Luisa Iero

Follow-up of bone mineral density and body composition in adolescents with restrictive anorexia nervosa: role of dual-energy X-ray absorptiometry.

Background/Objectives:Restrictive Anorexia nervosa (ANR) is an eating disorder (ED) characterized by a low bone mineral content (BMC) and by an alteration in body composition (reduction and abnormal distribution of fat mass—FM and lean mass—LM). The aim of our study was to address whether bone and body composition changes could be influenced by hormonal status and sport in female adolescents with restrictive anorexia nervosa-ANR.Subjects/Methods:Prospective study on 79 adolescents with ANR submitted to Dual Energy X-Ray Absorptiometry—DXA at baseline-T0 and after 12 months-T12. Among the 46/79—58.2% patients that completed the study, we evaluated total and regional FM and LM%, as well as lumbar bone mineral density (BMD) and Z-score, linking them to clinical variables: menarche/amenorrhea/hormonal therapy and physical activity.Results:At T0: body mass index (BMI)=16.4±1.4 kg/m2 with low levels of FM% (21.7±5.7) low BMC in 12/46—26.0% (mean Z-score: −1.21±1.27, with higher values related to physical activity—P=0.001). At T12: a significant increase in BMI—P=0.001, with LM reduction and FM increase (more evident in the trunk—P<0.001); regarding bone, no significant changes were observed, though a tendency in terms of improvement associated with resumption of menses.Conclusions:After 1 year, weight recovery was not associated with a reestablishment of bone values; by contrast, it was associated with an increase and a distortion in FM distribution, more evident in trunk region (potential and adjunctive risk factor for the relapse of the psychiatric condition). The complexity of these clinical findings suggested DXA, a low-dose and low-cost technique, in long-term monitoring of ANR patients.

SAFA: A new measure to evaluate psychiatric symptoms detected in a sample of children and adolescents affected by eating disorders. Correlations with risk factors

In order to evaluate the psychiatric symptoms associated with a diagnosis of eating disorders (ED) we have administered a new psychometric instrument: the Self Administrated Psychiatric Scales for Children and Adolescents (SAFA) test. SAFA was administered to a cohort of 97 patients, aged from 8.8 to 18, with an ED diagnosis. Age, body mass index (BMI) and BMI standard deviation score were analyzed. Furthermore, while looking for linkable risk factors, we evaluated other data that took an influence over the SAFA profile, like parental separation and family components’ number. Compared to the range of statistical normality (based on Italian population), patients with bulimia nervosa or binge-eating disorder showed higher and pathologic values in specific subscales. When analyzing sex, males showed more pathologic values in most anxiety-related, obsessiveness–compulsiveness-related and insecurity subscales. A correlation among age, BMI and specific subscales (low self esteem, psychological aspects) emerged in participants with anorexia nervosa. In order to plan more appropriate diagnostic and therapeutic approaches in children or adolescents suffering from ED, the SAFA test can be an important instrument to evaluate psychiatric symptoms. Therefore, we propose to include this useful, simple self-administered test as a new screening tool for ED diagnosis.

Is cognitive behavioural therapy an effective complement to antidepressants in adolescents? A meta-analysis

Calati R, Pedrini L, Alighieri S, Alvarez MI, Desideri L, Durante D, Favero F, Iero L, Magnani G, Pericoli V, Polmonari A, Raggini R, Raimondi E, Riboni V, Scaduto MC, Serretti A, De Girolamo G. Is cognitive behavioural therapy an effective complement to antidepressants in adolescents? A meta-analysis. Objective: Evidence on effectiveness of combined treatments versus antidepressants alone in adolescents consists on a few studies in both major depressive and anxiety disorders. A meta-analysis of randomised 12-week follow-up studies in which antidepressant treatment was compared to combined treatment consisting of the same antidepressant with cognitive behavioural therapy has been performed. Methods: Data were entered into the Cochrane Collaboration Review Manager software and were analysed within a random effect framework. A quality assessment has been performed through Jadad Scale. Results: Higher global functioning at the Childrens Global Assessment Scale was found in the combined treatment group (p < 0.0001) as well as higher improvement at the Clinical Global Impressions Improvement Scale (p = 0.04). No benefit of combined treatment was found on depressive symptomatology at the Childrens Depression Rating Scale – Revised. Conclusion: Combined treatment seems to be more effective than antidepressant alone on global functioning and general improvement in adolescents with major depressive and anxiety disorders.

Psychometric Evaluation of SAFA P Test for Eating Disorders in Adolescents: Comparative Validation with EDI-2

OBJECTIVE This study evaluates the psychometric properties of self-administered psychiatric scale for children and adolescents with psychogenic eating disorders (SAFA P)--a brief self-report designed to screen and assess eating disorders (ED) in children and adolescents. Although SAFA P belongs to a broad battery of tests (SAFA) that explores different psychiatric conditions, it has not undergone appropriate validation until now. METHOD We administered SAFA P and Eating Disorder Inventory 2 (EDI-2) to 87 ED patients, with an average age of 15.4 ± 1.6 years. RESULTS The internal reliability of SAFA P is good (Cronbach α = .776). Convergent validity with EDI-2 was assessed: both SAFA P subscale P1 (p < .005) and EDI-2 subscale bulimia (p < .001) showed a statistically significant difference among the three diagnostic categories (anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified). Sensibility and specificity range from 62 to 91%, depending on the subscales. McNemars test did not reveal statistically significant differences in assessing the concordance of the two measures. Statistically significant correlations were found between specific couples of subscales (p < .001). CONCLUSIONS Cross-validation with EDI-2 showed good results. SAFA P may be an alternative, useful and reliable instrument for assessing cursory ED in childhood and adolescence.

