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International audience; OBJECTIVE: The objective of this study was to evaluate the proportion of therapeutics that have proven their efficacy on patient-important outcomes with a high quality of evidence among Cochrane systematic reviews (SRs). METHODS: We surveyed a random sample of 400 SRs’ abstracts published between September 2012 and December 2015, which compared therapeutic interventions with at least a placebo or no intervention control. The primary endpoint was the proportion of SRs with a statistically significant efficacy on a patient-important outcome and with a high quality of evidence. RESULTS: Among the 400 abstracts surveyed, 32 (8%) found efficacy on a patient-important outcome with a high quality of evidence. Half of the 400 SRs (50.2%) evaluated a pharmacological intervention and 12% of these found efficacy of the intervention on a patient-important outcome with a reported high quality of evidence. CONCLUSION: Based on an analysis of 400 abstracts of SRs from the Cochrane Collaboration, we found that there is a low number of therapeutic interventions which have proven their efficacy on patient-important outcomes with a high quality of evidence.

This study aimed to estimate the 5-year mortality among people admitted into a transdisciplinary unit providing combined psychiatric and somatic rehabilitation treatment.In this retrospective study, we analyzed the clinical records of all individuals admitted into the transdisciplinary unit from 01/01/2011 to 12/31/2017 after a suicide attempt using violent means. Vital status was ascertained for these 215 people, a standardized mortality ratio (SMR) was calculated and Log-rank tests were used to identify factors associated with mortality.The crude mortality rate was 5.12% (11 deaths) and the SMR was 15.45 (95% CI = [7.71-27.65]; p 0.001) 5.40 years after admission into the transdisciplinary unit. Factors associated with mortality were: older age (29.91 years versus 25.30 years, p 0.001), a longer stay in acute care (p = 0.002) and a shorter stay in the transdisciplinary unit (p 0.001).Long-term mortality among people who have attempted suicide using violent means is 15 times higher than in the corresponding general young adult population. This study supports the hypothesis that the severity of a suicide attempt is associated with subsequent excess mortality. Therefore, there is a need to consolidate outpatient facilities that provide appropriate support for this specific population after discharge. These programmes need to ensure the continuity of coordinated psychiatric and somatic care and psychosocial rehabilitation in order to prevent the risk of suicide.

International audience; BACKGROUND: Persons who have attempt suicide by jumping often require intensive treatment for their somatic injuries and the high risk of future completed suicide. The FSEF (French Student Health Foundation) developed a Transdisciplinary unit specifically designed for these people. AIM: The aim of this study was to investigate psychiatric and somatic factors associated with Length Of Stay (LOS) in this unit. DESIGN: Cohort observational retrospective study. SETTING: The Transdisciplinary unit provide a dual approach, combining rehabilitation (physiotherapy, balneotherapy, occupational therapy, speech therapy, cognitive rehabilitation, social and family support) and psychiatric care. POPULATION: Men and women admitted into the Transdisciplinary unit, after a suicide attempt by jumping from a height with severe somatic injuries. METHODS: We examined the associations between potential predictors and LOS with Stepwise regressions: model 1 included all variables assessed at admission (age, sex, occupational status, psychiatric disorder history, height of the fall, type of injury, LOS in acute care units and dependences at admission); model 2: all variables at discharge (main psychiatric diagnosis, orientation at discharge, psychotropic treatments, pain treatments, arms mobility limitation, legs mobility limitation, sphincter disorders and dependences at discharge); final model: all significant variables in models 1 and 2. RESULTS: One hundred ninety-seven subjects were included (49.7% of men; mean age: 25.6 years, ±6.21). Most factors associated with LOS were related to injuries due to the suicide attempt. LOS in the Transdisciplinary unit increased with longer LOS in acute care (β=0.589; P=0.003), higher dependence for continence at admission (β=44.640; P

