Publications
168 results found
Petkova H, Simic M, Nicholls D, et al., 2019, Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study, BMJ Open, Vol: 9, Pages: 1-9, ISSN: 2044-6055
Objectives This study aimed to estimate the incidence of DSM5 anorexia nervosa in young people in contact with child and adolescent mental health services in the UK and Ireland.Design Observational, surveillance study, using the Child and Adolescent Psychiatry Surveillance System, involving monthly reporting by child and adolescent psychiatrists between 1st February 2015 and 30th September 2015.Setting The study was based in the UK and Ireland.Participants Clinician-reported data on young people aged 8–17 in contact with child and adolescent mental health services for a first episode of anorexia nervosa.Main outcome measures Annual incidence rates (IRs) estimated as confirmed new cases per 100 000 population at risk.Results 305 incident cases of anorexia nervosa were reported over the 8-month surveillance period and assessed as eligible for inclusion. The majority were young women (91%), from England (70%) and of white ethnicity (92%). Mean age was 14.6 years (±1.66) and mean percentage of median expected body mass index for age and sex was 83.23% (±10.99%). The overall IR, adjusted for missing data, was estimated to be 13.68 per 100 000 population (95% CI 12.88 to 14.52), with rates of 25.66 (95% CI 24.09 to 27.30) for young women and 2.28 (95% CI 1.84 to 2.79) for young men. Incidence increased steadily with age, peaking at 15 (57.77, 95% CI 50.41 to 65.90) for young women and 16 (5.14, 95% CI 3.20 to 7.83) for young men. Comparison with earlier estimates suggests IRs for children aged 12 and under have increased over the last 10 years.Conclusion These results provide new estimates of the incidence of anorexia nervosa in young people. Service providers and commissioners should consider evidence to suggest an increase in incidence in younger children.
Viner RM, Aswothikutty-Gireesh A, Stiglic N, et al., 2019, Roles of cyberbullying, sleep, and physical activity in mediating the effects of social media use on mental health and wellbeing among young people in England: a secondary analysis of longitudinal data, LANCET CHILD & ADOLESCENT HEALTH, Vol: 3, Pages: 685-696, ISSN: 2352-4642
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Viner R, Ward J, Hudson L, et al., 2019, Roles of cyberbullying, sleep and physical activity in mediating the impact of social media use on mental health and wellbeing: findings from a national cohort of English young people, The Lancet Child and Adolescent Health, Vol: 3, Pages: 685-696, ISSN: 2352-4642
BackgroundThere is growing concern about the potential associations between social media use and mental health and wellbeing in young people. We explored associations between the frequency of social media use and later mental health and wellbeing in adolescents, and how these effects might be mediated.MethodsWe did secondary analyses of publicly available data from the Our Futures study, a nationally representative, longitudinal study of 12 866 young people from age 13 years to 16 years in England. The exposure considered was the frequency of social media use (from weekly or less to very frequent [multiple times daily]) at wave 1 (participants aged 13–14 years) through wave 3 of the study (participants aged 15–16 years). Outcomes were mental health at wave 2 (with high 12-item General Health Questionnaire [GHQ12] scores [≥3] indicating psychological distress), and wellbeing at wave 3 (life satisfaction, feeling life is worthwhile, happiness, and anxiety, rated from 1 to 10 by participants). Analyses were adjusted for a minimal sufficient confounding structure, and were done separately for boys and girls. Cyberbullying, sleep adequacy, and physical activity were assessed as potential mediators of the effects.FindingsVery frequent use of social media increased from wave 1 to wave 3: from 34·4% (95% CI 32·4–36·4) to 61·9% (60·3–63·6) in boys, and 51·4% (49·5–53·3) to 75·4% (73·8–76·9) in girls. Very frequent social media use in wave 1 predicted a high GHQ12 score at wave 2 among girls (adjusted odds ratio [OR] 1·31 [95% CI 1·06–1·63], p=0·014; N=4429) and boys (1·67 [1·24–2·26], p=0·0009; N=4379). Persistent very frequent social media use across waves 1 and 2 predicted lower wellbeing among girls only (adjusted ORs 0·86 [0·74–0·99], N=3753, p=0·039
