1
|
Sokolov M, Levy-Schiff R, Enoch-Levy A, Stein D. Self-perception and perceived parental perception in adolescent girls with anorexia nervosa. Front Psychol 2024; 14:1301927. [PMID: 38314249 PMCID: PMC10834772 DOI: 10.3389/fpsyg.2023.1301927] [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: 09/25/2023] [Accepted: 12/14/2023] [Indexed: 02/06/2024] Open
Abstract
Negative self-perception is associated with poor outcomes in adults with anorexia nervosa (AN). Our study aimed to assess the association between the self-perception of female adolescents with AN and how these adolescents perceive the attitudes of their parents toward them on the severity and short-term outcome of their illness. For this purpose, we assessed 30 adolescent girls hospitalized with AN and 30 female controls. Self-perception and perceived parental attitudes were assessed using the Structural Analysis of Social Behavior (SASB), according to which self-perception is formed via close relations with significant others in early life. Patients with AN responded to the SASB and to questionnaires assessing eating disorder (ED) symptomatology and emotional distress at both admission and discharge. Controls were similarly assessed once. We found that patients with AN showed a more negative self-perception than controls. Negative self-perception was associated with negative perceptions of the mothers' attitudes toward the girls. There was no between-group difference in the perceived perception of the fathers' attitude to the girls. Self-perception and perceived parental attitudes were associated with the severity of ED symptoms and emotional distress. Finally, an improvement was found in self-perception and perceived maternal attitudes toward the girl from admission to discharge, alongside a decrease in the severity of ED symptoms and emotional distress. Self-perception at admission was associated with ED pathology and emotional distress at discharge. These findings suggest that self-perception and perceived parental attitudes toward the adolescent with AN may be associated with the severity of the illness and its short-term outcome.
Collapse
Affiliation(s)
- Mariana Sokolov
- Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | - Adi Enoch-Levy
- Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Daniel Stein
- Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
2
|
Zielinski-Gussen IM, Herpertz-Dahlmann B, Dahmen B. Involuntary Treatment for Child and Adolescent Anorexia Nervosa-A Narrative Review and Possible Advances to Move Away from Coercion. Healthcare (Basel) 2023; 11:3149. [PMID: 38132039 PMCID: PMC10742854 DOI: 10.3390/healthcare11243149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Children and adolescents with psychiatric disorders frequently experience hospital treatment as coercive. In particular, for patients with severe anorexia nervosa (AN), clinical and ethical challenges often arise if they do not voluntarily agree to hospital admission, often due to the ego-syntonic nature of the disorder. In these cases, involuntary treatment (IVT) might be life-saving. However, coercion can cause patients to experience excruciating feelings of pressure and guilt and might have long-term consequences. METHODS This narrative review aimed to summarize the current empirical findings regarding IVT for child and adolescent AN. Furthermore, it aimed to present alternative treatment programs to find a collaborative method of treatment for young AN patients and their families. RESULTS Empirical data on IVT show that even though no inferiority of IVT has been reported regarding treatment outcomes, involuntary hospital treatment takes longer, and IVT patients seem to struggle significantly more with weight restoration. We argue that more patient- and family-oriented treatment options, such as home treatment, might offer a promising approach to shorten or even avoid involuntary hospital admissions and further IVT. Different home treatment approaches, either aiming at preventing hospitalization or at shortening hospital stays, and the results of pilot studies are summarized in this article.
