251
|
Long CG, Fitzgerald KA, Hollin CR. Treatment of chronic anorexia nervosa: a 4-year follow-up of adult patients treated in an acute inpatient setting. Clin Psychol Psychother 2011; 19:1-13. [DOI: 10.1002/cpp.738] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
252
|
One size fits all: or horses for courses? Recovery-based care in specialist mental health services. Soc Psychiatry Psychiatr Epidemiol 2011; 46:127-36. [PMID: 21391337 DOI: 10.1007/s00127-009-0174-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The ‘recovery approach’ to the management of severe mental health problems has become a guiding vision of service provision amongst many practitioners, researchers, and policy makers as well as service users. METHOD This qualitative pilot study explored the meaning of ‘recovery’ with users of three specialist mental health services (eating disorders, dual diagnosis, and forensic) in 18 semi-structured interviews. RESULTS The relevance of themes identified in mainstream recovery literature was confirmed; however, the interpretation and relative weight of these themes appeared to be affected by factors that were specific to the diagnosis and treatment context. ‘Clinical’ recovery themes were also seen as important, as were aspects of care that reflect core human values, such as kindness.
Collapse
|
253
|
Greenblatt JM, Sussman C, Jameson M, Yuan L, Hoffman DA, Iosifescu DV. Retrospective chart review of a referenced EEG database in assisting medication selection for treatment of depression in patients with eating disorders. Neuropsychiatr Dis Treat 2011; 7:529-41. [PMID: 21931495 PMCID: PMC3173036 DOI: 10.2147/ndt.s22271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A retrospective chart review was undertaken in a private clinic to examine the clinical outcomes for patients with an eating disorder comorbid with depression or bipolar illness who underwent a referenced electroencephalographic (EEG) database analysis to help guide medication selection. METHOD We examined 33 charts for patients with the primary psychiatric diagnosis of an eating disorder and comorbid major depressive disorder or bipolar disorder who underwent a quantitative EEG database assessment to provide additional information for choices of medication. The current analysis includes data from 22 subjects who accepted treatments based on information from the referenced-EEG medication database. Hamilton Depression Rating Scale, Clinical Global Impression-Severity, Clinical Global Impression-Improvement, and hospitalization data were examined for these patients. RESULTS Patients whose EEG data was used for clinical treatment reported significant decreases in associated depressive symptoms (HDRS scores), overall severity of illness (Clinical Global Impression-Severity), and overall clinical global improvement (Clinical Global Impression- Improvement). This cohort also reported fewer inpatient, residential, and partial hospitalization program days following referenced-EEG compared with the two-year period prior to treatment. CONCLUSION These findings are consistent with previously reported data for patients with eating disorders and suggest the need for future studies using EEG data correlated with those from other patients with similar quantitative EEG features.
Collapse
|
254
|
Schmidt U, Oldershaw A, van Elburg A. Translating experimental neuroscience into treatment of eating disorders: two examples. Curr Top Behav Neurosci 2011; 6:253-268. [PMID: 21243480 DOI: 10.1007/7854_2010_76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Anorexia nervosa (AN) is a serious mental disorder with impaired functioning including not only the cognitive and socio-emotional but also physical domains. Improved treatments, especially for adults with AN, are urgently needed. The insights gained from basic research in experimental animal models and the advent of cognitive neuroscience have produced major advances in our understanding of the condition, but translating these into clinical research or practice remains a challenge. We describe here what the eating disorders field can gain from schizophrenia research in this area. We use the example of socio-emotional impairments in AN to describe the iterative process between basic research and intervention development for neurobiologically informed and based treatments for this condition and briefly touch on some other examples that stem from translational science.
Collapse
Affiliation(s)
- Ulrike Schmidt
- Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
| | | | | |
Collapse
|
255
|
Bulik CM, Baucom D, Kirby J, Pisetsky E. Uniting Couples (in the treatment of) Anorexia Nervosa (UCAN). Int J Eat Disord 2011; 44:19-28. [PMID: 20063308 PMCID: PMC2889168 DOI: 10.1002/eat.20790] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe the development of a novel couple-based cognitive-behavioral intervention for adult anorexia nervosa (AN) called Uniting Couples (in the treatment of) Anorexia Nervosa (UCAN). METHOD We review the state of the science for the treatment of adult AN, the nature of relationships in AN, our model of couple functioning in AN, and the development of the UCAN intervention. RESULTS We present the UCAN treatment for patients with AN and their partners and discuss important considerations in the delivery of the intervention. DISCUSSION With further evaluation, we expect that UCAN will emerge to be an effective, acceptable, disseminable, and developmentally tailored intervention that will serve to improve both core AN pathology as well as couple functioning.
Collapse
Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, Chapel Hill, North Carolina.
| | - Donald Baucom
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Jennifer Kirby
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Emily Pisetsky
- Department of Psychology, University of North Carolina at Chapel Hill
| |
Collapse
|
256
|
Merwin RM, Timko CA, Moskovich AA, Ingle KK, Bulik CM, Zucker NL. Psychological inflexibility and symptom expression in anorexia nervosa. Eat Disord 2011; 19:62-82. [PMID: 21181580 DOI: 10.1080/10640266.2011.533606] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this article is to outline a model of anorexia nervosa (AN) as a disorder of psychological inflexibility, motivated by an insatiable desire for prediction and control with related intolerance for uncertainty. We describe preliminary data that provide initial support for this conceptualization and point to the ways in which mindfulness and acceptance-based strategies might be particularly useful for treating AN. This article is not intended to be an exhaustive literature review, rather a conceptual framework to guide future research and treatment development.
