Publications by authors named "Amy Harrison"

85 Publications

Developing a novel intervention for type 1 diabetes and disordered eating using a participatory action design process: Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY).

Diabet Med 2021 Nov 25:e14749. Epub 2021 Nov 25.

Department of Diabetes, Faculty of Life Sciences and Medicine, King's College London, London, UK.

Aim: To develop a cognitive behavioural therapy based intervention for people with type 1 diabetes and disordered eating using Experience-Based Co-Design as part of the Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY).

Methods: Fifteen people with type 1 diabetes and experience of disordered eating (33±11 years old, 22±12 years diabetes duration) and 25 healthcare professionals working in type 1 diabetes or eating disorders (44±9 years old; 14±10 years of professional experience) attended six Experience-Based Co-Design workshops from July 2019-March 2020 to collaboratively develop intervention content.

Results: We developed a cognitive behaviour therapy intervention "toolkit" that can be tailored for individual patient needs. Participants designed and revised toolkit materials to ensure acceptability and relevance for people with diabetes and disordered eating by engaging in guided discussion, brainstorming, and rapid testing to review toolkit prototypes in an iterative process. Workshop themes were 'Insulin titration'; 'Hypoglycaemia'; 'Coming to terms with diabetes'; 'Fear of weight gain'; 'Toolkit revision'; and 'Practical elements of STEADY therapy'. The intervention is focussed on improving diabetes self-care and embedded in a multidisciplinary healthcare approach. The intervention will be delivered in 12 sessions by a diabetes specialist nurse trained in cognitive behavioural therapy.

Conclusions: Through an iterative co-design process, people with type 1 diabetes and healthcare professionals collaboratively developed a novel intervention toolkit that can be used with a wide range of disordered eating presentations. The intervention will be tested in the STEADY feasibility randomized controlled trial.
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http://dx.doi.org/10.1111/dme.14749DOI Listing
November 2021

Successful Endovascular Therapy in COVID-19 Associated Pediatric Ischemic Stroke.

J Stroke Cerebrovasc Dis 2021 Dec 5;30(12):106152. Epub 2021 Oct 5.

Department of Neurology & Pediatrics, Emory University School of Medicine, Atlanta, GA, United States. Electronic address:

Cerebrovascular diseases attributed to coronavirus disease 2019 (COVID-19) are uncommon but can result in devastating outcomes. Pediatric acute ischemic strokes are themselves rare and with very few large vessel occlusion related acute ischemic strokes attributed to COVID-19 described in the literature as of date. COVID-19 pandemic has contributed to acute stroke care delays across the world and with pediatric endovascular therapy still in its infancy, it poses a great challenge in facilitating good outcomes in children presenting with acute ischemic strokes in the setting of COVID-19. We present a pediatric patient who underwent endovascular therapy for an internal carotid artery occlusion related acute ischemic stroke in the setting of active COVID-19 and had an excellent outcome thanks to a streamlined stroke pathway involving the vascular neurology, neuro-interventional, neurocritical care, and anesthesiology teams.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.106152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491968PMC
December 2021

How to Respond to a Ransomware Attack? One Radiation Oncology Department's Response to a Cyber-Attack on Their Record and Verify System.

Pract Radiat Oncol 2021 Oct 10. Epub 2021 Oct 10.

Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.

The digitization of healthcare for patient safety and efficiency introduced third party networks into closed hospital systems increasing the probability of cyberattacks and their consequences(1). In April 2021, a major vendor of a Radiation Oncology (RO) record and verify system (RVS) suffered a ransomware attack, affecting our department and many others across the United States. This article summarizes our response to the ransomware event including workflows, team member roles, responsibilities, communications and departmental recovery. The RVS created or housed accurate patient dose records for 6 locations. The immediate response to the ransomware attack was to shut down the system including the ability to treat patients. With the utilization of the hospital EMR and pre-existing interfaces with RVS, the department was able to safely continue patient radiotherapy treatments innovatively utilizing a direct Digital Imaging and Communications in Medicine (DICOM) transfer of patient data to the linear accelerators and implementing paper charting. No patients were treated in the first 24 hours of the attack. Within 48 hours of the ransomware event, 50% of patients were treated, and within 1 week, 95% of all patients were treated using direct DICOM transfer and paper charts. The RVS was completely unavailable for 2.5 weeks and full functionality was not restored for 4.5 weeks. A phased approach was adopted for re-introduction of patient treatments back into the RVS. Human capital costs included communication, outreach, workflow creation, quality assurance and extended clinical hours. Key lessons learned were to have a back-up of essential information, employ 'dry run' emergency training, having consistent parameter requirements across different vendor hardware and software, and having a plan for the recovery effort of restoring normal operations once software is operational. The provided report presents valuable information for the development of cyber-attack preparedness for RO departments.
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http://dx.doi.org/10.1016/j.prro.2021.09.011DOI Listing
October 2021

Association of Emotion Regulation Trajectories in Childhood With Anorexia Nervosa and Atypical Anorexia Nervosa in Early Adolescence.

JAMA Psychiatry 2021 Nov;78(11):1249-1257

Division of Psychiatry, University College London, London, United Kingdom.

Importance: People with anorexia nervosa often experience difficulties regulating their emotions. There is no longitudinal evidence as to whether these differences are already present in childhood or when they begin to emerge.

Objective: To investigate the association between emotion regulation trajectories from 3 to 7 years of age and symptoms of anorexia nervosa and atypical anorexia nervosa in adolescence.

Design, Setting, And Participants: This cohort study included all children with complete exposure data in the Millennium Cohort Study, a UK general population birth cohort. Data were acquired from June 2001 to March 2016 and analyzed from June to November 2020.

Exposures: Mothers reported on their children's emotion regulation skills at 3, 5, and 7 years of age using the Children's Social Behavior Questionnaire. Multilevel models were used to derive early childhood emotion regulation scores (ie, predicted intercept) and within-child changes in emotion regulation scores from 3 to 7 years of age (ie, predicted slope).

Main Outcome And Measures: Symptoms consistent with a DSM-5 diagnosis of anorexia nervosa or atypical anorexia nervosa at 14 years of age, defined using a range of questions relative to body image, weight perception, and dieting behaviors (hereinafter referred to as broad anorexia nervosa). Univariable and multivariable logistic regression models tested the association between exposures and outcome. Regression models were adjusted for child and family sociodemographic and socioeconomic characteristics and mental health difficulties, prenatal and perinatal factors, child's cognitive development, and maternal attachment.

