Abstract Background Alkaline urine pH has previously been reported in patients with restrictive eating disorders (EDs) over 30 years ago, however its prevalence is not routinely reported. This study carries out a preliminary investigation of the change in urine pH in malnourished adolescent and young adult patients hospitalised with restrictive EDs during an initial two weeks of higher energy nutritional rehabilitation. Methods A retrospective review was carried out of the medical charts of malnourished adolescent and young adult patients (aged 14–21) hospitalised with restrictive EDs for ≥ 14 days during a 2-year period (January 2018–December 2019) and provided with assertive nutritional rehabilitation. Linear mixed effects models were used to estimate weekly within patient change in urine pH and identify possible associations with degree of malnutrition, medical instability, and purging status. Results Seventy-nine patients (75 female, 4 male) with mean age 17.3 ± 1.4 years were included. On admission, patients were commenced on mean 2179 ± 476 kcal/day. No incidence was recorded of clinical refeeding syndrome during nutritional rehabilitation. The average decrease in urine pH ≥ 7 from baseline to 1 week of medical refeeding was statistically significant (56.6% vs. 29.9%, p = 0.001). Urine pH decreased from a mean of 7.0 ± 0.9 at baseline to a mean of 6.6 ± 0.7 after one week of refeeding, and further decreased to a mean of 6.5 ± 0.7 by the end of two weeks. Compared with purging patients, for non-purging patients there was a stronger association between medical instability at admission, low percentage median body mass index, and urine pH ≥ 7. Conclusion The findings of this study suggest a change in urine pH from ≥ 7 to < 7 can be observed after one week of assertive nutritional rehabilitation in adolescent and young adults hospitalised with restrictive EDs. Further research is required to investigate potential mechanisms underlying elevated urine pH observed in patients with restrictive EDs, and the change that is observed during nutritional rehabilitation.