Collapse
Affiliation(s)
- Rhonda M Merwin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA
| | | | | | | | | | | |
Collapse
|
257
|
Bamford BH, Mountford VA. Cognitive behavioural therapy for individuals with longstanding anorexia nervosa: Adaptations, clinician survival and system issues. EUROPEAN EATING DISORDERS REVIEW 2010; 20:49-59. [DOI: 10.1002/erv.1080] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
258
|
Lopez C, Stahl D, Tchanturia K. Estimated intelligence quotient in anorexia nervosa: a systematic review and meta-analysis of the literature. Ann Gen Psychiatry 2010; 9:40. [PMID: 21182794 PMCID: PMC3016382 DOI: 10.1186/1744-859x-9-40] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 12/23/2010] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It has been hypothesised that people with anorexia nervosa have a higher intelligence quotient (IQ) level than the general population. The purpose of this review was to systematically appraise the research into reported IQ levels in people with anorexia nervosa. METHODS A search using the terms intelligence quotient, IQ, intelligence, cognition, eating disorders and anorexia was conducted in electronic databases only. RESULTS In all, 30 peer-reviewed studies written in English that used well established measures of intelligence quotient (the National Adult Reading Test and Wechsler Intelligence Scales) were identified. This review established that people with anorexia nervosa score 10.8 units and 5.9 units above the average intelligence quotient of the normative population on the National Adult Reading Test and Wechsler Intelligence Scales, respectively. An association was found between Body Mass Index and intelligence quotient, as measured by the National Adult Reading Test. CONCLUSIONS More studies including other eating disorder categories and recovered people are needed to explore important questions regarding the role of the intelligence quotient in treatment response.
Collapse
Affiliation(s)
- Carolina Lopez
- Institute of Psychiatry, Kings College London, London, UK
- Faculty of Medicine, University of Chile, Santiago, Chile
| | - Daniel Stahl
- Institute of Psychiatry, Kings College London, London, UK
| | | |
Collapse
|
259
|
Malson H, Bailey L, Clarke S, Treasure J, Anderson G, Kohn M. Un/imaginable future selves: A discourse analysis of in-patients' talk about recovery from an ‘eating disorder’. EUROPEAN EATING DISORDERS REVIEW 2010; 19:25-36. [DOI: 10.1002/erv.1011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
260
|
Björk T, Clinton D, Norring C. The impact of different outcome measures on estimates of remission in a 3-year follow-up of eating disorders. EUROPEAN EATING DISORDERS REVIEW 2010; 19:2-11. [DOI: 10.1002/erv.1031] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
261
|
Hart S, Abraham S, Franklin R, Russell J. Weight changes during inpatient refeeding of underweight eating disorder patients. EUROPEAN EATING DISORDERS REVIEW 2010; 19:390-7. [PMID: 24081714 DOI: 10.1002/erv.1052] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM To describe patterns of weight change in patients admitted to a specialised eating disorder program with established protocols for inpatient refeeding. METHODS Weight records between January 2000 and December 2006 were categorised using Body Mass Index (BMI) at first admission (BMI ranges < 14.0, 14.1-17.49, 17.5-18.9 kg/m(2)). Total weight gained, number of days of inpatient treatment and rate of weekly weight gain were examined. RESULTS In total there were 247 patients representing 414 admissions. The rate of weight gain was 0.77, 0.63 and 0.53 kg/week, respectively, for each BMI group. Twenty patients (8.1%) in the refeeding program did not gain weight. CONCLUSION Weight gain in underweight patients is highly variable. A greater understanding of the processes that contribute to weight gain, and establishment of best practice in achieving weight gain in patients needs to be determined. This data provide detailed information about expectations for refeeding without artificial feeding.
Collapse
Affiliation(s)
- Susan Hart
- Accredited Practising Dietitian, Department of Obstetrics and Gynaecology, University of Sydney, Royal North Shore Hospital, Australia.
| | | | | | | |
Collapse
|
262
|
Affiliation(s)
- Caitlin B O'Hara
- PhD student, psychology, Institute of Psychiatry, Section of Eating Disorders, King's College London
| |
Collapse
|
263
|
Bosanac P, Newton R, Harari E, Castle D. Mind the evidence gap: do we have any idea about how to integrate the treatment of anorexia nervosa into the Australian mental health context? Australas Psychiatry 2010; 18:517-22. [PMID: 20932198 DOI: 10.3109/10398562.2010.499433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this paper is to review recent developments in the treatment of anorexia nervosa (AN) and how this translates to clinical and population-based care in the Australian context. CONCLUSIONS Overall, there is a paucity of high-quality research into treatments for AN, albeit that a number of biological and psychological interventions show promise as avenues for further research. There are significant impediments to the provision of comprehensive longitudinal care for people with AN within Australian mental health services. Evaluation of novel strategies, such as home-based support, is required as part of enhancing options for Australians suffering with AN and their families.
Collapse
Affiliation(s)
- Peter Bosanac
- St. Vincents' Mental Health and Senior Lecturer, Dept. Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
| | | | | | | |
Collapse
|
264
|
Simpson SG, Morrow E, van Vreeswijk M, Reid C. Group schema therapy for eating disorders: a pilot study. Front Psychol 2010; 1:182. [PMID: 21833243 PMCID: PMC3153792 DOI: 10.3389/fpsyg.2010.00182] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 10/09/2010] [Indexed: 11/27/2022] Open
Abstract
This paper describes the use of Group Schema Therapy for Eating Disorders (ST-E-g) in a case series of eight participants with chronic eating disorders and high levels of co-morbidity. Treatment was comprised of 20 sessions which included cognitive, experiential, and interpersonal strategies, with an emphasis on behavioral change. Specific schema-based strategies focused on bodily felt-sense and body-image, as well as emotional regulation skills. Six attended until end of treatment, two dropped-out at mid-treatment. Eating disorder severity, global schema severity, shame, and anxiety levels were reduced between pre- and post-therapy, with a large effect size at follow-up. Clinically significant improvement in eating severity was found in four out of six completers. Group completers showed a mean reduction in schema severity of 43% at post-treatment, and 59% at follow-up. By follow-up, all completers had achieved over 60% improvement in schema severity. Self-report feedback suggests that group factors may catalyze the change process in schema therapy by increasing perceptions of support and encouragement to take risks and try out new behaviors, whilst providing a de-stigmatizing and de-shaming therapeutic experience.