Beykloo M, Nicholls D, Simic M, et al., 2019, A survey on self-reported psychotropic drug prescribing practices of eating disorder psychiatrists for the treatment of young people with anorexia nervosa, BMJ Open, Vol: 9, ISSN: 2044-6055
Objectives: To survey current prescribing practices of psychotropic drugs by child and adolescent eating disorder (CAED) psychiatrists in the treatment of anorexia nervosa (AN). Design: Cross-sectional self-administered survey.Setting: All child and young people eating disorder services (CYP EDS) in England during a national training program. Participants: 44 child and adolescent eating disorder psychiatrists practicing in CYP EDS in England. Primary and secondary outcome measures: CAED psychiatrists completed a questionnaire regarding the pattern of psychopharmacological care in AN they provide and the medication treatment pattern at their CYP EDS. Secondary outcome measures included the process of continuing pharmacotherapy from secondary care to primary care. Results: Of the 77 CYP EDS representing every team in England, 44 teams represented by a CAED psychiatrist responded, despite 13 having no psychiatrists in post at the time of the study (response rate 69%). Most (40%) respondents estimated <10% of patients with AN were prescribed psychotropic medications. Olanzapine was reported as the most commonly prescribed medication for AN by 38% of respondents, followed by fluoxetine (29%) and sertraline (10%). The most common minimum olanzapine initiation dose in this study was at 2.5mg/day for a duration of 2 to 4 weeks, reaching a maximum dose of 5mg/day. Most (68%) reviewed medications every week (30%) or every two weeks (38%). Over 50% of respondents reported to continue olanzapine prescribing within the CYP EDS teams. Conclusions: This nationally representative survey showed that despite a lack of evidence, psychotropic medications are commonly prescribed to a minority of patients, most frequently olanzapine. Further evidence is needed on which patients may potentially benefit from pharmacotherapy as an adjunct to psychological interventions.
Mitrofan O, Petkova H, Janssens A, et al., 2019, Care experiences of young people with eating disorders and their parents: qualitative study, BJPsych Open, Vol: 5, ISSN: 2056-4724
BackgroundPerspectives of young people with eating disorders and their parents on helpful aspects of care should be incorporated into evidence-based practice and service design, but data are limited.AimsTo explore patient and parent perspectives on positive and negative aspects of care for young people with eating disorders.MethodSix online focus groups with 19 young people aged 16–25 years with existing or past eating disorders and 11 parents.ResultsThematic analysis identified three key themes: the need to (a) shift from a weight-focused to a more holistic, individualised and consistent care approach, with a better balance in targeting psychological and physical problems from an early stage; (b) improve professionals' knowledge and attitude towards patients and their families at all levels of care from primary to ‘truly specialist’; (c) enhance peer and family support.ConclusionsYoung people and parents identified an array of limitations in approaches to care for young people with eating disorders and raised the need for change, particularly a move away from a primarily weight-focused treatment and a stronger emphasis on psychological needs and individualised care.
