Martine F. Flament

Body Dissatisfaction, Dietary Restraint, Depression, and Weight Status in Adolescents.

BACKGROUNDnAdolescence may be a crucial period for developing obesity and associated mental health problems. This study examined the relationship of weight status on body image, eating behavior, and depressive symptoms in youth.nnnMETHODSnA survey was conducted on 1490 youth attending grades 7-12. Participants completed questionnaires on body image, eating behavior, and mood and were measured for height and weight to calculate body mass index (BMI). Weight classification was based on the International Obesity Task Force guidelines, whereby youth at or above the 95th BMI percentile for age and sex were classified as obese, those between 85th and 94th BMI percentile as overweight, and those between 5th and 84th BMI percentile as normal weight. Several multivariate analyses of variance (MANOVAs) were conducted to examine these relationships.nnnRESULTSnClear relationships emerged between body image and weight classification. Obese youth reported higher body dissatisfaction than overweight youth, who reported more body dissatisfaction than normal weight youth. These effects were independent of age and gender. A relationship was also found for dietary restraint and weight status whereby higher restraint scores were associated with greater adiposity. Similarly, obese youth reported greater depressive symptoms, including anhedonia, negative self-esteem, and higher overall depression scores compared with overweight and normal-weight youth.nnnCONCLUSIONSnPsychopathology in obese youth is well known in clinical samples but this study suggests that obese youth in the community may be at increased risk of developing body dissatisfaction, dietary restraint, and depressive symptoms compared with overweight or normal weight youth.

Posttraumatic stress symptoms after childhood cancer.

Abstract.The posttraumatic stress model has recently been appliednto understand the impact of life-threatening illness in adultsnand in children. From 1991 to 2001, 20 studies have reportednposttraumatic stress symptoms and/or posttraumatic stressndisorder (PTSD) in childhood cancer survivors and/or theirnparents. A review of these studies is proposed. Prevalence ofnposttraumatic stress symptoms and/or PTSD in children and inntheir parents has been estimated, across studies, between 2 andn20 % in survivors and between 10 and 30 % in their parents, evennmany years after the end of cancer treatment. Time elapsed sincenthe diagnosis of cancer is usually not predictive of persistentnsymptoms. Subjective appraisal of life threat and illnessnbeliefs are more important predictors than objective medicalndata. The presence of symptoms in survivors is not alwaysnrelated to that in their parents. The posttraumatic stress modelnrenews the approach and understanding of psychopathologicalnreactions of children with cancer, regarding trauma features andnthe role of parental responses. This model has importantnimplications for individual and family clinical interventions. Anreflection on the disruption of family functioning by childhoodncancer (an example being bone marrow transplantation with anrelated donor) and on the recovery processes is needed.

Evidence-based pharmacotherapy of eating disorders

The objective was to review scientific evidence for efficacy and safety of pharmacotherapy in adults or children with an eating disorder (ED). We conducted a computer search for all randomized controlled trials (RCTs) published between 1960 and May 2010 for treatment of anorexia nervosa (AN), bulimia nervosa (BN) or binge-eating disorder (BED). For drugs for which no RCT was found, open trials or case reports were retrieved. Clinically relevant RCTs in the treatment of AN have used atypical antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and zinc supplementation. Olanzapine demonstrated an adjunctive effect for in-patient treatment of underweight AN patients, and fluoxetine helped prevent relapse in weight-restored AN patients in 1/2 studies. For treatment of BN, controlled studies have used SSRIs, other antidepressants, and mood stabilizers. In 9/11 studies, pharmacotherapy yielded a statistically significant although moderate reduction in binge/purge frequency, and some additional benefits. For BED, RCTs have been conducted using SSRIs and one serotonin norepinephrine reuptake inhibitor (SNRI), mood stabilizers, and anti-obesity medications. In 11/12 studies, there was a statistically significant albeit limited effect of medication. Meta-analyses on efficacy of pharmacotherapy for BN and BED support moderate effect sizes for medication, but generally low recovery rates. Treatment resistance is an inherent feature of AN, where treatment should focus on renourishment plus psychotherapy. For BN and BED, combined treatment with pharmacotherapy and cognitive behaviour therapy has been more effective than either alone. Data on the long-term efficacy of pharmacotherapy for EDs are scarce. Short- and long-term pharmacotherapy of EDs still remains a challenge for the clinician.

