Eating disorders and disordered eating symptoms in individuals at clinical high risk for psychosis: a systematic review and meta-analysis

Gabriele Lo Buglio; Marta Mirabella; Laura Muzi; Tommaso Boldrini; Erika Cerasti; Jone Bjornestad; Flavia Fiorentino; Andrea Polari; Eleonora Riccioli; Michele Angelo Rugo; Marco Solmi; Vittorio Lingiardi; Annalisa Tanzilli

doi:10.1007/s40519-024-01708-x

Eating disorders and disordered eating symptoms in individuals at clinical high risk for psychosis: a systematic review and meta-analysis

Eat Weight Disord. 2024 Dec 27;29(1):78. doi: 10.1007/s40519-024-01708-x.

Authors

Gabriele Lo Buglio¹, Marta Mirabella¹, Laura Muzi², Tommaso Boldrini³, Erika Cerasti⁴, Jone Bjornestad^{5

6

7}, Flavia Fiorentino¹, Andrea Polari^{8

9}, Eleonora Riccioli¹, Michele Angelo Rugo¹⁰, Marco Solmi^{11

12

13

14}, Vittorio Lingiardi^#¹, Annalisa Tanzilli^#¹⁵

Affiliations

¹ Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
² Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy.
³ Department of Psychology and Educational Science, Pegaso Telematic University, Naples, Italy.
⁴ Io Se Posso Komunico, Rome, Italy.
⁵ Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.
⁶ TIPS - Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.
⁷ Department of Psychiatry, District General Hospital of Førde, Førde, Norway.
⁸ Orygen Specialist Programs, Melbourne, Australia.
⁹ Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
¹⁰ Eating Disorder Clinic "Residenza Gruber", Bologna, Italy.
¹¹ SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
¹² Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
¹³ Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa , Ottawa, ON, Canada.
¹⁴ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
¹⁵ Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy. [email protected].

^# Contributed equally.

Abstract

Background: Eating disorders (EDs) are among the least studied mental disorders in individuals at clinical high risk for psychosis (CHR-P). The primary aim (a) of this systematic review and meta-analysis was to identify factors predicting ED diagnoses in CHR-P individuals. The secondary aim (b) was providing a comprehensive clinical description of individuals with both CHR-P and EDs/ED-related symptoms.

Methods: Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review and meta-analysis, searching PubMed/(EBSCO)PsycINFO/Web of Science for studies published between 01/01/2018 and 30/05/2023, including individuals with CHR-P and EDs/ED symptoms (PROSPERO CRD42023488792). Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). We performed a meta-regression model on the proportion of EDs in CHR-P individuals (primary aim) and conducted a narrative synthesis (secondary aim).

Results: We included 26 articles, reporting on 2,060 and 589 subjects for study aim (a) and (b), respectively (mean NOS score = 6.38). The prevalence of EDs in CHR-P individuals was 0.05 (95% CI 0.3-0.8). No factor had a significant effect on the proportion of EDs in CHR-P individuals. This result is limited by the inability to include ED-related symptoms and antipsychotic prescriptions in the meta-regression model, due to an insufficient number of studies reporting on these variables. The narrative synthesis offers a characterization of individuals with both CHR-P and ED/ED-related symptoms; however, the limited number of included studies is insufficient to support definitive conclusions.

Conclusions: No significant predictor of EDs was found in CHR-P individuals. Transdiagnostic, prospective cohort studies are warranted to examine long-term outcomes in individuals with both CHR-P and EDs, beyond diagnostic silos.

Level of evidence: I. Systematic review and meta-analysis.

Keywords: Clinical high risk for psychosis; Eating disorders; Meta-analysis; Prodrome; Psychosis; Transdiagnostic approach.

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Feeding and Eating Disorders* / diagnosis
Feeding and Eating Disorders* / psychology
Humans
Psychotic Disorders* / diagnosis
Psychotic Disorders* / psychology
Risk Factors