Byford S, Petkova H, Stuart R, et al., 2019, Alternative community-based models of care for young people with anorexia nervosa: the CostED national surveillance study
<h4>Background</h4>Evidence suggests that investing in specialist eating disorders services for young people with anorexia nervosa could have important implications for the NHS, with the potential to improve health outcomes and reduce costs through reductions in the number and length of hospital admissions.<h4>Objectives</h4>The primary objectives were to evaluate the costs and cost-effectiveness of alternative community-based models of service provision for young people with anorexia nervosa and to model the impact of potential changes to the provision of specialist services.<h4>Design</h4>Observational surveillance study using the Child and Adolescent Psychiatry Surveillance System.<h4>Setting</h4>Community-based secondary or tertiary child and adolescent mental health services (CAMHS) in the UK and the Republic of Ireland.<h4>Participants</h4>A total of 298 young people aged 8–17 years in contact with CAMHS for a first episode of anorexia nervosa in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria.<h4>Interventions</h4>Community-based specialist eating disorders services and generic CAMHS.<h4>Main outcome measures</h4>Children’s Global Assessment Scale (CGAS) score (primary outcome) and percentage of median expected body mass index (BMI) for age and sex (%mBMI) (secondary outcome) were assessed at baseline and at 6 and 12 months.<h4>Data sources</h4>Data were collected by clinicians from clinical records.<h4>Results</h4>Total costs incurred by young people initially assessed in specialist eating disorders services were not significantly different from those incurred by young people initially assessed in generic CAMHS. However, adjustment for baseline covariates resulted in observed differences favouring specialist services (costs were lower, on average) because of the significantly poorer
Nicholls D, 2018, ARFID and other eating disorders of childhood, Eating Disorders and Obesity in Children and Adolescents, Pages: 29-33, ISBN: 9780323548533
Avoidant restrictive food intake disorder (ARFID) does not exclusively occur in childhood, although most literature to date relates to this age group. Data supporting the subcategorization of ARFID are emerging; a transdiagnostic approach to restrictive eating disorders (EDs) based on neurobiological commonalities also has merit. Prevalence data suggest ARFID is more common than EDs in middle childhood, but not all reach clinical care. Research on pica and rumination disorder, which are also relatively common in the population, is limited. Childhood-onset anorexia nervosa (AN) is emerging as distinct from adolescent-onset AN in risk and outcome.
Viner RM, Kinra S, Nicholls D, et al., 2018, Burden of child and adolescent obesity on health services in England, Arch Dis Child, Vol: 103, Pages: 247-254, ISSN: 0003-9888
OBJECTIVE: To assess the numbers of obese children and young people (CYP) eligible for assessment and management at each stage of the childhood obesity pathway in England. DESIGN: Pathway modelling study, operationalising the UK National Institute for Health and Care Excellence guidance on childhood obesity management against national survey data. SETTING: Data on CYP aged 2-18 years from the Health Survey for England 2006 to 2013. MAIN OUTCOME MEASURES: Clinical obesity (body mass index (BMI) >98th centile), extreme obesity (BMI >/=99.86th centile); family history of cardiovascular disease or type 2 diabetes; obesity comorbidities defined as primary care detectable (hypertension, orthopaedic or mobility problems, bullying or psychological distress) or secondary care detectable (dyslipidaemia, hyperinsulinaemia, high glycated haemoglobin, abnormal liver function). RESULTS: 11.2% (1.22 million) of CYP in England were eligible for primary care assessment and for community lifestyle modification. 2.6% (n=283 500) CYP were estimated to be likely to attend primary care. 5.1% (n=556 000) were eligible for secondary care referral. Among those aged 13-18 years, 8.2% (n=309 000) were eligible for antiobesity drug therapy and 2.4% (90 500) of English CYP were eligible for bariatric surgery. CYP from the most deprived quintile were 1.5-fold to 3-fold more likely to be eligible for obesity management. CONCLUSIONS: There is a mismatch between population burden and available data on service use for obesity in CYP in England, particularly among deprived young people. There is a need for consistent evidence-based commissioning of services across the childhood obesity pathway based on population burden.
White B, Doyle J, Matschull K, et al., 2017, Outcomes of 50 patients entering an adolescent bariatric surgery programme, Arch Dis Child, ISSN: 0003-9888
OBJECTIVE: Bariatric surgery is the most effective intervention for weight loss and obesity-related comorbidities currently available. Little is known about adolescents entering National Health Service (NHS) bariatric programmes. We aimed to characterise those entering a pathway and report their outcomes. DESIGN: Prospective service evaluation of patients assessed within a single NHS adolescent bariatric service. RESULTS: 50 patients assessed between 26 July 2007 and 27 January 2014; 6 (12%) were not eligible for surgery, 7 (14%) actively opted out, 8 (16%) were lost to follow-up and 29 (58%) underwent surgery (18 sleeve gastrectomy (SG) 11 Roux-en-y gastric bypass (RYGB) and 0 adjustable gastric band). Mean (SD) age at initial assessment was 16.0 (1.3) years and 18.3 (1.3) at surgery (youngest 15.7 years). Mean time taken to surgery was 1.8 years; longer in those with higher body mass index (BMI) and aged below 14 at first assessment. Mean (SD) BMI at surgery was 53.1 (8.3) kg/m(2), lower in those undergoing RYGB (-5.2, 95% CI -11.6 to 1.13). Follow-up was inconsistent and challenging; 1/29 (3.5%) was transferred to a regional centre, 10/29 (34.5%) attended ongoing follow-up within our protocol, 6/29 (20.7%) had intermittent monitoring and 12/29 (41.4%) were lost to follow-up. Mean BMI change at 1 year (-14.0 kg/m(2)) and complications were similar to published cohorts. Data from 11 lost to follow-up were obtained and outcomes appeared similar to those who actively followed up. CONCLUSION: Adolescent bariatric surgery in the NHS appears effective, with outcomes similar to those reported internationally. Further work is needed to optimise postsurgical surveillance and reduce age at surgery.
