Latest news with #JAMAPsychiatry
Sydney Morning Herald
3 days ago
- General
- Sydney Morning Herald
Anorexia is the deadliest mental health condition. Experts say we are treating it completely wrong
A disturbing reality De Cicco Carr learned while seeking treatment in the public hospital system was that unless her body weight was considered dangerously low, she had great difficulty accessing physical or mental health care for anorexia. Loading 'I refer to it as the 'sick Olympics': eating disorders are quite competitive [with one's own, mental ill-health ideals] by nature, and are fuelled by the healthcare system that is supposed to be there, but is only there to help the people who are the most physically unwell with eating disorders,' she says. And even then, she found the emphasis to be on physical weight improvement, and not on quality mental healthcare for the underlying causes. Thankfully, after three months in private residential treatment, De Cicco Carr has achieved recovery stable enough to have conceived her first child and be well into a healthy pregnancy. Anorexia nervosa is considered the mental health condition with the highest mortality rate, in part because only about half of patients respond to treatment methods developed decades ago. Up to 10 per cent of those with the disease lose their lives to it within 10 years of getting it, and up to 20 per cent will pass away because of it within 20 years. In Australia, 1.1 million people live with an eating disorder, and 1273 people died of them in 2023, a higher toll than those killed on the roads. Data provided by Orygen the National Centre of Excellence for Youth Mental Health shows that since 2012, the incidence of eating disorders among those under 19 has increased by 86 per cent. Meanwhile, progress towards more effective treatments has been hindered by stigma, including the mistaken belief that anorexia nervosa affects only 'young, affluent white females', according to a paper to be published on Thursday in the journal, JAMA Psychiatry. Associate Professor Andrea Phillipou, a co-author and principal research fellow in eating disorders at Orygen and the Centre for Youth Mental Health at the University of Melbourne, describes anorexia as 'an unbelievably under-funded area of research – a lot of it is [down to] stigma associated with eating disorders: they are still seen as a trivial thing that only affects young, white affluent women'. Loading Despite some promising developments, current treatment outcomes are 'unacceptably poor', and a narrow focus on weight restoration is a key reason medical understanding and effective treatment lags. 'Anorexia can be and is life-threatening in a lot of circumstances, and weight restoration is usually the main outcome [of current treatments]; we want to stabilise people and get the weight restored, but this has taken away from the fact this is a psychological condition,' Phillipou says. 'We need to also focus on the psychological aspect driving the eating disorder.' Because anorexia is one of the few mental illnesses to also require a physical diagnosis, its treatment and research into better approaches has been 'siloed' and held back decades. Loading Phillipou describes the paper, co-authored with global experts from King's College, London, and Harvard Medical School, as a call to action for research that treats anorexia holistically, as a physical and as a mental health condition. She says that approach will boost understanding of what causes the condition and in turn promote more modern and effective treatments. 'Recovery rates haven't budged in about 50 years, we're still getting the same poor responses to treatments ... and that's on the treatments, it's not the individual or the family's fault,' she says. 'It's been decades since we've had any innovation in treatments.' Clinical psychologist Sarah Cox, manager of the Butterfly Foundation National Helpline, agrees with the paper, Anorexia Nervosa—Facts, Frustrations, and the Future, that treatments and research have been stymied by bias and misconceptions. 'A lot of people still believe [anorexia] is a lifestyle choice, but eating disorders are very serious mental illnesses; people can't just make a choice to turn that on or off, they need the right treatment support and compassion,' Cox says. Loading On World Eating Disorders Action Day, on Monday, the Butterfly Foundation released statistics stating that one in seven people believe those with eating disorders could 'snap out of it', and one in six people 'perceive eating disorders as a sign of weakness'. Cox said these ideas must be challenged because they could contribute to patients missing out on early intervention, which could be vital to prevent the illnesses progressing to a life-threatening stage. She said clinical experience backed up the claim in Phillipou's JAMA paper that anorexia patients were 'often falling in the gap between physical and mental healthcare'. 'Something we hear from people we support is people can slip through the cracks because they might be considered not being of a low enough weight for some treatment options, and being of too low a weight for others,' Cox said. 'Sometimes they are hitting that crisis point before they can join the public or private systems.' She described the paper demanding a rethink in anorexia research and treatment as a powerful and important step in highlighting reasons that progress for patients had been so slow, 'and trying to point to possible solutions to correct it'.