Collapse
Affiliation(s)
- Susan G Simpson
- School of Psychology, Social Work and Social Policy, Division of Education, Arts and Social Sciences, University of South Australia Adelaide, SA, Australia
| | | | | | | |
Collapse
|
265
|
Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. ACTA ACUST UNITED AC 2010; 67:1025-32. [PMID: 20921118 DOI: 10.1001/archgenpsychiatry.2010.128] [Citation(s) in RCA: 485] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONTEXT Evidence-based treatment trials for adolescents with anorexia nervosa are few. OBJECTIVE To evaluate the relative efficacy of family-based treatment (FBT) and adolescent-focused individual therapy (AFT) for adolescents with anorexia nervosa in full remission. DESIGN Randomized controlled trial. SETTING Stanford University and The University of Chicago (April 2005 until March 2009). PARTICIPANTS One hundred twenty-one participants, aged 12 through 18 years, with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement. Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT. Participants were assessed at baseline, end of treatment (EOT), and 6 months' and 12 months' follow-up posttreatment. MAIN OUTCOME MEASURES Full remission from anorexia nervosa defined as normal weight (≥95% of expected for sex, age, and height) and mean global Eating Disorder Examination score within 1 SD of published means. Secondary outcome measures included partial remission rates (>85% of expected weight for height plus those who were in full remission) and changes in body mass index percentile and eating-related psychopathology. RESULTS There were no differences in full remission between treatments at EOT. However, at both the 6- and 12-month follow-up, FBT was significantly superior to AFT on this measure. Family-based treatment was significantly superior for partial remission at EOT but not at follow-up. In addition, body mass index percentile at EOT was significantly superior for FBT, but this effect was not found at follow-up. Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT, but there were no differences at follow-up. CONCLUSION Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT, FBT was more effective in facilitating full remission at both follow-up points. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00149786.
Collapse
Affiliation(s)
- James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305, USA.
| | | | | | | | | | | |
Collapse
|
266
|
Pardo M, Roca-Rivada A, Al-Massadi O, Seoane LM, Camiña JP, Casanueva FF. Peripheral leptin and ghrelin receptors are regulated in a tissue-specific manner in activity-based anorexia. Peptides 2010; 31:1912-9. [PMID: 20600421 DOI: 10.1016/j.peptides.2010.06.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 06/22/2010] [Accepted: 06/22/2010] [Indexed: 11/26/2022]
Abstract
The aim of this research was to investigate the effect of long-term exposure to low leptin and high ghrelin levels, inherent to activity-based anorexia (ABA), on peripheral metabolism-implicated tissues such as muscle and fat depots. For this purpose, rats under ABA were submitted to a global study which included the characterization of body weight and composition change, the evaluation of leptin and ghrelin levels as well as their receptors expression at peripheral level. Our results confirm that feeding restriction to 1 h per day, and particularly the combination of this fasting regime with exercise (ABA), significantly reduces fat mass, decreases leptin circulating levels, increases ghrelin levels strikingly and enhances insulin sensitivity. By direct in vitro assays, we show that visceral and gonadal fat participate more than subcutaneous fat in the hypoleptinemia of these animals. The study of ghrelin (GHS-R1a) and leptin (LEPR) receptors at peripheral level exhibits a tissue-specific expression pattern. Concretely, oxidative-soleus type of muscle appears to be more susceptible to ghrelin and leptin circulating levels than glycolytic-gastrocnemius type under exercise and food restriction situations. In relation to adipose tissue, chronic hyperghrelinemia induces GHS-R1a expression on visceral and subcutaneous fat which might suggest the prevention of lipid loss. On the other hand, only subcutaneous fat express the active long form of LEPR compared to visceral and gonadal fat under low leptin levels in ABA animals. All together, these findings indicate tissue-specific mechanisms for the control of energy homeostasis in response to nutrient and energy availability.
Collapse
Affiliation(s)
- María Pardo
- Laboratorio de Endocrinología Molecular y Celular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain.
| | | | | | | | | | | |
Collapse
|
267
|
Roberts ME, Tchanturia K, Treasure JL. Exploring the neurocognitive signature of poor set-shifting in anorexia and bulimia nervosa. J Psychiatr Res 2010; 44:964-70. [PMID: 20398910 DOI: 10.1016/j.jpsychires.2010.03.001] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 02/26/2010] [Accepted: 03/01/2010] [Indexed: 12/30/2022]
Abstract
Poor set-shifting has been implicated as a risk marker, maintenance factor and candidate endophenotype of eating disorders (ED). This study aimed to add clarity to the cognitive profile of set-shifting by examining the trait across ED subtypes, assessing whether it is a state or trait marker, and whether it runs in families. A battery of neuropsychological tasks was administered to 270 women with current anorexia (AN) and bulimia nervosa (BN), women recovered from AN, unaffected sisters of AN and BN probands, and healthy control women. Set-shifting was examined using both individual task scores and a composite variable (poor/intact/superior shifting) calculated from four neuropsychological tasks. Poor set-shifting was found at a higher rate in those with an ED particularly binge/purging subtypes. Some evidence for poor set-shifting was also present in those recovered from AN and in unaffected sisters of AN and BN. Clinically, poor set-shifting was associated with a longer duration of illness and more severe ED rituals but not body mass index. In sum, poor set-shifting is a transdiagnostic feature related to aspects of the illness but not to malnutrition. In part it is a familial trait, and is likely involved in the maintenance of the illness.