Results: A total of 15 896 participants (85.7% of total sample; 51.0% boys; 84.5% White individuals) had complete data on the exposure and were included in the main analyses. Among those with complete exposure and outcome data (9912 of the analytical sample [62.4%]), 97 participants (1.0%; 86 [88.7%] girls and 85 [87.6%] White individuals) had symptoms consistent with a diagnosis of broad anorexia nervosa at 14 years of age. No evidence suggested that children with lower emotion regulation ability at 3 years of age had greater odds of later reporting symptoms of broad anorexia nervosa (odds ratio [OR], 1.21; 95% CI, 0.91-1.63). However, children whose emotion regulation skills did not improve over childhood and who had greater problems regulating emotions at 7 years of age had higher odds of having broad anorexia nervosa at 14 years of age (OR, 1.45; 95% CI, 1.16-1.83).

Conclusions And Relevance: These findings suggest that difficulties in developing age-appropriate emotion regulation skills in childhood are associated with experiencing broad anorexia nervosa in adolescence. Interventions to support the development of emotion regulation skills across childhood may help reduce the incidence of anorexia nervosa.
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http://dx.doi.org/10.1001/jamapsychiatry.2021.1599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264752PMC
November 2021

High-Dose-Rate Brachytherapy for the Treatment of Basal and Squamous Cell Carcinomas on Sensitive Areas of the Face: A Report of Clinical Outcomes and Acute and Subacute Toxicities.

Adv Radiat Oncol 2021 Mar-Apr;6(2):100616. Epub 2020 Dec 16.

Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.

Purpose: Basal cell and cutaneous squamous cell carcinoma are common malignancies (keratinocyte carcinomas [KCs]). Surgical resection is the standard of care. Radiation using high-dose rate brachytherapy (HDR-BT) may serve as a superior alternative where surgical scars may be of cosmetic concern or in elderly patients with significant comorbidity. We aim to describe the clinical and cosmetic outcomes as well as posttreatment radiation toxicities associated with HDR-BT in patients who were treated for KCs of the face.

Methods And Materials: Patients with KCs treated with HDR-BT from 2015 to 2018 were included in the study. Patient medical records and clinical photos were reviewed at multiple time points: start of treatment, end of treatment, short-term (2 week) follow-up, 3-month follow-up, and if needed at 6 months. Radiation toxicity was graded using the Radiation Therapy Oncology Grading (RTOG) acute toxicity scale. Median (range) toxicity grades at follow-up intervals were calculated. Clinical outcomes including local recurrence were evaluated for all patients.

Results: The study included 19 patients and 20 KCs. The median radiation dose was 42 Gy (39-42 Gy) over 6 fractions. The median toxicity at completion of treatment was RTOG grade 2 (85% of patients). At short-term follow-up, 50% of patients (n = 10) improved to RTOG grade 1 (0-2). At 3 months, 70% of patients (n = 14) had RTOG grade 0, and by 6 months, 100% of patients (n = 18) had RTOG grade 0. No RTOG grade 3 or higher skin toxicity was observed. With a median follow-up of 7.2 months (range, 1.3-54.4 months), the local recurrence-free survival was 95%.

Conclusions: We demonstrate that HDR-BT can be used as definitive treatment of KCs of the face with excellent cosmetic outcomes and local control. Acute and subacute skin toxicities were most commonly RTOG grade 2 or less with resolution of patient's skin toxicity by 3 months.
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http://dx.doi.org/10.1016/j.adro.2020.10.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071728PMC
December 2020

A cognitive behavioural model of the bidirectional relationship between disordered eating and diabetes self care in people with type 1 diabetes mellitus.

Diabet Med 2021 Jul 6;38(7):e14578. Epub 2021 May 6.

Diabetes Research Group, Weston Education Centre, King's College London, London, UK.

Aims: This qualitative study aimed to develop the first cognitive behavioural therapy model outlining the development and maintenance of disordered eating in type 1 diabetes and report on recovery strategies and resilience factors to improve previous theoretical models of type 1 diabetes and disordered eating.

Methods: Twenty-three women (n = 9 with type 1 diabetes and disordered eating, n = 5 with type 1 diabetes recovering from disordered eating, and n = 9 with type 1 diabetes without disordered eating) participated in semi-structured interviews. Data were analysed using grounded theory and individual cognitive-behavioural formulations were developed for each participant to inform the development/maintenance and resilience models.

Results: The development/maintenance model summarises commonly experienced vicious cycles of thoughts, feelings and behaviours in type 1 diabetes and disordered eating. The resilience model summarises strategies and knowledge acquired by those with type 1 diabetes in recovery from disordered eating and individuals with type 1 diabetes who did not develop disordered eating. Early adverse life events, past psychiatric history, perfectionist personality traits, difficult experiences around type 1 diabetes diagnosis and its relentless daily management sensitise individuals to eating, weight and shape cues. Alongside physical symptoms/complications, unhelpful interpersonal reactions and inadequate healthcare, vicious cycles of thoughts, feelings and behaviours develop. 'Good enough' psychological adaptation to type 1 diabetes, integrating type 1 diabetes into one's identity, self care and compassion around eating, weight and shape were key protective/post-traumatic resilience factors.

Conclusions: This first cognitive behavioural therapy model of type 1 diabetes and disordered eating informed by personal experience will inform an intervention for type 1 diabetes and disordered eating.
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http://dx.doi.org/10.1111/dme.14578DOI Listing
July 2021

Believing emotions are uncontrollable is linked to eating disorder psychopathology via suppression and reappraisal.

J Eat Disord 2021 Apr 1;9(1):43. Epub 2021 Apr 1.

UCL Institute of Education, University College London, London, UK.

Objective: Research suggests that beliefs about emotional controllability influence the use of emotion regulation strategies, which in turn impact psychological health and illness. However, no research has yet investigated whether emotional controllability is linked to eating psychopathology. The current study investigates whether these concepts are related, as individuals with eating disorders have problems with emotion regulation.

Method: We collected self-report data from 718 participants from a community sample using validated questionnaires, and ran mediational analyses to assess the relationship between emotional controllability and eating psychopathology, via reappraisal and suppression, two emotion regulation strategies.

Results: Our mediational analyses suggest that believing emotions to be uncontrollable relates to high levels of suppression (β = -.08), low levels of reappraisal (β = .19) and poorer eating disorder psychopathology (β = -.11). Reappraisal and suppression were found to partially mediate the relationship between emotional controllability and eating psychopathology.

