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Ralph-Nearman C, Rae J, Levinson CA. Using clinician and patient input to assess utility, accuracy, efficiency, and therapeutic implementation of a new data-driven digital therapeutic for personalized clinical eating disorder treatment: Awaken digital guide. Psychother Res 2024:1-14. [PMID: 38917165 DOI: 10.1080/10503307.2024.2360445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 05/18/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE Eating disorders (EDs) take a life every 52 minutes and treatments are ineffective for ∼50% of individuals. Though EDs are heterogeneous illnesses, current evidence-based treatments take a "one-size-fits-all" approach. Network-Informed Personalized Treatment is a new promising treatment for EDs, but clinician-patient-friendly software tools are needed to integrate this guidance system into routine treatment. Adoption is key for impact, necessitating the inclusion of clinicians in the software development. The current pilot assessed a new data-driven clinician-guidance therapeutic. METHOD A two-part pilot was analyzed for quantitative (0-not at all to 10-extremely) and qualitative input on user perception through quantitative and open-ended prompted questions evaluating using personalizing ED treatment with the Awaken Digital Guide therapeutic. RESULTS Results demonstrated that clinicians in a focus group (N = 9) and clinician/patient dyads within implementation (N = 10) endorsed improved efficiency, effectiveness, self-awareness, and accuracy using Awaken Digital Guide compared to current treatment as suggested by quantitative and qualitative results. Both clinicians and patients rated the tool positively (6.8-9.6/5.8-8.6, respectively) with an average rating of good and excellent. CONCLUSION Findings suggest that ED-specialized clinicians desire data-driven guidance on personalizing ED treatment. Users perceive Awaken Digital Guide therapeutic with potential to increase collaboration, motivation, efficiency, and effectiveness of ED personalized treatment.
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Affiliation(s)
- Christina Ralph-Nearman
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Jesse Rae
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
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2
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Martini M, Longo P, Di Benedetto C, Delsedime N, Panero M, Abbate-Daga G, Toppino F. Nasogastric Tube Feeding in Anorexia Nervosa: A Propensity Score-Matched Analysis on Clinical Efficacy and Treatment Satisfaction. Nutrients 2024; 16:1664. [PMID: 38892597 PMCID: PMC11174568 DOI: 10.3390/nu16111664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
The choice of a refeeding strategy is essential in the inpatient treatment of Anorexia Nervosa (AN). Oral nutrition is usually the first choice, but enteral nutrition through the use of a Nasogastric Tube (NGT) often becomes necessary in hospitalized patients. The literature provides mixed results on the efficacy of this method in weight gain, and there is a scarcity of studies researching its psychological correlates. This study aims to analyze the effectiveness of oral versus enteral refeeding strategies in inpatients with AN, focusing on Body Mass Index (BMI) increase and treatment satisfaction, alongside assessing personality traits. We analyzed data from 241 inpatients, comparing a group of treated vs. non-treated individuals, balancing confounding factors using propensity score matching, and applied regression analysis to matched groups. The findings indicate that enteral therapy significantly enhances BMI without impacting treatment satisfaction, accounting for the therapeutic alliance. Personality traits showed no significant differences between patients undergoing oral or enteral refeeding. The study highlights the clinical efficacy of enteral feeding in weight gain, supporting its use in severe AN cases when oral refeeding is inadequate without adversely affecting patient satisfaction or being influenced by personality traits.
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Affiliation(s)
| | | | | | | | | | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 11, 10126 Turin, Italy; (M.M.); (P.L.); (C.D.B.); (N.D.); (M.P.); (F.T.)