Journal of Paediatrics and Child HealthEarly View Case Report Double trouble: A case of chronic vomiting Elizabeth Yan Fun Tee, Corresponding Author Elizabeth Yan Fun Tee [email protected] orcid.org/0009-0006-4135-4579 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Correspondence: Dr Elizabeth Yan Fun Tee, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, NSW, Australia. Fax: 02-9893 9062; email: [email protected]Search for more papers by this authorSimon Clarke, Simon Clarke Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorChristine Wearne, Christine Wearne Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorGail Anderson, Gail Anderson Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorLinette Gomes, Linette Gomes Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorGordon Thomas, Gordon Thomas Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, AustraliaSearch for more papers by this authorEdward O'Loughlin, Edward O'Loughlin Department of Gastroenterology, The Children's Hospital at Westmead, Sydney, New South Wales, AustraliaSearch for more papers by this authorBasiliki Lampropoulos, Basiliki Lampropoulos Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorMichael Kohn, Michael Kohn Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this author Elizabeth Yan Fun Tee, Corresponding Author Elizabeth Yan Fun Tee [email protected] orcid.org/0009-0006-4135-4579 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Correspondence: Dr Elizabeth Yan Fun Tee, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, NSW, Australia. Fax: 02-9893 9062; email: [email protected]Search for more papers by this authorSimon Clarke, Simon Clarke Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorChristine Wearne, Christine Wearne Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorGail Anderson, Gail Anderson Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorLinette Gomes, Linette Gomes Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorGordon Thomas, Gordon Thomas Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, AustraliaSearch for more papers by this authorEdward O'Loughlin, Edward O'Loughlin Department of Gastroenterology, The Children's Hospital at Westmead, Sydney, New South Wales, AustraliaSearch for more papers by this authorBasiliki Lampropoulos, Basiliki Lampropoulos Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorMichael Kohn, Michael Kohn Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 20 June 2024 https://doi.org/10.1111/jpc.16601 Conflict of interest: None declared. Authors contributions: EYFT: Contribution – involved in patient's care; conceptualization; analysis; interpretation; writing of original draft, reviewing and editing. SC: Contribution – involved in patient's care; conceptualization; analysis; interpretation; writing of original draft, reviewing and editing, supervision. CW: Contribution – involved in patient's care; conceptualization; analysis; interpretation; writing of original draft, reviewing and editing. GA: Contribution – involved in patient's care; analysis; interpretation; writing of original draft, reviewing and editing. LG: Contribution – involved in patient's care; conceptualization; analysis; interpretation; writing – reviewing and editing. GT: Contribution – involved in patient's care; conceptualization; analysis; interpretation; writing – reviewing and editing, resources. EO: Contribution – involved in patient's care; analysis; interpretation; writing – reviewing and editing, resources. BL: Contribution – conceptualization; analysis; interpretation; writing – reviewing and editing. MK: Contribution – conceptualization; analysis; interpretation; writing – reviewing and editing, supervision. All authors have approved the final version to be published. All authors have agreed to be accountable for all aspects of the work. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Omiyale AO. Solid pseudopapillary neoplasm of the pancreas. World J. Hepatol. 2021; 13: 896–903. 10.4254/wjh.v13.i8.896 PubMedWeb of Science®Google Scholar 2Yu PF, Hu ZH, Wang XB et al. Solid pseudopapillary tumor of the pancreas: A review of 553 cases in Chinese literature. World J. Gastroenterol. 2010; 16: 1209–1214. 10.3748/wjg.v16.i10.1209 PubMedWeb of Science®Google Scholar 3Tanoue K, Mataki Y, Kurahara H et al. Multidisciplinary treatment of advanced or recurrent solid pseudopapillary neoplasm of the pancreas: Three case reports. Surg. Case Rep. 2022; 8: 7. 10.1186/s40792-022-01358-0 PubMedWeb of Science®Google Scholar 4Chen J, Zong L, Wang P et al. Solid pseudopapillary neoplasms of the pancreas: Clinicopathologic analysis and a predictive model. Mod. Pathol. 2023; 36: 10041. 10.1016/j.modpat.2023.100141 Web of Science®Google Scholar 5Ozgun YM, Oter V, Piskin E et al. Treatment modalities and the role of endoscopy for delayed gastric emptying after Whipple operation: Analysis of 53 patients. Am. Surg. 2022; 88: 273–279. 10.1177/0003134821989037 PubMedWeb of Science®Google Scholar 6Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: A new screening tool for eating disorders. West. J. Med. 2000; 172: 164–165. 10.1136/ewjm.172.3.164 CASPubMedWeb of Science®Google Scholar 7Hanachi M, Dicembre M, Rives-Lange C et al. Micronutrients deficiencies in 374 severely malnourished anorexia nervosa inpatients. Nutrients 2019; 11: 792. 10.3390/nu11040792 CASPubMedWeb of Science®Google Scholar 8Ali SI, Abber SR, Keel PK. Purging disorder. In: VB Patel, VR Preedy, eds. Eating Disorders. Cham: Springer; 2023. https://doi.org/10.1007/978-3-031-16691-4_69. 10.1007/978-3-031-16691-4_69 Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

BACKGROUND: Speculation exists as to whether lisdexamfetamine dimesylate (LDX) acts on the functional connectivity (FC) of brain networks that modulate appetite, reward, or inhibitory control in binge -eating disorder (BED). Better insights into its action may help guide the development of more targeted therapeutics and identify who will benefit most from this medication. Here, we use a comprehensive data -driven approach to investigate the brain FC changes that underlie the therapeutic action of LDX in patients with BED. METHODS: Forty-six participants with moderate to severe BED received LDX titrated to 50 or 70 mg for an 8 -week period. Twenty age -matched healthy control participants were also recruited. Resting -state functional magnetic resonance imaging was used to probe changes in brain FC pre- and post treatment and correlated with change in clinical measures. RESULTS: Ninety-seven percent of trial completers (n = 31) experienced remission or a reduction to mild BED during the 8 -week LDX trial. Widespread neural FC changes occurred, with changes in default mode to limbic, executive control to subcortical, and default mode to executive control networks associated with improvements in clinical outcomes. These connections were not distinct from control participants at pretreatment but were different from control participants following LDX treatment. Pretreatment connectivity did not predict treatment response. CONCLUSIONS: FC between networks associated with self -referential processing, executive function, and reward seem to underlie the therapeutic effect of LDX in BED. This suggests that LDX activates change via multiple systems, with most changes in compensatory networks rather than in those characterizing the BED diagnosis.