Discussion: The current study has demonstrated relationships that support investigations relating emotional controllability, emotion regulation and psychological health. This research has potential implications for developing interventions to target beliefs about emotions in order to help improve emotion regulation skills and eating psychopathology.
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http://dx.doi.org/10.1186/s40337-021-00395-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015150PMC
April 2021

Dosimetric Comparisons of Simulation Techniques for Left-Sided Breast Cancer in the COVID-19 Era: Techniques to Reduce Viral Transmission and Respect the Therapeutic Ratio.

Cureus 2021 Feb 15;13(2):e13354. Epub 2021 Feb 15.

Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA.

Background The COVID-19 pandemic challenges our ability to safely treat breast cancer patients and requires revisiting current techniques to evaluate optimal strategies. Potential long-term sequelae of breast radiation have been addressed by deep inspiration breath-hold (DIBH), prone positioning, and four-dimensional computed tomography (4DCT) average intensity projection (AveIP)-based planning techniques. Dosimetric comparisons to determine the optimal technique to minimize the normal tissue dose for left-sided breast cancers have not been performed. Methods Ten patients with left-sided, early-stage breast cancer undergoing whole breast radiation were simulated in the prone position, supine with DIBH, and with a free-breathing 4DCT scan. The target and organs at risk (OAR) contours were delineated in all scans. Target volume coverage and OAR doses were assessed. One-way analysis of variance (ANOVA) and Kruskal-Wallis one-way ANOVA were used to detect differences in dosimetric parameters among the different treatment plans. Significance was set as p < 0.05. Results We demonstrate differences in heart and lung dose by the simulation technique. The mean heart doses in the prone, DIBH, and AveIP plans were 129 cGy, 154 cGy, and 262 cGy, respectively (p=0.02). The lung V20 in the prone, DIBH, and AveIP groups was 0.5%, 10.3% and 9.5%, respectively (p <0.001). Regardless of technique, lumpectomy planning target volume (PTV) coverage did not differ between the three plans with 95% of the lumpectomy PTV volume covered by 100.4% in prone plans, 98.5% in AveIP plans, and 99.3% in DIBH plans (p=0.7). Conclusions Prone positioning provides dosimetric advantages as compared to DIBH. When infection risks are considered as in the current coronavirus disease 2019 (COVID-19) pandemic, prone plans have advantages in reducing the risk of disease transmission. In instances where prone positioning is not feasible, obtaining an AveIP simulation may be useful in more accurately assessing heart and lung toxicity and informing a risk/benefit discussion of DIBH vs free breath-hold techniques.
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http://dx.doi.org/10.7759/cureus.13354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968704PMC
February 2021

Social-emotional functioning in young people with symptoms of eating disorders: A gender inclusive analogue study.

Brain Behav 2021 03 9;11(3):e02017. Epub 2021 Jan 9.

Department of Psychology and Human Development, Institute of Education, University College London, London, UK.

Introduction: Contemporary models of eating disorders (EDs) suggest that EDs are maintained by social-emotional difficulties. However, supporting evidence is derived largely from female, clinic-based samples. This study, which refrained from gender specific inclusion criteria, aimed to improve understanding of social-emotional functioning in a large community-based analogue sample of young adults aged 16-26.

Methods: Five hundred and forty-four participants (85.1% female; mean age 21, SD = 4.3) completed the Eating Attitudes Test, Clinical Outcomes in Routine Evaluation, Difficulties in Emotion Regulation Scale, Social Phobia Inventory, Revised Social Anhedonia Scale, Toronto Alexithymia Scale, and the Reading the Mind in the Eyes Task.

Results: One hundred and sixty-four participants scored over the EAT-26 clinical cutoff, and a two-way multivariate analysis of covariance found a medium-sized, statistically significant main effect of group on social-emotional functioning (F(5, 530) = 6.204, p ≤ .001, Wilks' Λ = 0.945, d = 0.48.), suggesting that individuals with significant ED symptoms found it more challenging to notice, label, and regulate emotions in themselves and recognize emotions in others. Gender did not significantly impact social-emotional functioning (F(10, 1,060) = 0.556, p = .850, Wilks' Λ = 0.990), and there was no significant group by gender interaction (F(10, 1,060) = 0.688, p = .737, Wilks' Λ = 0.987).

Conclusion: These data suggest that the social-emotional difficulties, particularly with emotion recognition and regulation, present in clinical samples are also evident in young people of all genders with significant disordered eating. Future work could aim to recruit an even more gender-diverse community sample to further elucidate social-emotional functioning in individuals in the community with significant disordered eating.
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http://dx.doi.org/10.1002/brb3.2017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994675PMC
March 2021

The Presentation of Eating Disorders in Saudi Arabia.

Front Psychol 2020 21;11:586706. Epub 2020 Dec 21.

Sleep Education and Research Laboratory, UCL Institute of Education, London, United Kingdom.

: There is lack of information on the presentation of eating disorders (EDs) in Saudi Arabia using gold standard clinical tools. The present study aimed to provide data on the presentation of EDs in Saudi Arabia using clinically validated measures. : Hundred and thirty-three individuals (33 male) with a mean age of 22 years (2.63) completed three measures: the Eating Disorder Examination (EDE), a semi-structured interview, the Eating Disorder Examination Questionnaire (EDE-Q), a self-report measure, and the Depression Anxiety and Stress Scale (DASS-21) to measure comorbid symptoms. : Individuals in Saudi Arabia reported higher levels of restraint, eating concern and shape concern and a higher global score, but lower levels of weight concern on the EDE-Q compared to the EDE. Female participants reported a higher global score, alongside significantly higher scores on the restraint, shape concern and weight concern subscales than males. The most common ED subtype was other specific feeding or ED. Compared with Western community samples, symptom severity in this purposive sample obtained from community settings was significantly higher in this sample. : Individuals with eating, weight and shape concerns in Saudi Arabia may feel more comfortable expressing their symptoms on a self-report tool compared with a face to face interview. However, it is possible that a self-report measure may over-estimate the severity of symptoms. The data suggest that clinicians in Saudi Arabia should regularly screen for EDs in all genders. It is also important to note that ED symptoms are a cause for concern in young people in Saudi Arabia.
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http://dx.doi.org/10.3389/fpsyg.2020.586706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779393PMC
December 2020

The value of including families in the treatment of anorexia nervosa.

Eur Eat Disord Rev 2021 May 22;29(3):393-401. Epub 2020 Dec 22.