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3
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Muzi L, Carone N, Mirabella M, Franco A, Rugo MA, Mazzeschi C, Lingiardi V. Direct and indirect effects of psychological well-being and therapeutic alliance on therapy outcome in eating disorders. Front Psychol 2024; 15:1392887. [PMID: 38855305 PMCID: PMC11162114 DOI: 10.3389/fpsyg.2024.1392887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Outcome research in eating disorders (EDs) is commonly focused on psychopathological dysfunction. However, Ryff's model of psychological well-being (PWB) has shown promising-yet preliminary-results with ED patients. Additionally, despite substantial evidence highlighting the association between the therapeutic alliance and treatment outcome, findings in ED samples remain unclear. The present study aimed at exploring the direct effect of PWB dimensions and the early therapeutic alliance on ED patients' individual treatment responses, as well as the mediating role played by the early therapeutic alliance in the relationship between PWB dimensions and overall pre-post symptom change. Methods A sample of N = 165 ED patients assigned female at birth, who were receiving treatment in a residential program, completed the Psychological Well-Being Scale at treatment intake and the Working Alliance Inventory after the first four psychotherapy sessions. Patients also completed the Outcome Questionnaire-45.2 at the same time point and during the week prior to discharge. Results The PWB dimensions of autonomy, positive relations, and self-acceptance were associated with clinically significant change, while the dimensions of personal growth and self-acceptance were associated with reliable change. The early therapeutic alliance showed both direct and indirect effects on therapy outcome, predicting clinically significant and reliable symptom reduction. It also emerged as a significant mediator in the relationship between all PWB dimensions and overall symptomatic change. Conclusion The identification of individual, adaptive characteristics in ED patients that might influence their development of an early therapeutic alliance may help therapists to predict relationship ruptures and tailor their interventions to enhance treatment effectiveness.
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Affiliation(s)
- Laura Muzi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy
| | - Nicola Carone
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Anna Franco
- Eating Disorder Clinic “Residenza Gruber”, Bologna, Italy
| | | | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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4
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Toppino F, Martini M, Longo P, Caldas I, Delsedime N, Lavalle R, Raimondi F, Abbate-Daga G, Panero M. Inpatient treatments for adults with anorexia nervosa: a systematic review of literature. Eat Weight Disord 2024; 29:38. [PMID: 38767754 PMCID: PMC11106202 DOI: 10.1007/s40519-024-01665-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE Anorexia nervosa (AN) is a mental disorder for which hospitalization is frequently needed in case of severe medical and psychiatric consequences. We aim to describe the state-of-the-art inpatient treatment of AN in real-world reports. METHODS A systematic review of the literature on the major medical databases, spanning from January 2011 to October 2023, was performed, using the keywords: "inpatient", "hospitalization" and "anorexia nervosa". Studies on pediatric populations and inpatients in residential facilities were excluded. RESULTS Twenty-seven studies (3501 subjects) were included, and nine themes related to the primary challenges faced in hospitalization settings were selected. About 81.48% of the studies detailed the clinical team, 51.85% cited the use of a psychotherapeutic model, 25.93% addressed motivation, 100% specified the treatment setting, 66.67% detailed nutrition and refeeding, 22.22% cited pharmacological therapy, 40.74% described admission or discharge criteria and 14.81% follow-up, and 51.85% used tests for assessment of the AN or psychopathology. Despite the factors defined by international guidelines, the data were not homogeneous and not adequately defined on admission/discharge criteria, pharmacological therapy, and motivation, while more comprehensive details were available for treatment settings, refeeding protocols, and psychometric assessments. CONCLUSION Though the heterogeneity among the included studies was considered, the existence of sparse criteria, objectives, and treatment modalities emerged, outlining a sometimes ambiguous report of hospitalization practices. Future studies must aim for a more comprehensive description of treatment approaches. This will enable uniform depictions of inpatient treatment, facilitating comparisons across different studies and establishing guidelines more grounded in scientific evidence. LEVEL OF EVIDENCE Level I, systematic review.
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Affiliation(s)
- Federica Toppino
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Matteo Martini
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Paola Longo
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Inês Caldas
- Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - Nadia Delsedime
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Raffaele Lavalle
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Francesco Raimondi
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Matteo Panero
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy.
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5
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Elran-Barak R, Grundman-Shem Tov R, Zubery E, Lewis YD. Therapeutic alliance with psychotherapist versus dietician: a pilot study of eating disorder treatment in a multidisciplinary team during the COVID-19 pandemic. Front Psychiatry 2024; 14:1267676. [PMID: 38348361 PMCID: PMC10860050 DOI: 10.3389/fpsyt.2023.1267676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024] Open
Abstract
Little is known about the therapeutic alliance (TA) formed with different professionals in multidisciplinary eating disorder (ED) treatment, particularly in the context of online treatment during the COVID-19 pandemic. We aimed to conduct a pilot study during the COVID-19 pandemic examining characteristics of patients' TA with their dieticians and psychotherapists, associations between patients' and therapists' views of the TA, and relationships between psychological characteristics and TAs. Sixty-three patients with EDs and their treating psychotherapists and dieticians were surveyed during the COVID-19 pandemic using the Working Alliance Inventory (WAI-S). Spearman correlation tests were used to examine associations between variables. Positive associations were found between the TAs examined. Concordance was stronger in patient-dietician dyads than in patient-psychotherapist dyads. Severe ED psychopathology was associated with weaker TA (bond subscale). General psychopathology was associated with weaker TA with the dietician (task subscale). Given that several differences were found between the TAs of treatment dyads, further longitudinal studies are needed to validate our pilot findings and to investigate multidisciplinary TAs and their impact on treatment outcomes in online ED treatment settings during the COVID-19 pandemic, as well as in other treatment settings (e.g., in-person settings). This study will contribute to a deeper understanding of the dynamics of TAs in multidisciplinary ED treatment and inform the development of more effective interventions.