Collapse
Affiliation(s)
- Marion E Roberts
- Institute of Psychiatry, Division of Psychological Medicine and Psychiatry, Section of Eating Disorders, King's College London, United Kingdom.
| | | | | |
Collapse
|
268
|
Watson KK, Werling DM, Zucker NL, Platt ML. Altered social reward and attention in anorexia nervosa. Front Psychol 2010; 1:36. [PMID: 21887145 PMCID: PMC3157932 DOI: 10.3389/fpsyg.2010.00036] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 07/07/2010] [Indexed: 11/22/2022] Open
Abstract
Dysfunctional social reward and social attention are present in a variety of neuropsychiatric disorders including autism, schizophrenia, and social anxiety. Here we show that similar social reward and attention dysfunction are present in anorexia nervosa (AN), a disorder defined by avoidance of food and extreme weight loss. We measured the implicit reward value of social stimuli for female participants with (n = 11) and without (n = 11) AN using an econometric choice task and also tracked gaze patterns during free viewing of images of female faces and bodies. As predicted, the reward value of viewing bodies varied inversely with observed body weight for women with anorexia but not control women, in contrast with their explicit ratings of attractiveness. Surprisingly, women with AN, unlike control women, did not find female faces rewarding and avoided looking at both the face and eyes – independent of observed body weight. These findings suggest comorbid dysfunction in the neural circuits mediating gustatory and social reward in anorexia nervosa.
Collapse
Affiliation(s)
- Karli K Watson
- Department of Neurobiology, Center for Cognitive Neuroscience, and Center for Neuroeconomics, Duke University Durham, NC, USA
| | | | | | | |
Collapse
|
269
|
Hatch A, Madden S, Kohn MR, Clarke S, Touyz S, Gordon E, Williams LM. Emotion brain alterations in anorexia nervosa: a candidate biological marker and implications for treatment. J Psychiatry Neurosci 2010; 35:267-74. [PMID: 20598239 PMCID: PMC2895157 DOI: 10.1503/jpn.090073] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Identification of the biological markers of anorexia nervosa (AN) is crucial for the development of new treatments. We aimed to determine whether AN is associated with disturbances in the nonconscious neural processing of innate signals of emotion and whether these disturbances persist after weight gain. METHODS In a retest design, 28 adolescent females with AN were tested at first ad not mission to hospital and again after they had gained weight. Matched healthy control participants were tested at the same times. We assessed emotion-elicited event-related potentials (ERPs) during overt and covert presentation of emotion expressions, scores on an emotion-identification behavioural task, and symptom measures. We performed between and within group analyses. RESULTS Individuals with AN had a marked alteration in ERPs relative to healthy controls. Irrespective of the form of stimulus, early and late ERP componotnents were significantly reduced in AN patients at baseline (when underweight) and on retest (after weight gain), especially in the temporo-occipital regions, suggesting a persistent disruption of the early automatic appraisal of salient emotional signals. LIMITATIONS This study could have been improved with a longer standardized retest interval. CONCLUSION There is likely a core, generic disturbance in AN in the early "automatic" neural processing of emotion irrespective of weight or nutritional status. New innovative emotion-based psychologic or pharmacologic treatments targeting these nonconscious processes may prove beneficial.
Collapse
Affiliation(s)
- Ainslie Hatch
- The Brain Dynamics Center, Westmead Millennium Institute and University of Sydney at Westmead Hospital, Australia.
| | | | | | | | | | | | | |
Collapse
|
270
|
Haley CC, Hedberg K, Leman RF. Disordered eating and unhealthy weight loss practices: which adolescents are at highest risk? J Adolesc Health 2010; 47:102-5. [PMID: 20547299 DOI: 10.1016/j.jadohealth.2009.12.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Revised: 12/18/2009] [Accepted: 12/21/2009] [Indexed: 11/26/2022]
Abstract
Early diagnosis of unhealthy weight loss practices (UWLP) among adolescents improves treatment outcomes. Analysis of population-based school survey data in Oregon demonstrated that the 11.6% reporting UWLP were more likely to perceive themselves as overweight, depressed, and to have abused substances. Targeted screening of adolescents can help identify those with UWLP.
Collapse
Affiliation(s)
- Clinton C Haley
- Oregon Department of Human Services, Public Health Division, Office of Disease Prevention and Epidemiology, 800 NE Oregon Street, Portland, OR 97232, USA
| | | | | |
Collapse
|
271
|
Turkiewicz G, Pinzon V, Lock J, Fleitlich-Bilyk B. Feasibility, acceptability, and effectiveness of family-based treatment for adolescent anorexia nervosa: an observational study conducted in Brazil. REVISTA BRASILEIRA DE PSIQUIATRIA 2010; 32:169-72. [DOI: 10.1590/s1516-44462010005000001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 10/06/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: There is strong evidence that family-based treatment is effective in cases of adolescent anorexia nervosa. Although family-based treatment has been studied in English-speaking countries, there is a need to examine the generalizability of this approach to non-English speaking cultures. This pilot-study aimed to examine the feasibility, acceptability, and effectiveness of family-based treatment in Brazil. METHOD: Observational study of adolescents with anorexia nervosa (excluding menstrual criteria), as determined with the Diagnostic and Well-Being Assessment, referred for treatment at a specialized center in São Paulo, Brazil. The following data were collected at baseline, at the end of treatment, and after six months of follow-up: weight; height; body mass index; menstrual status; Eating Disorder Examination Questionnaire score; and Children Global Assessment of Functioning Scale score. RESULTS: Of 11 eligible patients/families, 9 (82%) enrolled in the study, and 7 (78%) completed the treatment. The mean patient age was 14.64 ± 1.63 years (range, 12.33-17.00 years). The Wilcoxon signed rank test showed statistically significant improvement in weight and body mass index at the end of treatment, as well as after six months of follow-up, at which point none of the patients met the diagnostic criteria for any eating disorder. CONCLUSION: The results suggest that family-based treatment is acceptable and feasible for Brazilian families. Outcomes suggest that the approach is effective in this cultural context, leading to improvements similar to those reported in previous studies conducted in other cultures.