A randomized controlled trial of adjunctive family therapy and treatment as usual following inpatient treatment for anorexia nervosa adolescents.

Research on treatments in anorexia nervosa (AN) is scarce. Although most of the therapeutic programs used in ‘real world practice’ in AN treatment resort to multidisciplinary approaches, they have rarely been evaluated. Objective To compare two multidimensional post-hospitalization outpatients treatment programs for adolescents with severe AN: Treatment as Usual (TAU) versus this treatment plus family therapy (TAU+FT). Method Sixty female AN adolescents, aged 13 to 19 years, were included in a randomized parallel controlled trial conducted from 1999 to 2002 for the recruitment, and until 2004 for the 18 months follow-up. Allocation to one of the two treatment groups (30 in each arm) was randomised. The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents. The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics, but not eating disorder symptoms. The main Outcome Measure was the Morgan and Russell outcome category (Good or Intermediate versus Poor outcome). Secondary outcome indicators included AN symptoms or their consequences (eating symptoms, body mass index, amenorrhea, number of hospitalizations in the course of follow-up, social adjustment). The evaluators, but not participants, were blind to randomization. Results At 18 months follow-up, we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy (Intention-to-treat: TAU+FT :12/30 (40%); TAU : 5/29 (17.2%) pu200a=u200a0.05; Per Protocol analysis: respectively 12/26 (46.2%); 4/27 (14.8%), pu200a=u200a0.01). Similar group effects were observed in terms of achievement of a healthy weight (i.e., BMI≥10th percentile) and menstrual status. Conclusions Adding family therapy sessions, focusing on intra-familial dynamics rather than eating symptomatology, to a multidimensional program improves treatment effectiveness in girls with severe AN. Trial Registration Controlled-trials.com ISRCTN71142875

Internalization of the thin and muscular body ideal and disordered eating in adolescence: the mediation effects of body esteem.

This study investigates body esteem factors (weight-esteem and appearance-esteem) as mediators of the relationship between internalization of the ideal body figure and disordered eating behaviors (restrained, emotional and external eating) in a community sample of adolescent males (n=810) and females (n=1137) from the Ontario Research on Eating and Adolescent Lifestyles (REAL) study. Mediation models were examined using a bootstrapping approach to test indirect effects and indirect contrasts. In males, weight-esteem partially mediated the relationship between muscular ideal and restrained eating; appearance-esteem partially mediated effects in the emotional and external eating regressions. In females, both weight-esteem and appearance-esteem partially mediated the relationship between thin ideal and all three forms of disordered eating; weight-esteem was a stronger mediator for restrained eating, and appearance-esteem a stronger mediator for emotional and external eating. Body esteem is important to consider for prevention and treatment of disordered eating in both genders.

Clinical relevance of chronic catatonic schizophrenia in children and adolescents: Evidence from a prospective naturalistic study

The paper examines the phenomenology, diagnosis, and course of catatonia in children and adolescents. From 1993 to 2003, 21 boys and 9 girls, aged 12 to 18 years, were admitted for a catatonic syndrome (0.6% of the total inpatient population). Phenomenology and associated diagnoses were similar to those reported in the adult literature but relative frequency differed, with schizophrenia being the most frequent diagnosis. Comparison of patients with schizophrenia (n=17) to those with other diagnoses (n=13) showed that the two groups differed in terms of sex ratio, type of onset and phenomenology of catatonic symptoms, duration of hospitalization, and severity at discharge. Using discriminant function analysis, the combination of three clinical variables--male gender, duration of catatonic episode, and severity at discharge--correctly classified 100% of cases in the schizophrenia group. Catatonia is an infrequent but severe condition in young people, and is usually associated with schizophrenia. There is a need for research in the field of catatonic schizophrenia in adolescents as it appears to be a clinically relevant but understudied subgroup.