Pinhas L, Nicholls D, Crosby RD, et al., 2017, Classification of childhood onset eating disorders: A latent class analysis, Int J Eat Disord, Vol: 50, Pages: 657-664, ISSN: 0276-3478
This study tested the hypothesis that latent class analysis (LCA) would successfully classify eating disorder (ED) symptoms in children into categories that mapped onto DSM-5 diagnoses and that these categories would be consistent across countries. Childhood onset ED cases were ascertained through prospective active surveillance by the Australian Paediatric Surveillance Unit, the Canadian Paediatric Surveillance Program, and the British Paediatric Surveillance Unit for 36, 24, and 14 months, respectively. Pediatricians and child psychiatrists reported symptoms of any child aged </= 12 years with a newly diagnosed restrictive ED. Descriptive analyses and LCA were performed separately for all three countries and compared. Four hundred and thirty-six children were included in the analysis (Australia n = 70; Canada n = 160; United Kingdom n = 206). In each country, LCA revealed two distinct clusters, both of which presented with food avoidance. Cluster 1 (75%, 71%, 66% of the Australian, Canadian, and United Kingdom populations, respectively) presented with symptoms of greater weight preoccupation, fear of being fat, body image distortion, and over exercising, while Cluster 2 did not (all p < .05). Cluster 1 was older, had greater mean weight loss and was more likely to have been admitted to an inpatient unit and have unstable vital signs (all p < .01). Cluster 2 was more likely to present with a comorbid psychiatric disorder (p < .01). Clusters 1 and 2 closely resembled the DSM-5 criteria for anorexia nervosa and avoidant/restrictive food intake disorder, respectively. Symptomatology and distribution were remarkably similar among countries, which lends support to two separate and distinct restrictive ED diagnoses.
Nicholls D, 2017, Eating Disorders in Adolescence, Child Psychology and Psychiatry Frameworks for Clinical Training and Practice, Editors: Skuse, Bruce, Dowdney, Mrazek, Publisher: John Wiley & Sons, ISBN: 9781119170204
Comprehensive in its coverage of child emotional and behavioural development, emphasising evidence-based interventions, this book is valuable learning tool for all those training in clinical or educational psychology, social work, ...
Katzman DK, Madden S, Nicholls D, et al., 2017, From questions to answers: Examining the role of pediatric surveillance units in eating disorder research, Int J Eat Disord, Vol: 50, Pages: 259-265, ISSN: 0276-3478
Pediatric Surveillance Units (PSUs) provide a unique model for the study of pediatric eating disorders (EDs). Australia, Britain, and Canada have surveillance programs that have generated valuable epidemiological and clinical data on early-onset eating disorders (EOED). The PSUs represent an important collaborative tool that has helped shape our understanding of EOEDs and offers potential to contribute to decisions regarding health resource allocation and public health policy. This paper reviews the role of PSUs as a unique model to study pediatric EDs and its success in translating the knowledge generated by these programs into improving the health of children and adolescents with EDs worldwide.
