Early-onset restrictive food intake disorders in children: a latent class analysis

The two most frequent early-onset restrictive food intake disorders are early-onset anorexia nervosa (EOAN) and avoidant/restrictive food intake disorders (ARFID). Although the core symptoms of EOAN (i.e., fear of gaining weight and disturbed body image) are not present in ARFID, these symptoms are difficult to assess during the initial phase of hospitalisation. Our aim was  to identify restrictive food intake disorder subtypes in children using latent class analysis (LCA) based on the information available at admission to hospital, and to determine the agreement between the subtypes identified using LCA and the final diagnosis: EOAN or ARFID. We retrospectively included 97 children under 13 years old with severe eating disorders (DSM-5) at their first hospitalisation in a specialised French paediatric unit. LCA was based on clinical information, growth chart analyses and socio-demographic parameters available at admission. We then compared the probabilities of latent class membership with the diagnosis (EOAN or ARFID) made at the end of the hospitalisation. The most parsimonious LCA model was a 2-class solution. Children diagnosed with EOAN at the end of hospitalisation had a 100% probability of belonging to class 1 while children diagnosed with ARFID had an 8% probability of belonging to class 1 based on parameters available at admission. Our results indicate that clinical and socio-demographic characteristics other than the core symptoms of EOAN may be discriminating for a differential diagnosis.

Comparison between continued inpatient treatment versus day patient treatment after short inpatient care in early onset anorexia nervosa (COTIDEA trial): a study protocol for a non-inferiority randomised controlled trial

BACKGROUND

In children with early-onset anorexia nervosa (first symptoms before 13 years old, EO-AN), experts recommend initial outpatient treatment but in-patient treatment (IP) is frequently indicated due to acute medical instability or for those who have not improved with outpatient treatment. This IP can target either a partial weight restauration or a total weight normalization (return to the previous BMI growth trajectory). There are no evidence in the literature on which is the better therapeutic option in EOAN. But as long length of stay induce social isolation, with elevated costs, we wonder if a stepped-care model of daypatient treatment (DP) after short IP stabilisation may be a treatment option as effective as full-time IP to target weight normalization. We designed a two-arm randomised controlled trial testing the non-inferiority of a stepped-care model of DP after short IP stabilisation versus full-time IP.

METHODS

Eighty-eight children aged 8 to 13 years suffering from EOAN with initial severe undernutrition will be randomly allocated to either IP treatment as usual or a stepped care DP model both targeting weight normalization. Assessments will be conducted at inclusion, somatic stabilization, weight normalization, 6 months and 12 months post randomisation. The primary outcome will be BMI at 12 months post-randomisation. Secondaries outcomes will included clinical (tanner stage), biological (prealbumin, leptin, total ghrelin and IGF1) and radiological (bone mineralization and maturation) outcomes, eating symptomatology and psychiatric assessments, motivation to change, treatment acceptability and quality of life assessments, cost-utility and cost-effectiveness analyses.

DISCUSSION

COTIDEA will provide rigorous evaluation of treatment alternative to full-time inpatient treatment to allow a reduction of social iatrogenic link to hospital length of stay and associated costs.

TRIAL REGISTRATION

Trial is registered on ClinicalTrials.gov (NCT04479683).

Inpatient target discharge weight for early-onset anorexia nervosa: Restoring premorbid BMI percentile to improve height prognosis

OBJECTIVE

Early-onset anorexia nervosa (EO-AN) is characterized by restricted food intake leading to low body weight, emerging before 14 years old. Most patients reaching a target body mass index (BMI) around the 25th percentile at hospitalization discharge display an incomplete prospective height catch-up. A better understanding of height prognosis determinants is required.

METHODS

In 74 children with an EO-AN, we collected height and weight premorbidly, at hospitalization, and at discharge, 6 months, 12 months, and at longer-term follow-up of 36 months. We defined a height prognosis parameter (HPP) as the difference between the height percentile at follow-up times and the premorbid height percentile. We explored the relationship between weight parameters and height catch-up at follow-up with linear regression analyses.

RESULTS

A higher weight suppression (WS) - i.e., difference between premorbid and current BMI - at admission and discharge was associated with lower HPP - i.e., a greater loss of height - at 12 months and 36 months follow-up. Similarly, a higher premorbid BMI percentile was associated with a lower HPP at 12 and 36 months.

CONCLUSION

Target discharge weight for EO-AN patients should be tailored and based on premorbid BMI trajectory to improve height prognosis.

Is SARS‐CoV‐2 seroconversion a risk factor for severe and acute psychiatric symptoms in children?

Aims

Since the beginning of the COVID pandemic, studies reported an increase in children’s mental health issues and questioned the impact of SARS‐CoV‐2 on psychiatric symptoms.

Methods

We compared COVID seroconversion in children hospitalized with acute, severe psychiatric symptoms (n = 52) with the sex‐ and age‐matched control group (n = 52) living in the same low‐income geographic area and sampled during the same time period.