Collapse
Affiliation(s)
- Ingar M. Zielinski-Gussen
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | | | | |
Collapse
|
3
|
Andersson P, Jamshidi E, Ekman CJ, Tedroff K, Björkander J, Sjögren M, Lundberg J, Jokinen J, Desai Boström AE. Mapping length of inpatient treatment duration and year-wise relapse rates in eating disordered populations in a well-defined Western-European healthcare region across 1998-2020. Int J Methods Psychiatr Res 2023; 32:e1960. [PMID: 36710656 DOI: 10.1002/mpr.1960] [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: 10/02/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Updated international guideline recommendations for AN inpatient care rely on expert opinions/observational evidence and promote extended inpatient stays, warranting investigation using higher-level ecological evidence. METHODS The study was conducted according to Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Data encompassing 13,885 ED inpatients (5336 adolescents and 8549 adults) was retrieved from Swedish public health registries. Variables analyzed included (1) ED inpatient care opportunities, (2) unique number of ED inpatients and (3) mean length of ED-related inpatient stays in age groups 15-19 and 20-88+, across 1998-2020. RESULTS Mean length of inpatient stays was inversely correlated to relapse to ED-related inpatient care within the same year (p < 0.001, R-squaredadj = 0.5216 and p < 0.00001, R-squaredadj = 0.5090, in the 15-19 and 20-88+ age groups, respectively), independent of number of ED inpatients treated within a year in both age groups. Extending mean adolescent inpatient duration from 35 to 45 days was associated with a ∼30% reduction in the year-wise relapse rate. CONCLUSIONS Mean length of ED-related inpatient treatment stays was associated with reduced relapses to inpatient care within the same year, which could be interpreted as support for recommendations to include a stabilization phase in inpatient ED treatment.
Collapse
Affiliation(s)
- Peter Andersson
- Department of Clinical Neuroscience/Psychology, Karolinska Institute, Stockholm, Sweden
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Esmail Jamshidi
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Carl-Johan Ekman
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's and Children's Health/Neuropediatrics, Karolinska Institutet, Stockholm, Sweden
| | | | - Magnus Sjögren
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Johan Lundberg
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - Adrian E Desai Boström
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health/Neuropediatrics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
Meule A, Kolar DR, Naab S, Voderholzer U. Distance to home does not influence treatment success during and after inpatient treatment in adolescents with anorexia nervosa. Eur Child Adolesc Psychiatry 2023; 32:2667-2670. [PMID: 35674837 PMCID: PMC10682196 DOI: 10.1007/s00787-022-02013-7] [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: 09/17/2021] [Accepted: 05/22/2022] [Indexed: 11/24/2022]
Abstract
Current treatment guidelines recommend that inpatients with eating disorders-particularly adolescents with anorexia nervosa-should receive treatment at facilities within close distance to their home. However, whether distance to home actually influences short- and long-term treatment outcome in adolescents with anorexia nervosa has not been investigated yet. We re-analyzed data at admission, discharge, and 1-year follow up from a recent study with N = 142 female, adolescent inpatients with anorexia nervosa. Distance to home did not moderate changes in body weight, eating disorder symptoms, depressive symptoms, compulsive exercise, and life satisfaction. This is the first analysis that indicates that specialized inpatient treatment for adolescents with anorexia nervosa is effective both close to and away from home.
Collapse
Affiliation(s)
- Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Germany.
| | - David R Kolar
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Silke Naab
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Germany
- Medical Center, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
5
|
Andersson P, Jamshidi E, Ekman CJ, Tedroff K, Björkander J, Sjögren M, Lundberg J, Jokinen J, Desai Boström AE. Anorexia Nervosa With Comorbid Severe Depression: A Systematic Scoping Review of Brain Stimulation Treatments. J ECT 2023; 39:227-234. [PMID: 37053429 DOI: 10.1097/yct.0000000000000922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
ABSTRACT Major depressive disorder (MDD) is highly prevalent in individuals with anorexia nervosa (AN) and is a predictor of greater clinical severity. However, there is a limited amount of evidence supporting the use of psychotropic medications for its management. A systematic scoping review was conducted to assess the current literature on brain stimulation treatments for AN with comorbid MDD, with a specific focus on MDD treatment response and weight restoration. This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the PubMed, PsycInfo, and MEDLINE databases were searched until July 2022 using specific key words related to AN and brain stimulation treatments. A total of 373 citations were identified, and 49 treatment studies that met the inclusion criteria were included in the review. The initial evidence suggests that electroconvulsive therapy, repetitive transcranial magnetic stimulation, and deep-brain stimulation may be effective in managing comorbid MDD in AN. Emerging evidence suggests that transcranial direct current stimulation may have a positive effect on body mass index in individuals with severe to extreme AN. However, there is a need for the development of better measurement techniques for assessing the severity of depression in the context of AN. Controlled trials that are adequately designed to account for these limitations are highly warranted for deep-brain stimulation, electroconvulsive therapy, and repetitive transcranial magnetic stimulation and hold promise for providing clinically meaningful results.
