Olanzapine use for the treatment of adolescents with anorexia nervosa - reflecting on research and clinical practice.

Anorexia nervosa is a complex and potentially devastating mental health (MH) diagnosis that is recognized as having high rates of non-response to treatment, pronounced medical as well as MH morbidity, and elevated mortality rates. Olanzapine is a second-generation atypical antipsychotic that has demonstrated benefit with weight gain in adults with anorexia nervosa (AN), although controlled research involving children and youth remains limited. In this commentary, the authors provide a brief history and review of research relating to olanzapine for the adjunctive treatment of children and adolescents with AN.

Exploring biologically oriented precision mental health initiatives for the care of patients with eating disorders: A narrative review.

Objective: Eating disorders (EDs) represent a major public health burden. Increasingly, studies suggest mental health (MH) fields are failing to improve the effectiveness of treatments and that alternative models of care must be considered. Precision mental health (PMH) seeks to tailor treatment to individual needs and relies on a comprehensive understanding of the neurobiological and physiological underpinnings of mental illness.

Examining the role of artificial intelligence to advance knowledge and address barriers to research in eating disorders.

Objective: To provide a brief overview of artificial intelligence (AI) application within the field of eating disorders (EDs) and propose focused solutions for research.

Method: An overview and summary of AI application pertinent to EDs with focus on AI's ability to address issues relating to data sharing and pooling (and associated privacy concerns), data augmentation, as well as bias within datasets is provided.

Results: In addition to clinical applications, AI can utilize useful tools to help combat commonly encountered challenges in ED research, including issues relating to low prevalence of specific subpopulations of patients, small overall sample sizes, and bias within datasets.

Pragmatic clinical trials to advance research in children and adolescents with eating disorders.

Objective: To discuss the utility of pragmatic clinical trials (PCTs) to help advance research in eating disorders (EDs).

Methods: We describe challenges associated with traditional explanatory research trials and examine PCTs as an alternative, including a review of the PRECIS-2 tool.

Results: There are many challenges associated with the design and completion of traditional RCTs within the field of EDs.

Adolescents' Cannabis Knowledge and Risk Perception: A Systematic Review.

To systematically review evidence evaluating cannabis-related knowledge and perception of risk in children and adolescents. We systematically searched Medline, PsycINFO, and EMBASE using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. 133 studies from around the world (including ages 10-18 yrs) met inclusion criteria, with 70% meeting grade 2C quality.

Approach to anorexia nervosa and atypical anorexia nervosa in adolescents.

Objective: To address screening, diagnosis, and treatment of adolescents with anorexia nervosa and atypical anorexia nervosa in primary care.

Sources Of Information: A literature search was conducted in PubMed using the subject headings , and . Applicable articles were reviewed, with key recommendations summarized.

Classification of Children and Adolescents With Avoidant/Restrictive Food Intake Disorder.

Background And Objectives: Evidence suggests that children and adolescents with avoidant/restrictive food intake disorder (ARFID) have heterogeneous clinical presentations. To use latent class analysis (LCA) and determine the frequency of various classes in pediatric patients with ARFID drawn from a 2-year surveillance study.

Methods: Cases were ascertained using the Canadian Pediatric Surveillance Program methodology from January 1, 2016, to December 31, 2017.

Incidence and Age- and Sex-Specific Differences in the Clinical Presentation of Children and Adolescents With Avoidant Restrictive Food Intake Disorder.

Importance: To our knowledge, this is the first pediatric surveillance study of children and adolescents with avoidant restrictive food intake disorder (ARFID).

Objectives: To examine the incidence and age- and sex-specific differences in the clinical presentation of ARFID in children and adolescents in Canada.

Design, Setting, And Participants: In this cross-sectional study, patients with ARFID were identified through the Canadian Paediatric Surveillance Program by surveying 2700 Canadian pediatricians monthly from January 1, 2016, to December 31, 2017.

Treatment Needs and Rates of Mental Health Comorbidity in Adolescent Patients With ARFID.

The purpose of this paper is to provide a descriptive overview of a single-center ARFID-specific pilot clinic that sought to better understand the specific needs of patients with ARFID including rates of comorbidities, and to gain insight into treatment requirements. A retrospective cohort study was completed on patients meeting criteria for ARFID admitted to a specialized pilot clinic within a tertiary care hospital. Over an 18 month period, a total of 26 patients were assessed and had follow-up data for a 12 month period.

The impact of COVID-19 on adolescents with eating disorders: a cohort study.

Background: There is a noticeable lack of evidence regarding the impact of COVID-19 and the associated lockdown on young people with eating disorders. The goals of this study were 1) to examine characteristics of adolescents presenting for eating disorder (ED) assessment since the onset of the COVID-19 pandemic; 2) to compare adolescents presenting for ED assessment since the onset of the COVID-19 pandemic to those that presented for assessment 1 year previously; 3) to examine implications of the pandemic on the system of care.

Methods: A retrospective chart review was completed on all patients assessed at a pediatric tertiary care ED program during the pandemic between April 1 and October 31, 2020, and on youth assessed during the same time frame 1 year previously.

Health professionals' familiarity and experience with providing clinical care for pediatric avoidant/restrictive food intake disorder.

Objective: The current study explored the experience and familiarity of pediatric health professionals with avoidant/restrictive food intake disorder (ARFID), and assessed the application of diagnostic criteria in a series of clinical vignettes.

Method: Pediatric health professionals were invited to complete an online survey. Data from 93 health professionals from medical and allied health roles who completed the survey were analyzed.