Collapse
|
272
|
Abstract
BACKGROUND Anorexia Nervosa (AN) is characterised by distorted body image and deliberately maintained low body weight. The long term prognosis is often poor, with severe medical, developmental and psychosocial complications, high rates of relapse and mortality. Different variants of family therapy have been commonly used for intervention. OBJECTIVES To evaluate the efficacy of family therapy compared with standard treatment and other treatments. SEARCH STRATEGY The Cochrane Collaboration Depression, Anxiety and Neuroses Controlled Trials Register (CCDANCTR) was searched until August 2008; MEDLINE, PsycInfo and EMBASE and ClinicalTrials.gov were searched up to January 2008. A conference abstract book and included studies reference lists were searched. All lead authors of included studies were also contacted. SELECTION CRITERIA Randomised controlled trials (RCTS) of interventions described as 'family therapy' compared to any other intervention or other types of family therapy were eligible for inclusion. Patients of any age or gender with a primary clinical diagnosis of anorexia nervosa (AN) were included. DATA COLLECTION AND ANALYSIS Two review authors selected the studies, assessed quality and extracted data. We used a random effects meta-analysis. Relative risk was used to summarise dichotomous outcomes and both the standardised mean difference and mean difference to summarise continuous measures. MAIN RESULTS 13 trials were included, the majority investigating family based therapy, or variants. Reporting of trial conduct was generally inadequate. The full extent of the risk of bias is unclear. There was some evidence (from two studies, 81 participants) to suggest that family therapy may be more effective than treatment as usual on rates of remission, in the short term (RR 3.83 95% CI 1.60 to 9.13). Based on one study (30 participants) there was no significant advantage for family therapy over educational interventions (RR 9.00 95% CI 0.53, 153.79) or over other psychological interventions (RR 1.13 95% CI 0.72 to 1.76) based on four studies (N=149).All other reported comparisons for relapse rates, cognitive distortion, weight measures and dropouts yielded non-significant results. AUTHORS' CONCLUSIONS There is some evidence to suggest that family therapy may be effective compared to treatment as usual in the short term. However, this is based on few trials that included only a small number of participants, all of which had issues regarding potential bias. There appears to be little advantage of family therapy over other psychological interventions. The field would benefit from a large, well-conducted trial.
Collapse
Affiliation(s)
- Caroline A Fisher
- Department of Clinical Neuropsychology, Austin Health, Heidelberg Repatriation Hospital, and Centre of Excellence in Youth Mental Health, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, PO Box 5444, Heidelberg West, Victoria, Australia, 3081
| | | | | |
Collapse
|
273
|
McKnight RF, Park RJ. Atypical antipsychotics and anorexia nervosa: a review. EUROPEAN EATING DISORDERS REVIEW 2010; 18:10-21. [PMID: 20054875 DOI: 10.1002/erv.988] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is currently mixed opinion regarding the value of using atypical antipsychotics to treat anorexia nervosa (AN). AIMS To evaluate the literature on the use of atypical antipsychotics in AN. METHOD A review of all studies and clinical guidelines published before September 2009 involving use of an atypical antipsychotic in patients with AN. Analysis is by narrative synthesis. RESULTS Forty-three publications or study protocols were found, including four randomized-controlled trials, five open-label trials and 26 case reports. The most studied drugs were olanzapine, quetiapine and risperidone. Atypical antipsychotics appear safe and there is some evidence of positive effects on depression, anxiety and core eating disordered psychopathology in patients with anorexia nervosa. Currently there is insufficient evidence to confirm atypical antipsychotics enhance weight gain in this setting. CONCLUSIONS Further high quality evidence is needed in this area in order to provide practical guidance to clinicians. However, the main challenge is to persuade adequate numbers of AN patients to participate in research trials.
Collapse
Affiliation(s)
- Rebecca F McKnight
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
| | | |
Collapse
|
274
|
East P, Startup H, Roberts C, Schmidt U. Expressive writing and eating disorder features: A preliminary trial in a student sample of the impact of three writing tasks on eating disorder symptoms and associated cognitive, affective and interpersonal factors. EUROPEAN EATING DISORDERS REVIEW 2010; 18:180-96. [DOI: 10.1002/erv.978] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
275
|
Affiliation(s)
- Evelyn Attia
- Weill Cornell Medical College and Columbia Center for Eating Disorders, Columbia University Medical Center, New York, New York;
| |
Collapse
|
276
|
Findlay S, Pinzon J, Taddeo D, Katzman DK. Le traitement familial des enfants et des adolescents anorexiques : Des lignes directrices pour le médecin communautaire. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
277
|
Detemining factors for target weights in an anorexia nervosa inpatient program for adolescents and young adults: study on the links between theory-based hypotheses and the realities of clinical practice. Eat Weight Disord 2009; 14:e176-83. [PMID: 20179403 DOI: 10.1007/bf03325114] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The aim is to study if the determination of target weights in a clinical therapeutic contract which guides weight gain for adolescent inpatients with anorexia nervosa (AN) is based on clearly pre-defined, objective clinical elements. METHOD Treating psychiatrists completed patient information questionnaires for 139 anorexic adolescent inpatients. These questionnaires included information related to factors that the clinical team had hypothesized to be decisive in weight contract determination. Comparative statistical procedures evaluated whether these factors were in fact decisive in clinical practice. RESULTS The two weight objectives comprising our therapeutic contract (separation end weight and final discharge weight) were significantly related to the clinical variables tested: separation end weight was explained by the theoretical separation end weight, the range of contract, and the desires of the patient and her parents; final discharge weight was explained by patient body mass index before AN and by the desires of the patient and her parents. CONCLUSION The therapeutic contract is based on objective criteria and implemented by our team in accordance with its theoretical design. It is therefore possible to establish goal weights in a defined and reliable manner.