The Age
4 days ago
- General
- The Age
Anorexia is the deadliest mental health condition. We are treating it completely wrong
A disturbing reality De Cicco Carr learned while seeking treatment in the public hospital system was that unless her body weight was considered dangerously low, she had great difficulty accessing physical or mental health care for anorexia. Loading 'I refer to it as the 'sick Olympics': eating disorders are quite competitive [with one's own, mental ill-health ideals] by nature, and are fuelled by the healthcare system that is supposed to be there, but is only there to help the people who are the most physically unwell with eating disorders,' she says. And even then, she found the emphasis to be on physical weight improvement, and not on quality mental healthcare for the underlying causes. Thankfully, after three months in private residential treatment, De Cicco Carr has achieved recovery stable enough to have conceived her first child and be well into a healthy pregnancy. Anorexia nervosa is considered the mental health condition with the highest mortality rate, in part because only about half of patients respond to treatment methods developed decades ago. Up to 10 per cent of those with the disease lose their lives to it within 10 years of getting it, and up to 20 per cent will pass away because of it within 20 years. In Australia, 1.1 million people live with an eating disorder, and 1273 people died of them in 2023, a higher toll than those killed on the roads. Data provided by Orygen the National Centre of Excellence for Youth Mental Health shows that since 2012, the incidence of eating disorders among those under 19 has increased by 86 per cent. Meanwhile, progress towards more effective treatments has been hindered by stigma, including the mistaken belief that anorexia nervosa affects only 'young, affluent white females', according to a paper to be published on Thursday in the journal, JAMA Psychiatry. Associate Professor Andrea Phillipou, a co-author and principal research fellow in eating disorders at Orygen and the Centre for Youth Mental Health at the University of Melbourne, describes anorexia as 'an unbelievably under-funded area of research – a lot of it is [down to] stigma associated with eating disorders: they are still seen as a trivial thing that only affects young, white affluent women'. Loading Despite some promising developments, current treatment outcomes are 'unacceptably poor', and a narrow focus on weight restoration is a key reason medical understanding and effective treatment lags. 'Anorexia can be and is life-threatening in a lot of circumstances, and weight restoration is usually the main outcome [of current treatments]; we want to stabilise people and get the weight restored, but this has taken away from the fact this is a psychological condition,' Phillipou says. 'We need to also focus on the psychological aspect driving the eating disorder.' Because anorexia is one of the few mental illnesses to also require a physical diagnosis, its treatment and research into better approaches has been 'siloed' and held back decades. Loading Phillipou describes the paper, co-authored with global experts from King's College, London, and Harvard Medical School, as a call to action for research that treats anorexia holistically, as a physical and as a mental health condition. She says that approach will boost understanding of what causes the condition and in turn promote more modern and effective treatments. 'Recovery rates haven't budged in about 50 years, we're still getting the same poor responses to treatments ... and that's on the treatments, it's not the individual or the family's fault,' she says. 'It's been decades since we've had any innovation in treatments.' Clinical psychologist Sarah Cox, manager of the Butterfly Foundation National Helpline, agrees with the paper, Anorexia Nervosa—Facts, Frustrations, and the Future, that treatments and research have been stymied by bias and misconceptions. 'A lot of people still believe [anorexia] is a lifestyle choice, but eating disorders are very serious mental illnesses; people can't just make a choice to turn that on or off, they need the right treatment support and compassion,' Cox says. Loading On World Eating Disorders Action Day, on Monday, the Butterfly Foundation released statistics stating that one in seven people believe those with eating disorders could 'snap out of it', and one in six people 'perceive eating disorders as a sign of weakness'. Cox said these ideas must be challenged because they could contribute to patients missing out on early intervention, which could be vital to prevent the illnesses progressing to a life-threatening stage. She said clinical experience backed up the claim in Phillipou's JAMA paper that anorexia patients were 'often falling in the gap between physical and mental healthcare'. 'Something we hear from people we support is people can slip through the cracks because they might be considered not being of a low enough weight for some treatment options, and being of too low a weight for others,' Cox said. 'Sometimes they are hitting that crisis point before they can join the public or private systems.' She described the paper demanding a rethink in anorexia research and treatment as a powerful and important step in highlighting reasons that progress for patients had been so slow, 'and trying to point to possible solutions to correct it'.
