By Scott Baltic
NEW YORK—Psychotic experiences before age 13 are markers of increased risk for such disordered-eating behaviors as binge eating, fasting and purging in late adolescence, according to a new U.K. study.
A third of children with psychotic experiences, such as delusions or hallucinations, by age 13 reported some disordered-eating behaviors by age 18, researchers report in The Lancet Child & Adolescent Health, online June 22.
"If a child has a psychotic experience, this should trigger a more in-depth mental health evaluation and guidance for the child and the parents," said Dr. R. Scott Benson, a child and adolescent psychiatrist in practice in Pensacola, Florida, who was not involved in the study.
"In most situations, the psychotic experience is not associated with other behavior disturbance in this age group," he told Reuters Health by email. "As a consequence, it is dismissed as a normal variant: 'She's just upset. She will outgrow it.'"
However, Dr. Benson continued, the new study and previous research make it clear that "too often she doesn't. We need to recognize the severity of this symptom as a marker for future problems. If those problems do develop, they will respond better to early treatment."
For the study, Dr. Francesca Solmi and colleagues at University College London used data from a longitudinal birth cohort of nearly 14,000 children born in Avon, England, in the early 1990s.
Data on psychotic experiences in 6,361 children were collected at clinic assessments when the children were nearly age 13. Psychotic experiences were excluded if they could be attributed to fever or an absence of sleep.
Most of the 734 participants (12%) who had psychotic experiences were girls and reported greater depressive symptoms and autistic traits than those without such experiences. They also tended to have younger mothers who were single, separated or widowed, had lower levels of education and more symptoms of depression.
Mailed questionnaires were used to gather information on disordered-eating behaviors around age 18.
Disordered-eating behaviors (binge eating, purging and fasting) were more common among children who had had psychotic experiences by age 13 compared with those who hadn't (odds ratio, 1.92; P<0.0001). After adjustment for maternal and child characteristics, the risk increase was only slightly attenuated.
Neither excessive exercise nor elevated BMI at age 18 was associated with earlier psychotic experiences.
"Psychotic experiences can be rather common occurrences in childhood and early adolescence," Dr. Solmi told Reuters Health by email. About 11%-12% of the children in this study reported at least one, which is similar to findings from other studies, she explained.
"For many of these children, these will be isolated episodes," she continued. "However, there is evidence showing that, on average, children who report these psychotic experiences have worse mental health outcomes in the long term."
Unfortunately, Dr. Solmi added, "Eating disorders are very often missed in primary care, which means that many adolescents do not receive the treatment that they need, or they only do once symptoms become more severe."
She was careful to note that the study investigated the presence of "disordered-eating behaviors" rather than eating-disorder diagnoses. "The former are more common in the general population, are associated with high levels of comorbid psychopathology, and are a risk factor for the development of eating disorders," she explained.
In an accompanying editorial, Drs. Stephan Zipfel and Katrin Giel of Medical University Hospital Tübingen, in Germany, said the study's "well powered results" help in the urgent search for eating-disorder risk factors.
The editorialists note that psychotic and eating disorders "share a range of clinical characteristics, including impairments in the domains of neurocognition, socioemotional regulation, and interpersonal skills" and that "concerns and cognitions that patients with eating disorders typically show around their disorder behaviour have sometimes been described as having delusional qualities."
SOURCE: https://bit.ly/2JdeKX4 and https://bit.ly/2KPLivS
Lancet Child Adolesc Health 2018.
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