South London and Maudsley NHS Foundation Trust, Adult Inpatient Eating Disorders Service, Tyson West 2, Bethlem Royal Hospital, Beckenham, UK.

The aim of this paper is to consider family and wider carer involvement in the treatment of anorexia nervosa, and how this can be used to add value to services. We discuss widely adopted interventions involving the family that have been manualised and studied in trials that have outcome measures that are of relevance to illness costs. The therapeutic targets of these interventions range from a focus on feeding to the wellbeing of the whole family. The theoretical models that underpin interventions involving the family/wider carers include both intra and interpersonal processes, with the exception of family-based therapy, which in its original form holds an agnostic stance towards aetiology. Although formal evaluation of the cost effectiveness of these interventions is minimal, there is evidence that involving the family can reduce bed use and improve the wellbeing of both patients and family members. Moreover, for the most part, these interventions are acceptable to patients and carers. Finally, we consider how these approaches can be disseminated and scaled up more widely into services.
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http://dx.doi.org/10.1002/erv.2816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246805PMC
May 2021

Individual and group format adjunct therapy on social emotional skills for adolescent inpatients with severe and complex eating disorders (CREST-A).

Neuropsychiatr 2020 Nov 30. Epub 2020 Nov 30.

Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.

Background: Relatively little is known about which psychological treatment adjuncts might be helpful for supporting people with the most severe and complex forms of anorexia nervosa (AN) with very low weight and malnutrition requiring inpatient admissions, but targeting key perpetuating factors such as social emotional difficulties may be one way to advance knowledge. This pilot feasibility project reports on the development of an adolescent adaptation of Cognitive Remediation and Emotion Skills Training (CREST-A) and explores its acceptability, feasibility and possible benefits.

Methods: An uncontrolled, repeated measures design was employed with data collected at the start and end of treatment. CREST‑A was investigated in two formats: a 10-session individual format delivered to a case series of 12 patients and a 5-session group format delivered to 3 groups of 9 patients.

Results: Acceptability, measured using a Patient Satisfaction Scale was 7/10 for the individual and 6/10 for the group format. Individual take-up was 100% and group take-up was 34.62%. Drop-out was 8.33% and 29.63% in the individual and group formats respectively. Homework was completed 66.67% and 75% of the time in the individual and group formats respectively. Patients reported medium-sized improvements in components of social emotional functioning measured using the Work and Social Adjustment Scale, the Toronto Alexithymia Scale and the Revised Social Anhedonia Scale in the individual and group formats.

Conclusion: Future studies employing randomized controlled designs may now be warranted to advance this evidence base of this low intensity treatment adjunct.
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http://dx.doi.org/10.1007/s40211-020-00375-5DOI Listing
November 2020

Slow oscillation density and amplitude decrease across development in pediatric Duchenne and Becker muscular dystrophy.

Sleep 2021 04;44(4)

Pulmonology Department, Children's Hospital of Orange County, Orange, CA.

Study Objectives: From childhood through adolescence, brain rhythms during non-rapid eye movement (NREM) sleep show dramatic development that mirror underlying brain maturation. For example, the function and characteristics of slow oscillations (SOs, <1 Hz) in healthy children are linked to brain development, motor skill, and cognition. However, little is known of possible changes in pediatric populations with neurologic abnormalities.

Methods: We measured slow oscillations in 28 Duchenne and Becker muscular dystrophy male patients from age 4 to 20 years old during overnight in-lab clinical sleep studies. We compared our pediatric patients by age to evaluate the developmental changes of SOs from childhood to early and late adolescence.

Results: Consistent with the current neuro- and physically typical literature, we found greater slow oscillation density (count of SOs per minute of each sleep stage) in NREM N3 than N2, and significantly greater slow oscillation density in frontal compared to central and occipital regions. However, separating patients into age-defined groups (child, early adolescent, and late adolescent) revealed a significant age effect, with a specific decline in the rate and amplitude of SOs.

Conclusions: We found that with age, pediatric patients with Duchenne muscular dystrophy show a significant decline in slow oscillation density. Given the role that slow oscillations play in memory formation and retention, it is critical to developmentally characterize these brain rhythms in medically complex populations. Our work converges with previous pediatric sleep literature that promotes the use of sleep electroencephalographic markers as prognostic tools and identifies potential targets to promote our patients' quality of life.
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http://dx.doi.org/10.1093/sleep/zsaa240DOI Listing
April 2021

Disordered eating in women with type 1 diabetes: Continuous glucose monitoring reveals the complex interactions of glycaemia, self-care behaviour and emotion.

Diabet Med 2021 02 23;38(2):e14446. Epub 2020 Nov 23.

Diabetes Research Group, King's College London, Weston Education Centre, London, UK.

Objectives: Glycaemia in people with type 1 diabetes and disordered eating is not well characterised. We explored the glycaemia, self-care behaviour and emotional state of women with type 1 diabetes and disordered eating.

Research Design And Methods: In all, 13 women with and 10 without disordered eating and type 1 diabetes participated in this case-control study. We used a mixed-methods approach with a 7-day blinded continuous glucose monitoring and real-time record of non-prompted capillary glucose (CG), emotion, activity and physical symptoms on a diabetes diary using a smartphone application (mySugr®). We compared groups using Mann-Whitney U test or Fisher's exact test. We conducted thematic analyses of free-text diary entries (NVivo®) and quantitative analysis of emotion/symptom tags.

Results: People with type 1 diabetes and disordered eating spent longer time above range in level 2 hyperglycaemia (>13.9 mmol/L, Median [interquartile range]: 21% [16,60] vs 5% [2,17], p = 0.015). They had lower time in range and similar time below range compared to those without disordered eating. The standard deviation of CG was significantly higher in the disordered eating group (4.7 mmol/L [4.5, 6.1] vs 3 [2.8, 3.2], p = 0.018). The median of the percentage of rising sensor glucose trends was three times higher in the disordered eating group. They also had higher negative emotional and physical symptoms associated with high blood glucose (>15 mmol/L).

Conclusions: Disordered eating has a significant impact on the glycaemia and emotion of a person with type 1 diabetes.
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http://dx.doi.org/10.1111/dme.14446DOI Listing
February 2021

A Critical Review of Studies Assessing Interpretation Bias Towards Social Stimuli in People With Eating Disorders and the Development and Pilot Testing of Novel Stimuli for a Cognitive Bias Modification Training.