Sydney Morning Herald
4 days ago
- General
- Sydney Morning Herald
Anorexia is the deadliest mental health condition. We are treating it completely wrong
A disturbing reality De Cicco Carr learned while seeking treatment in the public hospital system was that unless her body weight was considered dangerously low, she had great difficulty accessing physical or mental health care for anorexia. Loading 'I refer to it as the 'sick Olympics': eating disorders are quite competitive [with one's own, mental ill-health ideals] by nature, and are fuelled by the healthcare system that is supposed to be there, but is only there to help the people who are the most physically unwell with eating disorders,' she says. And even then, she found the emphasis to be on physical weight improvement, and not on quality mental healthcare for the underlying causes. Thankfully, after three months in private residential treatment, De Cicco Carr has achieved recovery stable enough to have conceived her first child and be well into a healthy pregnancy. Anorexia nervosa is considered the mental health condition with the highest mortality rate, in part because only about half of patients respond to treatment methods developed decades ago. Up to 10 per cent of those with the disease lose their lives to it within 10 years of getting it, and up to 20 per cent will pass away because of it within 20 years. In Australia, 1.1 million people live with an eating disorder, and 1273 people died of them in 2023, a higher toll than those killed on the roads. Data provided by Orygen the National Centre of Excellence for Youth Mental Health shows that since 2012, the incidence of eating disorders among those under 19 has increased by 86 per cent. Meanwhile, progress towards more effective treatments has been hindered by stigma, including the mistaken belief that anorexia nervosa affects only 'young, affluent white females', according to a paper to be published on Thursday in the journal, JAMA Psychiatry. Associate Professor Andrea Phillipou, a co-author and principal research fellow in eating disorders at Orygen and the Centre for Youth Mental Health at the University of Melbourne, describes anorexia as 'an unbelievably under-funded area of research – a lot of it is [down to] stigma associated with eating disorders: they are still seen as a trivial thing that only affects young, white affluent women'. Loading Despite some promising developments, current treatment outcomes are 'unacceptably poor', and a narrow focus on weight restoration is a key reason medical understanding and effective treatment lags. 'Anorexia can be and is life-threatening in a lot of circumstances, and weight restoration is usually the main outcome [of current treatments]; we want to stabilise people and get the weight restored, but this has taken away from the fact this is a psychological condition,' Phillipou says. 'We need to also focus on the psychological aspect driving the eating disorder.' Because anorexia is one of the few mental illnesses to also require a physical diagnosis, its treatment and research into better approaches has been 'siloed' and held back decades. Loading Phillipou describes the paper, co-authored with global experts from King's College, London, and Harvard Medical School, as a call to action for research that treats anorexia holistically, as a physical and as a mental health condition. She says that approach will boost understanding of what causes the condition and in turn promote more modern and effective treatments. 'Recovery rates haven't budged in about 50 years, we're still getting the same poor responses to treatments ... and that's on the treatments, it's not the individual or the family's fault,' she says. 'It's been decades since we've had any innovation in treatments.' Clinical psychologist Sarah Cox, manager of the Butterfly Foundation National Helpline, agrees with the paper, Anorexia Nervosa—Facts, Frustrations, and the Future, that treatments and research have been stymied by bias and misconceptions. 'A lot of people still believe [anorexia] is a lifestyle choice, but eating disorders are very serious mental illnesses; people can't just make a choice to turn that on or off, they need the right treatment support and compassion,' Cox says. Loading On World Eating Disorders Action Day, on Monday, the Butterfly Foundation released statistics stating that one in seven people believe those with eating disorders could 'snap out of it', and one in six people 'perceive eating disorders as a sign of weakness'. Cox said these ideas must be challenged because they could contribute to patients missing out on early intervention, which could be vital to prevent the illnesses progressing to a life-threatening stage. She said clinical experience backed up the claim in Phillipou's JAMA paper that anorexia patients were 'often falling in the gap between physical and mental healthcare'. 'Something we hear from people we support is people can slip through the cracks because they might be considered not being of a low enough weight for some treatment options, and being of too low a weight for others,' Cox said. 'Sometimes they are hitting that crisis point before they can join the public or private systems.' She described the paper demanding a rethink in anorexia research and treatment as a powerful and important step in highlighting reasons that progress for patients had been so slow, 'and trying to point to possible solutions to correct it'.
