Paediatrics (RCH) - Theses
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ItemInvestigation of the short- and long-term complications of anorexia nervosa/atypical anorexia nervosa and the impact of the coronavirus pandemic( 2022-10)Anorexia nervosa (AN) is an increasingly prevalent psychiatric disorder in which restricted energy intake leads to significantly low weight, a fear of weight gain, and a distorted perception of one’s body image. Individuals with this condition experience complications which affect the heart, muscles and bones, hormones, and mental health. The long-term prognosis for AN is difficult to predict; whilst many complications resolve with refeeding and weight gain, some damage may be permanent and disordered cognitions may persist. Furthermore, the impact of the coronavirus (COVID-19) pandemic on mental health and eating disorders is increasingly evident. However, reasons for declining mental health and the onset of disordered behaviours, as well as how the treatment of individuals is affected, remains unclear. The aim of this project was to (1) assess long-term cardiovascular and mental health following recovery from AN, and (2) determine the impact of the COVID-19 pandemic on both current and former AN patients. To achieve this, four separate but interrelated studies were conducted. The first study involved a four-year retrospective chart review of all patients presenting to the Royal Children’s Hospital Eating Disorder Service between 2017-2020. To assess the impact of the COVID-19 pandemic, the number and severity of presentations was compared between years via analyses of variance. The second study investigated long-term psychological outcomes and predictors of recovery and prognosis by administering online questionnaires to former AN patients from the Royal Children’s Hospital and Monash Children’s Hospital. The questionnaires assessed eating and exercising behaviours, mood, and COVID-19 impact. The third study involved non-invasive physical testing of the former patients to assess long-term cardiovascular health post AN recovery. Finally, further interrogation of carotid ultrasound images using wave analysis techniques provided valuable insight into the biomechanical interactions between the heart and vascular network. All outcome measures were compared to healthy controls and/or normal thresholds. Results revealed there was a surge in new AN cases under COVID-19 restrictions in 2020. Changes to routines, and feelings of isolation and loneliness were recognised as triggers for disordered behaviours. Mixed responses to telehealth and online learning were also reported. Former patient questionnaire responses indicated that psychological recovery from AN can be sustained long-term when individuals receive early and intense treatment. However, elevated levels of stress were exhibited by the former AN patients. This may reflect inherent personality features, such as perfectionism, which have been closely correlated with the condition. Despite increased stress and a history of an eating disorder, the former AN patients did not appear more susceptible to the impacts of the COVID-19 pandemic and faired comparably to controls. Cardiovascular assessments indicated that an increased propensity for cardiovascular disease may be associated with AN even after recovery. Regional changes in arterial stiffness, endothelial dysfunction, and abnormal autonomic regulation were identified in early adulthood. Overall, as the first research study to report on long-term cardiovascular and mental health following AN recovery, and the impact of the COVID-19 pandemic on an adolescent population within Melbourne (the most locked down city in the world), this thesis fills a critical gap in eating disorders literature. It identifies factors that contribute to patient course and outcome, reveals persisting cardiovascular adaptations, and informs of specific issues faced by both current and former AN patients during the pandemic. These findings have the potential to guide disease surveillance strategies and optimise clinical interventions.