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Nicholls D.,Feeding and Eating Disorders Service | Nicholls D.,Institute of Child Health
Advances in Psychiatric Treatment | Year: 2014

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. Source

Nicholls D.,Feeding and Eating Disorders Service | Barrett E.,South London and Maudsley NHS Foundation Trust
Advances in Psychiatric Treatment | Year: 2015

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. Source

Nicholls D.,Child and Adolescent Psychiatry and Honorary Senior Lecturer | Grindrod C.,Feeding and Eating Disorders Service
Paediatrics and Child Health (United Kingdom) | Year: 2013

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. Source

Rose M.,The Huntercombe Group | Frampton I.J.,Feeding and Eating Disorders Service | Frampton I.J.,University of Oslo | Frampton I.J.,University of Exeter | And 2 more authors.
Applied Neuropsychology: Child | Year: 2014

The vast majority of studies in anorexia nervosa that have investigated the domains of central coherence, organizational strategy, and visuospatial memory have focused on adult samples. In addition, studies investigating visuospatial memory have focused on free recall. No study to date has reported the association between recognition memory and central coherence or organizational strategy in younger people with this disorder, yet the capacity to recognize previously seen visual stimuli may contribute to overall visuospatial ability. Therefore, we investigate these domains in children and adolescents with anorexia nervosa compared to age- and gender-matched healthy controls. There were no significant group differences in immediate, delayed, or recognition memory, central coherence, or organization strategy. When compared with controls, patients with anorexia nervosa scored significantly higher on accuracy and took significantly longer when copying the Rey Complex Figure Task. Caution must be taken when interpreting these findings due to lower-than-expected scores in memory performance in the control group and because of a potential lack of sensitivity in the measures used when assessing this younger population. For neuropsychological functions where no normative data exist, we need a deeper, more thorough knowledge of the developmental trajectory and its assessment in young people in the general population before drawing conclusions in anorexia nervosa. © 2014, Taylor & Francis Group, LLC. Source

Nicholls D.,Feeding and Eating Disorders Service | Hudson L.,University College London | Mahomed F.,Feeding and Eating Disorders Service
Archives of Disease in Childhood | Year: 2011

Clinical confidence and coordinated multidisciplinary care can influence the course of anorexia nervosa in children and adolescents. Sicker and younger patients with anorexia nervosa often present first to a paediatrician, requiring early recognition and appropriate management. Paediatric knowledge and skills are also needed to manage the impact of eating disorders on growth and development. This review provides practical guidance on the management of anorexia nervosa for paediatricians, in the areas of assessment, acute management and re-feeding, and long-term monitoring. In the absence of a strong evidence base for some of these recommendations, local protocols based on best practice guidelines can reduce anxiety, increase cooperation and reduce risk. Source

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