Robust evidence from adult samples indicates that neurocognitive dysfunction is a hallmark of many mental illnesses, contributing to the loss of daily function and quality of life that these illnesses cause. However, it is still unclear whether neurocognitive deficits associated with mental illnesses begin to manifest well before adulthood or impact treatment response. Here we address this gap by evaluating neurocognitive function in four groups of children and adolescents with different mental illnesses compared to their matched healthy peers. Our team evaluated the neurocognitive performance of youth diagnosed with attention deficit and hyperactivity disorder ( N = 343), anorexia ( N = 40), first onset psychosis ( N = 25) and functional neurological disorder ( N = 56) versus age-matched healthy controls ( N = 483), cross-sectionally. Performance was assessed using an objective assessment battery designed for use across diagnoses and settings and validated for its correlations with underlying brain structure and function. The following cognitive domains were assessed: sustained attention, cognitive flexibility, decision speed, executive function, information processing speed, psychomotor response speed, response inhibition, verbal memory and working memory. Distinct profiles of neurocognitive dysfunction were detected for each diagnosis relative to the healthy reference group. Youth with first onset psychosis displayed the most severe and generalized impairments across domains of sustained attention, verbal memory, response inhibition, cognitive flexibility, information processing speed and working memory. Children and adolescents with attention deficit and hyperactivity disorder showed impairments in multiple domains of at least moderate severity with the most pronounced impairments in executive function, sustained attention and working memory. Children and adolescents with anorexia displayed more specific moderate impairments limited to cognitive flexibility, response inhibition, sustained attention, decision speed and verbal memory. Impairments in functional neurological disorder were also relatively specific and moderate, limited to executive function, working memory, cognitive flexibility, decision speed and information processing speed. These findings suggest that neurocognitive impairment in mental illness is transdiagnostic and can be detected as early as childhood or adolescence with standardized computerized testing.

Journal of Paediatrics and Child HealthEarly View Instructive Case Anorexia nervosa and relative energy deficiency syndrome causing extreme bradycardia, growth failure and pituitary failure Lauren SH Chong, Corresponding Author Lauren SH Chong lauren.chong1@health.nsw.gov.au orcid.org/0000-0002-1791-1500 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Correspondence: Dr Lauren SH Chong, Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Cnr Hawkesbury Road and Darcy Rd, Westmead, NSW 2145, Australia. Fax: +61 2 9893 9062; email: lauren.chong1@health.nsw.gov.auSearch for more papers by this authorMushira Mokhtar, Mushira Mokhtar orcid.org/0000-0001-5322-2174 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorGail Anderson, Gail Anderson Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorLinette Gomes, Linette Gomes Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorBasiliki Lampropoulos, Basiliki Lampropoulos Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorRod McClymont, Rod McClymont Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorMichael Kohn, Michael Kohn Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this authorSimon Clarke, Simon Clarke Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this author Lauren SH Chong, Corresponding Author Lauren SH Chong lauren.chong1@health.nsw.gov.au orcid.org/0000-0002-1791-1500 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Correspondence: Dr Lauren SH Chong, Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Cnr Hawkesbury Road and Darcy Rd, Westmead, NSW 2145, Australia. Fax: +61 2 9893 9062; email: lauren.chong1@health.nsw.gov.auSearch for more papers by this authorMushira Mokhtar, Mushira Mokhtar orcid.org/0000-0001-5322-2174 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorGail Anderson, Gail Anderson Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorLinette Gomes, Linette Gomes Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorBasiliki Lampropoulos, Basiliki Lampropoulos Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorRod McClymont, Rod McClymont Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorMichael Kohn, Michael Kohn Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this authorSimon Clarke, Simon Clarke Centre for Research into Adolescent's Health (CRASH), Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 21 October 2021 https://doi.org/10.1111/jpc.15807 Conflict of interest: None declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Neuroimaging studies have revealed neurobiological differences in ADHD, particularly studies examining connectivity disruption and anatomical network organization. However, the underlying pathophysiology of ADHD types remains elusive as it is unclear whether dysfunctional network connections characterize the underlying clinical symptoms distinguishing ADHD types. Here, we investigated intrinsic functional network connectivity to identify neural signatures that differentiate the combined (ADHD-C) and inattentive (ADHD-I) presentation types. Applying network-based statistical (NBS) and graph theoretical analysis to task-derived intrinsic connectivity data from completed fMRI scans, we evaluated default mode network (DMN) and whole-brain functional network topology in a cohort of 34 ADHD participants (aged 8-17 years) defined using DSM-IV criteria as predominantly inattentive (ADHD-I) type (n = 15) or combined (ADHD-C) type (n = 19), and 39 age and gender-matched typically developing controls. ADHD-C were characterized from ADHD-I by reduced network connectivity differences within the DMN. Additionally, reduced connectivity within the DMN was negatively associated with ADHD-RS hyperactivity-impulsivity subscale score. Compared with controls, ADHD-C but not ADHD-I differed by reduced connectivity within the DMN; inter-network connectivity between the DMN and somatomotor networks; the DMN and limbic networks; and between the somatomotor and cingulo-frontoparietal, with ventral attention and dorsal attention networks. However, graph-theoretical measures did not significantly differ between groups. These findings provide insight into the intrinsic networks underlying phenotypic differences between ADHD types. Furthermore, these intrinsic functional connectomic signatures support neurobiological differences underlying clinical variations in ADHD presentations, specifically reduced within and between functional connectivity of the DMN in the ADHD-C type.