Collapse
Affiliation(s)
| | | | | | - Kristina Tedroff
- Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital
| | | | - Magnus Sjögren
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå
| | | | | | | |
Collapse
|
6
|
Federico B, Federica S, Ilaria B, Valentina V, Gianluca C, Emanuela A, Sandra S, Leonardo M. Short-term effects of a multidisciplinary inpatient intensive rehabilitation treatment on body image in anorexia nervosa. J Eat Disord 2023; 11:178. [PMID: 37803403 PMCID: PMC10559592 DOI: 10.1186/s40337-023-00906-9] [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: 07/25/2023] [Accepted: 10/02/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Positive changes in weight gain and eating pathology were reported after inpatient treatments for anorexia nervosa (AN). However, changes in the physical body do not always mirror changes in the imagined body. Here, the effect of a treatment focused on body image (BI) was described. METHODS This retrospective observational study had a quasi-experimental pre-post design without the control group. During the treatment, participants (N = 72) undertake a variety of activities focused on BI. The main outcome was tested through the Body Uneasiness Test. RESULTS At the end of the treatment, BI uneasiness decreased with a significant increase in weight gain. CONCLUSION This study highlights the positive short-term effect of a multidisciplinary inpatient intensive rehabilitation treatment on BI in AN. We encourage to design of psychological treatments focusing on the cognitive and emotional bodily representation (i.e. the body in the mind) to increase physical well-being.
Collapse
Affiliation(s)
- Brusa Federico
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy.
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy.
| | - Scarpina Federica
- "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Turin, Italy
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo, VCO, Italy
| | - Bastoni Ilaria
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy
| | - Villa Valentina
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy
| | - Castelnuovo Gianluca
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy
- Psychology Department, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Apicella Emanuela
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy
| | - Savino Sandra
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy
| | - Mendolicchio Leonardo
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy
| |
Collapse
|
7
|
Quadflieg N, Naab S, Schlegl S, Bauman T, Voderholzer U. Inpatient Treatment Outcome in a Large Sample of Adolescents with Anorexia Nervosa. Nutrients 2023; 15:4247. [PMID: 37836531 PMCID: PMC10574756 DOI: 10.3390/nu15194247] [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: 08/28/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Anorexia nervosa is an illness affecting primarily adolescent girls and young women. Clinical guidelines recommend early intervention, with inpatient treatment for more severe cases. We present an evaluation of a multi-modal cognitive-behavioral inpatient treatment (CBT-E) involving carers in specialized units for adolescents. Routine data of 962 adolescent inpatients (26 boys) (mean age 15.48 [1.26]; range 12-17 years) were analyzed. Predictors of good body weight outcome (achieving a discharge BMI of at least 18.5 kg/m2) were identified by logistic regression analysis. Mean inpatient treatment lasted 96.69 (45.96) days. The BMI increased significantly from 14.93 (1.38) kg/m2 at admission to 17.53 (1.58) kg/m2 at discharge (z = 26.41; p < 0.001; d = 1.708). Drive for thinness decreased from 29.08 (9.87) to 22.63 (9.77; z = 18.41; p < 0.001; d = 0.787). All other subscores of the Eating Disorder Inventory also decreased significantly, with small to medium effect sizes. General psychopathology also showed significant decreases. The Beck Depression Inventory-II score decreased from 26.06 (11.74) to 16.35 (12.51; z = 18.41; p < 0.001; d = 0.883). A good body weight outcome was predicted by a higher BMI at admission (OR = 1.828), age at onset at 15 years or higher (OR = 1.722), and higher Somatization (OR = 1.436), Anxiety (OR = 1.320), and Bulimia (OR = 1.029) scores. CBT-E involving carers is an efficient intervention for adolescents with anorexia nervosa.
Collapse
Affiliation(s)
- Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Ludwig-Maximilians-University Munich (LMU), 80336 Munich, Germany; (S.S.); (U.V.)
| | - Silke Naab
- Schoen Clinic Roseneck Affiliated with the Medical Faculty of the University of Munich (LMU), 83209 Prien, Germany; (S.N.); (T.B.)
| | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Ludwig-Maximilians-University Munich (LMU), 80336 Munich, Germany; (S.S.); (U.V.)
| | - Tabea Bauman
- Schoen Clinic Roseneck Affiliated with the Medical Faculty of the University of Munich (LMU), 83209 Prien, Germany; (S.N.); (T.B.)