Contexte : Nombre de patients et de medecins generalistes montrent une reticence a parler du poids en consultation, alors que la pesee est un acte clinique routinier. Une etude a ete realisee afin d’explorer les modalites d’abord du poids en medecine generale et le vecu des patients adultes, quel que soit leur statut ponderal et leur motif de consultation.Methode : Une methode mixte a ete utilisee reposant sur une observation directe des consultations (avec une grille d’observation) et des entretiens menes en parallele a l’issue des consultations (avec un guide d’entretien) ; l’analyse descriptive des donnees d’observation et thematique a ete realisee en double aveugle des entretiens.Resultats : Au total, 187 consultations et 81 entretiens ont ete realises. En consultation, le poids etait majoritairement aborde par le medecin, selon trois approches : discussion seule, discussion et pesee, pesee seule. La demande de pesee etait parfois ressentie comme trop directive, et donc mal vecue par les patients, tandis que la discussion provoquait une reflexion sur un possible changement de comportement.Lors des entretiens, la majorite des patients declaraient avoir bien vecu la maniere dont le poids etait aborde, quel que soit ce dernier, grâce a la relation de confiance les liant a leur medecin ou au contexte de la consultation. Deux patientes l’avaient mal vecu, alors que leur indice de masse corporelle (IMC) etait considere comme normal. Le caractere intime de la perception du poids etait souligne. Pour le patient, l’œil etait invoque comme l’outil de mesure du poids, dont le medecin pouvait percevoir les variations.Conclusion : La confrontation de ces resultats exploratoires a permis l’emergence d’hypotheses, et questionne le role de la balance en consultation.

Background: The effectiveness of any national healthcare system is highly correlated with the strength of primary care within that system. A strong research basis is essential for a firm and vibrant primary care system. General practitioners (GPs) are at the centre of most primary care systems. Objectives: To inform on actions required to increase research capacity in general practice, particularly in low capacity countries, we collected information from the members of the European General Practice Research Network (EGPRN) and the European World Organization of Family Doctors (Wonca). Methods: A qualitative design including eight semi-structured interviews and two discursive workshops were undertaken with members of EGPRN and Wonca Europe. Appreciative inquiry methods were utilized. Krueger’s (1994) framework analysis approach was used to analyse the data. Results: Research performance in general practice requires improvements in the following areas: visibility of research; knowledge acquisition; mentoring and exchange; networking and research networks; collaboration with industry, authorities and other stakeholders. Research capacity building (RCB) strategies need to be both flexible and financially supported. Leadership and collaboration are crucial. Conclusion: Members of the GP research community see the clear need for both national and international primary care research networks to facilitate appropriate RCB interventions. These interventions should be multifaceted, responding to needs at different levels and tailored to the context where they are to be implemented. publishedVersion

The interweaving of malnutrition and symptoms of anxiety and depression in anorexia Nervosa (AN) is mentioned without any consensus regarding the course of anxious-depressive symptoms in relation to nutritional status in the course of treatment of patients with AN. The objectives of the current study in a large sample of AN inpatients were to assess the relationships between anxiety and depression symptoms and nutritional status both over the course of inpatient treatment and at discharge. 222 consecutive inpatients with AN (DSM-IV TR) were assessed (entrance and discharge) for duration of illness, psychiatric treatments, sociodemographic data and with psychometric scales for different psychopathological symptoms [depressive (BDI), anxiety and depressive (HAD scale), obsessive–compulsive (MOCI) and social phobia (LSAS fear score)]. Nutritional status was assessed with Body Mass Index (BMI) and body composition by bioelectrical impedance. The Fat free mass index [FFMI = FFM (kg)/height (m2)] was considered for the analysis. Two models were developed where the dependent variables were each psychopathological score at discharge (BDI, HAD anxiety, MOCI, and LSAS fear) in the cross-sectional model, and their variation in the longitudinal model (where a positive score reflected symptom decrease at discharge). A fixed set of predictors, defined on presumed clinical and statistical relevance (FFMI in the cross-sectional model and Variation of FFMI in the longitudinal model), were considered in each model, without any model selection procedure. This is the first study to confirm a positive relationship between the course of eating disorder symptoms and that of anxious-depressive symptoms during inpatient treatment of AN even after adjustment on a vast array of possibly confounding factors.