OBJECTIVE:The trail making task is used to assess executive functioning in ADHD youth, yet has only been validated in adult populations. We compare the relative contributions of various cognitive measures to performance on a trail making task analog, the Switching of Attention (SoA) task, in typically-developing and ADHD adolescents.METHOD:Participants were 160 adolescents with ADHD from the International Study to Predict Optimized Treatment-in ADHD, assessed at pretreatment baseline and 6-week medicated follow-up, and 160 matched typically-developing peers. Attention, processing speed, working memory, impulsivity, and motor speed were assessed using a cognitive battery.RESULTS:Processing speed and working memory significantly contributed to SoA performance in ADHD, regardless of medication status. While medicated, motor speed also underpinned the prediction of most task measures. For typically-developing adolescents, sustained attention and working memory contributed to SoA performance.CONCLUSION:Typically-developing, unmedicated and treated ADHD adolescents recruit different aspects of cognition during SoA completion.

Journal of Paediatrics and Child HealthVolume 58, Issue 7 p. 1267-1269 Instructive Case Severe hyponatraemia secondary to psychogenic polydipsia in a patient with anorexia nervosa Mushira Che Mokhtar, Corresponding Author Mushira Che Mokhtar mushira.chemokhtar@health.nsw.gov.au orcid.org/0000-0001-5322-2174 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Correspondence: Dr Mushira Che Mokhtar, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia. Fax: +61 2 9893 9062; email: mushira.chemokhtar@health.nsw.gov.auSearch for more papers by this authorLauren Chong, Lauren Chong orcid.org/0000-0002-1791-1500 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, AustraliaSearch for more papers by this authorGail Anderson, Gail Anderson Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorChristine Wearne, Christine Wearne Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorLinette Gomes, Linette Gomes Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorBasiliki Lampropoulos, Basiliki Lampropoulos Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Department of Paediatrics, Nepean Blue Mountains Local Health District, Penrith, New South Wales, AustraliaSearch for more papers by this authorMichael Kohn, Michael Kohn Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorSimon Clarke, Simon Clarke Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this author Mushira Che Mokhtar, Corresponding Author Mushira Che Mokhtar mushira.chemokhtar@health.nsw.gov.au orcid.org/0000-0001-5322-2174 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Correspondence: Dr Mushira Che Mokhtar, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia. Fax: +61 2 9893 9062; email: mushira.chemokhtar@health.nsw.gov.auSearch for more papers by this authorLauren Chong, Lauren Chong orcid.org/0000-0002-1791-1500 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, AustraliaSearch for more papers by this authorGail Anderson, Gail Anderson Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorChristine Wearne, Christine Wearne Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorLinette Gomes, Linette Gomes Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorBasiliki Lampropoulos, Basiliki Lampropoulos Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Department of Paediatrics, Nepean Blue Mountains Local Health District, Penrith, New South Wales, AustraliaSearch for more papers by this authorMichael Kohn, Michael Kohn Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorSimon Clarke, Simon Clarke Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 18 November 2021 https://doi.org/10.1111/jpc.15820 Conflict of interest: None declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume58, Issue7July 2022Pages 1267-1269 RelatedInformation