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Ludwig-Maximilians-University Munich (LMU), 80336 Munich, Germany; (S.S.); (U.V.)
- Schoen Clinic Roseneck Affiliated with the Medical Faculty of the University of Munich (LMU), 83209 Prien, Germany; (S.N.); (T.B.)
- Department of Psychiatry and Psychotherapy, University Hospital, 79106 Freiburg, Germany
| |
Collapse
|
8
|
Meule A, Kolar DR, Rauh E, Voderholzer U. Comparing illness duration and age as predictors of treatment outcome in female inpatients with anorexia nervosa. Eat Disord 2022; 31:274-284. [PMID: 36178330 DOI: 10.1080/10640266.2022.2114586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
It has been widely assumed that longer illness duration predicts poorer treatment outcome in persons with anorexia nervosa (AN). However, studies on the prognostic effects of illness duration have produced mixed results. Thus, the aim of the current study was to examine the relationship between illness duration and short-term treatment outcome in a large sample of female inpatients with AN (n = 902, aged 12-73 years). Treatment outcome variables included body mass index, therapist-rated global functioning (Global Assessment of Functioning scale and Clinical Global Impression-Improvement scale) and subscales of the Eating Disorder Inventory-2. Longer illness duration predicted smaller weight gain, smaller improvements in global functioning, and smaller decreases in self-reported eating disorder symptoms. However, illness duration was almost perfectly correlated with patients' age (r = .81, 95% CI [.76, .85]), and comparing regression models revealed that models using either illness duration or age were indistinguishable. Results suggest that longer illness duration does indeed relate to worse short-term treatment outcome in inpatients with AN. This effect, however, does not add significant information above and beyond patients' age and, thus, the importance of illness duration for anticipating treatment outcome both in research and in clinical practice must be critically examined.
Collapse
Affiliation(s)
- Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - David R Kolar
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Elisabeth Rauh
- Schoen Clinic Bad Staffelstein, Bad Staffelstein, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| |
Collapse
|
9
|
Changes in obsessive-compulsive symptoms during inpatient treatment of anorexia nervosa. J Eat Disord 2022; 10:106. [PMID: 35851073 PMCID: PMC9295505 DOI: 10.1186/s40337-022-00629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is one of the most prevalent comorbidities in anorexia nervosa (AN). As AN is a severe, life-threatening condition, reducing obsessive-compulsive symptomatology is not the primary objective during treatment of AN and, thus, these symptoms may remain unchanged or may even increase in terms of a "symptom shift". METHODS In this retrospective analysis, we examined clinical records of 149 adolescents (n = 96, 64%) and adults (n = 53, 36%) with AN (6 males, 4%) who received inpatient treatment and completed the Obsessive-Compulsive Inventory-Revised at admission and discharge. RESULTS Obsessive-compulsive symptoms decreased from admission to discharge, irrespective of whether patients had comorbid OCD or not. Within-person decreases in obsessive-compulsive symptoms weakly correlated with increases in body weight. CONCLUSIONS These results indicate that obsessive-compulsive symptoms decrease during inpatient treatment of AN although they are not primarily targeted during treatment. Furthermore, these improvements seem to be associated with general improvements in AN symptomatology, suggesting the absence of a "symptom shift". Yet, effect sizes were small and obsessive-compulsive symptoms were still clinically elevated in patients with comorbid OCD at discharge, suggesting that these patients need OCD-specific, psychotherapeutic aftercare.