Su1641 Audit of Gastrointestinal Symptoms and Psychopathological Traits in Patients With Eating Disorders: A Prospective Study

BACKGROUND: Esophago-gastrointestinal (EGI) symptoms are frequently reported by patients with eating disorders (ED), who tend to use somatic disturbances to justify modifications of alimentary behaviour. It is not clear if referred symptoms are real, whether they ameliorate after controlled diet or if there are related to psychopathogical traits. AIM: (i) to analyze the prevalence of moderate-severe EGI symptoms, either individual or pooled, and of Minnesota Multiphasic Personality Inventory (MMPI-2 or MMPI-A) scales in hospitalized ED patients and symptoms modifications after 6 months of follow-up; (ii) to correlate EGI symptoms and sds-body mass index (sdsBMI) changes with MMPI scales. METHODS: We enrolled 48 consecutive patients (41 F, median age 15) hospitalized with a diagnosis of ED. Thirty-nine patients (81%) were classified as AN and 9 (19%) as BN. At admission (T1) all patients completed MMPI-2 or MMPI-A and the italian version of a validated questionnaire on gastroesophageal (E) and gastrointestinal (GI) symptoms. EGI questionnaire was then completed at discharge (T2), at 1 month of follow up (T3) and after 6 months (T4). RESULTS: (i) the most frequently reported symptoms classified as moderate-severe were postprandial fullness (70%) and abdominal distention (57%). The most prevalent pychopathological trait with abnormal MMPI score (>55) was depression (67%). During observational period of 6 months (T1-T4), E and GI symptoms significantly decreased (IR 3-19 and 0.5-6.5, IR 1444 and 4-28, p<0.05 and p<0.0001, respectively), as well as sdsBMI (-3.4 -1.7 e -1.5 -0.4; p<0.001). Patients with abnormal scores of Hypochondriasis (HS) had significantly more severe abdominal distention and pooled GI symptoms than patients with normal HS scores (p<0.05 and p<0.005, respectively). (ii) sdsBMI change did not correlate with EGI symptoms improvement (p=NS). Normal HS, Hysteria (HY), Psychoastenia (PT), Schizophrenia (SC) scores were significantly correlated with reduction of postprandial fullness compared to abnormal scores (p<0.05). Abdominal distention improved in all patients, irrespectively of MMPI scores (p<0.05). Pooled E symptoms significantly diminished in patients with normal HY scores vs abnormal (p<0.05), whereas pooled GI symptoms improved irrespectively of high HS and HY scores (p<0.05). All patients showed a reduction in sdsBMI, irrespectively of MMPI scores (p<0.05). CONCLUSIONS: Postprandial fullness and abdominal distention are the most prevalent digestive complaints reported by ED patients. An improvement of sdsBMI is observed in controlled ED patients as well as EGI symptoms. Abnormal MMPI traits may interfere with amelioration of postprandial fullness, but has no influence on abdominal distention, nor on sdsBMI.

P02-131 - Reconsidering food avoidance emotional disorder through discussion of four cases

Objectives The Authors investigate the conceptualization of a group of patients with the same clinical and psychological patterns, affected by eating disturbances arisen during the age of latency. Methods Four cases are presented and discussed. Each subject was diagnosed as Food Avoidance Emotional Disorder (FAED). Results The described subjects present some of the typical features of eating disorders of adolescence. Moreover, regressive aspects, obligingness, dichotomyc behaviors and thoughts were noticed. The Authors observed that parental expectations and needs were transmitted to their sons. Conclusions Through the refusal of food the dochotomyc and fearful thoughts are crystallized. The child cannot comprehend the existence of a false Self built on the Others expectations. The Authors believe that FAED can be a precursor of Anorexia nervosa in the affected children, who show a less organized cognitive structure due to their young age.

The refusal of food in childhood: From our clinical experience to an evaluation of recent diagnostic classifications.

The aim of this study, which was carried out because of the importance of eating disorders (EDs) acquired by the young and the need to organise resources and interventions for patients and their families, was to quantify the increased incidence of EDs arising early in life in order to identify the nosographic classification that best reflects the complexity of the symptoms. Between 2003 and 2008, we assessed 128 subjects aged less than 14 years and observed a constant increase in ED-related problems. Our analysis shows the importance of representative classification criteria suitable for young patients in order to improve diagnosis and therapeutic planning. The need for a specific classification for early childhood is underlined by the fact that comorbidities and overlapping patterns often complicate adequate assessment.

I disturbi del comportamento alimentare (DCA): riflessioni e problematiche

Eating disorders (ED) are an important cause of physical and psychosocial morbidity in adolescents and young adults, characterized by aberrant patterns of eating behavior and weight regulation and by disturbances in attitudes towards weight and perception of body shape. This article, through the description of a clinical case, focuses on the complexities of clinical management and on the importance of an integrated approach.