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Although eating disorders in children and adolescents remain a serious cause of morbidity and mortality, the evidence base for effective interventions is surprisingly weak. The adult literature is growing steadily, but this is mainly with regard to psychological therapies for bulimia nervosa and to some extent in the field of pharmacotherapy. This review summarises the recent research literature covering management in three areas, namely physical management, psychological therapies, and service issues, and identifies prognostic variables. Findings from the adult literature are presented where there is good reason to believe that these might be applied to younger patients. Evidence-based good practice recommendations from published clinical guidelines are also discussed. Suggestions for future research are made, focusing on 1) the need for trials of psychological therapies in anorexia nervosa, 2) applications of evidence-based treatments for adult bulimia nervosa to the treatment of adolescents, and 3) clarification of the benefits and costs of different service models.

A UK study of 35 UK anorexic patients, psychiatric patients, and groups of people with no clinical disorder looked at the differences between anorexics suffering from comorbid depression and those who were not depressed. Anorexics and psychiatric patients had similar Eating Disorder Inventory (EDI) ratings. There were great differences between those with no clinical disorder, known as community controls, and anorexics with comorbid depression, but little difference in ratings between community controls and non-depressive anorexics.

The prevalence of psychiatric disorder in children aged between eight and 12 in Calicut District, Kerala, India, is towards the lower end of the range of prevalence indicated in studies undertaken in other parts of the world. No evidence was found of any link between psychiatric disorder and height or body mass index. There was also no evidence that obstetric problems play a role in subsequent psychiatric disorder. There was found to be a link between externalizing disorder and adverse social conditions reflected in the poverty score and lower social class.

A study of the outpatient individual and family psychotherapy of 12 DSM-III-R anorexia nervosa patients after a 2-year follow up shows that the patients exhibited satisfactory improvements in psychological factors and physical factors such as weight and body mass index. A comparison of these results with those of patients allocated to only assessment and no treatment shows that after one year, outpatient therapy is more effective than assessment. An analysis of the prognostic indicators for the therapy suggests that although age of the patient is not a good predictor of treatment outcomes, the degree of compliance can influence its success.

Abstract Background Common mental health problems impose substantial challenges to patients, carers, and health care systems. A range of interventions have demonstrable efficacy in improving the lives of people experiencing such problems. However many people are disadvantaged, either because they are unable to access primary care, or because access does not lead to adequate help. New methods are needed to understand the problems of access and generate solutions. In this paper we describe our methodological approach to managing multiple and diverse sources of evidence, within a research programme to increase equity of access to high quality mental health services in primary care. Methods We began with a scoping review to identify the range and extent of relevant published material, and establish key concepts related to access. We then devised a strategy to collect - in parallel - evidence from six separate sources: a systematic review of published quantitative data on access-related studies; a meta-synthesis of published qualitative data on patient perspectives; dialogues with local stakeholders; a review of grey literature from statutory and voluntary service providers; secondary analysis of patient transcripts from previous qualitative studies; and primary data from interviews with service users and carers. We synthesised the findings from these diverse sources, made judgements on key emerging issues in relation to needs and services, and proposed a range of potential interventions. These proposals were debated and refined using iterative electronic and focus group consultation procedures involving international experts, local stakeholders and service users. Conclusions Our methods break new ground by generating and synthesising multiple sources of evidence, connecting scientific understanding with the perspectives of users, in order to develop innovative ways to meet the mental health needs of under-served groups.