Evidence from functional neuroimaging studies support neural differences between the Attention Deficit Hyperactivity Disorder (ADHD) presentation types. It remains unclear if these neural deficits also manifest at the structural level. We have previously shown that the ADHD combined, and ADHD inattentive types demonstrate differences in graph properties of structural covariance suggesting an underlying difference in neuroanatomical organization. The goal of this study was to examine and validate white matter brain organization between the two subtypes using both scalar and connectivity measures of brain white matter. We used both tract-based spatial statistical (TBSS) and tractography analyses with network-based Statistics (NBS) and graph-theoretical analyses in a cohort of 35 ADHD participants (aged 8-17 years) defined using DSM-IV criteria as combined (ADHD-C) type (n=19) or as predominantly inattentive (ADHD-I) type (n=16), and 28 matched neurotypical controls. We performed TBSS analyses on scalar measures of fractional anisotropy (FA), mean (MD), radial (RD), and axial (AD) diffusivity to assess differences in WM between ADHD types and controls. NBS and graph theoretical analysis of whole brain inter-regional tractography examined connectomic differences and brain network organization, respectively. None of the scalar measures significantly differed between ADHD types or relative to controls. Similarly, there were no tractography connectivity differences between the two subtypes and relative to controls using NBS. Global and regional graph measures were also similar between the groups. A single significant finding was observed for nodal degree between the ADHD-C and controls, in the right insula (corrected p=.029). Our result of no white matter differences between the subtypes is consistent with most previous findings. These findings together might suggest that the white matter structural architecture is largely similar between the DSM-based ADHD presentations.

The trail making task (TMT) is commonly used as a measure of executive function in children with ADHD. However, previous literature suggests that the cognitive components of TMT performance may differ between normal and neuropsychologically impaired individuals. This study aims to investigate whether the cognitive contributions of TMT performance differ between adolescent participants with and without ADHD, as well as between individuals with ADHD when medicated and unmedicated.

Journal of Paediatrics and Child HealthVolume 57, Issue 4 p. 581-583 Instructive Case Sexual identity in congenital adrenal hyperplasia Isabelle ML Bosi, Corresponding Author isabelle.bosi@health.nsw.gov.au orcid.org/0000-0001-9313-6692 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, AustraliaCorrespondence: Dr Isabelle ML Bosi, The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, Sydney, NSW 2145, Australia. Fax: +61 2 9845 3489; email: isabelle.bosi@health.nsw.gov.auSearch for more papers by this authorJane Holmes-Walker, Department of Endocrinology, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorNamson S Lau, Department of Diabetes and Endocrinology, Liverpool Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorSlavica Bate, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorGail Anderson, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorMichael Kohn, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia Centre for Research into Adolescents' Health, Western Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorSimon Clarke, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia Centre for Research into Adolescents' Health, Western Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this author Isabelle ML Bosi, Corresponding Author isabelle.bosi@health.nsw.gov.au orcid.org/0000-0001-9313-6692 Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, AustraliaCorrespondence: Dr Isabelle ML Bosi, The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, Sydney, NSW 2145, Australia. Fax: +61 2 9845 3489; email: isabelle.bosi@health.nsw.gov.auSearch for more papers by this authorJane Holmes-Walker, Department of Endocrinology, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorNamson S Lau, Department of Diabetes and Endocrinology, Liverpool Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorSlavica Bate, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorGail Anderson, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorMichael Kohn, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia Centre for Research into Adolescents' Health, Western Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorSimon Clarke, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia Centre for Research into Adolescents' Health, Western Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 29 May 2020 https://doi.org/10.1111/jpc.14912 Conflict of interest: None declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume57, Issue4April 2021Pages 581-583 RelatedInformation