Front Psychol 2020 29;11:538527. Epub 2020 Sep 29.

Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.

People with eating disorders display a negative interpretation bias towards ambiguous social stimuli. This bias may be particularly relevant to young people with the illness due to the developmental salience of social acceptance and rejection. The overall aim of this study was to systematically develop and validate stimuli for a cognitive bias modification training to reduce a social rejection-related negative interpretation bias in young people with eating disorders. A mixed-methods design was used to achieve this aim. A review of the literature was conducted using EMBASE, MEDLINE, PsycINFO, Web of Science, and PubMed. Six studies were included in the review. Focus groups were held with patients with eating disorders, carers and healthcare professionals. Content analysis was used to identify key themes from the qualitative data. Based on these themes, a total of 339 scenarios were generated by the researchers. Salient themes identified from the focus group data included virtual rejection/exclusion, rejection associated with an aspect of the eating disorder, rejection triggered by ambiguous/benign comments or behaviors of others and rejection perceived when confiding in others. Patients rated these scenarios in terms of their age-relevance and emotional salience and 301 scenarios were included in the final stimulus set. These materials may be used by researchers conducting future experimental research into the potential benefits of interpretation bias training for young people with eating disorders.
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http://dx.doi.org/10.3389/fpsyg.2020.538527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556207PMC
September 2020

Autistic Traits Mediate Reductions in Social Attention in Adults with Anorexia Nervosa.

J Autism Dev Disord 2021 Jun;51(6):2077-2090

Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.

Anorexia nervosa (AN) is associated with difficulties in social and emotional functioning. A significant proportion of individuals with AN show autistic traits, which may influence social attention. This study examined attention to faces and facial features in AN, recovered AN (REC), and healthy controls, as well as relationships with comorbid psychopathology. One hundred and forty-eight participants' eye movements were tracked while watching a naturalistic social scene. Anxiety, depression, alexithymia, and autistic traits were assessed via self-report questionnaires. Participants with AN spent significantly less time looking at faces compared to REC and controls; patterns of attention to individual facial features did not differ across groups. Autistic traits mediated the relationship between group and time spent looking at faces.
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http://dx.doi.org/10.1007/s10803-020-04686-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124046PMC
June 2021

Exploring Relationships Between Autism Spectrum Disorder Symptoms and Eating Disorder Symptoms in Adults With Anorexia Nervosa: A Network Approach.

Front Psychiatry 2020 12;11:401. Epub 2020 May 12.

Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.

Over the past few decades, research has accumulated to suggest a relationship between anorexia nervosa (AN) and autism spectrum disorder (ASD). Elevated ASD traits are present in around one third of those with AN, and there is some evidence to suggest that ASD traits are associated with more severe eating disorder (ED) psychopathology. The current study aimed to examine relationships between ED and ASD symptoms in individuals with a lifetime history of AN using network analysis. One hundred and one participants completed the ED Examination Questionnaire (EDE-Q) and the Social Responsiveness Scale (SRS-2). A regularized partial correlation network was estimated using a graphical least absolute shrinkage and selection operator. Expected influence (EI) and bridge EI values were calculated to identify central and bridge symptoms respectively. Isolation, difficulties with relating to others, and feelings of tension during social situations were most central to the network, while poor self-confidence, concerns over eating around others, and concerns over others seeing one's body were the strongest bridge symptoms. Our findings confirm that interpersonal problems are central to ED psychopathology. They also suggest poor self-confidence and social anxiety-type worries may mediate the relationship between ED and ASD symptoms in those with a lifetime diagnosis of AN. Longitudinal studies examining fluctuations in symptoms over time may be helpful in understanding direction of causality.
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http://dx.doi.org/10.3389/fpsyt.2020.00401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235355PMC
May 2020

Emotion Recognition Abilities in Adults with Anorexia Nervosa are Associated with Autistic Traits.

J Clin Med 2020 Apr 8;9(4). Epub 2020 Apr 8.

Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AB, UK.

Difficulties in socio-emotional functioning are proposed to contribute to the development and maintenance of anorexia nervosa (AN). This study aimed to examine emotion recognition abilities in individuals in the acute and recovered stages of AN compared to healthy controls (HCs). A second aim was to examine whether attention to faces and comorbid psychopathology predicted emotion recognition abilities. The films expressions task was administered to 148 participants (46 AN, 51 recovered AN, 51 HC) to assess emotion recognition, during which attention to faces was recorded using eye-tracking. Comorbid psychopathology was assessed using self-report questionnaires and the Autism Diagnostic Observation Schedule-2nd edition (ADOS-2). No significant differences in emotion recognition abilities or attention to faces were found between groups. However, individuals with a lifetime history of AN who scored above the clinical cut-off on the ADOS-2 displayed poorer emotion recognition performance than those scoring below cut-off and HCs. ADOS-2 scores significantly predicted emotion recognition abilities while controlling for group membership and intelligence. Difficulties in emotion recognition appear to be associated with high autism spectrum disorder (ASD) traits, rather than a feature of AN. Whether individuals with AN and high ASD traits may require different treatment strategies or adaptations is a question for future research.
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http://dx.doi.org/10.3390/jcm9041057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230901PMC
April 2020

Do anxiety, depression, and intolerance of uncertainty contribute to social problem solving in adult women with anorexia nervosa?

Brain Behav 2020 06 9;10(6):e01588. Epub 2020 Apr 9.

Department of Psychology and Human Development, Institute of Education, University College London, London, UK.

Introduction: Inefficient problem solving in the social domain may be one of the difficulties underlying the interpersonal challenges thought to maintain anorexia nervosa (AN). However, past studies have neglected to control for depression, anxiety, and intolerance of uncertainty (IU), which are known to contribute to social problem solving.

Methods: This study aimed to investigate whether adults with AN would show differences in social problem solving on an experimental task (Means-End Problem Solving; MEPS) and report differences in their attitudes (positive, negative) toward social problem solving and their use of social problem-solving styles (rational, impulsive-careless, avoidant) on the Social Problem-Solving Inventory Revised (SPSRI) compared to a non-AN control group.

Results: Seventy-four adult women took part (30 with AN and 44 non-AN controls), and data show that those with AN generated significantly less effective solutions on the MEPS (d = 1.96) reported overall poorer social problem solving on the SPSRI (d = 0.58), reporting more negative and less positive attitudes toward social problem solving, and less impulsive and more avoidant social problem-solving styles. However, those with AN did not differ from controls in being able to rationalize social problems. Once depression (Beck Depression Inventory: BDI), state anxiety (State-Trait Anxiety Inventory: STAI), and IU (Intolerance of Uncertainty Scale-12; IUS-12) were included as covariates, these differences were no longer significant, suggesting that comorbid depression, anxiety, and IU symptoms may contribute to social problem solving in AN.

