NICE Bites – Eating disorders: recognition and treatment

This guideline covers recognition and treatment of eating disorders including anorexia nervosa, binge eating and bulimia nervosa for children, young people and adults | NICE

NICE Bites is a monthly prescribing bulletin published by North West Medicines Information centre which summarises key recommendations from NICE guidance. NICE Bites No 98 June 2017 includes one topic: Eating disorders: recognition and treatment. It includes the following sections: Identification and assessment, referral, treatment and management, anorexia nervosa, dietary advice for anorexia nervosa, low bone mineral density and anorexia nervosa, other specified feeding and eating disorders, medication risk management, health monitoring, diabetes.

NICE Bites: Eating disorders: recognition and treatment

New ways to treat depression in teenagers

By Ian Michael Goodyer (University of Cambridge) for The Conversation | Published online: 6 March 2017

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Image source: Mary Lock – Flickr // CC BY-NC-ND 2.0

Around one in 20 teenagers suffers from depression. Episodes can last for several months. Unfortunately, about 50% of teenagers who have a depressive episode are at risk of falling ill again, increasing the likelihood of relationship difficulties, educational failure and poor employment prospects. It’s important that treatments have a lasting effect to reduce the risk of becoming ill a second time.

My research investigates the causes of and treatments for adolescent mental illnesses, with a particular focus on depression. One of our key projects is evaluating the importance of various psychological treatments that are effective in helping young people with depression.

Only one treatment – cognitive behavioural therapy (CBT) – is approved by the UK’s National Institute for Health and Care Excellence (NICE) for treating depression in teenagers. Unfortunately, there is a shortage of CBT therapists in the UK. This means that many young people with depression are placed on a waiting list, increasing their risk of worsening mental health.

Read the full blog post here

Does more mental health treatment and less stigma produce better mental health?

Two articles published this week shine a revealing light on how the general public views mental health care and its practitioners | The Conversation

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Mental health problems continue to carry a heavy stigma. People who experience them are often feared, excluded, shamed and discriminated against. Overcoming that stigma is a high priority, not least because it’s a barrier to engaging people in treatments that might help them.

People suffering from mental health problems are not the only ones to experience the stigma of mental illness, however. Those who treat them sometimes share the burden. Just as the shadow of death falls on workers in the funeral industry, psychiatric stigma casts a shadow on the public image of mental health professionals.

Psychiatrists in particular have been concerned they are held in low esteem by the public and within the medical profession. This negative view of the field has significant consequences, such as making it difficult to recruit students into psychiatric training. The chronic under-funding of mental health research and treatment arguably reflects the same devaluation.

Read the full blog post here

Diagnosis and treatment of ADHD in Primary Care

Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder During Adolescence in the Primary Care Setting: A Concise Review

Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder with a worldwide prevalence of about 5% in school-age children. This review is intended to assist primary care providers (PCPs) in diagnosing and treating ADHD in adolescents.

PubMed, PsychInfo, and Science Citation Index databases were searched from March 1990 to 2015 with the keywords: ADHD, primary care/pediatrics and children/adolescents, abstracts addressing diagnosis and/or treatment with 105 citations identified including supplementary treatment guidelines/books.

Adolescent ADHD presents with significant disturbances in attention, academic performance, and family relationships with unique issues associated with this developmental period. Diagnostic challenges include the variable symptom presentation during adolescence, complex differential diagnosis, and limited training and time for PCPs to conduct thorough evaluations.

The evidence base for treatments in adolescence in comparison to those in children or adults with ADHD is relatively weak. Providers should be cognizant of prevention, early identification, and treatment of conditions associated with ADHD that emerge during adolescence as substance use disorders.

Adolescent ADHD management for the PCP is complex, requires further research, and perhaps new primary care psychiatric models, to assist in determining the optimal care for patients at this critical period.

Full reference: Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder During Adolescence in the Primary Care Setting: A Concise Review. Journal of Adolescent Health. Published Online:May 18, 2016

Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis

Zhou, X. et al. World Psychiatry. 2015 Jun; 14(2): 207–222.

Previous meta-analyses of psychotherapies for child and adolescent depression were limited because of the small number of trials with direct comparisons between two treatments. A network meta-analysis, a novel approach that integrates direct and indirect evidence from randomized controlled studies, was undertaken to investigate the comparative efficacy and acceptability of psychotherapies for depression in children and adolescents.

Systematic searches resulted in 52 studies (total N=3805) of nine psychotherapies and four control conditions. We assessed the efficacy at post-treatment and at follow-up, as well as the acceptability (all-cause discontinuation) of psychotherapies and control conditions.

At post-treatment, only interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) were significantly more effective than most control conditions (standardized mean differences, SMDs ranged from −0.47 to −0.96). Also, IPT and CBT were more beneficial than play therapy. Only psychodynamic therapy and play therapy were not significantly superior to waitlist.

At follow-up, IPT and CBT were significantly more effective than most control conditions (SMDs ranged from −0.26 to −1.05), although only IPT retained this superiority at both short-term and long-term follow-up. In addition, IPT and CBT were more beneficial than problem-solving therapy. Waitlist was significantly inferior to other control conditions.

With regard to acceptability, IPT and problem-solving therapy had significantly fewer all-cause discontinuations than cognitive therapy and CBT (ORs ranged from 0.06 to 0.33).

These data suggest that IPT and CBT should be considered as the best available psychotherapies for depression in children and adolescents. However, several alternative psychotherapies are understudied in this age group. Waitlist may inflate the effect of psychotherapies, so that psychological placebo or treatment-as-usual may be preferable as a control condition in psychotherapy trials.

Read analysis of the article via the Mental Elf Blog

View the full article here