Mint
26-05-2025
- Health
- Mint
Why more adults than ever are being diagnosed with autism
More U.S. adults than ever before have autism, and many are being diagnosed not as children, but in later years. While the data don't pinpoint how many people are over age 18 when diagnosed, clinical psychologists say many more adults are seeking evaluations for autism than a decade ago. 'We have adults reaching out every week," said Paige Siper, chief psychologist at the Seaver Autism Center for Research and Treatment at the Icahn School of Medicine at Mount Sinai in New York. Overall, the rate of autism in people 18 or older more than doubled between 2011 and 2019, from 4.2 per 1,000 to 9.5 per 1,000, according to an analysis of Medicaid data published in the journal JAMA Psychiatry in 2023. Researchers saw the most rapid growth in adults between the ages of 26 and 34, according to a study, published in the journal JAMA Network Open in 2024, that analyzed U.S. health records and insurance claims for more than nine million individuals a year from 2011 to 2022. That group's rate of autism increased from 0.7 per 1,000 people in 2011 to 3.7 per 1,000 in 2022. Some of this growth comes from autistic children aging into adulthood. For adults seeking evaluations for the first time, scientists attribute the rise to a variety of factors. Social media has increased awareness of autism. Autism has shed the stigma it used to hold. The definition of the condition has expanded over time to include a broader range of behaviors. And some parents who have children diagnosed with autism then recognize their own challenges and seek out evaluations, said Michelle Gorenstein-Holtzman, a clinical psychologist who works with adults at the NewYork-Presbyterian/Weill Cornell Medical Center and the Center for Autism and the Developing Brain. Three years ago, before she joined, the center did one adult autism evaluation a month. Now Gorenstein-Holtzman does two a week. People diagnosed as adults typically don't have severe communication challenges or intellectual disabilities, clinical psychologists said. But they have struggled socially, and show subtle repetitive behaviors like rocking in a chair, or nearly obsessive interests in certain topics. They often have other continuing mental-health conditions, such as anxiety, bipolar disorder or ADHD. Many are highly educated, and some have successful careers, though some have been in and out of jobs. Many are women whose autism was missed when they were children, said Catherine Lord, a clinical psychologist and autism researcher at the David Geffen School of Medicine at UCLA. About three times as many boys are diagnosed with autism as girls, partly because some of the behaviors psychologists look for are less pronounced in girls, and partly because researchers have been trained to better recognize the condition in boys. Growing up, Sonia Chand said she felt out of touch with her peers and judged by teachers and therapists. 'I was made to feel like I was the bad kid," she said. 'I wasn't trying to act up in a bad way. I was just trying to fit in." Sonia Chand and her parents, Kishan Chand and Krishna Pahuja, looking at photos up, Chand said, she felt misunderstood and rejected by her peers, teachers and therapists. In sixth grade, she was diagnosed with depression, prescribed lithium and flagged at risk for suicide. At age 20, after a new therapist had heard her story and referred her for an advanced neuropsychological evaluation, she was diagnosed with Asperger's in 2002. Now 42, she works as a therapist herself, runs marathons and hosts a podcast in her free time. At the time Chand was diagnosed, Asperger's syndrome was considered a developmental disorder in which people had trouble with social interactions but didn't have language delays or cognitive impairments associated with autism. Autism first appeared as a distinct diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, a standardized classification system for mental disorders, in 1980. Initially, the diagnosis required children by age 2.5 years to exhibit a narrow set of behaviors that typically applied only to those with severe disabilities. Each subsequent edition of the manual has broadened the definition of the condition, said David Mandell, director of the Penn Center for Mental Health at the University of Pennsylvania. In 2013, Asperger's and other developmental disorders were included under the category of autism spectrum disorder, which acknowledged varying levels of severity—and helped to pave the way for more diagnoses in adults. Chand now works as a licensed professional counselor and hosts a podcast.. Holden Thorp, editor in chief of the Science family of journals, was in his 50s when a psychologist evaluating senior administrators at Washington University in St. Louis, where he was provost, told him he was autistic in 2016. Thorp had established himself as a research scientist, climbed the ranks of university leadership and served as chancellor of the University of North Carolina at Chapel Hill. 