Conclusions: There was no specific effect of depression. Treating anxiety and IU might help to improve social problem solving and enable people with AN to be able to better access social support to aid their recovery.
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http://dx.doi.org/10.1002/brb3.1588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303378PMC
June 2020

The social responsiveness scale is an efficient screening tool for autism spectrum disorder traits in adults with anorexia nervosa.

Eur Eat Disord Rev 2020 07 3;28(4):433-444. Epub 2020 Apr 3.

Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.

Objective: A significant proportion of individuals with anorexia nervosa (AN) show high levels of autism spectrum disorder (ASD) traits, a factor associated with poorer treatment outcomes. An important question for both researchers and clinicians relates to how ASD traits should be assessed in individuals with AN. This study aimed to examine scores on the Social Responsiveness Scale adult self-report version (SRS-2) in individuals in the acute (AN) and recovered stages (REC) of illness compared to healthy controls (HCs). We also aimed to examine associations between the SRS-2 and an observational diagnostic measure, the Autism Diagnostic Observation Schedule - second edition (ADOS-2).

Method: The SRS-2 and ADOS-2 were administered to 142 adults with AN, REC, and HCs. Eating disorder (ED) psychopathology and functional impairment were also assessed.

Results: AN and REC scored significantly higher than HCs on the SRS-2. SRS-2 scores significantly predicted ADOS-2 classification and were positively associated with ED psychopathology and functional impairment. SRS-2 scores were not associated with BMI or illness duration.

Conclusions: The SRS-2 may be a useful tool in screening for ASD traits in individuals with AN. Although cross-sectional, the results also suggest ASD symptoms are independent of BMI and persist in individuals recovered from AN.
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http://dx.doi.org/10.1002/erv.2736DOI Listing
July 2020

A phase IB clinical trial of 15 Gy HDR brachytherapy followed by hypofractionated/SBRT in the management of intermediate-risk prostate cancer.

Brachytherapy 2020 May - Jun;19(3):282-289. Epub 2020 Mar 23.

Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.

Purpose: High dose-rate (HDR) brachytherapy is commonly administered as a boost to external beam radiation therapy (EBRT). Our purpose was to compare toxicity with increasingly hypofractionated EBRT in combination with a single 15 Gy HDR boost for men with intermediate-risk prostate cancer.

Methods And Materials: Forty-two men were enrolled on this phase IB clinical trial to one of three EBRT dose cohorts: 10 fractions, seven fractions, or five fractions. Patients were followed prospectively for safety, efficacy, and health-related quality of life (Expanded Prostate Index Composite). Efficacy was assessed biochemically using the Phoenix definition.

Results: With a median follow up of 36 months, the biochemical disease-free survival was 95.5%. One man developed metastatic disease at 5 years. There was no significant minimally important difference in EPIC PRO for either urinary, bowel, or sexual domains. There was one acute Grade 3 GI and GU toxicity, but no late Grade 3 GU or GI toxicities.

Conclusion: Fifteen gray HDR brachytherapy followed by a five fraction SBRT approach results in high disease control rates and low toxicity similar to previously reported HDR protocols with significant improvement in patient convenience and resource savings. While mature results with longer follow up are awaited, this treatment approach may be considered a safe and effective option for men with intermediate-risk disease.
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http://dx.doi.org/10.1016/j.brachy.2020.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172676PMC
January 2021

Autism spectrum disorder traits are associated with empathic abilities in adults with anorexia nervosa.

J Affect Disord 2020 04 29;266:273-281. Epub 2020 Jan 29.

King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom; South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, United Kingdom; Department of Psychology, Ilia State University, Tbilisi, Georgia.

Background: Social and emotional difficulties have been identified as key factors in the development and maintenance of anorexia nervosa (AN). However, few studies have investigated the influence of comorbid psychopathology on social cognition. The aim of the current study was to examine perception of nonverbal communication and empathy in AN using ecologically valid, performance-based measures, and to explore associations with comorbid psychopathology (anxiety, depression, autism spectrum disorder (ASD) traits, alexithymia, and social anxiety).

Methods: In this cross-sectional study, the Multifaceted Empathy Test (MET) and the Mini Profile of Nonverbal Sensitivity (MiniPONS) were administered to 51 adults with AN, 51 recovered AN (REC), and 51 healthy controls (HCs). Comorbid psychopathological traits were assessed using self-report questionnaires and the Autism Diagnostic Observation Schedule - 2nd edition (ADOS-2).

Results: Individuals with AN showed reduced affective empathy to positive stimuli compared to HCs, and a trend towards lower vocal prosody recognition scores relative to REC. Around a quarter of AN and REC scored above the clinical cut-off for ASD on the ADOS-2, and high ASD symptoms predicted lower cognitive and affective empathy scores.

Limitations: The study is cross-sectional, future research would benefit from examining social-cognition performance and comorbid psychopathology longitudinally.

Conclusions: The findings highlight the importance of ASD symptoms in empathy dysfunction in those with a lifetime history of AN. Future research should explore whether treatment adaptations to accommodate for differences in social-cognitive abilities may be helpful in the treatment of AN.
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http://dx.doi.org/10.1016/j.jad.2020.01.169DOI Listing
April 2020

Single institution implementation of permanent Cs interstitial brachytherapy for previously irradiated patients with resectable recurrent head and neck carcinoma.

J Contemp Brachytherapy 2019 Jun 28;11(3):227-234. Epub 2019 Jun 28.

Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, United States.

Purpose: Permanent interstitial brachytherapy is an appealing treatment modality for patients with locoregional recurrent, resectable head and neck carcinoma (HNC), having previously received radiation. Cesium-131 (Cs) is a permanent implant brachytherapy isotope, with a low average photon energy of 30 keV and a short half-life of 9.7 days. Exposure to medical staff and family members is low; patient isolation and patient room shielding are not required. This work presents a single institution's implementation process of utilizing an intraoperative, permanent Cs implant for patients with completely resected recurrent HNC.

Material And Methods: Fifteen patients receiving Cs permanent seed brachytherapy were included in this analysis. The process of pre-planning, selecting the dose prescription, seed ordering, intraoperative procedures, post-implant planning, and radiation safety protocols are described.