Collapse
|
10
|
Dalenbrook S, Naab S, Garber AK, Correll CU, Voderholzer U, Haas V. Outcomes of a Standardized, High-Caloric, Inpatient Re-Alimentation Treatment Protocol in 120 Severely Malnourished Adolescents with Anorexia Nervosa. J Clin Med 2022; 11:jcm11092585. [PMID: 35566710 PMCID: PMC9105338 DOI: 10.3390/jcm11092585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023] Open
Abstract
Evidence accumulates that, with close medical monitoring and phosphate supplementation, higher-caloric re-alimentation protocols beginning at 2000 kcal/day (HCR) are not associated with an increased incidence of electrolyte abnormalities in patients with anorexia nervosa (AN) but rather result in faster weight gain. These studies are still scant and have largely been performed in adults or moderately malnourished adolescents. Methods: A retrospective chart review of patients with AN aged 12−20 years and with a body mass index (BMI) < 15 kg/m2 alimented according to a standardized treatment protocol in a German clinic specialized in AN was conducted. All patients received 2000 kcal/day from day one. The effect of HCR was examined with respect to laboratory changes and weight development over 4 weeks. Results: In 120 youth (119 (99.2%) females and 1 (0.8%) male, the mean BMI was 13.1 ± 1.1 (range = 10.2−15.0), %mBMI was 62.1 ± 6.0% and weight gain was 0.76 ± 0.22 kg per week, with the highest rate of weight gain during week 1 (1.25 ± 1.28 kg/week). Over 4 weeks, the total weight gain was 3.00 ± 1.92 kg. Nine patients (7.5%) developed mild hypophosphatemia, and none developed refeeding syndrome. Conclusions: Starting re-alimentation with 2000 kcal/d under close medical surveillance, severely malnourished youth with AN met the recommended weight gain targets between 0.5 and 1 kg/week according to current treatment guidelines, without anyone developing refeeding syndrome.
Collapse
Affiliation(s)
- Sophia Dalenbrook
- Department of Child and Adolescent Psychiatry, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 3, 13353 Berlin, Germany;
- Correspondence: (S.D.); (V.H.); Tel.: +49-157-588-70585 (S.D.)
| | - Silke Naab
- Schoen Clinic Roseneck, Prien am Chiemsee, 83209 Prien am Chiemsee, Germany; (S.N.); (U.V.)
| | - Andrea K. Garber
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, CA 94143, USA;
| | - Christoph U. Correll
- Department of Child and Adolescent Psychiatry, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 3, 13353 Berlin, Germany;
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY 11004, USA
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, 83209 Prien am Chiemsee, Germany; (S.N.); (U.V.)
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximillians Universität München, 80539 Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, 79106 Freiburg, Germany
| | - Verena Haas
- Department of Child and Adolescent Psychiatry, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 3, 13353 Berlin, Germany;
- Correspondence: (S.D.); (V.H.); Tel.: +49-157-588-70585 (S.D.)
| |
Collapse
|
11
|
Alcaraz-Ibáñez M, Paterna A, Sicilia Á, Griffiths MD. Examining the reliability of the scores of self-report instruments assessing problematic exercise: A systematic review and meta-analysis. J Behav Addict 2022; 11:326-347. [PMID: 35482912 PMCID: PMC9295230 DOI: 10.1556/2006.2022.00014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/09/2021] [Accepted: 03/12/2022] [Indexed: 01/23/2023] Open
Abstract
Background and aims Problematic exercise (PE) has mainly been assessed with self-report instruments. However, summarized evidence on the reliability of the scores derived from such instruments has yet to be provided. The present study reports a reliability generalization meta-analysis of six well-known self-report measures of PE (Commitment to Exercise Scale, Compulsive Exercise Test, Exercise Addiction Inventory, Exercise Dependence Questionnaire, Exercise Dependence Scale, and Obligatory Exercise Questionnaire). Methods Pooled effect sizes were computed using a random-effect model employing a restricted maximum likelihood estimation method. Univariable and multivariable meta-regressions analyses were employed for testing moderator variables. Results Data retrieved from 255 studies (741 independent samples, N = 254,174) identified three main groups of findings: (i) pooled alpha values that, ranging from 0.768 to 0.930 for global scores and from 0.615 to 0.907 for subscale scores, were found to be sensitive to sociodemographic and methodological characteristics; (ii) reliability induction rates of 47.58%; and (iii) the virtually non-existent testing of the assumptions required for the proper applicability of alpha. Data unavailability prevented the provision of summarized reliability estimates in terms of temporal stability. Discussion These findings highlight the need to improve reliability reporting of the scores of self-reported instruments of PE in primary studies. This implies providing both prior justification for the appropriateness of the index employed and reliability data for all the subpopulation of interest. The values presented could be used as a reference both for comparisons with those obtained in future primary studies and for correcting measurement-related artefacts in quantitative meta-analytic research concerning PE.
