Wilfahrt, Robert P.

Objective The aim of the study was to assess the characteristics and outcomes of adults with attention-deficit/hyperactivity disorder (ADHD) and a previous history of restrictive eating disorder symptoms. Method We retrospectively reviewed the health records of patients with ADHD and a history of disordered eating who were treated at our institution with medications that have potential anorexiant properties from October 1, 2022, through March 31, 2024. Results We initially identified 159 patients who were referred to an ADHD program at our institution during the study period. Of 72 patients who met criteria for an ADHD diagnosis, 18 had SCOFF questionnaire scores of 2 or higher, which suggests symptoms of a restrictive eating disorder. Of these 18 patients, 3 had a previous diagnosis of an eating disorder documented in their health records. Each patient was treated with medications chosen to manage their reported ADHD symptoms, regardless of eating disorder concerns. All patients had improvements in ADHD symptoms without reporting adverse effects on disordered eating behaviors. Body weight and body mass index values did not significantly change after treatment with atomoxetine, dextroamphetamine/amphetamine, or methylphenidate (all P ≥ 0.14). Conclusions Our findings are consistent with those of previous reports and suggest that ADHD treatment, including treatment with stimulant medications, is safe and tolerable for patients with a history of restrictive eating disorder symptoms.

Abstract Psychopharmacologic treatments for eating disorders (EDs) remain unclear, particularly for anorexia nervosa. As in attention-deficit hyperactivity disorder, a dopaminergic mechanism has been implicated in EDs, prompting our use of atomoxetine in an 18-year-old woman with anorexia nervosa, binge/purge type. Atomoxetine is a highly selective norepinephrine reuptake inhibitor with nonaddictive properties and limited effects of appetite suppression. Doses followed those used in a previous trial of atomoxetine in the treatment of binge ED, and response was assessed over 4 months, with significant improvement in ED behaviors and mood. Larger-scale, randomized studies that assess the efficacy of atomoxetine in the treatment of anorexia nervosa, binge/purge type are warranted.

Introduction: Medical schools have an enduring need to provide ongoing faculty development and to foster educational alliances between teachers and learners, so that feedback provided to learners is both frequent and of high quality. We hypothesized that medical students trained as academic detailers with a mission to increase the emphasis on feedback could serve in this role during our clerkship, while still being evaluated as students in our clerkship rotation. Methods: The family medicine clerkship at Mayo Clinic School of Medicine launched a revised curriculum in 2016 in which students were taught how they might build an educational alliance with preceptors, were taught characteristics of high-quality feedback, and practiced requesting more useful feedback when initial quality was poor. After utilizing a clerkship-specific curriculum with small group sessions on receiving feedback, and training students and preceptors on the SNAPPs model, students were then directed to request feedback from their preceptors and model successful feedback conversations for preceptors. The study evaluated the medical students’ summative evaluations to compare the rate from the preintervention year (2015-2016) and the intervention year (2016-2017) at which preceptors added comments on students’ use of feedback. Results: Preceptors’ written comments about students seeking feedback increased at about a four-fold rate (74.4% vs 18.8%, P<.001) after implementing a suite of changes to our clerkship curriculum. Conclusions: Using medical students to change preceptor behaviors was an important part of our suite of interventions. This intervention directed preceptor attention toward our instructional goal of increased medical student feedback.

AbstractAdolescents with type 1 diabetes mellitus (T1DM) are at increased risk for poor treatment adherence and glycaemic lability. Parental involvement in a youth's diabetes regimen is associated with better outcomes, yet supported treatments may be inaccessible due to limited community resources and financial constraints. Furthermore, existing interventions emphasise a collaborative effort between family members, which may not be effective with youth with particular vulnerabilities. Similarities between T1DM and anorexia nervosa prompted our use of modified family‐based therapy (FBT) with a 16‐year‐old male with poor glycaemic control. FBT‐guided strategies were brief and implemented by a family medicine physician at routine visits. Medical symptoms dramatically improved over a four‐month period, demonstrating that FBT tailored to T1DM warrants further investigation for youth with poor treatment adherence. Copyright © 2017 John Wiley & Sons.