Results: Tumor volumes were contoured on the available preoperative PET/CT scans and a pre-implant treatment plan was created using uniform source strength and uniform 1 cm seed spacing. Implants were performed intraoperatively, following tumor resection. In five of the fifteen cases, intraoperative findings necessitated a change from the planned number of seeds and recalculation of the pre-implant plan. The average prescription dose was 56.1 ±6.6 Gy (range, 40-60 Gy). The average seed strength used was 2.2 ±0.2 U (3.5 ±0.3 mCi). Patients returned to a recovery room on a standard surgical floor and remained inpatients, without radiation safety restrictions, based on standard surgical recovery protocols. A post-implant treatment plan was generated based on immediate post-operative CT imaging to verify the seed distribution and confirm delivery of the prescription dose. Patients were provided educational information regarding radiation safety recommendations.

Conclusions: Cesium-131 interstitial brachytherapy is feasible and does not pose major radiation safety concerns; it should be considered as a treatment option for previously irradiated patients with recurrent, resectable HNC.
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http://dx.doi.org/10.5114/jcb.2019.85778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701381PMC
June 2019

"Our daily life was mainly comprised of eating and sitting:" a qualitative analysis of adolescents' experiences of inpatient eating disorder treatment in China.

Authors:
Yi Wu Amy Harrison

J Eat Disord 2019 17;7:20. Epub 2019 Jun 17.

Department of Psychology and Human Development, Institute of Education, University College London, 25 Woburn Square, London, WC1H 0AA UK.

Background: Some individuals with Eating Disorders (EDs) require hospitalization to stabilize and improve life-threatening physical complications. The experiences of those receiving inpatient treatment for EDs are well-documented in western samples, but less is known about the experiences of those in China, the world's most populous country in which the incidence of EDs may be increasing.

Methods: This qualitative study aimed to use Interpretative Phenomenological Analysis to understand the experiences of four adolescents receiving inpatient treatment for EDs in China. Individual, semi-structured interviews were conducted.

Results: Four themes emerged from the data: perceptions of the treatment received, peer influences during admission, the impact of treatment on wellbeing and participants' sense of self.

Conclusions: This is the first published study on the experience of Chinese participants with EDs. Their experiences share commonalities with those reported by participants in Western studies and also illuminate differences in how EDs are understood and managed in inpatient settings in China. Cross-cultural collaborations will be important to share knowledge and practice.
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http://dx.doi.org/10.1186/s40337-019-0250-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572752PMC
June 2019

Evaluation of a novel transition support intervention in an adult eating disorders service: ECHOMANTRA.

Int Rev Psychiatry 2019 06 27;31(4):382-390. Epub 2019 Mar 27.

a South London and Maudsley NHS Foundation Trust , Bethlem Royal Hospital , Kent , United Kingdom.

Admissions and re-admissions for inpatient care for anorexia nervosa have been increasing. The aim of this study was to examine whether the transition from inpatient care to the community could be facilitated by supplementing usual treatment with ECHOMANTRA (transition interventions) for both patients and carers. A case series study was employed using a mixed-methods approach to measure the feasibility and efficacy of augmenting intensive hospital treatment with ECHOMANTRA. A consecutive series of consenting patients ( 31) and carers ( 21) were assessed on admission, discharge, and at 3 months follow-up. These outcomes were compared with audit data ( 152) previously collected (2007-2017). The length of stay for the ECHOMANTRA intervention group was 4.5 weeks less than the comparison group, and weight gain was 0.11 kg per week higher. Improvements in patient symptomology were sustained at follow-up. Thematic analysis of the feedback from both patients and carers suggests that the intervention is valued. Carer burden was reduced and their skills improved (both moderate size changes). In conclusion, both the acceptability and efficiency of inpatient care for anorexia nervosa may be improved by augmenting treatment to prepare for transition from inpatient care by giving support to both patients and their carers.
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http://dx.doi.org/10.1080/09540261.2019.1573721DOI Listing
June 2019

Neurohospitalist Practice, Perspectives, and Burnout.

Neurohospitalist 2019 Apr 30;9(2):85-92. Epub 2018 Dec 30.

Evergreen Hospital Medical Center, Kirkland, WA, USA.

Background And Purpose: Neurohospitalist neurology is a fast-growing subspecialty with a variety of practice settings featuring neurohospitalist models of care. Since inception, the subspecialty has responded to new challenges in resident training, hospital reimbursement, practice, and burnout.

Methods: To characterize neurohospitalists' current practice and perspectives, we surveyed the neurohospitalists and trainees affiliated with the Neurohospitalist Society using an electronic survey distributed through the society listserv.

Results: Of 501 individuals surveyed by e-mail, 119 began the survey (23.8% response rate), with 88.2% self-identifying as neurohospitalists. Most neurohospitalists (63%) are 10 years or less out of training, devoting 70% of their professional time to inpatient clinical activities while also performing administrative or teaching activities. Only 38% are employed by an academic department. Call schedules are common, with 75% of neurohospitalists participating in a hospital or emergency call schedule, while 55% provide telemedicine services. The majority (97%) of neurohospitalists primarily care for adults, most commonly treating patients with cerebrovascular disease, seizures, and delirium/encephalopathy. The majority (87%) are overall pleased with their work, but 36% report having experienced burnout.

Conclusions: Neurohospitalists are a diverse group of neurologists primarily practicing in the inpatient setting while performing a variety of additional activities. They provide a wide array of clinical expertise for acute neurological diseases and neurological emergencies that require hospitalization, including stroke, seizure, and encephalopathy. Neurohospitalists in general are very pleased with their work, while burnout, as in neurology and other areas of medicine, remains a concern.
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http://dx.doi.org/10.1177/1941874418813029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429679PMC
April 2019

Cognitive and Affective Empathy in Eating Disorders: A Systematic Review and Meta-Analysis.

Front Psychiatry 2019 4;10:102. Epub 2019 Mar 4.

Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.