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Affiliation(s)
| | - Rinat Grundman-Shem Tov
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Eynat Zubery
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Yael D. Lewis
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Rankin R, Conti J, Ramjan L, Hay P. A systematic review of people's lived experiences of inpatient treatment for anorexia nervosa: living in a "bubble". J Eat Disord 2023; 11:95. [PMID: 37296440 DOI: 10.1186/s40337-023-00820-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Treatment for anorexia nervosa (AN) is typically delivered on a continuum of care, starting with outpatient treatment, and moving onto intensive outpatient, day or residential treatment and/or inpatient hospitalisation. However, minimal attention has been afforded to the lived experiences of persons undergoing inpatient treatment for AN. In particular, qualitative literature pertaining to the lived experiences of specialist inpatient or residential treatment of AN remains fragmented and incomplete. The aim of this review was to synthesise current literature exploring patients' lived experiences of residential and inpatient treatment for AN within eating disorder-specific treatment services. METHODS Five databases were searched and a qualitative thematic systematic review and meta-synthesis of 11 studies were conducted. RESULTS Eleven studies of 159 participants were included. Four meta-themes were constructed from the data: (1) a medical discourse-"I don't think it's individualised here"; (2) restrictive practice-living in a "bubble"; (3) myself, others and "a similar demon"; and (4) I am "not just another anorexic". The data also revealed two cross-cutting themes: (1) more than a single experience; and (2) meaning making and identity. CONCLUSIONS These findings highlight the complex and multifaceted nature of the inpatient treatment experience as well as the inherent conflicts in balancing the necessity of medical and psychological intervention with person-centred treatment approaches in the treatment of AN.
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Affiliation(s)
- Rebekah Rankin
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia.
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Lucie Ramjan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Campbelltown Hospital, South West Sydney Local Health District (SWSLHD), Sydney, Australia
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7
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Lev Ari HS, Gur E, Lotan‐Wohl M, Bernstein ZL, Tuval‐Mashiach R. Facilitators and obstacles to therapeutic alliance among patients with anorexia nervosa: A qualitative dyadic research. COUNSELLING & PSYCHOTHERAPY RESEARCH 2023. [DOI: 10.1002/capr.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Eitan Gur
- Sheba Medical Center Ramat Gan Israel
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8
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Alliance matters: but how much? A systematic review on therapeutic alliance and outcome in patients with anorexia nervosa and bulimia nervosa. Eat Weight Disord 2022; 27:1279-1295. [PMID: 34374966 PMCID: PMC9079014 DOI: 10.1007/s40519-021-01281-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/23/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Patients with eating disorders (ED) pose a high-risk group regarding relapse. The understanding of factors contributing to a better outcome is much-needed. Therapeutic alliance (TA) is one important, pantheoretical variable in the treatment process, which has shown to be connected with outcome. This review looks into a possible predictive effect of TA on outcome as well as related variables. METHODS A systematic review with pre-determined inclusion criteria following the PRISMA guidelines was conducted for studies published since 2014. Three previous reviews including studies up until 2014 were analyzed for studies matching our inclusion criteria. A total of 26 studies were included. RESULTS The results were heterogeneous between different patient groups. Regarding the predictive effect of TA, in adolescent samples, the TA of either the patients or their parents seems to impact outcome as well as completion. For adults, results are mixed, with a tendency to a greater impact of TA for anorexia nervosa (AN) patients, while some samples of adult bulimia nervosa (BN) patients did not find any relation between TA and outcome. CONCLUSION The effect of TA on clinical outcome depends on the patient group. TA has a greater impact on adolescents, irrespective of diagnosis, and on adults with AN. The examined studies have different limitations which include small sample sizes and questionable study design. The examination of motivation as a potential influencing factor is recommended. LEVEL OF EVIDENCE Level I, systematic review.