Results

Contrary to our hypothesis, we observed less seroconverted children with psychiatric conditions 9.61% (95% CI, 3.59‐21.80) vs 34.61% (95% CI, 22.33‐49.16; χ² = 14.7, P = 1.24E−4; OR = 0.20; 95% CI, 0.05‐0.64).

Conclusion

This suggests a lower direct impact of SARS‐CoV‐2 compared with the impact of mitigation strategies on psychiatric symptom deterioration in children reported since early stages of the pandemic.

HyPyP: a Hyperscanning Python Pipeline for inter-brain connectivity analysis

The bulk of social neuroscience takes a 'stimulus-brain' approach, typically comparing brain responses to different types of social stimuli, but most of the time in the absence of direct social interaction. Over the last two decades, a growing number of researchers have adopted a 'brain-to-brain' approach, exploring similarities between brain patterns across participants as a novel way to gain insight into the social brain. This methodological shift has facilitated the introduction of naturalistic social stimuli into the study design (e.g. movies) and, crucially, has spurred the development of new tools to directly study social interaction, both in controlled experimental settings and in more ecologically valid environments. Specifically, 'hyperscanning' setups, which allow the simultaneous recording of brain activity from two or more individuals during social tasks, has gained popularity in recent years. However, currently, there is no agreed-upon approach to carry out such 'inter-brain connectivity analysis', resulting in a scattered landscape of analysis techniques. To accommodate a growing demand to standardize analysis approaches in this fast-growing research field, we have developed Hyperscanning Python Pipeline, a comprehensive and easy open-source software package that allows (social) neuroscientists to carry-out and to interpret inter-brain connectivity analyses.

Paris MEM: a study protocol for an effectiveness and efficiency trial on the treatment of traumatic stress in France after the 2015-16 terrorist attacks

BACKGROUND

The Paris and Nice terrorist attacks affected a thousand of trauma victims and first-line responders. Because there were concerns that this might represent the first of several attacks, there was a need to quickly enhance the local capacities to treat a large number of individuals suffering from trauma-related disorders. Since Reconsolidation Therapy (RT) is brief, relatively easy to learn, well tolerated and effective, it appeared as the ideal first-line treatment to teach to clinicians in this context.

METHODS

This study protocol is a two-arm non-randomized, multicenter controlled trial, comparing RT to treatment as usual for the treatment of trauma-related disorders. RT consists of actively recalling one's traumatic event under the influence of the ß-blocker propranolol, once a week, for 10-25 min with a therapist, over 6 consecutive weeks. This protocol evaluates the feasibility, effectiveness, and cost-utility of implementing RT as part of a large multi-center (N = 400) pragmatic trial with a one-year follow-up.

DISCUSSION

Paris MEM is the largest trial to date assessing the efficiency of RT in the aftermath of a large-scale man-made disaster. RT could possibly reinforce the therapeutic arsenal for the treatment of patients suffering from trauma-related disorders, not only for communities in western countries but also worldwide for terror- or disaster-stricken communities.

TRIAL REGISTRATION

Clinical Trials (ClinicalTrials.gov). June 3, 2016. NCT02789982.

[Body dysmorphic disorder: Future prospects of medical care]

Body dysmorphic disorder (BDD) is characterized by excessive preoccupation with a slight or imagined defect in one's physical appearance, believing they look ugly, abnormal or deformed. While the most common preoccupations focus on the skin, hair and nose, any part of the body may be involved. Preoccupations are intrusive, time-consuming and hard to control. Repetitive behaviors are performed in response to the preoccupations. BDD is associated with marked impairment in socio-professional functioning, poor quality of life and high suicide rates.

CLINICAL CHARACTERISTICS

BDD appears to be relatively common with a prevalence rate between 1 and 2% in general population with a chronic course evolution without treatment, it is also associated with a high rate of depression and suicide. The current prevalence in adult psychiatric population is estimated over 10%; prevalence is also elevated in dermatology and cosmetic surgery patients.

THERAPEUTIC

Adequate treatments may improve symptoms and quality of life. International guidelines recommend cognitive behavior therapy (CBT) as first line of treatment. Several studies have shown evidence of CBT benefit. High dose selective serotonin reuptake inhibitors (SRI) for at least 12weeks are recommended in more severe cases. SRI augmentation strategies with antipsychotic adjunction do not report benefit in small-size sample. Antipsychotic medication for BDD even with delusional beliefs is not indicated. Attachment based interpersonal psychotherapy, analyzing and correcting interpersonal relationship from individuals with BDD may represent an alternative therapy improving self-esteem.

COSMETIC TREATMENTS

Insight is generally poor and patients often require cosmetic and surgical treatments to "correct" their imagined defect with sometimes a transitional initial benefit but without positive impact on long-term remission and can exacerbate preoccupation.

SCREENING AND AWARENESS

Healthcare professionals need to be aware of an early detection of this trouble, clinical tools validated in cosmetic population can help them to identify BDD in order to provide education about diagnosis and refer patients to a psychiatrist. More collaboration between psychiatrists and cosmetic practitioners is necessary.