Behavioral, nutritional, and local risk factors for oral health are frequent in people with anorexia nervosa. However no self-report questionnaire is available for screening in clinical practice or for research purposes. The objective of this study was to design a questionnaire to identify risk factors and symptoms of oral diseases and to test its reliability as a self-report form among people with anorexia nervosa. A 26-item questionnaire was designed based on a sound literature review performed by a group of dentists, psychiatrists, and epidemiologists specialized in the field of eating disorders. Sixty-nine anorexia nervosa inpatients (mean age 18.72 ± 5.1) were included from four specialized units. The questionnaire was first self-reported by the patients, then the same questionnaire was administrated by a dentist during a structured face-to-face interview as the gold standard. The concordance between the two forms was evaluated globally and item per item using Cohen’s kappa statistical tests. The overall concordance between the self-report questionnaire and the face-to-face structured interview was 55%. Of the 26 items, 19 showed significant concordance. Items relating to water intake, extracted teeth, gingival status, and oral hygiene had the best concordance (all kappa coefficients &gt, 0.4). A questionnaire that identifies risk factors and symptoms of oral diseases in anorexia nervosa was developed and tested. The 26-item form of the questionnaire (long version) is moderately reliable as a self-reported form. A short version of the questionnaire, including the 10 most reliable items, is recommended for oral risk assessment in patients with anorexia nervosa. The clinical value of the self-administered questionnaire remains to be evaluated.

International audience; Background: Hypnosis in labour and childbirth is a complex intervention. Both qualitative and quantitative assessment methods have been used, but have targeted different outcomes. We followed a synergistic approach and a reconciliation strategy to further understand and evaluate this intervention.Methods: A mixed-method analysis of quantitative and qualitative evidence was conducted. The assessment of efficacy was based on a recent Cochrane review (9 trials, 2954 women randomised). Four qualitative studies and 4 case studies were included.Results: The outcomes addressed by the qualitative studies (mostly concerning maternal experiences) and in the quantitative studies (mostly concerning analgesic use) overlapped slightly. Discrepancies across results from the two study types suggested that response shift issues could occur.Conclusion: Patient-centred instruments exploring response shift issues would be of great value. Hypnosis can be presented as a technique enabling patients to have a positive birth experience.

Early detection of eating disorders (EDs) could improve their prognosis, decrease morbidity and mortality, and prevent the risk of evolution towards a chronic form and somatic, psychiatric and psychosocial complications. The objective of this review was to examine the current scientific data concerning the early detection of EDs, which is one of the facets of secondary prevention. A scoping literature review was carried out following the PRISMA-ScR criteria, including all articles on ED detection published up to 2021 on PUBMED and PSYCINFO. 43 articles were included. Anorexia nervosa and bulimia nervosa were the most widely studied disorders. The articles focused on professionals from the medical field (GPs, psychiatrists, gynaecologists, gastroenterologists and residents), from the paramedical field, from education and sport, and from the general population. The assessments conducted with the professionals receiving interventions aiming to improve detection demonstrated their efficacy. Interventions for ED detection in the general population and at school seemed less efficacious. The results highlighted some lines of action to be implemented. They pointed towards improving initial and continuing education for professional carers; e-learning could be an interesting solution for continuing education. Improving training with specific instructors, school personnel and sports professionals is also one of the solutions for a better detection of EDs. Specific recommendations could be published for fitness centre professionals to help them to deal with clients suspected of having an ED. Among secondary school students and in the general population, a better dissemination of mental health literacy and the development of mental health first aid programs could help improve early detection. Level I: Evidence obtained from systematic reviews.