'A lot of things came together all at once," Thorp said, ranging from his habit of staring at a wall when people were talking to him to student evaluations that said he was 'a great teacher" but 'very monotone." Now, he tells classes on the first day that he's on the spectrum and explains that expressive intonations or big arm gestures are a challenge. 'That was very liberating," he said. Some adults welcome the diagnosis as a way to make sense of the challenges they have faced all their lives. 'When I started in the field, everyone's vision of autism was more like Rain Man," said Gorenstein-Holtzman. 'Now, I think people have more ideas of what autism could look like." Write to Nidhi Subbaraman at
Medscape
21-05-2025
- Health
- Medscape
New Data on GLP-1 RAs and Psychiatric Side Effects
Treatment with glucagon-like peptide 1 receptor agonists (GLP-1 RAs) for weight loss or diabetes management doesn 't raise the risk for adverse psychiatric events and improves quality of life (QOL) in people with no history of mental illness, a large new review has found. The results, gleaned from placebo-controlled trials involving over 100,000 participants, are important given recent concerns about an increased risk for suicidality, self-injury, and psychiatric adverse events in people prescribed GLP-1 RAs. Toby Pillinger, PhD 'Our analysis of data from a large number of clinical trials shows that GLP-1 RAs are not only safe from a psychiatric perspective but may improve mental health outcomes. As the use of these medications continues to grow, our findings provide important reassurance to patients and clinicians alike that these treatments can support both body and mind,' investigator Toby Pillinger, PhD, clinical lecturer, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England, told Medscape Medical News . However, patients with serous psychiatric diagnoses were excluded from reviewed studies, so the findings may not completely settle the question of whether GLP-1 RAs impact mental illness in all individuals, Pillinger added. The findings were published online on May 14 in JAMA Psychiatry . 'Reassuring' Findings GLP-1 RAs are highly effective in treating obesity and type 2 diabetes, and there's some evidence they're also beneficial for patients with type 1 diabetes. However, a few meta-analyses of randomized clinical trials have examined their psychiatric effects. The analysis included 107,860 adults (mean age, 60 years; 40% women) enrolled in 80 randomized double-blind controlled trials that compared mental health outcomes between those treated with a GLP-1 RA and those treated with a placebo. About 62% of the studies included patients with type 2 diabetes, while 29% of those had patients with overweight or obese, and 9% enrolled those with type 1 diabetes. The most studied drug was liraglutide (30% of studies), followed by semaglutide (24.7%). Studies that included participants with preexisting psychiatric or neurologic disorders such as Alzheimer's disease were excluded. The analysis found no significant difference in rates of serious psychiatric adverse events (log risk ratio [logRR], −0.02; 95% CI, −0.20 to 0.17; P = .90, with moderate certainty) or of nonserious psychiatric adverse events (logRR, −0.03; 95% CI, −0.21 to 0.16; P = .76, with low certainty) between GLP-1 RAs and placebo. GLP-1 RA treatment was associated with significantly improved restrained eating and reduced emotional eating. This finding, said the authors, was expected given the medications have known satiety-inducing effects leading to reduced food intake. 'Overall, our results provide reassurance regarding the psychiatric safety profile of GLP-1 RAs and suggest that GLP-1 RA treatment is associated with improved mental well-being, in addition to the known physical health improvements,' investigators wrote. Improved QOL The analysis also found GLP-1 RA treatment positively affected several aspects of QOL relative to placebo, including improved mental health ( P < .001), physical health ( P < .001), diabetes-related QOL ( P < .001), weight-related QOL ( P < .001), and overall QOL ( P = .01), all with moderate certainty. There were greater improvements in physical health–related QOL in women and younger patients. 