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9
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Marzola E, Martini M, Brustolin A, Abbate-Daga G. Inpatients with severe-enduring anorexia nervosa: Understanding the "enduringness" specifier. Eur Psychiatry 2021; 64:e44. [PMID: 34254574 PMCID: PMC8278247 DOI: 10.1192/j.eurpsy.2021.2218] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Despite the need for a common definition of severe and enduring anorexia nervosa (SE-AN) with the overarching goal to optimize treatments, this definition still is being debated. Therefore, in this study we conducted an in-depth investigation of the history of AN and its clinical outcomes on inpatients with AN to ascertain the eventual “profiles” for individuals with varying durations of the illness (DOI). Methods We recruited 169 inpatients with AN, grouping them according to DOI: <3 years (short duration, SD-AN); 3–6.99 years (medium duration, MD-AN); and ≥7 years (long duration, LD-AN). We then performed a self-report and interview-based investigation of AN history, clinical data, eating, and general psychopathology, including personality, premorbid traits, stage of change, and quality of life. We measured the clinical outcomes for hospitalization as well. Results The majority of the measures did not differ across groups. Those with LD-AN were older and diagnosed mostly with the binge-purging AN subtype, failed more previous AN-related treatments, reported a lower lifetime body mass index, and trended toward a younger age at onset when compared to the other groups. All patients responded equally well to hospitalization, but patients with SD-AN improved less in drive for thinness and body-related concerns. Conclusions We did not find the “enduringness” of AN to be a specifier of severity. Hospitalization was effective for those with LD-AN and MD-AN, while interventions for the core cognitive aspects of over-evaluation of body shape should be offered to patients with SD-AN.
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Affiliation(s)
- Enrica Marzola
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Matteo Martini
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Annalisa Brustolin
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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10
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From the patients' perspective: what it is like to suffer from eating disorders. Eat Weight Disord 2021; 26:751-755. [PMID: 32440995 DOI: 10.1007/s40519-020-00913-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/29/2020] [Indexed: 02/07/2023] Open
Abstract
The available treatments of Eating Disorders (EDs) mirror an excessive focus on symptoms to be eliminated rather than on the acknowledgment of what is relevant from the patient's perspective. This Editorial offers a critical review of the limitations of the DSM-5-oriented approaches, as well as of their extreme consequences, namely ocularcentrism, nosographism, and paternalistic moralism. To overcome these limitations, it is suggested to get back to Psychopathology as the basic science of psychiatric practice whose aim is to grasp the distinctly personal dimension of the patient's experience and to connect understanding with care. With the help of Psychopathology, clinicians engaged in the treatment of ED patients will better make sense of what it is like to suffer from these disorders and be encouraged to suspend their judgment and take patient's perspective in the light of their troubled existence which is rich in meanings and not merely in abnormal beliefs and trivial anomalous behavior. According to these principles, treatment is a journey shared with the patient, which allows her/him to feel recognized and accepted in terms of her/his individuality.
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11
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Fernández-Aranda F, Treasure J, Paslakis G, Agüera Z, Giménez M, Granero R, Sánchez I, Serrano-Troncoso E, Gorwood P, Herpertz-Dahlmann B, Bonin EM, Monteleone P, Jiménez-Murcia S. The impact of duration of illness on treatment nonresponse and drop-out: Exploring the relevance of enduring eating disorder concept. EUROPEAN EATING DISORDERS REVIEW 2021; 29:499-513. [PMID: 33599348 DOI: 10.1002/erv.2822] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE There are no generally accepted definitions or markers of treatment nonresponse in eating disorders (EDs). The aim of this paper was to examine how the duration of illness and other potential prognostic markers impacted on nonresponse and drop-out from treatment across different EDs subtypes. METHODS A total sample of 1199 consecutively treated patients with EDs, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, participated in this study. Kaplan-Meier curves were calculated for each ED diagnosis in which the probability of recovery was plotted against the duration of illness. RESULTS Full remission was more likely for people with binge eating disorder (BED; 47.4%) and anorexia nervosa (AN; 43.9%) compared to bulimia nervosa (BN; 25.2%) and other specified feeding and EDs (OSFED; 23.2%). The cut-off points for the duration of the illness related with high likelihoods of poor response was 6-8 years among OSFED, 12-14 years among AN and BN and 20-21 years among BED. Other variables predicting nonresponse included dysfunctional personality traits. CONCLUSIONS Nonresponse to treatment is associated with duration of illness which is in turn associated with poor response to previous treatment. However, there was no evidence for staging the illness using specific duration of illness criteria. Nevertheless, the shorter temporal trajectory for OSFED suggests that early interventions may be of importance for this group.