Overweight patients feel stigmatized and are reluctant to talk about weight. Physicians question the efficiency of weight management. This work explored how the weight topic was initiated in GP consultations and the experience of patients about this action, whatever their weight or reason for consultation.Mixed method study conducted in parallel with direct observation of GPs' consultations by trainees (with a standardized observation grid) and semi directive interview (with guide) after the consultation. Analyses were descriptive on quantitative data, and thematic on verbatim (double blind coding).187 consultations were observed and 81 patients interviewed. In consultation, GPs initiated the majority of the weight discussions, with three types of approach: discussion alone, discussion and/or weighing, and weighing alone. GP's demands of weighing were very directive and sometimes seemed to make patients feel uncomfortable. The discussion about weight without weighing seemed to enhance a reflection on a possible change of patient's behavior.The joint analysis questions the scale's role in consultation since the discussion approach to the weight debate led to more patient mobilization and, according to them, "the weight is seen". For the patient, the eye appeared as a tool to measure weight, especially since the doctor could see variations.Comparing the results of the two exploratory studies, in order to better understand this little studied phenomenon, allowed for the emergence of hypotheses and questions the role of the scale in consultations.

The incidence and prevalence of eating disorders (ED) is low in general practice (GP) settings. Studies in secondary care suggest that the general practitioner has an important role to play in the early detection of patients with EDs. The aim of this study was to describe the effect (clinical outcomes and care trajectory) of screening for EDs among patients in general practice settings. A systematic review was conducted on Medline, PsycINFO, CINAHL, Embase and WOS. The studies included were to have been carried out in a primary care setting, with screening explicitly performed in GP practices and follow-up information. Ten studies met the inclusion criteria. For all ED patients, there was an increase in the frequency of consultations in GP setting, referrals to psychiatric resources and drug prescriptions such as antidepressants, following screening procedures. Clinical outcomes remained unclear and heterogeneous. One study focused on the course and outcome of ED patients identified by screening in the GP setting and reported recovery for anorexia nervosa (AN) and BN in more than half of the cases, after 4.8 years of mean follow-up. In this study, early age at detection predicted better recovery. Most of the literature on the role of the GP in screening for and managing EDs consists of opinion papers and original studies designed in a secondary care perspective. The impact of systematically screening for EDs in a primary care setting is not clarified and requires further investigation in collaborative cohort studies with a patient-centered approach, and outcomes focused on symptoms.

Purpose: To assess the prevalence of DSM-IV anorexia nervosa criteria, anorexia nervosa and subthreshold subgroups, and their incidence between the ages of 12 and 17 years using Cole’s international thinness cut-offs, and to characterize these anorexic adolescents by parental socioeconomic status and whether or not they reported receiving treatment. Method: In all, a representative sample of 39,542 French adolescents (19,658 girls and 19,884 boys) was recruited in a cross-sectional study in 2008. Anorexia nervosa DSM-IV diagnosis was determined by a self-administered questionnaire. Results: Among females, 0.5% (n = 105) met criteria for anorexia nervosa between the ages of 12 and 17 years, whereas among males, the prevalence was 0.03% (n = 6). In females, the prevalence of sub-threshold anorexia nervosa was found to be between 1.2% (n = 216) and 3.3% (n = 618); more than 75% were of the restrictive subtype. The highest incidence of anorexia nervosa was at 16 years. There was also a greater prevalence of sub-threshold anorexia nervosa subgroups among subjects with high parental socioeconomic status. More than half of the female adolescents who met the anorexia nervosa criteria reported receiving treatment for their disorder, versus 23% to 40% of the adolescents in the sub-threshold subgroups (P sample of adolescents. Using Cole’s international thinness cut-off could improve international comparability among studies. Adolescents from the higher socioeconomic categories were more likely to be anorexic.