IMPORTANCE Transgender and nonbinary youths have a higher incidence of a range of health conditions and may paradoxically face limited access to health care. OBJECTIVE To describe the perspectives and needs of transgender youths in accessing health care. EVIDENCE REVIEW MEDLINE, Embase, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature were searched from inception to January 2021. Qualitative studies of transgender youths' perspectives on accessing health care were selected. Results from primary studies were extracted. Data were analyzed using thematic synthesis. FINDINGS Ninety-one studies involving 884 participants aged 9 to 24 years across 17 countries were included. We identified 6 themes: experiencing pervasive stigma and discrimination in health care, feeling vulnerable and uncertain in decision-making, traversing risks to overcome systemic barriers to transitioning, internalizing intense fear of consequences, experiencing prejudice undermining help-seeking efforts, and experiencing strengthened gender identity and finding allies. Each theme encapsulated multiple subthemes. CONCLUSIONS AND RELEVANCE This review found that transgender youths contend with feelings of gender incongruence, fear, and vulnerability in accessing health care, which are compounded by legal, economic, and social barriers. This can lead to disengagement from care and resorting to high-risk and unsafe interventions. Improving access to gender-affirming care services with a cultural humility lens and addressing sociolegal stressors may improve outcomes in transgender and nonbinary youths.

Behavioural disturbances in attention deficit hyperactivity disorder (ADHD) are thought to be due to dysfunction of spatially distributed, interconnected neural systems. While there is a fast-growing literature on functional dysconnectivity in ADHD, far less is known about the structural architecture underpinning these disturbances and how it may contribute to ADHD symptomology and treatment prognosis. We applied graph theoretical analyses on diffusion MRI tractography data to produce quantitative measures of global network organisation and local efficiency of network nodes. Support vector machines (SVMs) were used for comparison of multivariate graph measures of 37 children and adolescents with ADHD relative to 26 age and gender matched typically developing children (TDC). We also explored associations between graph measures and functionally-relevant outcomes such as symptom severity and prediction of methylphenidate (MPH) treatment response. We found that multivariate patterns of reduced local efficiency, predominantly in subcortical regions (SC), were able to distinguish between ADHD and TDC groups with 76% accuracy. For treatment prognosis, higher global efficiency, higher local efficiency of the right supramarginal gyrus and multivariate patterns of increased local efficiency across multiple networks at baseline also predicted greater symptom reduction after 6 weeks of MPH treatment. Our findings demonstrate that graph measures of structural topology provide valuable diagnostic and prognostic markers of ADHD, which may aid in mechanistic understanding of this complex disorder.

Anorexia nervosa (AN) affects approximately 2.9% of females and has the highest mortality rate among all psychiatric disorders. Despite several advances, the neurobiology of this disorder is still not well understood. Several studies have reported abnormalities in the white matter, but it is not know if these are disease-related or secondary to undernutrition. This study aimed to further our understanding of white matter pathology using diffusion-weighted imaging in underweight adolescents with AN, and to examine changes occurring after short-term weight restoration. Analyses were conducted on diffusion-weighted imaging from 24 female adolescents with AN and 17 age- and gender-matched healthy controls (HC), aged 14–19 years. Groups were compared on fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) using tract-based spatial statistics analysis and DTI measures were correlated with eating disorder examination questionnaire (EDE-Q) subscales and body mass index (BMI). Preliminary repeated-measure analyses were also conducted on eight participants after short-term weight restoration (median 41 days). Widespread increases in MD of up to 9% were found in underweight AN relative to HC, particularly in the corpus callosum. This was associated with both increased AD and RD, suggestive of dys- or de-myelination. There were no significant group differences in FA, and no significant correlations between DTI measures, BMI or EDE-Q subscale score. Weight restoration therapy significantly reduced MD, to levels significantly lower than HC, but did not consistently alter FA across individuals. White matter microstructure is significantly altered in female adolescents with AN, with preliminary longitudinal data suggesting that it may be reversible with short-term weight restoration. Level III: evidence obtained from well-designed cohort or case–control analytic studies.