Diffusion of efficacious interventions for children and adolescents with mental health problems

BACKGROUNDnChild and adolescent mental health problems are prevalent and require adequate interventions. Despite several evidence-based interventions for these problems described in the literature, few studies addressed strategies to diffuse efficacious interventions for child mental disorders especially in developing countries.nnnMETHODSnAn extensive but not systematic review of the literature was performed aiming to identify evidence-based interventions for children and adolescents with mental disorders, professionals to target in disseminating these interventions, and the available strategies to diffuse information.nnnRESULTSnSubstantial evidence-based information is available to guide preventive, psychosocial and psychopharmacological interventions. The effectiveness of treatments in real-world settings and the cost-effectiveness of interventions are rarely tested. Professionals at different levels (teachers, school counselors, social workers, general practitioners, pediatricians, child psychologists and psychiatrists) should be targeted in diffusing efficacious interventions for child mental health problems worldwide. Telepsychiatry and the internet seem to be the most promising strategies to diffuse knowledge with lower costs.nnnCONCLUSIONSnMedical and allied professionals must incorporate child and adolescent mental health issues in their under- and postgraduate curricula, and be better prepared to critically evaluate available information. Professionals need to disseminate evidence-based programs to guide parents and teachers in developing countries to deal with child and adolescent difficulties. Countries need to explore internet solutions for dissemination of medical information.

Cognitive control in childhood-onset obsessive-compulsive disorder : a functional MRI study

BACKGROUNDnFailure to resist chronic obsessive-compulsive symptoms may denote an altered state of cognitive control. We searched for the cerebral regions engaged in this dysfunction.nnnMETHODnDifferences in brain regional activity were examined by event-related functional magnetic regional imaging (fMRI) in a group of adolescents or young adults (n = 12) with childhood-onset obsessive-compulsive disorder (OCD), relative to healthy subjects. Subjects performed a conflict task involving the presentation of two consecutive and possibly conflicting prime and target numbers. Patients image dataset was further analysed according to resistance or non-resistance to symptoms during the scans.nnnRESULTSnUsing volume correction based on a priori hypotheses, an exploratory analysis revealed that, within the prime-target repetition condition, the OCD subjects activated more than healthy subjects a subregion of the anterior cingulate gyrus and the left parietal lobe. Furthermore, compared with resistant patients, the non-resistant OCD subjects activated a bilateral network including the precuneus, pulvinar and paracentral lobules.nnnCONCLUSIONSnHigher regional activations suggest an abnormal amplification process in OCD subjects during the discrimination of repetitive visual stimuli. The regional distribution of functional changes may vary with the patients ability to resist obsessions.

Discrimination of face identities and expressions in children with autism: same or different?

Abstract.Autism is a pervasive developmental disorder (PDD) characterized by the association of communication and socialization impairments, and by repetitive stereotyped behaviours. The Minnesota Test of Affective Processing (MNTAP) was used to investigate the discrimination of face identities and face expressions by autistic children. Young children in the 6- to 10-year-old age range suffering from PDD were compared to paired normal children. When the expressions on faces remained neutral, autistic patients had more difficulty in distinguishing different faces than in matching the same facial identities in face pairs: they perceived different faces as being identical. However, recognition errors disappeared when expressions were changed together with face identity. When autistic children were asked to distinguish expressions, they discriminated better identity than difference, just as normal children do. Analysis of face and expression discrimination in terms of identity and difference is a novel approach for the understanding of the clinical features of autism. Autistic children seek sameness and use an atypical strategy to analyse human faces and expressions.

Family meals and body mass index among adolescents: effects of gender

Family meals have been identified as a protective factor against obesity among youth. However, gender specificities with respect to the relationship between the frequency of family meals and body mass index (BMI) have not been investigated. The purpose of this study was to examine the relationship between the frequency of family meals and BMI in male and female adolescents, while controlling for potential confounding factors associated with BMI, such as parental education, adolescents age, and snack-food eating. Research participants were 734 male and 1030 female students (mean age, 14.12 years, SD = 1.62) recruited from middle schools and high schools in the capital region of Canada. Participants completed validated, self-report measures to assess the frequency of family meals and the risk factors associated with increased BMI, which was derived from objective measures of height and weight. After controlling for proposed confounding variables, a higher frequency of family meals was associated with lower BMI in females, but not in males. A Z-transformation test of the homogeneity of adjusted correlation coefficients showed a significant trend (p = 0.06), indicating that the relationship between family meals and BMI is stronger in females than males, consistent with our regression analyses. Our findings suggest that eating together as a family may be a protective factor against obesity in female adolescents, but not in male adolescents. Findings from this study have important implications for parents and health care practitioners advocating for more frequent family meals as part of a comprehensive obesity prevention and treatment program for female adolescents.