behavioral and emotional regulation. In this study, impairment of executive functioning is investigated in patients with eating disorders and the associations with clinical features and clinical subtypes are analyzed. Method75 female patients (m = 22.01 years, sd = 9.15) with eating disorder (43 restrictive anorexia, 30 binge-eating anorexia and 13 bulimia nervosa) and 37 healthy controls (m = 18.54 years, sd = 4.21) were included in the study. An extensive assessment of executive function domains (verbal fluency, set shifting, attention span, selective attention, working memory, inhibitory control and processing speed) was carried out in both groups. Clinical scales for food intake restriction, binge-eating/purging, depression, anxiety and impulsivity were also administered and correlated with scores on executive function tests. ResultsPatients with an ED had significantly lower scores than healthy controls in performance of several executive function tests, particularly in set shifting, interference control and processing speed (p < .01, in all three domains). Executive function impairment was related to anxious, depressive and eating disorder symptoms (p < .05), regardless of clinical subtype. ConclusionsExecutive function impairment in eating disorders is associated with greater ED symptomatic severity and might involve a negative treatment outcome. Therefore, cognitive remediation techniques should probably be considered in a number of severe patients with ED.