'The reason for this is unclear, and these results should be interpreted cautiously,' said Pillinger, adding the analysis wasn't based on individual patient data, which limited the ability to explore the full range of contributing factors. Interestingly, the analysis didn't uncover a relationship between QOL and the amount of weight loss or degree of improved blood sugar control. Pillinger speculated that in addition to the impact losing weight or optimizing diabetes control can have on self-esteem and well-being, a neurobiological mechanism may also be at play. 'One possibility is that GLP-1 RAs exert direct effects on the brain, particularly within regions involved in mood and reward processing,' said Pillinger. 'These central pathways may influence emotional well-being independently of physical health improvements.' There was no clear evidence of an association between GLP-1 RA treatment and cognitive outcomes, likely owing to the small number of studies. Sensitivity analyses looking at different GLP-1 RA doses relative to placebo yielded results similar to the main analysis. This was also the case for an analysis excluding studies of patients with type 1 diabetes, although due to the limited number of related trials, it's impossible to draw firm conclusions concerning type 1 diabetes, said Pillinger. 'More research specifically in people with type 1 diabetes is needed to determine whether the psychiatric and quality-of-life effects of GLP-1 receptor agonists are consistent across diabetes subtypes,' he said. As researchers didn't perform separate meta-analyses for individual drugs, more head-to-head studies are needed to determine whether some GLP-1 RA agents are more beneficial than others. 'For now, the evidence supports a broadly reassuring psychiatric safety profile across commonly used GLP-1 RAs,' Pillinger said. While this new analysis found no relationship between GLP-1 RAs and adverse psychiatric outcomes, previous studies have. Pillinger explained that people living with obesity and diabetes already have a higher baseline risk for psychiatric symptoms, including depression and suicidal ideation. 'Previously observed signals of suicidality may reflect this underlying vulnerability in the patient population rather than an effect of the drug itself,' he said. Included studies didn't collect data on a broader range of psychiatric symptoms, such as changes in energy or activity levels, sleep, and obsessional symptoms. Another limitation was that mental health effects were secondary rather than primary outcomes of included studies. Questions Remain Reached for comment, Mahavir Agarwal, MD, PhD, associate professor, Department of Psychiatry, University of Toronto, and medical head of Clinical Research, Schizophrenia Division, Center for Addiction and Mental Health, both in Toronto, Ontario, Canada, said the review shows 'fairly well' that psychiatric issues 'are unlikely to be a common side effect' of GLP-1 RAs. However, Agarwal reiterated that studies that enroll people with diabetes or obesity, like those included in the review, typically exclude anyone with a severe mental illness, so the study cohorts are generally a relatively 'mentally healthy' population. Agarwal and his colleagues are conducting a study of these drugs in people with schizophrenia who have gained weight while taking antipsychotics. It is one of several such projects underway to investigate the effects of GLP-1 RAs in people with psychiatric illnesses and addiction. Importantly, said Agarwal, side effects and responses to these relatively new drugs may vary from patient to patient. 'What happens at an individual level is still unpredictable, and therefore, clinicians should still be on guard.' Indeed, there is some reported evidence of people with depression or anxiety actually experiencing worsening symptoms while on these weight-loss drugs, noted Paul Keedwell, MBChB, PhD, consultant psychiatrist and fellow of the Royal College of Psychiatrists, London, England, said in a statement from the nonprofit Science Media Centre. '(F)or most people, these drugs seem mentally safe, and may even help mood, but for those with a history of mental illness, there may be a risk,' Keedwell said. 'More research is needed, and anyone with past mental health issues should speak with a doctor before starting them.'