Attitudes toward physical activity as a treatment component for adolescents with anorexia nervosa: An exploratory qualitative study of patient perceptions.

Objective: Anorexia nervosa (AN) with compulsive exercise is associated with poor treatment outcomes. This study sought to understand the attitudes of adolescents with AN from various stages of treatment, toward physical activity research practices and physical activity as a component of treatment.

Method: Seventeen adolescents 12-18 years old (15 female) with AN (10 with acknowledged history of compulsive exercise) were recruited from a Canadian Tertiary Care Hospital's Eating Disorder Program.

A Brief Modified Family-Based Treatment Intervention for Youth With Mild Eating Disorders: A Case Series.

Background: Family-based treatment (FBT), an outpatient treatment which is typically offered for 6-12 months by specially trained therapists, is currently the first line treatment for adolescent anorexia nervosa and bulimia nervosa. The success of FBT for adolescents with moderate to severe eating disorders indicates a potential use for a short course of modified FBT which could be offered as an early intervention by nonspecialized community mental health counselors to adolescents with mild or subsyndromal eating disorders.

Methods: In 2016, seven adolescents with mild eating disorders underwent a brief intervention in the form of five FBT-inspired therapy sessions (called 'DREAMS' sessions).

Cocreating research priorities for anorexia nervosa: The Canadian Eating Disorder Priority Setting Partnership.

Objective: The Canadian Eating Disorder Priority Setting Partnership was established to identify and prioritize the top 10 research priorities for females, 15 years or older, with anorexia nervosa, by incorporating equal input from those with lived experience, families, and healthcare professionals.

Method: This project, which closely followed the James Lind Alliance guidelines, solicited research priorities from the Canadian eating disorder community by means of a five-step process including use of a survey, response collation, literature checking, interim ranking survey, and in-person prioritization workshop.

Results: The initial survey elicited 897 priorities from 147 individuals, with almost equal representation from all three stakeholder groups.

Asceticism, perfectionism and overcontrol in youth with eating disorders.

Purpose: Personality traits such as perfectionism and asceticism, and combinations of these traits (i.e., overcontrol) have been related to eating disorder (ED) diagnosis, symptoms, and chronicity in adult patients with EDs.

Feasibility of Implementing a Family-Based Inpatient Program for Adolescents With Anorexia Nervosa: A Retrospective Cohort Study.

Manualized Family Based Therapy (FBT) is the treatment of choice for adolescent anorexia nervosa, but it is an outpatient treatment. Very little research has examined whether or how the principles of FBT might be successfully adapted to an inpatient setting, and there is little other evidence in the literature to guide us on how to best treat children and adolescents with eating disorders (EDs) while in hospital. This paper describes and provides treatment outcomes for an intensive inpatient program that was designed for the treatment of adolescents less than 18 years of age with severe anorexia nervosa, based on the principles of FBT.

Characteristics and clinical trajectories of patients meeting criteria for avoidant/restrictive food intake disorder that are subsequently reclassified as anorexia nervosa.

Objective: To examine the initial assessment profiles and early treatment trajectories of youth meeting the criteria for avoidant/restrictive food intake disorder (ARFID) that were subsequently reclassified as anorexia nervosa (AN).

Method: A retrospective cohort study of patients assessed and treated in a tertiary care eating disorders (ED) program was completed.

Results: Of the 77 included patients initially meeting criteria for ARFID, six were reclassified as having AN (7.

Development of the Ottawa Disordered Eating Screen for Youth: The ODES-Y.

Objective: To develop a concise screening tool that allows for early identification of disordered eating in youth.

Study Design: In this 2-step classification accuracy study, questions for the Ottawa Disordered Eating Screen-Youth, a 2-question screening tool (index test), were conceptualized by clinician-scientists from tertiary care pediatric eating disorder and weight-related clinics, and was validated using retrospective data (2004-2010) from a community-based study, the Research on Eating and Adolescent Lifestyles (REAL) study.

Results: Analyses of contrast between the index test and the reference standard using data from 2892 (1714 females) students between grade 7 and grade 12 revealed classification statistics of 67.

Determining treatment goal weights for children and adolescents with anorexia nervosa.

One of the challenges faced by paediatric health professionals treating children and adolescents with anorexia nervosa (AN) is determining the specific weight needed to achieve physical, emotional and cognitive recovery. Clinicians and researchers have struggled to standardize process, methods and terminology around what is now referred to as the 'treatment goal weight' (TGW). This practice point summarizes recommendations drawn from common methods used to determine TGWs in children and adolescents with AN, which are based on both the evidence-based literature and expert consensus.

Use of cyproheptadine to stimulate appetite and body weight gain: A systematic review.

Objective: A systematic review identifying the use of cyproheptadine (CY) as an appetite stimulant was completed.

Method: Studies of any design exploring the efficacy of CY as an appetite stimulant in all age groups and populations were included. Primary outcomes of studies included were weight gain, appetite stimulation, and/or caloric/nutritional intake increase.

Avoidant Restrictive Food Intake Disorder.

Avoidant restrictive food intake disorder (ARFID) is a rearticulated eating disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5), published in 2013. The purpose of this article is to review what is known about ARFID; specifically outline the DSM-5 diagnostic criteria; review the epidemiology; describe the clinical characteristics of patients with this disorder; and discuss evolving treatment approaches. Although this disorder occurs across the lifespan, the focus of recent research has been primarily in children and adolescents with ARFID.