Introduction The aims of this systematic review and meta-analysis are to provide a summary of the current literature concerning compulsory treatments in patients with eating disorders (ED) and to understand whether compulsorily and involuntarily treated patients differ in terms of baseline characteristics and treatment outcomes. Methods Relevant articles were identified following the PRISMA guidelines by searching the following terms: “treatment refusal”, “forced feeding”, “compulsory/coercive/involuntary/forced treatment/admission”, “eating disorders”, “feeding and eating disorders”, “anorexia nervosa”, “bulimia nervosa”. Research was restricted to articles concerning humans and published between 1975 and 2020 in English. Results Out of 905 articles retrieved, nine were included for the analyses allowing the comparisons between 242 compulsorily and 738 voluntarily treated patients. Mean body mass index (BMI) was slightly lower in patients compelled to treatments. Mean illness duration, BMI at discharge and BMI variation showed no significant differences between the two groups. Average length of hospitalization was 3 weeks longer among compulsory-treated patients, but this did not result in a higher increase in BMI. No significant risk difference on mortality was estimated (three studies). Conclusions Compulsory treatments are usually intended for patients having worse baseline conditions than voluntary ones. Those patients are unlikely to engage in treatments without being compelled but, after the treatments, albeit with longer hospitalisations, they do achieve similar outcomes. Therefore, we can conclude that forcing patients to treatment is a conceivable option. Level of evidence Level I, systematic review and meta-analysis.

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Objective: Bradycardia is one of the common cardiac abnormalities in patients with eating disorders. It ensues from hypometabolism, which results from reduced caloric intake and consequential weight loss. Hypothermia is another consequence of hypometabolism. While at-rest metabolism and body mass index (BMI) are typically used to assess hypometabolism and estimate potential bradycardia, we hypothesised that body temperature, which is easy to measure, could also capture the presence of this threatening cardiovascular condition. Method:We monitored heart rate continuously for 72 h, measured resting energy expenditure (REE) and assessed body temperature in 12 body parts for 58 patients with anorexia nervosa (AN) and 29 patients with bulimia nervosa (BN). Results: Palm temperature reflects bradycardia in both AN and BN, explaining 18% of its variance (p < 0.001), capturing this aspect even more efficiently than BMI. We also observe different correlations between palm temperature, abdominal temperature, BMI, REE and levels of physical activity. Conclusion:Palm temperature could be used as a warning of bradycardia, a serious cardiovascular condition which can be difficult to detect in short visits with outpatients. Further studies are needed to determine how useful bradycardia and palm temperature could be to assess severity and prognosis of the disorder.

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IntroductionDiabetic patients are asked to focus on their eating habits and calories intake. Together with individual factors, this could increase the risk of developing Eating Disorders (ED) associated with diabetes. A score of 20 points at the Diabetes Eating Problem Survey-Revised (DEPS-R) scale is considered as a valid threshold to identify Disordered Eating Behaviours (DEB) in diabetic patients. DEB can be considered as altered eating behaviours not fully meeting criteria for ED. As DEB are not formally recognised as specific ED in DSM-5, there is a great risk of not detecting them, thus underestimate their consequences.ObjectivesTo meta-analyse literature on ED and DEB, when in comorbidity with Type 1 and Type 2 Diabetes Mellitus, focusing on pathological medical consequences.MethodsPRISMA guidelines were followed for this meta-analysis. Articles were identified in literature by searching into PubMed, PsycINFO and Embase.Results1141 records were identified through database search. Figure 1 shows six studies comparing HbA1c % values for 2857 diabetic patients versus 752 diabetic patients with DEB. HbA1c % levels appear to be higher in patients with DEPS-R ≥ 20, compared to those with DESP-R scores below 20.ConclusionsRoutine screening for DEB using DEPS-R scale could favour early identification of diabetic individuals, at risk for progression into a proper ED. Clinicians should be vigilant about potential DEB when patients show poor long-term glycaemic control; similarly, patients with a DEPS-R score over 20 points may require more frequent glycaemic checks. This could help prevent serious medical complications.

Therapeutic Drug Monitoring (TDM) is an evidence-based practice consistent with the assumption that pharmacological plasmatic concentrations correlate better with clinical effects than prescribed doses of the used drugs. TDM has several indications in treated psychiatry patients: comorbidities, suspected non-compliance, severe adverse effects and tailored pharmacotherapy. Antidepressant Drugs (AD) are prescribed in patients with Eating Disorders (ED) to treat depression or anxiety disorders associated with ED or to reduce binge-eating behaviours. TDM may represent a valid tool in this population, considering the limited efficacy of ED's pharmacological treatment and the high rate of adverse effects. Nineteen outpatients affected by ED with a Body Mass Index (BMI) < 20 or > 30 kg/m 2 treated with antidepressants agreed to participate in this study. Participants were treated with Sertraline (N=5), Fluoxetine (N=6), Vortioxetine (N=4), Citalopram (N=2), Escitalopram (N=1), Fluvoxamine (N=1). Oral fluid samples and whole blood dried microsamples by finger puncture using VAMS (Volumetric Absorptive Microsampling) technique were obtained from patients. Sociodemographic and clinical information were also collected.Preliminary results by our pilot study show a correlation between plasmatic and salivary concentrations only for Vortioxetine but not for other examined antidepressants. Additionally, plasmatic concentrations of all examined antidepressants are constant for extreme BMI when dose-corrected. By considering these preliminary data, we are confident that further studies characterized by the expansion of the sample size will allow us to outline that TDM may represent a valid tool in order to better explain the limited efficacy of AD in patients with starvation state or obesity.

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