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Affiliation(s)
- Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Georgios Paslakis
- Medical Faculty, University Clinic for Psychosomatic Medicine and Psychotherapy, Campus East-Westphalia, Ruhr-University of Bochum, Luebbecke, Germany
| | - Zaida Agüera
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Mónica Giménez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Eduardo Serrano-Troncoso
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu and Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Philip Gorwood
- CMME, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM, U1266, Paris, France
| | - Beate Herpertz-Dahlmann
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen, Aachen, Germany
| | - Eva-Maria Bonin
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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12
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Ziser K, Rheindorf N, Keifenheim K, Becker S, Resmark G, Giel KE, Skoda EM, Teufel M, Zipfel S, Junne F. Motivation-Enhancing Psychotherapy for Inpatients With Anorexia Nervosa (MANNA): A Randomized Controlled Pilot Study. Front Psychiatry 2021; 12:632660. [PMID: 33597901 PMCID: PMC7882628 DOI: 10.3389/fpsyt.2021.632660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with anorexia nervosa (AN) are frequently characterized by an unstable readiness to change and high ambivalence toward treatment. Enhancing readiness to behavioral change therefore plays an essential role for adherence to treatment especially for severely ill patients treated in inpatient settings. Therefore, a novel 10 week program for the individual psychotherapy sessions was designed using elements from motivational interviewing to be applied within the multidisciplinary inpatient treatment for patients with AN. In a randomized controlled pilot trial, N = 22 patients with AN received either the new intervention or treatment as usual in one of two recruiting university hospitals. Readiness to change, eating disorder pathology, therapeutic alliance as well as acceptance and feasibility of the new intervention were measured from patients and therapists in week 1, 5, and 10 of inpatient treatment. Results confirm acceptance and feasibility of the MANNA intervention as evaluated by patients as well as therapists. Patients receiving the new intervention completed their inpatient treatment significantly more often on regular terms than patients receiving treatment as usual. No differences between the groups could be found concerning therapeutic alliance during and at the end of treatment and readiness to change. Absolute numbers of BMI increase indicate a larger increase in the intervention group albeit not significant in this pilot study sample. Limitations of the study such as the small sample size as well as possible adaptions and advancements of the intervention that need to be examined in a larger clinical trial of efficacy are discussed. This phase II study is registered with the German Clinical Trials Register (DRKS) under the trial number DRKS00015639.
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Affiliation(s)
- Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Nadine Rheindorf
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University Duisburg-Essen, Essen, Germany
| | - Katharina Keifenheim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Sandra Becker
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders, University of Tuebingen, Tuebingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders, University of Tuebingen, Tuebingen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University Duisburg-Essen, Essen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders, University of Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders, University of Tuebingen, Tuebingen, Germany
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Frank GKW. Pharmacotherapeutic strategies for the treatment of anorexia nervosa - too much for one drug? Expert Opin Pharmacother 2020; 21:1045-1058. [PMID: 32281881 DOI: 10.1080/14656566.2020.1748600] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Anorexia nervosa is a severe psychiatric illness and no medication has been approved for its treatment. This lack of biological treatments requires the development of new directions for pharmacological research. AREAS COVERED There is modest but emerging evidence that dopamine D2 and serotonin 1A and 2A receptor agonistic and antagonist medication might be beneficial for weight gain, although the underlying mechanisms are uncertain. Improving quality of life including treating comorbid conditions is an additional important outcome measure, but this has not been well researched. Biological and psychological risk factors together with neurobiological alterations during the illness maintain the disorder 's pathophysiology. Neuroscience research can be used to understand those interactions and advance the research agenda. The authors discuss the above as well as give perspectives on future research. EXPERT OPINION If a multidisciplinary approach that includes evidence-based psychotherapy shows unsatisfactory success in weight normalization and cognitive-emotional recovery, then more experimental treatments that are safe and have indicated treatment effectiveness should be tried to augment treatment. Identification and treatment of comorbid conditions to improve quality of life of the patient should also be part of the treatment regimen, even if the effect on weight gain is uncertain.
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Affiliation(s)
- Guido K W Frank
- UCSD Eating Disorder Center for Treatment and Research, University of California San Diego , San Diego, CA, USA
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