Collapse
|
278
|
[Tube feeding at home in anorexia nervosa patients]. Presse Med 2009; 38:1739-45. [PMID: 19647392 DOI: 10.1016/j.lpm.2009.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 04/10/2009] [Accepted: 04/30/2009] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In the aim to explore the efficacy of tube feeding (TF) in ambulatory anorexia nervosa (AN) patients, we prospectively treated 60 AN patients by tube feeding (TF) at home, using a nasogastric tube. METHODS Nutritional (clinical, biological) and psychological (Hamilton and Beck scores) markers were assessed before and after 2 months of NEAD. RESULTS While the patient's body weight was decreasing during the previous 2 months, it significantly increased (P<0.001) during the 2-month TF, both in the restrictive and the binge/purging form: +3,42 +/- 2,39 kg in the restrictive ones and +2,82 +/- 2,17 kg in the binge/purging ones. Patients were rapidly (48 h) and frequently abstinent from binge/purging during TF: 90% had no more binge/purging episodes (P<0.0001). TF did not worse the eating behavior, and did increase neither anxiety nor depressive levels (Hamilton and Beck scores). Biological nutritional markers were normal before TF and remained so (2nd month), except haptoglobin which was low before and reached normal range during TF (P<0,01). CONCLUSION Ambulatory TF seems to be useful in AN patients at home. This could permit to avoid hospitalization, but needs to be confirmed by a randomized trial.
Collapse
|
279
|
Abstract
In the first part of this decade, many reviews of the impact of treatments for the eating disorders were conducted, with broadly similar conclusions. This review provides an update on progress (or otherwise) in the field over the past three years.
Collapse
Affiliation(s)
- Glenn Waller
- Vincent Square Clinic Osbert Street, London SW1P 2QU UK
| |
Collapse
|
280
|
Thomas JJ, Roberto CA, Brownell KD. Eighty-five per cent of what? Discrepancies in the weight cut-off for anorexia nervosa substantially affect the prevalence of underweight. Psychol Med 2009; 39:833-43. [PMID: 18775087 PMCID: PMC2847836 DOI: 10.1017/s0033291708004327] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND DSM-IV cites <85% of expected body weight (EBW) as a guideline for the diagnosis of anorexia nervosa (AN) but does not require a specific method for calculating EBW. The purpose of the present study was to determine the degree to which weight cut-off calculations vary across studies, and to evaluate whether differential cut-offs lead to discrepancies in the prevalence of individuals who are eligible for the AN diagnosis. METHOD Two coders independently recorded the EBW calculation methods from 99 studies that either (a) compared individuals with AN to those with subclinical eating disorders or (b) conducted AN treatment trials. Each weight cut-off was applied to a nationally representative (n=12001) and treatment-seeking (n=189) sample to determine the impact of EBW calculation on the proportion who met the AN weight criterion. RESULTS Coders identified 10 different EBW methods, each of which produced different weight cut-offs for the diagnosis of AN. Although only 0.23% of the national sample met the lowest cut-off, this number increased 43-fold to 10.10% under the highest cut-off. Similarly, only 48.1% of treatment seekers met the lowest cut-off, whereas 89.4% met the highest. CONCLUSIONS There is considerable variance across studies in the determination of the AN weight cut-off. Discrepancies substantially affect the proportion of individuals who are eligible for diagnosis, treatment and insurance reimbursement. However, differences may not be fully appreciated because the ubiquitous citation of the 85% criterion creates a sense of false consensus.
Collapse
Affiliation(s)
- J J Thomas
- Department of Psychology, Yale University, New Haven, CT, USA.
| | | | | |
Collapse
|
281
|
Schauenburg H, Friederich HC, Wild B, Zipfel S, Herzog W. Fokale psychodynamische Psychotherapie der Anorexia nervosa. PSYCHOTHERAPEUT 2009. [DOI: 10.1007/s00278-009-0668-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
282
|
McElroy SL, Guerdjikova AI, Martens B, Keck PE, Pope HG, Hudson JI. Role of antiepileptic drugs in the management of eating disorders. CNS Drugs 2009; 23:139-56. [PMID: 19173373 DOI: 10.2165/00023210-200923020-00004] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Growing evidence suggests that antiepileptic drugs (AEDs) may be useful in managing some eating disorders. In the present paper, we provide a brief overview of eating disorders, the rationale for using AEDs in the treatment of these disorders and review the data supporting the effectiveness of specific AEDs in the treatment of patients with eating disorders. In addition, the potential mechanisms of action of AEDs in these conditions are discussed. Of the available AEDs, topiramate appears to have the broadest spectrum of action as an anti-binge eating, anti-purging and weight loss agent, as demonstrated in two placebo-controlled studies in bulimia nervosa and three placebo-controlled studies in binge-eating disorder (BED) with obesity. Topiramate may also have beneficial effects in night-eating syndrome and sleep-related eating disorder, but controlled trials in these conditions are needed. The results of one small controlled study suggest that zonisamide may have efficacy in BED with obesity. However, both topiramate and zonisamide are associated with adverse effect profiles that may limit their use in patients with eating disorders. Phenytoin may be effective in some patients with compulsive binge eating, particularly if co-morbid EEG abnormalities are present, but available data are too varied to allow definitive conclusions to be made. Carbamazepine and valproate may be effective in treating patients with bulimia nervosa or anorexia nervosa when they are used to treat an associated psychiatric (e.g. mood) or neurological (e.g. seizure) disorder; otherwise, both agents, particularly valproate, are associated with weight gain. In conclusion, AEDs have an emerging role in the management of some eating disorders.