Recent models of eating disorders (EDs) have proposed social and emotional difficulties as key factors in the development and maintenance of the illness. While a number of studies have demonstrated difficulties in theory of mind and emotion recognition, little is known about empathic abilities in those with EDs. Further, few studies have examined the cognitive-affective empathy profile in EDs. The aim of this systematic review and meta-analysis was to provide a synthesis of empathy studies in EDs, and examine whether those with EDs differ from healthy controls (HC) on self-reported total, cognitive, and affective empathy. Electronic databases were systematically searched for studies using self-report measures of empathy in ED populations. In total, 17 studies were identified, 14 of which could be included in the total empathy meta-analysis. Eight of the 14 studies were included in the cognitive and affective empathy meta-analyses. Meta-analyses showed that while total empathy and affective empathy scores did not differ between those with anorexia nervosa (AN) and HC, those with AN had significantly lower cognitive empathy scores compared to HCs (small effect size). Meta-analyses of Interpersonal Reactivity Index sub-scores revealed that AN had significantly lower Fantasy scores than HC (small effect size), indicating that those with AN have more difficulty in identifying themselves with fictional characters. Only 3 studies examined empathy in those with bulimia nervosa (BN) or binge eating disorder (BED). The lowered cognitive empathy and intact affective empathy profile found in AN is similar to that found in other psychiatric and neurodevelopmental conditions, such as autism spectrum disorder (ASD). These findings add to the literature characterizing the socio-emotional phenotype in EDs. Future research should examine the influence of comorbid psychopathology on empathy in EDs.
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http://dx.doi.org/10.3389/fpsyt.2019.00102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410675PMC
March 2019

Web-based indicated prevention of common mental disorders in university students in four European countries - Study protocol for a randomised controlled trial.

Internet Interv 2019 Apr 15;16:35-42. Epub 2018 Mar 15.

King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO59, 16 De Crespigny Park, London SE5 8AF, United Kingdom.

Background: Mental disorders and their symptoms are highly prevalent in the university student population, and the transition from secondary to tertiary education is associated with a rise in mental health problems. Existing web-based interventions for the prevention of common mental disorders in student populations often focus on just one disorder and have not been designed specifically for students. There is thus a need for transdiagnostic, student-specific preventative interventions that can be widely disseminated. This two-arm, parallel group randomised controlled trial aims to evaluate the effectiveness and cost-effectiveness of a web-based transdiagnostic mental health problem prevention programme (PLUS) across several universities in four countries.

Method: Students ( = 5550) will be recruited through a variety of channels and asked to complete a personality assessment to determine whether they are at high risk for developing common mental disorders. Students at high risk will be randomly allocated to either PLUS or a control intervention, which provides practical support around issues commonly experienced at university. Students at low risk will be allocated to the control intervention. Both intervention groups will be assessed at baseline, 4 weeks, 3 months, 6 months and 12 months after randomisation. Depression and generalised anxiety, assessed using the Patient Health Questionnaire and the Generalised Anxiety Disorder scales, will form the primary outcomes in this study. Secondary outcome measures include alcohol and drug use, eating behaviour, self-esteem, and quality of life. The cost-effectiveness of the intervention will also be evaluated.

Conclusions: This study will contribute to understanding the role of transdiagnostic indicated web-based interventions for the prevention of common mental disorders in university students. It will also be one of the first studies to investigate the cost-effectiveness of such interventions.

Trial Registration: This trial was registered in the ISRCTN register (ISRCTN15570935) on 12th February 2016.
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http://dx.doi.org/10.1016/j.invent.2018.02.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364328PMC
April 2019

SpaceOAR to improve dosimetric outcomes for monotherapy high-dose-rate prostate implantation in a patient with ulcerative colitis.

J Contemp Brachytherapy 2018 Dec 28;10(6):577-582. Epub 2018 Dec 28.

Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

High-dose-rate (HDR) brachytherapy is an attractive option for patients receiving definitive radiation therapy for prostate cancer with decreased overall dose to the pelvis. However, ulcerative colitis increases rectal toxicity risk and may be a contraindication. A synthetic hydrogel, SpaceOAR (Augmentix Inc., Waltham, MA, USA), can facilitate the use of HDR brachytherapy for patients where rectal toxicity is a limiting factor. SpaceOAR gel (13.19 cc) was utilized in a monotherapy HDR prostate treatment with Ir-192 under transrectal ultrasound guidance, with the intention of decreasing rectal dose. SpaceOAR gel was inserted transperineally into the patient 18 days prior to the procedure. The HDR brachytherapy procedure was tolerated without incident. All planning constraints were met, and the following dosimetry was achieved: Prostate - V = 97.3%, V = 35%, V = 14.5%; Urethra - V = 0%; Rectum - D = 51.6%, V = 0 cc. The rectum-catheter spacing was on average between 6-8 mm. Average spacing for our 10 most recent patients without SpaceOAR was 3 mm. SpaceOAR did not hinder or distort ultrasound imaging or increase treatment time. SpaceOAR successfully increases catheter-rectal wall spacing and decreases rectal dose due to improved planning capabilities, while decreasing the likelihood of rectal perforation. One application of this tool is presented to mitigate potential toxicities associated with ulcerative colitis. At five months, one week, and one day follow-up, the patient reported no bowel issues following HDR brachytherapy.
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http://dx.doi.org/10.5114/jcb.2018.81001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335554PMC
December 2018

Eye-tracking research in eating disorders: A systematic review.

Int J Eat Disord 2018 Dec 23. Epub 2018 Dec 23.

Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, UK.

Objective: Those with eating disorders (EDs) show attentional biases to disorder-relevant stimuli, such as food and body shape information. However, attentional bias research in EDs largely relies on reaction time based measures, which are limited in their ability to assess different components and the time course of attention. Eye-tracking paradigms have therefore been utilized to provide greater ecological validity, and directly capture the detailed sequence of processes in perception and attention. While numerous studies have examined eye movements in the mood, anxiety, and psychotic disorders, there has been a lack of studies in EDs. The purpose of this qualitative review is to provide a summary of eye-tracking studies in clinical ED populations.

Method: The review was conducted using the PRISMA guidelines. Electronic databases were systematically searched to identify studies examining gaze parameters in ED compared to healthy controls (HCs). Thirty-one studies met inclusion criteria.

Results: Across ED diagnoses, there was evidence of attentional biases towards food and body stimuli. In addition, differential patterns of attention to social information, and differences in smooth pursuit and saccadic eye movements were found in anorexia nervosa (AN).

Discussion: Findings are discussed in relation to research in other psychiatric disorders, and recommendations for future studies using eye-tracking in EDs are given. The findings add to the wider literature on attentional biases in EDs, and provide potential avenues for treatment. IJED-18-0331.R1. Investigación de seguimiento ocular en trastornos de la conducta alimentaria: una revisión sistemática.
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http://dx.doi.org/10.1002/eat.22998DOI Listing
December 2018
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