Dropout rates from inpatient treatment for eating disorders are very high and have a negative impact on outcome. The purpose of this study was to identify personality factors predictive of dropout from hospitalization. A total of 64 adult patients with anorexia nervosa consecutively hospitalized in a specialized unit were included; 19 patients dropped out. The dropout group and the completer group were compared for demographic variables, clinical features, personality dimensions, and personality disorders. There was no link between clinical features and dropout, and among demographic variables, only age was associated with dropout. Personality factors, comorbidity with a personality disorder and Self-transcendence dimension, were statistically predictive of premature termination of hospitalization. In a multivariate model, these two factors remain significant. Personality traits (Temperament and Character Inventory personality dimension and comorbid personality disorder) are significantly associated with dropout from inpatient treatment for anorexia nervosa. Implications for clinical practice, to diminish the dropout rate, will be discussed.

Background The risk of mortality remains unclear for bulimia nervosa (BN) patients, especially the most severe. The aims of this study were to improve knowledge on BN and mortality. Methods With initial evaluation at admission, 258 BN (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) consecutive inpatients were included (1988–2004). Vital status was established from the French national register. Standardized Mortality Ratio (SMR) calculation and bivariate Cox analysis were performed for the hypothesised predictors of mortality. Results Mean follow-up duration was 10.5 years. Ten deaths were recorded, and the crude mortality ratio was 3.9%; SMR = 5.52 [CI95 (2.64–10.15)]. The majority of deaths were from suicide [6/10, SMR = 30.9 (5.7–68.7)]. The mean age at time of death was 29.6 years. Predictive factors were previous suicide attempt and low minimum BMI. Conclusions Severe BN patients are at higher risk of death (mainly suicide) especially if previous suicide attempt or previous low BMI. More studies are needed to confirm these results. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.

Objective: To compare clinical characteristics of men and women with severe AN and to analyze mortality in men. Method: One thousand and nine patients including 23 anorectic males were hospitalized in St. Anne Hospital in Paris between 1988 and 2004. Data were collected during hospitalization. Fatal outcome was assessed in 2008. Results: Men presented significantly later age of onset, were more likely to have a history of premorbid overweight than women and less likely to have attempted suicide. Mortality in men was high (standardized mortality ratio: 8.08; 95% CI: 1.62–23.62). Several predictive factors for mortality in men were identified: lower admission body mass index (BMI), later age at admission, and AN-R subtype. All the three deceased patients had dropped out from the inpatient unit. The 10-year survival did not differ between men and women, but men died sooner after hospitalization. Discussion: Male inpatients should receive close follow-up after their discharge, especially if they have a restrictive form of AN, present low BMI, or are older at admission. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)

Background Depression, anxiety and obsessive–compulsive disorder (OCD) frequently co-occur with Anorexia Nervosa (AN). Clinical consensus admits that depressive symptoms and anxiety are the sequelae of malnutrition in AN. This review presents a critical assessment of the literature that looked into the link between depression/anxiety symptoms in relation to malnutrition and their improvement throughout the treatment. Methods We performed a systematic search of literature in Medline and PsychInfo for all the studies done to investigate psychological factors in relation to malnutrition in AN using the keywords “Anorexia Nervosa”, “depression”, “anxiety”, “obsessive-compulsive disorder” and “malnutrition”. Only articles published between 1980 and 2010 in English or French were reviewed. From the articles on AN and depression, anxiety, and/or OCD, only the ones which investigated on the relation with malnutrition were kept. This search was complemented by a manual search. We also checked the reference lists of the articles we found. Results Seven papers were analyzed and critically reviewed for their methods and results. Results are contradictory and inconsistent at all levels of assessment. Conclusions Evidence based data is very rare. From the 7 reviewed studies, none of them draw the same conclusion. This is mainly due to the large differences in the samples' populations and the studies' protocols. Future studies are needed to focus on the relationship between depression/anxiety symptoms and malnutrition. A more critical nutritional assessment should be undertaken with multiple psychological assessment scales.