Collapse
Affiliation(s)
| | - Adrian Paterna
- Health Research Centre and Department of Education, University of Almería, Spain
| | - Álvaro Sicilia
- Health Research Centre and Department of Education, University of Almería, Spain
| | | |
Collapse
|
12
|
Kolar DR, Meule A, Naab S, Voderholzer U. Early within-person weight gain and variability during inpatient treatment for anorexia nervosa: Age-dependent effects on treatment outcome. EUROPEAN EATING DISORDERS REVIEW 2022; 30:328-340. [PMID: 35297141 DOI: 10.1002/erv.2893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Early weight gain during inpatient treatment for anorexia nervosa (AN) is a dynamic process characterised by within-person variability that may be age-dependent. We examined whether age moderates the effect of within-person weight gain and variability on treatment outcome. METHOD Within-person level estimates of N = 2881 underweight adolescents and adults with AN for daily average weight gain (linear slope) and variability (root mean squared errors) were obtained using random-effects modelling. Between-person level regression analyses were calculated to assess effects on weight, eating disorder psychopathology and attaining normal body weight (body mass index [BMI]: 18.5-25 kg/m2 ). RESULTS Higher weight gain during first 2 weeks of inpatient treatment predicted higher weight, lower drive for thinness and lower body dissatisfaction at discharge, but not lower bulimic symptoms. Moreover, it predicted a higher probability of discharge weight within normal range. Younger age was associated with stronger effects of early weight gain on weight, drive for thinness and body dissatisfaction at discharge. Weight variability was not associated with any outcome. CONCLUSIONS Age moderated effects of early weight gain on treatment outcomes, with larger effects for younger patients. Weight variability alone did not influence treatment across age and should be of lesser clinical concern during early inpatient treatment.
Collapse
Affiliation(s)
- David R Kolar
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Silke Naab
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| |
Collapse
|
13
|
Meule A, Furst Loredo A, Schrambke D, Schlegl S, Naab S, Voderholzer U. Adolescent inpatients with anorexia nervosa can roughly predict their own weight trajectories after discharge. Eat Disord 2022; 30:223-229. [PMID: 34370628 DOI: 10.1080/10640266.2021.1931647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Most adolescents with anorexia nervosa (AN) gain a substantial amount of weight during inpatient treatment, but many relapse after discharge. Therefore, there is a need to identify variables that predict weight changes after treatment. The current study tested whether such a variable may be patients' own predictions about their future weight. Data of 120 female adolescent inpatients with AN were available at discharge and one-year follow-up. Patients' own predictions about their future weight trajectories predicted their actual weight change after discharge: those who indicated that they would gain weight, gained weight, those who indicated that they would lose weight, lost weight, and those who indicated to maintain their weight, had no weight change on average. Similarly, expected weight change in kilograms correlated positively with actual weight change after discharge. Thus, patients who expect that they will lose weight again should receive intensified aftercare that fosters motivation to change.
Collapse
Affiliation(s)
- Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | | | | | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Silke Naab
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| |
Collapse
|
14
|
Pettersson C, Svedlund A, Wallengren O, Swolin-Eide D, Paulson Karlsson G, Ellegård L. Dietary intake and nutritional status in adolescents and young adults with anorexia nervosa: A 3-year follow-up study. Clin Nutr 2021; 40:5391-5398. [PMID: 34563763 DOI: 10.1016/j.clnu.2021.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/28/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND & AIMS Patients with anorexia nervosa (AN) restrict their dietary intake leading to malnutrition. Information is scarce on nutrition status during recovery. The aim of the study was to investigate dietary intake, body composition, biochemistry, and status in young women three years after hospital treatment due to severe restrictive AN. METHODS Dietary intake from four-day food records were compared to a reference group and the Nordic Nutrition Recommendations. Body composition was assessed by dual-energy X-ray absorptiometry (DXA). Serum levels of vitamin A, E, D, folate, and ferritin were assessed. RESULTS Three years after hospital treatment for AN, 12 subjects (60%) were recovered or in partial remission from AN. Subnormal values of body fat and skeletal muscle mass were present in 30% and 25%. Energy intake was 1730 kcal/day (min-max 705-2441) or 33 kcal/kg/day (16-54). Most (80%) had a total energy intake/day below the estimated needs and 6 (32%) had energy intakes below 1550 kcal/day. Micronutrient intakes from food were low; 16 (85%) had intakes below recommendations of iron, folate, and vitamin D. Serum levels of vitamins A, E, D, and folate were on average adequate; but a subnormal value (<50 nmol/L) of vitamin D was found in 20%. Ferritin levels were significantly lower at follow-up, and 25% had values below reference range. Return of menstruation was dependent of energy intake and body fat. CONCLUSIONS A regular and careful assessment of nutritional status along with nutritional counseling during recovery is recommended to reduce malnutrition in patients with AN.