Lewis B, Nicholls D, 2016, Behavioural eating disorders, Paediatrics and Child Health (United Kingdom), Vol: 26, Pages: 519-526, ISSN: 1751-7222
The eating disorders, anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED), manifest through distorted or chaotic eating and in the case of AN and BN are characterised by a morbid preoccupation with weight and shape. Whilst recent changes in diagnostic criteria have changed the landscape to some extent, eating disorders and partial syndromes, including avoidant/restrictive food intake disorder (ARFID), remain relatively common and early recognition and intervention is helpful. Aetiology is multifactorial, with high heritability. Prognosis overall is good but treatment can be long and intensive, significantly impacting families. An integrated multidisciplinary approach is essential, working collaboratively with families and young people. Psychological interventions focus on the eating disorder, supported by medical monitoring and dietetic guidance. Although working with families is the backbone of treatment for AN, young people also need opportunities for confidential discussion. For BN, family or individual approaches may be equally effective. Evidence for effectiveness of psychopharmacological agents is limited in both AN and BN. Psychological and pharmacological approaches may both be of benefit for BED. Cases of ARFID require individualised approaches, often involving anxiety reduction. Paediatric expertise is of particular value in the assessment and management of acute malnutrition and complications secondary to disordered eating behaviours, in the early stages of re-feeding, and in the monitoring and management of long-term complications such as growth retardation, pubertal delay and osteopenia. This article offers an overview of eating disorders in children offering advice for clinicians who will undoubtedly encounter them in clinical practice.
Mairs R, Nicholls D, 2016, Assessment and treatment of eating disorders in children and adolescents, Arch Dis Child, Vol: 101, Pages: 1168-1175, ISSN: 0003-9888
Feeding and eating disorders (FEDs) are serious mental health disorders that cause impairments in physical health, development, cognition and psychosocial function and can go undetected for months or years. They are characterised by disturbed eating behaviour associated with concerns about weight and shape or by disinterest in food, phobic avoidance or avoidance due to sensory aspects of food. Restrictive forms of FEDs lead to significant weight loss requiring intervention. Without specific knowledge of these conditions, they can evade detection, delaying time to diagnosis and treatment and potentially influencing outcome. This review article focuses on the key factors involved in the psychiatric assessment and treatment of four feeding or eating disorders (EDs): anorexia nervosa, avoidant-restrictive food intake disorder, bulimia nervosa and binge eating disorder. They have been chosen for discussion as they are most likely to be encountered in both a psychiatric and paediatric setting. It emphasises the importance of a family-focused, developmentally appropriate and multidisciplinary approach to care. It does not address aspects of medical assessment and treatment. Other feeding or EDs not included in this article are pica, rumination disorder, other specified feeding and eating disorder and unspecified feeding and eating disorder.
Nicholls D, Statham R, Costa S, et al., 2016, Childhood risk factors for lifetime bulimic or compulsive eating by age 30 years in a British national birth cohort, Appetite, Vol: 105, Pages: 266-273, ISSN: 0195-6663
OBJECTIVE: To examine whether previously identified childhood risk factors for bulimia or compulsive eating (BCE) predict self-reported lifetime BCE by age 30 years in a prospective birth cohort. METHOD: Using data from the 1970 British Cohort Study at birth, 5, and 10 years, associations between 22 putative childhood risk factors and self-reported lifetime BCE at 30 years were examined, adjusting for sex and socioeconomic status. RESULTS: Only female sex (odds ratio (OR): 9.2; 95% confidence interval (CI): 1.9-43.7; p = 0.005), low self-esteem (OR:2.9; 95%CI: 1.1-7.5; p = 0.03) and high maternal education (OR:5.4; 95%CI: 2.0-14.8; p = 0.001) were significantly associated with higher risk of BCE, whereas high SES at 10 years was significantly protective (OR:0.2; 95%CI: 0.1-0.8; p = 0.022) of BCE in fully adjusted multivariable logistic regression analysis. DISCUSSION: Our findings do not support a strong role for childhood weight status and eating behaviours in the development of bulimia and compulsive eating pathology, rather suggesting a focus on self esteem may have greater relative importance. Findings in relation to maternal education and SES need further exploration.