Introduction Providing effective nutritional rehabilitation to patients hospitalised with anorexia nervosa (AN) is challenging, partly due to conservative recommendations that advocate feeding patients at low energy intakes. An ‘underfeeding syndrome’ can develop when patients are not provided with adequate nutrition during treatment, whereby malnourished patients fail to restore weight in a timely matter, and even lose weight. Of particular concern, the reintroduction of carbohydrate in a starved patient can increase the risk of developing electrolyte, metabolic and organ dysfunction. The proposed trial assesses the efficacy and safety of a lower carbohydrate enteral formula (28% carbohydrate) against a standard enteral formula (54% carbohydrate), in adolescent and young adult patients (aged 15–25 years), hospitalised with AN. Methods and analysis The study employs a double-blind randomised controlled trial design. At admission to hospital, malnourished adolescent and young adults with AN will be randomly allocated to commence feeding on a standard enteral feeding formula (1.5 kcal/mL, 54% carbohydrate) or a lower carbohydrate isocaloric enteral feeding formula (1.5 kcal/mL, 28% carbohydrate). Assessments of nutritional intake, weight and biochemistry (phosphate, magnesium, potassium) will be conducted at baseline and during the first 3 weeks of hospital admission. The primary outcome measure will be incidence of hypophosphatemia. Secondary outcomes include weight gain, oedema, other electrolyte distortion, length of hospital admission, admission to the Intensive Care Unit (ICU) and number of days to reach medical stability, using defined parameters. Ethics and dissemination The protocol was approved by the Western Sydney Local Health District Human Research Ethics Committee and institutional research governance approvals were granted. Written informed consent will be sought prior to study enrolment. Study findings will be widely disseminated through peer-reviewed publications and conference presentations. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12617000342314); Pre-results.

Objectives: To investigate emotional responses to food images in women with eating disorders (EDs) and healthy controls (HCs); and in underweight individuals post weight-restoration. Methods: Women (>14 years) with (n = 139) and without (n = 41) an ED rated food images evoking fear, disgust and happiness on a three-visual-analogue scale. Underweight participants viewed the images at two time-points; pre- and post-weight-restoration. Results: HCs were significantly happier, less fearful/anxious prior to viewing the images compared with EDs. Negative emotional responses when viewing images were significantly greater (p < .001) in EDs compared with HCs; however, groups did not differ in happiness. Emotional responses were not significantly different within the ED groups. At post weight-restoration, individuals were significantly less anxious/disgusted when viewing the images. Conclusions: The importance of considering emotional responses when discussing food consumption in EDs trans-diagnostically is highlighted. Weight recovery reduces negative food responses, although responses remained high in comparison to HCs.

Purpose: Anorexia nervosa (AN) is a chronic and life-threatening eating disorder that can have a considerable negative impact on the growing skeleton. We hypothesized that the long-term impact on bone health may persist even after normalization of body weight. Methods: 41 females (mean age 21.2 +/- 2.9 years) with a history of adolescent-onset AN attended a follow-p bone health assessment at 5 years (T5, n = 28) or 10 years (T10, n = 13) after their first AN-related hospital admission. Assessment included dual-energy x-ray absorptiometry measurements of the total body, lumbar spine, and proximal femur, peripheral quantitative computed tomography at the radius and tibia, anthropometric measurements, serumbiochemistry, fracture history, and a patient questionnaire. Results: A recovery in body weight and BMI was seen for both the T5 and T10 cohorts (BMI at intake 16.6, BMI at T5-T10 21.2-21.3). Dual-energy x-ray absorptiometry body composition indicated a recovery of fat mass and lean tissue mass. Total BMD was unaffected, but reductions were seen at the femoral neck and arms. Peripheral quantitative computed tomography showed reduced trabecular and cortical bone in the radius, and cortical thinning in the tibia. AN patients showed a statistically significant reduction in measures of radiographic bone health at follow up, although not to a degree that necessitated clinical intervention. Serum insulin-like growth factor 1 was also positively correlated with total BMD and BMC measures. While fracture risk was not increased, a subset of participants (8%) showed multiple (> 4) fractures. Conclusion: A longitudinal study of adolescent AN showed persisting negative effects on bone health. Crown Copyright (c) 2018 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine. All rights reserved.

