M. Susan Jay

Distribution of eating disorders in children and adolescents using the proposed DSM-5 criteria for feeding and eating disorders.

PURPOSEnTo determine the distribution of eating disorders (ED) in children and adolescents comparing the fourth edition of the Diagnostic and Statistical Manual (DSM) to the proposed fifth edition DSM criteria.nnnMETHODSnA total of 215 consecutive patients (15.4 ± 3.3 years) presenting for initial ED evaluation to adolescent medicine physicians from six institutions were assigned ED diagnoses using current DSM-IV criteria as well as proposed DSM-5 criteria.nnnRESULTSnDiagnoses of anorexia nervosa and bulimia nervosa increased using the proposed DSM-5 criteria (from 30.0% to 40.0% and from 7.3% to 11.8%, p < .001). Approximately 14% of patients received the presumptive DSM-5 diagnosis of avoidant/restrictive food intake disorder. Cases of ED not otherwise specified decreased from 62.3% to 32.6% (p < .001).nnnCONCLUSIONSnProposed DSM-5 criteria substantially decreased the frequency of ED not otherwise specified diagnoses and increased the number of cases of anorexia nervosa and bulimia nervosa in a population of young patients presenting for ED treatment. Avoidant/restrictive food intake disorder appears to be a significant diagnosis.

Predictors of Outcome at 1 Year in Adolescents With DSM-5 Restrictive Eating Disorders: Report of the National Eating Disorders Quality Improvement Collaborative

PURPOSEnThe National Eating Disorders Quality Improvement Collaborative evaluated data of patients with restrictive eating disorders to analyze demographics of diagnostic categories and predictors of weight restoration at 1 year.nnnMETHODSnFourteen Adolescent Medicine eating disorder programs participated in a retrospective review of 700 adolescents aged 9-21 years with three visits, with DSM-5 categories of restrictive eating disorders including anorexia nervosa (AN), atypical AN, and avoidant/restrictive food intake disorder (ARFID). Data including demographics, weight and height at intake and follow-up, treatment before intake, and treatment during the year of follow-up were analyzed.nnnRESULTSnAt intake, 53.6% met criteria for AN, 33.9% for atypical AN, and 12.4% for ARFID. Adolescents with ARFID were more likely to be male, younger, and had a longer duration of illness before presentation. All sites had a positive change in mean percentage median body mass index (%MBMI) for their population at 1-year follow-up. Controlling for age, gender, duration of illness, diagnosis, and prior higher level of care, only %MBMI at intake was a significant predictor of weight recovery. In the model, there was a 12.7% change in %MBMI (interquartile range, 6.5-19.3). Type of treatment was not predictive, and there were no significant differences between programs in terms of weight restoration.nnnCONCLUSIONSnThe National Eating Disorders Quality Improvement Collaborative provides a description of the patient population presenting to a national cross-section of 14 Adolescent Medicine eating disorder programs and categorized by DSM-5. Treatment modalities need to be further evaluated to assess for more global aspects of recovery.

Primary Position Upbeat Nystagmus With Organophosphate Poisoning

: Upbeat nystagmus is a vertical jerk nystagmus present in the primary position with a fast upward phase. It is to be distinguished from gaze-evoked upbeating nystagmus which is not present in the primary position, but is elicited only on upgaze. Drug toxicity commonly causes gaze-evoked upbeating nystagmus but rarely primary position upbeat nystagmus. A 21-month-old white girl swallowed Dermaton, an organophosphate pesticide, and developed primary position upbeat nystagmus, RBC and plasma cholinesterase levels were markedly depressed, confirming organophosphate poisoning. When the youngster was treated with intravenous atropine, the nystagmus quickly resolved.

Use of Psychopharmacologic Medications in Adolescents With Restrictive Eating Disorders: Analysis of Data From the National Eating Disorder Quality Improvement Collaborative

PURPOSEnPsychopharmacologic medications are often prescribed to patients with restrictive eating disorders (EDs), and little is known about the frequency of use in adolescents. We examined the use of psychopharmacologic medications in adolescents referred for treatment of restrictive ED, potential factors associated with their use, and reported psychiatric comorbidities.nnnMETHODSnRetrospective data from the initial and 1-year visits were collected for patients referred for evaluation of restrictive ED at 12 adolescent-based ED programs during 2010 (Group 1), including diagnosis, demographic information, body mass index, prior treatment modalities, and psychopharmacologic medications. Additional data regarding patients comorbid psychiatric conditions and classes of psychopharmacologic medications were obtained from six sites (Group 2).nnnRESULTSnOverall, 635 patients met inclusion criteria and 359 had 1-year follow-up (Group 1). At intake, 20.4% of Group 1 was taking psychopharmacologic medication and 58.7% at 1xa0year (pxa0≤xa0.0001). White, non-Hispanic race (pxa0= .020), and prior higher level of care (p < .0001) were positively associated with medication use at 1 year. Among Group 2 (nxa0= 256), serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors use was most common, and 62.6% had a reported psychiatric comorbidity. Presence of any psychiatric comorbidity was highly associated with medication use; odds ratio, 10.0 (5.6, 18.0).nnnCONCLUSIONSnAdolescents with restrictive ED treated at referral centers have high rates of reported psychopharmacologic medication use and psychiatric comorbidity. As more than half of this referral population were reported to be taking medication, continued investigation is warranted to ensure the desired outcomes of the medications are being met.

Vision and Motion Sickness

: The development of motion sickness appears intimately related to the visual system. The Sensory Rearrangement Theory states that situations which promote motion sickness are characterized by a condition in which the motion signals transmitted by the eyes, vestibular system, and the nonvestibular proprioceptors are at variance as to what was expected previously. The evolutionary significance of motion sickness rests in its linkage to an early warning system to avoid poisoning. Vision is capable of aiding in the development of suppression of motion sickness. Therapy of motion sickness includes posture, restriction of head movement, visual manipulations, concurrent activity, drugs, and adaptation.