O'Connor G, Nicholls D, Hudson L, et al., 2016, Refeeding Low Weight Hospitalized Adolescents With Anorexia Nervosa: A Multicenter Randomized Controlled Trial, Nutr Clin Pract, Vol: 31, Pages: 681-689, ISSN: 0884-5336
BACKGROUND: Refeeding patients with anorexia nervosa (AN) is associated with high morbidity and mortality. A lack of evidence from interventional studies has hindered refeeding practice and led to worldwide disparities in management recommendations. In the first randomized controlled trial in this area, we tested the hypothesis that refeeding adolescents with AN with a higher energy intake than what many guidelines recommend improved anthropometric outcomes without adversely affecting cardiac and biochemical markers associated with refeeding. MATERIALS AND METHODS: Participants aged 10-16 years with a body mass index (BMI) <78% of the median (mBMI) for age and sex were recruited from 6 UK hospitals and randomly allocated to start refeeding at 1200 kcal/d (n = 18, intervention) or 500 kcal/d (n = 18, control). RESULTS: Compared with controls, adolescents randomized to high energy intake had greater weight gain (mean difference between groups after 10 days of refeeding, -1.2% mBMI; 95% confidence interval, -2.4% to 0.0%; P = .05), but randomized groups did not differ statistically in QTc interval and other outcomes. The nadir in postrefeeding phosphate concentration was significantly related to percentage mBMI at the start of refeeding (baseline; P = .04) and baseline white blood cell count (P = .005) but not to baseline energy intake (P = .08). CONCLUSIONS: Refeeding adolescents with AN with a higher energy intake was associated with greater weight gain but without an increase in complications associated with refeeding when compared with a more cautious refeeding protocol-thus challenging current refeeding recommendations.
Wells JC, Haroun D, Williams JE, et al., 2015, Body composition in young female eating-disorder patients with severe weight loss and controls: evidence from the four-component model and evaluation of DXA, European Journal of Clinical Nutrition, Vol: 69, Pages: 1330-1335, ISSN: 0954-3007
BACKGROUND/OBJECTIVES: Whether fat-free mass (FFM) and its components are depleted in eating-disorder (ED) patients is uncertain. Dual energy X-ray absorptiometry (DXA) is widely used to assess body composition in pediatric ED patients; however, its accuracy in underweight populations remains unknown. We aimed (1) to assess body composition of young females with ED involving substantial weight loss, relative to healthy controls using the four-component (4C) model, and (2) to explore the validity of DXA body composition assessment in ED patients. SUBJECTS/METHODS: Body composition of 13 females with ED and 117 controls, aged 10-18 years, was investigated using the 4C model. Accuracy of DXA for estimation of FFM and fat mass (FM) was tested using the approach of Bland and Altman. RESULTS: Adjusting for age, height and pubertal stage, ED patients had significantly lower whole-body FM, FFM, protein mass (PM) and mineral mass (MM) compared with controls. Trunk and limb FM and limb lean soft tissue were significantly lower in ED patients. However, no significant difference in the hydration of FFM was detected. Compared with the 4C model, DXA overestimated FM by 5 +/- 36% and underestimated FFM by 1 +/- 9% in ED patients. CONCLUSION: Our study confirms that ED patients are depleted not only in FM but also in FFM, PM and MM. DXA has limitations for estimating body composition in individual young female ED patients.
Robinson PH, Nicholls D, 2015, Critical Care for Anorexia Nervosa The MARSIPAN Guidelines in Practice, Publisher: Springer, ISBN: 9783319081748
This book focuses on the role of the psychiatric, medical, nutritional and psychiatric assessment and management of severely ill patients with anorexia nervosa.
Nicholls D, Barrett E, 2015, Eating disorders in children and adolescents, BJ Psych Advances, Vol: 21, Pages: 206-216, ISSN: 2056-4678
This article provides an overview of classification and outcome of eating disorders, before focusing on current evidence-based treatment for the two main disorders of anorexia nervosa and bulimia nervosa. LEARNING OBJECTIVES: • Recognise the changing view of eating disorders with respect to DSM-5/ICD-11 classifications • Recognise the differences between child and adolescent eating disorders and those of later onset • Understand the comprehensive approach to the management and treatment of eating disorders in young people.