Collapse
|
283
|
Wild B, Friederich HC, Gross G, Teufel M, Herzog W, Giel KE, de Zwaan M, Schauenburg H, Schade-Brittinger C, Schäfer H, Zipfel S. The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa--a randomized controlled trial. Trials 2009; 10:23. [PMID: 19389245 PMCID: PMC2683809 DOI: 10.1186/1745-6215-10-23] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 04/23/2009] [Indexed: 12/20/2022] Open
Abstract
Background Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition and suicide. The seriousness of the disorder requires extensive knowledge of effective treatment options. However, evidence for treatment efficacy in this area is remarkably weak. A recent Cochrane review states that there is an urgent need for large, well-designed treatment studies for patients with anorexia nervosa. The aim of this particular multi-centre study is to evaluate the efficacy of two standardized outpatient treatments for patients with anorexia nervosa: focal psychodynamic (FPT) and cognitive behavioural therapy (CBT). Each therapeutic approach is compared to a "treatment-as-usual" control group. Methods/Design 237 patients meeting eligibility criteria are randomly and evenly assigned to the three groups – two intervention groups (CBT and FPT) and one control group. The treatment period for each intervention group is 10 months, consisting of 40 sessions respectively. Body weight, eating disorder related symptoms, and variables of therapeutic alliance are measured during the course of treatment. Psychotherapy sessions are audiotaped for adherence monitoring. The treatment in the control group, both the dosage and type of therapy, is not regulated in the study protocol, but rather reflects the current practice of established outpatient care. The primary outcome measure is the body mass index (BMI) at the end of the treatment (10 months after randomization). Discussion The study design surmounts the disadvantages of previous studies in that it provides a randomized controlled design, a large sample size, adequate inclusion criteria, an adequate treatment protocol, and a clear separation of the treatment conditions in order to avoid contamination. Nevertheless, the study has to deal with difficulties specific to the psychopathology of anorexia nervosa. The treatment protocol allows for dealing with the typically occurring medical complications without dropping patients from the protocol. However, because patients are difficult to recruit and often ambivalent about treatment, a drop-out rate of 30% is assumed for sample size calculation. Due to the ethical problem of denying active treatment to patients with anorexia nervosa, the control group is defined as "treatment-as-usual". Trial registration Current Controlled Trials ISRCTN72809357
Collapse
Affiliation(s)
- Beate Wild
- Department of Psychosomatic and General Internal Medicine, Medical University Hospital, Heidelberg, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
284
|
The impact of narcissism on drop-out from cognitive-behavioral therapy for the eating disorders: a pilot study. J Nerv Ment Dis 2009; 197:278-81. [PMID: 19363385 DOI: 10.1097/nmd.0b013e31819dc150] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the relationship between narcissism and drop-out from the early stage of cognitive behavioral therapy (CBT) for the eating disorders. Narcissism was defined in terms of both its core elements and the narcissistic defense styles. The participants were 41 patients presenting for CBT at a specialist eating disorders service. Each completed measures of narcissism and eating disorder psychopathology. Attendance at sessions was also recorded. The presence of the narcissistically abused personality defense style was associated with a higher likelihood of dropping out of outpatient CBT. This "martyred" form of narcissism appears to have a significant role in the adherence to treatment for the eating disorders. The limitations and the clinical implications of this preliminary research are discussed, and future directions for research are suggested.
Collapse
|
285
|
Affiliation(s)
- James D Lock
- Department of Psychiatry, Stanford University, Stanford, California
| |
Collapse
|
286
|
Affiliation(s)
- Evelyn Attia
- Eating Disorders Research Unit, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032,USA.
| | | |
Collapse
|
287
|
Herpertz-Dahlmann B, Salbach-Andrae H. Overview of treatment modalities in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am 2009; 18:131-45. [PMID: 19014862 DOI: 10.1016/j.chc.2008.07.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this article is to scrutinize and compare the benefits of distinct treatment settings for anorexia nervosa (AN) and to review the different treatment modalities that have proven helpful in the management of young patients with AN. Evidence-based findings on the effect of different treatment methods for AN are limited. Besides different treatment settings, a multimodal treatment approach comprising nutritional rehabilitation, nutritional counseling, individual psychotherapy and family-based interventions emphazising a group psychoeducation program for parents is presented.
Collapse
Affiliation(s)
- Beate Herpertz-Dahlmann
- Departments of Child and Adolescent Psychiatry and Psychotherapy, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
| | | |
Collapse
|
288
|
Crow SJ, Mitchell JE, Roerig JD, Steffen K. What potential role is there for medication treatment in anorexia nervosa? Int J Eat Disord 2009; 42:1-8. [PMID: 18683884 DOI: 10.1002/eat.20576] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To review selected issues regarding the development of drug treatments for anorexia nervosa (AN). METHOD The existing pharmacotherapy literature for AN is reviewed, and the theoretical and practical considerations are discussed. RESULTS A very wide variety of drugs have been examined in AN, generally with negative results. There are a number of potential reasons for this finding, including compliance, nutritional deficits, selection of the wrong targets or the wrong outcome measures, use of monotherapy, lack of animal models, or factors intrinsic to AN. CONCLUSION Pharmacotherapy provides little benefit in the treatment of AN at present. Several strategies might lead to the identification of more effective agents, including new measurement strategies, identification of novel pharmacologic targets, and consideration of a clinical trials network.
Collapse
Affiliation(s)
- Scott J Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota 55454-1495, USA.
| | | | | | | |
Collapse
|
289
|
Gentile MG, Manna GM, Ciceri R, Rodeschini E. Efficacy of inpatient treatment in severely malnourished anorexia nervosa patients. Eat Weight Disord 2008; 13:191-7. [PMID: 19169075 DOI: 10.1007/bf03327506] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Our aim is to present clinical results achieved with an intensive treatment programme for severe anorexia nervosa (AN) patients at risk of severe disability or death. Aims of the treatment are to remove life threatening conditions, physical and nutritional rehabilitation, and psychological and relational rehabilitation. METHODS We present an observational retrospective study of a cohort of 99 consecutive patients affected by severe AN [according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)] and a body mass index (BMI) <or=13.5 kg/m2 treated by a multidisciplinary comprehensive medical, nutritional, psychological treatment. Intensive treatment (inpatient day and night and day hospital care) of variable length, with resort to enteral nutrition if needed, ends by achieving a BMI of at least 18 kg/m2. Outpatient care phase follows. Main goals were the recovery of BMI and the ability to maintain it. RESULTS Ninety-nine patients affected by severe Protein- Energy-Malnutritrion (PEM) due to AN were eligible in the study. Mean BMI was 12.5+/-0.9 kg/m2, mean age 21.9+/-8.6 yrs. Of 99 patients, 75 (75.5%) completed the planned treatment (completer subgroup). Eighteen patients prematurely interrupted their treatment before achieving complete weight restoration (dropout subgroup); on average they were older and ill for a longer time before admission. Six patients asked to be transferred to other eating disorder units closer to their towns. Seventy-five completer AN patients continued to undergo intensive inpatient treatment till the achievement of BMI 18.3+/-0.8 kg/m2 and then they have been in follow-up outpatient for a mean period of 17.4+/-1.6 months with an average extra increase of their BMI until to 19.1+/-1.6 kg/m2. In 32 patients with a more severe malnutrition we had to resort to nasogastric enteral feeding for 4.4+/-2.5 months, with a mean caloric supply of 1375+/-211 Kcal until the patients were no longer at life risk and they started to co-operate to treatment, increasing oral food amounts. DISCUSSION Our results seem to provide strong support for using a highly structured program for treating patients with severe AN, including inpatient care and multidisciplinary medical and psychological teams specialized in eating disorder treatment.