Collapse
Affiliation(s)
- Cecilia Pettersson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Eating Disorder Unit - Children & Young Adults, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Anna Svedlund
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Department of Paediatrics, Gothenburg, Sweden
| | - Ola Wallengren
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Diana Swolin-Eide
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Department of Paediatrics, Gothenburg, Sweden
| | - Gunilla Paulson Karlsson
- Eating Disorder Unit - Children & Young Adults, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Ellegård
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
15
|
Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria. J Clin Med 2021; 10:jcm10143190. [PMID: 34300355 PMCID: PMC8307185 DOI: 10.3390/jcm10143190] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/13/2021] [Accepted: 07/18/2021] [Indexed: 12/12/2022] Open
Abstract
This study evaluated the short-term outcome of a multimodal inpatient treatment concept for adolescents with anorexia nervosa (AN). In this prospective observational study, a cohort of 126 female adolescents with AN (age range: 11–17, mean age: 14.83) was longitudinally followed from admission to discharge (average duration of stay: 77 days). We used gold-standard clinical interviews and self-report data, as well as DSM-5 remission criteria, to evaluate the treatment outcome. From admission to discharge, body-mass-index (BMI) significantly improved by 2.6 kg/m2. Data from clinical interviews and self-reports yielded similar improvements in restraint eating and eating concerns (large effects). Lower effects were observed for variables assessing weight/shape concerns and drive for thinness. At discharge, 23.2% of patients showed full remission of AN, 31.3% partial remission, and 45.5% no remission according to DSM-5 criteria. Differences in remission groups were found regarding AN severity, age at admission, and use of antidepressant medication. Living with both parents, longer duration of inpatient treatment and the use of antipsychotic medication were significantly associated with higher BMI change. The findings provide evidence for the short-term effectiveness of our inpatient treatment concept. We recommend using DSM-5 based remission criteria to evaluate the treatment outcome to improve the comparability of studies.
Collapse
|
16
|
Puckett L, Grayeb D, Khatri V, Cass K, Mehler P. A Comprehensive Review of Complications and New Findings Associated with Anorexia Nervosa. J Clin Med 2021; 10:jcm10122555. [PMID: 34207744 PMCID: PMC8226688 DOI: 10.3390/jcm10122555] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 02/08/2023] Open
Abstract
Anorexia nervosa is a complex and deadly psychiatric disorder. It is characterized by a significant degree of both co-occurring psychiatric diseases and widespread physiological changes which affect nearly every organ system. It is important for clinicians to be aware of the varied consequences of this disorder. Given the high rate of mortality due to AN, there is a need for early recognition so that patients can be referred for appropriate medical and psychiatric care early in the course of the disorder. In this study, we present a comprehensive review of the recent literature describing medical findings commonly encountered in patients with AN. The varied and overlapping complications of AN affect pregnancy, psychological well-being, as well as bone, endocrine, gastrointestinal, cardiovascular, and pulmonary systems.
Collapse
Affiliation(s)
- Leah Puckett
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Daniela Grayeb
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Vishnupriya Khatri
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Kamila Cass
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Philip Mehler
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
- Eating Recovery Center, Denver, CO 80230, USA
- Correspondence: ; Tel.: +1-(303)-602-4972
| |
Collapse
|
17
|
Meule A. Commentary: Lifetime Weight Characteristics of Adult Inpatients With Severe Anorexia Nervosa: Maximal Lifetime BMI Predicts Treatment Outcome. Front Psychiatry 2021; 12:775033. [PMID: 34819889 PMCID: PMC8606785 DOI: 10.3389/fpsyt.2021.775033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| |
Collapse
|