White B, Doyle J, Colville S, et al., 2015, Systematic review of psychological and social outcomes of adolescents undergoing bariatric surgery, and predictors of success, Clin Obes, Vol: 5, Pages: 312-324, ISSN: 1758-8103
The psychological and social outcomes of bariatric surgery in adolescents, together with psychological and social predictors of success, were systematically reviewed. PubMed, EMBASE, ISI Web of Science and PsychInfo were searched on July 2014. Existing data were sparse; 15 were suitable for qualitative review and six for meta-analysis (four quality of life [QOL], two depression). One study was a randomized controlled trial. A total of 139 subjects underwent Roux-en-Y gastric bypass, 202 underwent adjustable gastric band and 64 underwent sleeve gastrectomy. Overall QOL improved after bariatric surgery, regardless of surgical type with peak improvement at 6-12 months. Meta-analysis of four studies showed changed in overall QOL at latest follow-up of 2.80 standard deviation (SD) (95% confidence interval [CI] 1.23-4.37). Depression improved across all studies, regardless of procedure (effect size -0.47 SD [95% CI -0.76, -0.18] at 4-6 months). Two cohorts reported changes in both overall QOL and depression following a quadratic trajectory, with overall improvement over 2 years and deterioration in the second post-operative year. There were limited data on other psychological and social outcomes. There were insufficient data on psychosocial predictors of outcome to form evidence-based recommendations for patient selection for bariatric surgery at this time.
Nicholls D, Barrett E, Huline-Dickens S, 2014, Atypical early-onset eating disorders, Advances in Psychiatric Treatment, Vol: 20, Pages: 330-339, ISSN: 1355-5146
This article reviews the recent changes to the DSM diagnostic classification of feeding and eating disorders with particular reference to children and adolescents. The common clinical presentations of the 'atypical' feeding and eating problems of middle childhood and early adolescence are reviewed using clinical case vignettes, and the limited evidence base regarding management is summarised. There are many gaps in the evidence base and this is likely to be an area of rapid development for the field subsequent on the new terminology outlined in DSM-5.
Nicholls D, Barrett E, 2014, Eating Disorders, Clinical Topics in Child and Adolescent Psychiatry, Editors: Huline-Dickens, Publisher: RCPsych Publications, ISBN: 9781909726178
This is a comprehensive update on the field that will inform the clinical practice of all child and adolescent mental health professionals.
O'Connor G, Nicholls D, 2013, Refeeding hypophosphatemia in adolescents with anorexia nervosa: a systematic review, Nutrition in Clinical Practice, Vol: 28, Pages: 358-364, ISSN: 0884-5336
The rate of adolescents presenting with anorexia nervosa (AN) is increasing. Medically unstable adolescents are admitted to the hospital for nutrition restoration. A lack of global consensus on appropriate refeeding practices of malnourished patients has resulted in inconsistent refeeding practices. Refeeding hypophosphatemia (RH) is the most common complication associated with refeeding the malnourished patient. This review sought to identify the range of refeeding rates adopted globally and the implication that total energy intake and malnutrition may have on RH while refeeding adolescents with anorexia nervosa. Studies were identified by a systematic electronic search of medical databases from 1980 to September 2012. Seventeen publications were identified, including 6 chart reviews, 1 observational study, and 10 case reports, with a total of 1039 subjects. The average refeeding energy intake was 1186 kcal/d, ranging from 125–1900 kcal/d, with a mean percentage median body mass index (% mBMI) of 78%. The average incidence rate of RH was 14%. A significant correlation between malnutrition (% mBMI) and post‐refeeding phosphate was identified (R 2 = 0.6, P = .01). This review highlights the disparity in refeeding rates adopted internationally in treating malnourished adolescents with anorexia nervosa. Based on this review, the severity of malnutrition seems to be a marker for the development of RH more so than total energy intake.