Collapse
Affiliation(s)
- M G Gentile
- Eating Disorders Unit, Niguarda Hospital, Milan, Italy.
| | | | | | | |
Collapse
|
290
|
Golden NH. Variability in admission practices for teens hospitalized with anorexia nervosa: a call for evidence-based outcome studies. J Adolesc Health 2008; 43:417-8. [PMID: 18848666 DOI: 10.1016/j.jadohealth.2008.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Indexed: 10/21/2022]
|
291
|
Gutierrez E, Cerrato M, Carrera O, Vazquez R. Heat reversal of activity-based anorexia: implications for the treatment of anorexia nervosa. Int J Eat Disord 2008; 41:594-601. [PMID: 18446833 DOI: 10.1002/eat.20535] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Activity-based anorexia (ABA) provides an animal model of anorexia nervosa (AN). In this model, rats given restricted access to food but unrestricted access to activity wheels, run excessively while reducing food intake, lose a sizeable percentage of body weight, become hypothermic, and can fail to recover unless removed from these conditions. METHOD Once rats had lost 20% of body weight under standard ABA conditions, they were assigned to one of two ambient temperature (AT) conditions. RESULTS Increased AT reduced running rates and led to weight gain in active rats. The effect of increasing AT on food intake was dependent on whether the rats were sedentary or active. Although warming reduced food intake in the sedentary rats their body weight remained stable, whereas in active rats increased AT did not reduce food intake and weight gain gradually rose. CONCLUSION From a translational perspective, these findings offer a fresh perspective to the disorder, and underscore the need for further studies to assess the effects of heat treatment in patients as an innovative adjunctive treatment for anorexia nervosa.
Collapse
Affiliation(s)
- Emilio Gutierrez
- Departamento de Psicología Clinica y Psicobiología, Facultad de Psicología, Universidad de Santiago de Compostela, Spain.
| | | | | | | |
Collapse
|
292
|
Abstract
PURPOSE OF REVIEW The aim is to summarize recent evidence from the National Institute for Health and Clinical Excellence clinical guidelines and high-quality systematic reviews for the use of cognitive behavioural therapy to treat children and adolescents with mental health problems. RECENT FINDINGS Data from meta-analyses of randomized controlled trials suggest that the best evidence for the potential of cognitive behavioural therapy is in the treatment of children and adolescents with generalized anxiety disorder, depression, obsessive compulsive disorder and posttraumatic stress disorder. More limited evidence suggests that attention deficit hyperactivity disorder and behavioural problems may also respond to cognitive behavioural therapy. We found no or insufficient evidence to determine whether cognitive behavioural therapy is useful for the treatment of antisocial behaviour, psychotic and related disorders, eating disorders, substance misuse and self-harm behaviour. SUMMARY Clinical guidelines and recent systematic reviews establish that cognitive behavioural therapy has a potentially important role in improving the mental health of children and adolescents.
Collapse
|
293
|
Abstract
This article provides an overview of psychopharmacological treatments for pediatric eating disorders (EDs). Although EDs usually begin in adolescence, there are few pharmacological treatment trials specific to this age group and a paucity of controlled data. Empirical evidence suggests that psychological, behavioural and family interventions should be the primary modalities of treatment for these conditions. In severely underweight patients behavioural weight restoration should be attempted before pharmacological intervention, especially since starvation is known to aggravate obsessional and depressive symptomatology. Evidence from controlled trials supports the use of antidepressants for the treatment of bulimia nervosa (BN) in adults; however, similar studies have not yet been performed in youths. For anorexia nervosa (AN), there are no pharmacotherapies of proven efficacy in either adults or youths. Nonetheless, clinical experience and uncontrolled evidence suggests that some children and adolescents may benefit from thoughtful use of psychotropic medications on an individual basis in the context of a multimodal treatment plan. Regarding binge eating disorder (BED), adult literature shows positive short-term effects on binge eating for both pharmacological (especially selective serotonin reuptake inhibitors) and behavioural interventions, but unclear effects on weight. Clearly, psychopharmacological interventions for pediatric EDs would benefit from more research.
Collapse
Affiliation(s)
- Shauna Pencer Reinblatt
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | | |
Collapse
|
294
|
Rapee, RM. Prevention of Mental Disorders: Promises, Limitations, and Barriers. COGNITIVE AND BEHAVIORAL PRACTICE 2008. [DOI: 10.1016/j.cbpra.2007.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
295
|
Abstract
This paper reviews progress in the treatment of the eating disorders between 1968 and 2008. In 1968, no evidence-based treatments were available for any of the eating disorders, and binge eating disorder had not yet been described. In 2008, there are still no evidence-based treatments for anorexia nervosa, although a specific form of family therapy (based on the Maudsley model) appears promising. Both psychotherapeutic and psychopharmacological evidence-based treatments are now available for bulimia nervosa and binge eating disorder. Therapist-assisted self-help is a promising approach to treatment because it may reduce the costs of treatment, allow for more adequate dissemination to areas lacking specialty resources and also provide a basis for algorithm-driven approaches to treatment.
Collapse
Affiliation(s)
- W Stewart Agras
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | | |
Collapse
|
296
|
Léonard T. Thérapies comportementales et cognitives de l’anorexie mentale. NUTR CLIN METAB 2007. [DOI: 10.1016/j.nupar.2007.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|