Dropout from anorexia nervosa inpatient treatment programs is frequent and is linked to a poorer outcome. This study aimed to identify predictive factors for dropout among anorexia nervosa inpatients. Between 1988 and 2004, 601 consecutive female inpatients with anorexia, restrictive (AN-R) or binge/purging (AN-B/P) subtype (Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)), were assessed at admission (clinical, socio-demographic, and psychological data). A stepwise logistic model was developed. Dropout rates were respectively 50.0% and 56.2% for AN-R and AN-B/P. Seven predictive factors were identified in multivariate analysis: having one or more children, low desired body mass index (BMI), a low minimum BMI, high scores on the SCL-90 paranoid ideation and the Morgan and Russell eating behavior subscales, and low educational status. Early dropouts had a particular profile: lower desired BMI, higher score on SCL90 paranoid subscale, and more impulsive behaviors (alcohol use, suicide attempts). Dropout appeared as a multifactorial event. In clinical practice, certain factors could serve as warning messages reflecting the severity of the illness (high EDI score and low minimum BMI); while others could be targeted before hospitalization (having at least one child and low desired BMI).

Background/Aims: To empirically classify phenotypes of eating disorders (ED) using latent class analysis (LCA), and to validate this classification based on clinical outcomes. Methods: LCA was applied to 968 inpatients. The resultant classes were validated by clinical outcomes including mortality. Results: A 5-class solution showed the best fit. The symptoms of latent class 1 (LC1; 26% of the sample) resembled anorexia nervosa (AN), bingeing-purging (AN-B/P) subtype; those of LC2 (23%) resembled bulimia nervosa; those of LC3 (11%) were close to AN-B/P without weight and body concerns; those of LC4 resembled restrictive anorexia nervosa (RAN) without weight and body concerns, and those of LC5 RAN. A history of hospitalization for ED was significantly more frequent for LC3 and LC4. The lowest BMI at admission were presented in LC4. LC1 showed the highest level of psychological disturbances and LC4 the lowest. LC3 and LC4 differed from LC1 and LC5 by higher percentages of treatment dropout (64.9 vs. 57.2 and 55.7 vs. 47.5%, respectively; overall p = 0.001). Survival rates tended to be different between the LC (p = 0.09). Conclusions: Subgroups of AN patients with low weight and body concerns seem more severe at hospitalization and more difficult to manage, with a higher rate of treatment dropout than the ‘typical’ AN patients.

Objective: Little is known concerning mortality and predictive factors for anorexia nervosa in-patients. This study aimed to establish mortality rates and identify predictors in a large sample of adults through a 10-year post in-patient treatment follow-up. Method: Vital status was established for 601 anorexia nervosa (DSM-IV) consecutive in-patients with initial evaluation at admission. Standardized mortality ratio (SMR) was calculated. Cox analyses for hypothesized predictors of mortality were performed. Results: Forty deaths were recorded. SMR was 10.6 [CI 95% (7.6-14.4)]. Six factors at admission were associated with death: older age, longer eating disorder duration, history of suicide attempt, diuretic use, intensity of eating disorder symptoms, and desired body mass index at admission. Conclusion: Anorexia nervosa in-patients are at high risk of death. This risk can be predicted by both chronicity and seriousness of illness at hospitalization. These elements should be considered as warnings to adapt care provision and could be targeted by treatment. Language: en

Objective: High dropout rates from inpatient treatment for Anorexia Nervosa (AN) pose a serious obstacle to successful treatment. Because dropping out of inpatient treatment may have a negative impact on outcome, it is important to understand why dropout occurs so that treatment can be targeted toward keeping patients in care. We therefore conducted a critical literature review of studies on dropout from inpatient treatment for AN. Method: Searches of Medline and PsycINFO revealed nine articles on this subject. Two were excluded because they did not differentiate AN from other eating disorders in analyses. Results: Results were scarce and conflicting, with methodological issues complicating comparisons. Weight on admission, AN subtype, eating disorder symptoms, greater psychiatric difficulty in general, and the absence of depression were related to dropout in multivariate analyses. Discussion: Authors should use a common definition of dropout and continue research on the identified predictors as well as potential predictors such as impulsivity and family factors. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2009