Hudson LD, Cumby C, Klaber RE, et al., 2013, Low levels of knowledge on the assessment of underweight in children and adolescents among middle-grade doctors in England and Wales, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 98, Pages: 309-311, ISSN: 0003-9888
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Nicholls D, Grindrod C, 2013, Behavioural eating disorders, Paediatrics and Child Health (United Kingdom), Vol: 23, Pages: 11-17, ISSN: 1751-7222
Eating disorders are serious mental health disorders characterized by morbid preoccupation with weight and shape, manifest through distorted or chaotic eating. Planned changes to diagnostic criteria will broaden the definition of feeding and eating disorders to include presentations characterized by restricted food intake not associated with weight and shape concerns. Anorexia nervosa (AN), bulimia nervosa (BN) and partial syndromes are relatively common, and early intervention is advisable. Aetiology is multifactorial, with high heritability. Prognosis overall is good but treatment can be long and intensive, significantly impacting families. Essential aspects of management are an integrated multidisciplinary approach, working collaboratively with families and young people when possible. Psychological interventions focus on the eating disorder, supported by medical monitoring and dietetic guidance. Although working with families is the backbone of treatment for AN, young people also need opportunities for confidential discussion. The role of inpatient treatment is evolving. For BN, family or individual approaches may be equally effective. Paediatric expertise is of particular value in the assessment and management of acute malnutrition and complications secondary to disordered eating behaviours, in the early stages of re-feeding, and in the monitoring and management of long-term complications such as growth retardation, pubertal delay and osteopenia. © 2012 Elsevier Ltd.
Nicholls D, 2013, Aetiology, Eating Disorders in Childhood and Adolescence, Editors: Lask, Bryant-Waugh, Publisher: Routledge, ISBN: 9780415686419
This fully revised edition offers a distillation of current information relating to the younger population, and contains brand new chapters on areas of experience, research and practice including: The perspective of a young person going ...
Hudson L, Nicholls D, Katzman D, et al., 2012, Eating disorder in children and adolescents - Risky business?, Psychiatrist, Vol: 36, ISSN: 1758-3209
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Lynn RM, Viner RM, Nicholls DE, 2012, Ascertainment of early onset eating disorders: a pilot for developing a national child psychiatric surveillance system, CHILD AND ADOLESCENT MENTAL HEALTH, Vol: 17, Pages: 109-112, ISSN: 1475-357X
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Nicholls D, Davies H, 2012, Treating Eating Disorders in Middle Childhood, The Oxford Handbook of Child and Adolescent Eating Disorders: Developmental Perspectives, Editors: Lock, Publisher: OUP USA, ISBN: 9780199744459
This book considers the risk, diagnosis, treatment, and outcome of eating disorders in children and adolescents from a developmental perspective.
Nicholls DE, Yi I, 2012, Early intervention in eating disorders: a parent group approach, Early Interv Psychiatry, Vol: 6, Pages: 357-367, ISSN: 1751-7885
AIM: Early intervention in eating disorders (EDs) has been a neglected area. Peak onset is in adolescence, suggesting that early intervention should include parents. We synthesize findings from five key theoretical domains, and present pilot data from a phase-specific early intervention for new onset EDs in young people. METHODS: From literature searches, we reviewed current knowledge on risk factors for EDs; ED prevention in young people; the evidence base for treatment for young people with EDs; early intervention in other mental health fields; and parenting interventions. Based on these findings, we devised and piloted a parent group intervention. RESULTS: Presenting features are typically parental concern about changes in eating behaviour and/or weight loss. There is a delay between symptom onset and help seeking, by which time the illness is well established. Early intervention should therefore target parents and be delivered at secondary rather than primary care. Effective treatments favour family-focused interventions with parental responsibility for symptom management. We hypothesized that a parents' group might be effective for addressing the specific emotional experience of parents in the early stages and their relative lack of knowledge and understanding. Pilot data show significant improvements in knowledge, skills, confidence, understanding and their child's adherence to meal plans as a result of a 6-week parent group intervention. CONCLUSION: A parent group intervention addressing themes identified from risk factor, prevention and treatment research is a potentially promising approach to early intervention for EDs. The impact of the intervention on patient outcome needs evaluation.
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