The efficacy and safety of Lisdexamfetamine dimesylate (LDX) in the treatment of moderate to severe binge eating disorder (BED) has been demonstrated in multiple randomised clinical trials. Despite this, little is known about how LDX acts to improve binge eating symptoms. This study aims to provide a comprehensive understanding of the neural mechanisms by which LDX improves symptoms of BED. We hypothesise that LDX will act by normalising connectivity within neural circuits responsible for reward and impulse control, and that this normalisation will correlate with reduced binge eating episodes. This is an open-label Phase 4 clinical trial of LDX in adults with moderate to severe BED. Enrolment will include 40 adults with moderate to severe BED aged 18–40 years and Body Mass Index (BMI) of 20–45 kg/m2, and 22 healthy controls matched for age, gender and BMI. Clinical interview and validated scales are used to confirm diagnosis and screen for exclusion criteria, which include comorbid anorexia nervosa or bulimia nervosa, use of psychostimulants within the past 6 months, and current use of antipsychotics or noradrenaline reuptake inhibitors. Baseline assessments include clinical symptoms, multimodal neuroimaging, cognitive assessment of reward sensitivity and behavioural inhibition, and an (optional) genetic sample. A subset of these assessments are repeated after eight weeks of treatment with LDX titrated to either 50 or 70 mg. The primary outcome measures are resting-state intrinsic connectivity and the number of binge eating episodes. Analyses will be applied to resting-state fMRI data to characterise pharmacological effects across the functional connectome, and assess correlations with symptom measure changes. Comparison of neural measures between controls and those with BED post-treatment will also be performed to determine whether LDX normalises brain function. First enrolment was in May 2018, and is ongoing. This study is the first comprehensive investigation of the neurobiological changes that occur with LDX treatment in adults with moderate to severe BED. ACTRN12618000623291, Australian and New Zealand Clinical Trials Registry URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374913&isReview=true . Date of Registration: 20 April 2018.

Factors underlying disturbed appetite perception in anorexia nervosa (AN) are poorly characterized. We examined in patients with AN whether fasting and postprandial appetite perceptions, gastrointestinal (GI) hormones, GI symptoms and state anxiety (i) differed from healthy controls (HCs) and (ii) were modified by two weeks of refeeding. 22 female adolescent inpatients with restricting AN, studied on hospital admission once medically stable (Wk0), and after one (Wk1) and two (Wk2) weeks of high-calorie refeeding, were compared with 17 age-matched HCs. After a 4 h fast, appetite perceptions, GI symptoms, state anxiety, and plasma acyl-ghrelin, cholecystokinin (CCK), peptide tyrosine tyrosine (PYY) and pancreatic polypeptide (PP) concentrations were assessed at baseline and in response to a mixed-nutrient test-meal (479 kcal). Compared with HCs, in patients with AN at Wk0, baseline ghrelin, PYY, fullness, bloating and anxiety were higher, and hunger less, and in response to the meal, ghrelin, bloating and anxiety were greater, and hunger less (all p < 0.05). After two weeks of refeeding, there was no change in baseline or postprandial ghrelin or bloating, or postprandial anxiety, but baseline PYY, fullness and anxiety decreased, and baseline and postprandial hunger increased (p < 0.05). We conclude that in AN, refeeding for 2 weeks was associated with improvements in PYY, appetite and baseline anxiety, while increased ghrelin, bloating and postprandial anxiety persisted.