The association between cannabis use and health or behaviour problems is quite well established. Little is known about the risk markers related to occasional or former use. This work aims to explore associations between well-being in life and different levels of cannabis use.A total of 16 934 French adolescents completed self-administered multi-choice questionnaires (from the European Study ESPAD 2003) on substance consumption, psychopathology, socio-demographics and schooling. Four groups were defined according to cannabis use: Never-Users (no lifetime consumption and no consumption during the last month), Former Users (at least one lifetime consumption but none in the last month), Current Occasional Users (5 times during the previous month) and Current Heavy Users (or =5 times during the previous month). Analyses were performed with SAS 8.2 software and adjusted for gender and age.A total of 68.2% of students aged 12-19 years were Never-Users, 15.5% Former Users, 8.3% Current Occasional Users and 8.0% Current Heavy Users. When Former Users were compared with Never-Users, significant differences were found with regard to suicide attempt, odds ratio (OR) = 2.9 (2.4-3.4); multiple acts of violence, OR = 6.4 (5.4-7.7) and running away from home, OR = 3.1 (2.5-3.8). These differences were greater when Current Occasional Users were compared with Never-Users: suicide attempt, OR = 4.2 (3.5-5.0); multiple acts of violence, OR = 12.6 (10.2-15.5) and running away from home OR = 4.2 (3.4-5.4). Differences remain even after adjustment for alcohol and tobacco consumption.These results showed that occasional and even former marijuana use is associated with risky behaviour among adolescents.

We examined factors predictive of dropout from inpatient treatment for anorexia nervosa (AN) among adolescents in a prospective study of 359 consecutive hospitalizations for AN (DSM-IV). Patients were assessed at admission (clinical, socio-demographic, and psychological data). Multivariate analyses were performed. Drop-out (i.e. leaving hospital before the target weight is achieved) occurred in 24% (n=86) of hospitalizations; in 42.3% (n=30) of the cases, dropout was initiated by the treatment team and in 58.6% (n=41) by the patients and/or their parents. 18.6% (16/86) occurred during the first half of the inpatient program. Frequency of drop-out was significantly higher when the patient was living with only one parent, had been hospitalized previously, had a lower BMI at admission and was over 18 at admission. These elements should draw the attention of the clinician, so that he/she can prepare hospitalization with patients presenting lower admission BMI, particularly by motivational interventions for a better therapeutic alliance, and by the deployment of intensive accompaniment of single parents. Further studies aiming to replicate these results, and including the evaluation of other clinical dimensions such as impulsivity and other personality traits, are needed to elucidate this important topic.

Depression, anxiety and obsessive-compulsive disorder are frequently reported to co-occur with anorexia nervosa (AN). There is clinical consensus that depressive symptoms and anxiety may in part be sequelae of malnutrition in AN. However, evidence-based data are still very rare. The present study among severe AN patients investigates links between these psychological variants and nutritional status at admission and subsequent to nutritional rehabilitation. Twenty-four women with AN diagnosed according to the Diagnostic and Statistical Manual IV (DSM-IV) were included prospectively and consecutively at hospitalisation. Nutritional status was assessed by body mass index (BMI). Several psychological aspects were assessed using various scales for depression, anxiety, social phobia, obsessive and eating behaviour symptoms. Follow-up weights and heights at 4-12 years after hospital discharge were measured in 18 patients. BMI and all the scores except the Yale-Brown obsessive-compulsive scale (Y-BOCS) showed significant improvement between admission and discharge. This study highlights the fact that some of the depressive and anxiety symptoms at least partially decrease with nutrition rehabilitation. The improvement in the scores on the psychometric scales between admission and discharge was not correlated with BMI improvement. Psychometric scores at admission and at discharge were not correlated with BMI at follow-up. BMI at follow-up was correlated with minimum lifetime BMI (r=0.486, P=0.04). Future studies should use a better indicator for nutritional status than BMI alone, and should also consider the initial degree of weight loss and the rate at which weight was lost.

Chances are high, that when you read this, the 76th EGPRN meeting in Kusadasi, Turkey will be a past event. Between 16 and 19 May 2013, the meeting was held in parallel to the 12th National Congres...